Objectives. We described the uptake and coverage rates of meningococcal conjugate vaccine (MCV4); tetanus-diphtheria-acellular pertussis vaccine (Tdap); and quadrivalent human papillomavirus vaccine (HPV4) in North Dakota using the North Dakota Immunization Information System (NDIIS).Methods. We analyzed all available MCV4, Tdap, and HPV4 doses given after vaccine licensure and through December 31, 2009, obtained from the NDIIS to identify trends and patterns in vaccine administration. We analyzed all data by administration date, age group, and health-care provider type. We also calculated missed opportunities to complete all recommended vaccines among vaccinated adolescents.Results. For adolescents aged 13-17 years, 69.2% had $1 dose of Tdap and 62.8% had $1 dose of MCV4. Of females aged 13-17 years, 42.8% initiated the HPV4 vaccination series and 24.9% received $3 HPV4 doses. Only 48.7% of males aged 13-17 years received both Tdap and MCV4 at the same visit, and only 11.5% of females aged 13-17 years received Tdap, MCV4, and HPV4 doses at the first visit.Conclusions. The NDIIS is useful in tracking adolescent vaccine uptake. The immunization rates for all three routinely recommended adolescent vaccines are rising in North Dakota, although at different paces. Providers should be educated about the importance of not missing opportunities to vaccinate, and school-based vaccination clinics should be used to reach adolescents who are less likely to have preventive care visits.