PDF IIS Codes for Common Vaccine in Washington

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

This document provides the information needed to accurately document vaccines in electronic health records and manage vaccine inventory in the Washington State Immunization Information System (IIS). This document includes four sections: COVID (EUA approval), pediatric, influenza, adult, and travel & other vaccines.

Symbols/Colors *

Description Vaccines available through the Washington State Childhood Vaccine Program. Vaccine is not available to order, but clinics may still have it in their inventory.

COVID-19 Vaccines

IIS Vaccine Name

Trade Name

COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 ml dose

Pfizer COVID-19 Vaccine

COVID-19, mRNA, LNP-S, PF, 100mcg/0.5 ml dose

Moderna COVID-19 Vaccine

COVID-19 vaccine, vector-nr, rS-Ad26, PF, 0.5ml (Janssen-J&J)

Janssen COVID-19 Vaccine

NDC Number

59267-1000-02

CPT CVX Code Code

Manufacturer Name - Code

91300 208 Pfizer-BioNtech ? PFR

80777-0273-99 59676-0580-15

91301 207

Moderna US, Inc. ? MOD

91303 212

Janssen Products, LP ? JSN

Pediatric Vaccines

IIS Vaccine Name

DT (Pediatric)

DTaP DTaP/HepB/IPV DTaP/HIB/IPV

Trade Name Diptheria and Tetanus Toxoids Adsorbed Daptacel

Infanrix

Pediarix

Pentacel

DTaP/HepB/HIB/IPV

Vaxelis

DTaP/IPV

Hep A 2 dose ? Ped/Adol

Hep B Ped/Adol ? Preservative Free (PF) Hib-PRP-OMP

Kinrix

Quadracel Vaqta Havrix Engerix-B

Recombivax

PedvaxHIB

NDC Number

CPT CVX Code Code

Manufacturer Name - Code

49281-0225-10 90702 28 Sanofi-Pasteur ? PMC

49281-0286-10 58160-0810-11* 58160-0810-52 58160-0811-52 49281-0510-05* 49281-0511-05 63361-0243-10 63361-0243-15 58160-0812-11* 58160-0812-52 49821-0562-10 00006-4095-02 58160-0825-52 58160-0820-52 00006-4981-00 00006-4093-02* 00006-4897-00

90700 90723 90698 90697

90696

90633

90744 90647

106 Sanofi-Pasteur ? PMC 20 GlaxoSmithKline ? SKB 110 GlaxoSmithKline ? SKB 120 Sanofi-Pasteur ? PMC

146 Merck ? MSD

130 GlaxoSmithKline ? SKB

Sanofi Pasteur - PMC

83

Merck ? MSD GlaxoSmithKline ? SKB

GlaxoSmithKline ? SKB

08 Merck ? MSD

49 Merck ? MSD

To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.. DOH 348-580 March 2021

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

IIS Vaccine Name

Trade Name

NDC Number

CPT CVX Code Code

Manufacturer Name - Code

Hib-PRP-T

ActHIB Hiberix

49281-0545-03 58160-0818-11

90648

48

Sanofi-Pasteur ? PMC GlaxoSmithKline ? SKB

HPV9

Gardasil 9

00006-4121-02 90651 165 Merck ? MSD

Influenza Vaccines ? see the separate Influenza Vaccines table below

IPV

IPOL

49281-0860-10 90713 10 Sanofi-Pasteur ? PMC

Meningococcal B, OMV

Bexsero

58160-0976-20 90620 163 GlaxoSmithKline ? SKB

Meningococcal B, Recombinant

Trumenba

00005-0100-10 90621 162 Pfizer ? PFR

Meningococcal Conjugate (MCV4P) Menactra Meningococcal Conjugate (MCV4O) Menveo

49281-0589-05 58160-0955-09

90734

114 Sanofi-Pasteur ? PMC 136 GlaxoSmithKline ? SKB

Meningococcal Polysaccharide TT Conjugate

MenQuadfi

49281-0590-05 90619 203 Sanofi-Pasteur - PMC

MMR

M-M-RII

00006-4681-00 90707 3 Merck ? MSD

MMR/Varicella

ProQuad

00006-4171-00 90710 94 Merck ? MSD

PCV13

Prevnar 13

00005-1971-02 90670 133 Pfizer ? PFR

PPSV23

Pneumovax 23

00006-4837-03 90732 33 Merck ? MSD

Rotavirus, Monovalent

Rotarix

58160-0854-52 90681 119 GlaxoSmithKline ? SKB

Rotavirus, Pentavalent

RotaTeq

00006-4047-41 00006-4047-20

90680

116 Merck ? MSD

Td (adult), 5 Lf tetanus toxoid, PF, adsorbed

Tenivac

49281-0215-15 49281-0215-10

90714

113 Sanofi-Pasteur - PMC

Td (adult), 2 Lf tetanus toxoid, PF, adsorbed

TDVAX

13533-0131-01 90714 09 Grifols - GRF

Tdap

Adacel Boostrix

49281-0400 10* 49281-0400-20 58160-0842-11* 58160-0842-52

90715

Sanofi-Pasteur ? PMC 115

GlaxoSmithKline ? SKB

Varicella

Varivax

00006-4827-00 90716 21 Merck ? MSD

Influenza Vaccines

IIS Vaccine Name

Trade Name

NDC Number

CPT CVX Code Code

Manufacturer Name - Code

2021-2022 State Supplied Childhood Flu Vaccines

Influenza, injectable, quadrivalent, preservative free Influenza, injectable, quadrivalent

