WyIR 2020-2021 Influenza Vaccine Cheat Sheet

Product Name

Afluria Quadrivalent

Fluarix Quadrivalent Flublok Quadrivalent Flucelvax Quadrivalent FluLaval Quadrivalent FluMist Quadrivalent Fluzone High-Dose Quadrivalent

Fluzone Quadrivalent

Formulation 5.0-mL MDV 0.5-mL PFS 0.25-mL PFS 0.5-mL PFS 0.5-mL PFS 0.5-mL PFS 5.0-mL MDV 0.5-mL PFS

WyIR 2020-2021 Influenza Vaccine Cheat Sheet

Vaccine Name/Description in WyIR

influenza, injectable, quadrivalent

Age Indication 36 mos

influenza, injectable, quadrivalent, preservative free

36 mos

Influenza, injectable,quadrivalent, preservative free, pediatric

6 through 35 mos

influenza, injectable, quadrivalent, preservative free

6 mos

influenza, recombinant, quadrivalent,injectable, preservative free

18 yrs

Influenza, injectable, MDCK, preservative free, quadrivalent

4 yrs

Influenza, injectable, MDCK, quadrivalent, preservative

4 yrs

influenza, injectable, quadrivalent, preservative free

6 mos

CVX Code 158 150

161

150

185

171 186 150

Unit of Sale NDC Unit of Use NDC CPT

Manufacturer Code

33333-0420-11 33332-0420-10 90688

SEQ

33332-0320-02 33332-0320-01 90686

SEQ

33332-0220-21 33332-0220-20 90685

SEQ

58160-0885-41 58160-0885-52 90686

SKB

49281-0720-88 49281-0720-10 90682

PMC

70461-0320-04 70461-0320-03 90674

SEQ

70461-0420-11 70461-0420-10 90756

SEQ

19515-0816-41 19515-0816-52 90686

IDB

0.2-mL prefilled single-use intranasal sprayer

influenza, live, intranasal, quadrivalent

2 through 49 yrs 149 66019-0307-01 66019-0307-10 90672

MED

0.7-mL PFS 5.0-mL MDV 0.5-mL PFS .25-mL PFS 0.5-mL SDV

Influenza, high-dose, quadrivalent influenza, injectable, quadrivalent

influenza, injectable, quadrivalent, preservative free

65 yrs 6 mos 6 mos

Influenza, injectable,quadrivalent, preservative free, pediatric

influenza, injectable, quadrivalent, preservative free

6 mos

197 49281-0120-88 49281-0120-65 90662

PMC

158 49281-0633-78 49281-0633-15 90688

PMC

150 49281-0420-88 49281-0420-50 90686

PMC

161 49281-0520-25 49281-0520-00 90685

PMC

150 49281-0420-58 49281-0420-10 90686

PMC

Product Name Fluad Fluad Quadrivalent

Formulation 0.5-ml PFS 0.5-mL PFS

WyIR 2020-2021 Influenza Vaccine Cheat Sheet

Vaccine Name/Description in WyIR

Age Indication

CVX Code

Unit of Sale NDC Unit of Use NDC CPT

Manufacturer Code

influenza, trivalent, adjuvanted 65 yrs

168 70461-0020-03 70461-0020-04 90653

SEQ

Influenza vaccine, quadrivalent, adjuvanted

65 yrs

205 70461-0120-03 70461-0120-04 90694

SEQ

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