2019-20 Flu Vaccine Cheat Sheet - Wyoming Department of …

WyIR 2019-20 Influenza Vaccine Cheat Sheet

Products highlighted in blue are the five presentations offered through the VFC Program in 2019-20

Product Name

Formulation

Vaccine Name/Description in WyIR

Age Indication

CVX Code

NDC

CPT Manufacturer Code

5.0-mL MDV Afluria Quadrivalent 0.5-mL PFS

0.25-mL PFS

influenza, injectable, quadrivalent

6 mos (needle/syringe) 18 through 64 yrs (jet injector)

158 33332-0419-10 90688

SEQ

influenza, injectable, quadrivalent, preservative free

3 yrs

150 33332-0319-01 90686

SEQ

Influenza, injectable,quadrivalent, preservative free, pediatric

6 through 35 mos

161 33332-0219-20 90685

SEQ

Fluad

0.5-mL PFS

influenza, trivalent, adjuvanted

65 yrs

168 70461-0019-03 90653

SEQ

Fluarix Quadrivalent 0.5-mL PFS

Flublok Quadrivalent 0.5-mL PFS

0.5-mL PFS Flucelvax Quadrivalent

5.0-mL MDV

influenza, injectable, quadrivalent, preservative free

6 mos

influenza, recombinant, quadrivalent, injectable, preservative free

18 yrs

Influenza, injectable, MDCK, preservative 4 yrs free, quadrivalent

Influenza, injectable, MDCK, quadrivalent, preservative

4 yrs

150 58160-0896-52 90686

SKB

185 49281-0719-10 90682

PMC

171 70461-0318-03 90674

SEQ

186 70461-0418-10 90756

SEQ

5.0-mL MDV FluLaval Quadrivalent

0.5-mL PFS

0.2-mL prefilled single-use intranasal FluMist Quadrivalent sprayer

influenza, injectable, quadrivalent

influenza, injectable, quadrivalent, preservative free

influenza, live, intranasal, quadrivalent

6 mos 6 mos 2 through 49 yrs

158 19515-0897-11 90688

IDB

150 19515-0906-52 90686

IDB

149 66019-0306-10 90672

MED

Fluzone High-Dose 0.5-mL PFS

Influenza, high dose seasonal

65 yrs

135 49281-0405-65 90662

PMC

5.0-mL MDV

influenza, injectable, quadrivalent, preservative free

6 mos

158 49281-0631-15 90688

PMC

0.5-mL PFS Fluzone Quadrivalent

0.5-mL SDV

0.25-mL PFS

influenza, injectable, quadrivalent, preservative free

Influenza, injectable,quadrivalent, preservative free, pediatric

6 mos 6 mos 6 through 35 mos

150 49281-0419-50 90686

PMC

150 49281-0419-10 90686

PMC

161 49281-0519-25 90685

PMC

Vaccine Description (Must match EXACTLY) influenza, injectable, quadrivalent

Product Name Afluria Quadrivalent

influenza, injectable, quadrivalent, preservative free

Afluria Quadrivalent

Influenza, injectable,quadrivalent, preservative free, pediatric Afluria Quadrivalent

influenza, trivalent, adjuvanted

Fluad

influenza, injectable, quadrivalent, preservative free

Fluarix Quadrivalent

influenza, recombinant, quadrivalent,injectable, preservative free Flublok Quadrivalent

Influenza, injectable, MDCK, preservative free, quadrivalent

Flucelvax Quadrivalent

Influenza, injectable, MDCK, quadrivalent, preservative

Flucelvax Quadrivalent

influenza, injectable, quadrivalent

FluLaval Quadrivalent

influenza, injectable, quadrivalent, preservative free

FluLaval Quadrivalent

influenza, live, intranasal, quadrivalent

FluMist Quadrivalent

Influenza, high dose seasonal

Fluzone High-Dose

influenza, injectable, quadrivalent

Fluzone Quadrivalent

influenza, injectable, quadrivalent, preservative free

Fluzone Quadrivalent

influenza, injectable, quadrivalent, preservative free

Fluzone Quadrivalent

Influenza, injectable,quadrivalent, preservative free, pediatric Fluzone Quadrivalent

Formulation

Age indication

CVX Sale NDC (package) CPT MVX

5.0-mL MDV

6 mos (needle/syringe)

158 33332-0419-10

18 through 64 yrs (jet injector)

90688 SEQ

0.5-mL PFS

3 yrs

150 33332-0319-01 90686 SEQ

0.25-mL PFS

6 through 35 mos

161 33332-0219-20 90685 SEQ

0.5-mL PFS

65 yrs

168 70461-0019-03 90653 SEQ

0.5-mL PFS

6 mos

150 58160-0896-52 90686 SKB

0.5-mL PFS

18 yrs

185 49281-0719-10 90682 PMC

0.5-mL PFS

4 yrs

171 70461-0318-03 90674 SEQ

5.0-mL MDV

4 yrs

186 70461-0418-10 90756 SEQ

5.0-mL MDV

6 mos

158 19515-0897-11 90688 IDB

0.5-mL PFS

6 mos

150 19515-0906-52 90686 IDB

0.2-mL prefilled single-use intranasal sprayer 2 through 49 yrs

149 66019-0306-10 90672 MED

0.5-mL PFS

65 yrs

135 49281-0405-65 90662 PMC

5.0-mL MDV

6 mos

158 49281-0631-15 90688 PMC

0.5-mL PFS

6 mos

150 49281-0419-50 90686 PMC

0.5-mL SDV

6 mos

150 49281-0419-10 90686 PMC

0.25-mL PFS

6 through 35 mos

161 49281-0519-25 90685 PMC

Sale Proprietary Name Afluria Quadrivalent

Manufacturer Seqirus Pty Ltd.

Use NDC (product) GTIN 33332-0419-11

Afluria Quadrivalent

Seqirus Pty Ltd.

33332-0319-02

Afluria Quadrivalent

Seqirus Pty Ltd.

33332-0219-21

FLUAD

Seqirus, Inc.

70461-0019-04

FLUARIX QUADRIVALENT

GlaxoSmithKline Biologicals SA

58160-0896-41

Flublok Quadrivalent

Sanofi Pasteur Inc.

49281-0719-88

FLUCELVAX QUADRIVALENT (PREFILLED SYRINGE) Seqirus, Inc.

70461-0318-04

FLUCELVAX QUADRIVALENT (MULTI-DOSE VIAL) Seqirus, Inc.

70461-0418-11

Flulaval Quadrivalent

ID Biomedical Corporation of Quebec 19515-0897-01

Flulaval Quadrivalent

ID Biomedical Corporation of Quebec 19515-0906-41

FluMist Quadrivalent

MedImmune, LLC

66019-0306-01

FLUZONE High-Dose

Sanofi Pasteur Inc.

49281-0405-88

FLUZONE QUADRIVALENT

Sanofi Pasteur Inc.

49281-0631-78

FLUZONE QUADRIVALENT

Sanofi Pasteur Inc.

49281-0419-88

FLUZONE QUADRIVALENT

Sanofi Pasteur Inc.

49281-0419-58

FLUZONE QUADRIVALENT

Sanofi Pasteur Inc.

49281-0519-00

N/A

349281719882

349281405884 349281631788 349281419881 349281419584 349281519000

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