Influenza, injectable, quadrivalent, preservative free

Influenza, live, intranasal, quadrivalent

Influenza, injectable, MDCK, preservative free, quadrivalent

Fluzone 0.5 mL Syringe Fluzone 5.0 mL MDV FluLaval 0.5 mL Syringe FluMist 0.2 mL Spray

Flucelvax 0.5 mL Syringe

49281-0421-50 49281-0635-15 19515-0818-52 66019-0308-10

90686 150 Sanofi-Pasteur ? PMC 90688 158 Sanofi-Pasteur ? PMC 90686 150 GlaxoSmithKline ? SKB 90672 149 MedImmune ? MED

70461-0321-03 90674 171 Seqirus - SEQ

To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.. DOH 348-580 March 2021

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

Influenza, high dose, quadrivalent

Influenza, Injectable, quadrivalent, preservative free

Influenza, injectable, quadrivalent, preservative free, pediatric Influenza, Injectable, quadrivalent Influenza, injectable, MDCK, quadrivalent, preservative Influenza, Recombinant, quadrivalent, Injectable, preservative free Influenza vaccine, quadrivalent, adjuvanted

Additional Influenza Vaccines

Fluzone High-Dose

Quadrivalent

49281-0121-65

0.7 mL Syringe

Fluarix 0.5 mL Syringe

58160-0887-52

Fluzone 0.5 mL SDV

49281-0421-10

Afluria 0.5 mL Syringe

33332-0321-01

Afluria 0.25mL Syringe

33332-0221-20

Afluria 5.0 mL MDV

Flucelvax 5.0 mL MDV

Flublok Quadrivalent 0.5 mL Syringe Fluad Quadrivalent 0.5 mL Syringe

33332-0421-10 70461-0421-10 49281-0721-10 70461-0121-03

90662

90686

90685 90688 90756 90682 90694

197 Sanofi-Pasteur - PMC GlaxoSmithKline ? SKB

150 Sanofi-Pasteur ? PMC Seqirus ? SEQ

161 Seqirus - SEQ 158 Seqirus ? SEQ 186 Seqirus ? SEQ 185 Sanofi-Pasteur ? PMC 205 Seqirus - SEQ

Adult Vaccines

This table includes adult-specific vaccines. Additional vaccines are listed in the pediatric table.

IIS Vaccine Name

Trade Name

NDC Number

CPT CVX Code Code

Manufacturer Name - Code

Hep A, Adult

Havrix Vaqta

58160-0826-11* 58160-0826-52 00006-4096-02 00006-4841-41

90632

GlaxoSmithKline ? SKB 52

Merck - MSD

Hep B (Recombinant), CpG adjuvanted

Heplisav ? B

43528-0002-05* 43528-0003-05

90739

189 Dynavax, Inc - DVX

Hep A/Hep B ? Adult

Twinrix

58160-0815-52 90636 104 GlaxoSmithKline ? SKB

Hep B, Adult

Engerix ? B Recombivax

58160-0821-11 58160-0821-52 00006-4995-41 00006-4094-02*

90746

GlaxoSmithKline ? SKB 43

Merck ? MSD

Influenza Vaccines ? see the Influenza Vaccines table above

Td (adult), 5 Lf tetanus toxoid, PF, adsorbed

Tenivac

49281-0215-10 49281-0215-15

90714 113 Sanofi-Pasteur ? PMC

Td (adult), 2 Lf tetanus toxoid, PF, adsorbed

Tdvax

13533-0131-01 90714 09 Grifols - GRF

Zoster, Recombinant

Shingrix

58160-0819-12 90750 187 GlaxoSmithKline - SKB

To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.. DOH 348-580 March 2021

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

58160-0823-11

Travel & Other Vaccines

IIS Vaccine Name Anthrax Cholera Japanese Encephalitis

Rabies Typhoid, Oral Typhoid, ViCPs Yellow Fever

Trade Name BioThrax VaxChora

IXIARO

RabAvert Imovax Rabies Vivotif Typhim Vi YF-Vax

NDC Number

64678-0211-01 70460-0001-01

42515-0002-01

58160-0964-12 49281-0252-51 69401-0000-02 50090-2292-00 49281-0790-51 49281-0915-01

CPT Code 90581 90625 90738

90675

90690 90691 90717

CVX Code

24 174

134

Manufacturer Name - Code

Emergent BioSolutions ? MIP

PaxVax ? PAX Vetter Pharma Fertigung GmbH & Co. KG ? VET

18 GlaxoSmithKline ? SKB

Sanofi-Pasteur ? PMC

25

PaxVax ? PAX A-s Medication

101 Sanofi-Pasteur ? PMC

37 Sanofi-Pasteur ? PMC

Questions? Contact the IIS Help Desk at 1-800-325-5599 or WAIISHelpDesk@doh.

To request this document in another format, call 1-800-525-0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email civil.rights@doh.. DOH 348-580 March 2021

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