Minnesota Department of Health
Monitoring “Improbable Shots”
in MIIC
Providers can use the Minnesota Immunization
Information Connection (MIIC) immunization
registry as a tool to help monitor and correct
“improbable shot” vaccine administration and
documentation errors. This can improve vaccine
forecasting and immunization coverage rates as
well as reduce wasted vaccine and potential
adverse events from administration errors.
Improbable shots report in MIIC
Within the MIIC application, providers can run an
Improbable Shots report to see improbable shots
specific to their organization at any time. The
report includes a summary and a detailed output
file. A sample MIIC Improbable Shots Summary
Report is shown below:
What are improbable shots?
Improbable shots are vaccinations that fall outside
of appropriate minimum and maximum age
indications for licensed vaccines. Providers can
use MIIC to identify the following improbable
shot scenarios:
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DTaP ≥ 7 years
Td/Tdap < 7 years
Hib ≥ 5 years
HPV < 9 or ≥ 27 years
Menactra (MCV) < 2 or ≥ 56 years
Menveo (MCV) < 11 or ≥ 56 years
Meninge-poly (MPSV) < 2 years
Pneumo-conj (PCV) ≥ 19 years
Pneumo-poly (PPSV) < 2 years
Rotavirus < 6 weeks or ≥ 8 months
Hepatitis A < 1 year
MMR < 1 year
Varicella < 1 year
Zoster < 50 years
Vaccination date = DOB
(excluding hepatitis B)
The report indicates the total improbable shots
attributed to the provider during a given time
period and the number of improbable shots by
scenario and data entry source.
At this time the MIIC report does not include “not
valid” shots in MIIC or shots given outside of
appropriate dosing intervals; the report is specific
to vaccinations administered outside of licensed
age indications.
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0975
651-201-5503, 800-657-3970
www.health.state.mn.us/immunize
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Monitoring “improbable shots” in MIIC
Where do they come from?
Resources
The improbable shots identified by MIIC may
truly be vaccine administration errors or they may
errors in the way the shot was submitted to the
registry. For example, common vaccine
administration errors include administering the
MMR and varicella vaccines before a child turns
one year. The first dose of these vaccines must be
given on or after the child’s first birthday to
ensure proper protection.
For more information on how to run and interpret
the Improbable Shots report in MIIC, review the
Improbable Shots MIIC User Guidance document
at
www.health.state.mn.us/divs/idepc/immunize/regi
stry/hp/train.html or contact your MIIC regional
coordinator. Their contact information is available
at
www.health.state.mn.us/divs/idepc/immunize/regi
stry/map.html.
On the other hand, vaccine documentation errors
occur when incorrect data is entered into MIIC.
An incorrect vaccine or vaccine code may be
chosen in the immunization registry, a practice
management system, or the electronic medical
record. Common documentation errors include
interchanging vaccines such as Td and DTaP and
Pneumo-conj (PCV) and Pneumo-poly (PPSV). A
wrong CPT code may also be selected and sent to
MIIC. The CPT codes for Hepatitis A and
Influenza A H1N1 vaccines are very similar, for
example: 90633 and 90663.
While some improbable shot scenarios are truly
administration or documentation errors, other
scenarios may be okay if the vaccination was
indicated by a physician.
What is their impact?
Improbable shots affect providers and patients.
Identifying and correcting these errors ensures that
patients are fully protected from vaccinepreventable diseases. Improbable shots may
impact:
 The accuracy of patients’ immunization
histories and vaccine forecasting;
 Reminder-recall;
 Provider and population-based immunization
coverage rates;
 Vaccine inventory; and
 Provider reimbursement for vaccines.
Because MIIC is a shared network of
immunization records, providers rely on the
registry for accurate and up to date immunization
data. Maintaining the accuracy of the data is a
shared responsibility.
Minnesota Department of Health – Immunization Program
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