Washington State Immunization Information System IIS Codes for Common ...

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 and Washington State COVID-19 Vaccine Program Vaccine is not available to order, but clinics may still have it in their inventory.

COVID-19 Vaccines, Adult and Pediatric

IIS Vaccine Name

Trade Name

COVID-19, mRNA, LNP-S, PF, 100mcg/0.5 ml dose or 50mcg/0.25 ml dose (Mod 12+, red)

Moderna COVID-19 Vaccine

NDC Number

80777-0273-98

COVID-19, mRNA, LNP-S, PF, 50 mcg/0.5 mL dose (Mod 6y-11y, blue)

Moderna COVID-19 Vaccine

COVID-19, mRNA, LNP-S, PF, pediatric 25 mcg/0.25 mL dose (Mod 6m-5y, blue)

Moderna COVID-19 Vaccine

Comirnaty

COVID-19, mRNA, LNP-S, PF, 30 mcg/0.3 ml dose, tris-sucrose (Pfizer Tris-Sucrose 12+, grey)

COVID-19 Vaccine Pfizer COVID-19

Vaccine

COVID-19, mRNA, LNP-S, PF, 10 mcg/0.2 Pfizer

ml dose, tris-sucrose (Pfizer 5y-11y,

COVID-19

orange)

Vaccine

COVID-19, mRNA, LNP-S, PF, 3 mcg/0.2 Pfizer

mL dose, tris-sucrose (Pfizer 6m-4y,

COVID-19

maroon)

Vaccine

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

Janssen COVID-19 Vaccine

COVID-19 vaccine, Subunit, rS-

Novavax

nanoparticle+Matrix-M1 Adjuvant, PF, COVID-19

0.5ml (Novavax 12+)

Vaccine

80777-0275-99 80777-0279-99 00069-2025-10 59267-1025-04 59267-1055-04 59267-0078-04 59676-0580-15 80631-0100-10

CPT CVX Code Code

Manufacturer Name - Code

91301 91306

207

Moderna US, Inc. ? MOD

91309

221

Moderna US, Inc. ? MOD

91311

228

Moderna US, Inc. ? MOD

91305 217 Pfizer-BioNtech ? PFR

91307 218 Pfizer-BioNtech ? PFR

91308 219 Pfizer-BioNtech - PFR

91303

212

Janssen Products, LP ? JSN

91304 211 Novavax, Inc. ? NVX

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 December 2022

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

COVID-19 Bivalent Boosters

COVID-19, mRNA, LNP-S, bivalent booster, PF, 50 mcg/0.5 mL or 25mcg/0.25 ml dose (Mod 6+, blue)

Moderna COVID-19 Vaccine

COVID-19, mRNA, LNP-S, bivalent booster, PF, 10mcg/0.2 mL (Mod 6mo-5y, pink)

Moderna COVID-19 Vaccine

COVID-19, mRNA, LNP-S, bivalent booster, PF, 30 mcg/0.3 mL dose (Pfizer 12+, grey)

Pfizer COVID-19 Vaccine

COVID-19, mRNA, LNP-S, bivalent booster, PF, 10 mcg/0.2 mL dose (Pfizer 5y-11y, orange)

Pfizer COVID-19 Vaccine

COVID-19, mRNA, LNP-S, bivalent Pfizer

booster, PF, 3mcg/0.2 mL dose (Pfizer COVID-19

6mo-4y, maroon)

Vaccine

80777-0282-99 80777-0283-99

91314

229

Moderna US, Inc. ? MOD

91316

230

Moderna US, Inc. MOD

59267-0304-02 91312 300 Pfizer-BioNtech - PFR

59267-0565-02 91315 301 Pfizer-BioNtech - PFR

59267-0609-02 91317 302 Pfizer-BioNtech - PFR

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 Hib-PRP-T

Kinrix

Quadracel Vaqta Havrix Engerix-B

Recombivax

PedvaxHIB ActHIB Hiberix

NDC Number

CPT CVX Code Code

Manufacturer Name - Code

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

49281-0286-10

58160-0810-52

58160-0811-52

49281-0511-05

63361-0243-10

63361-0243-15

58160-0812-52

49821-0562-10 00006-4095-02 58160-0825-52 58160-0820-52 00006-4981-00 00006-4093-02* 00006-4897-00 49281-0545-03 58160-0818-11

90700 90723 90698 90697

90696 90633 90744 90647 90648

106 Sanofi-Pasteur ? PMC

20 GlaxoSmithKline ? SKB

110 GlaxoSmithKline ? SKB

120 Sanofi-Pasteur ? PMC

MSP Vaccine Company 146 (partnership Merck and

Sanofi Pasteur) ? MSP

130 GlaxoSmithKline ? SKB

Sanofi Pasteur - PMC

83

Merck ? MSD GlaxoSmithKline ? SKB

GlaxoSmithKline ? SKB

08 Merck ? MSD

49 Merck ? MSD

48

Sanofi-Pasteur ? PMC 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 December 2022

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

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

114 Sanofi-Pasteur ? PMC 90734 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

2022-2023 State Supplied Childhood Flu Vaccines

Influenza, injectable,

Fluzone

quadrivalent, preservative free 0.5 mL Syringe

49281-0422-50 90686 150 Sanofi-Pasteur ? PMC

Influenza, injectable, quadrivalent

Fluzone 5.0 mL MDV

49281-0637-15 90688 158 Sanofi-Pasteur ? PMC

Influenza, injectable,

FluLaval

quadrivalent, preservative free 0.5 mL Syringe

19515-0808-52 90686 150 GlaxoSmithKline ? SKB

Influenza, live, intranasal, quadrivalent

FluMist 0.2 mL Spray

66019-0309-10 90672 149 MedImmune ? ME

Influenza, injectable, MDCK, preservative free, quadrivalent

Flucelvax 0.5 mL Syringe

70461-0322-03 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 December 2022

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

Influenza, high dose, quadrivalent

Influenza, Injectable, quadrivalent, preservative free

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

49281-0122-65 90662

0.7 mL Syringe

Fluarix 0.5 mL Syringe

58160-0890-52

Fluzone 0.5 mL SDV

49281-0422-10 90686

Afluria 0.5 mL Syringe

33332-0322-03

Afluria 5.0 mL MDV

33332-0422-10 90688

Flucelvax 5.0 mL MDV

70461-0422-10 90756

Flublok Quadrivalent 0.5 mL Syringe

Fluad Quadrivalent 0.5 mL Syringe

49281-0722-10 90682 70461-0122-03 90694

197 Sanofi-Pasteur - PMC GlaxoSmithKline ? SKB

150 Sanofi-Pasteur ? PMC 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

Hep B (Recombinant), CpG adjuvanted Hep A/Hep B ? Adult HebB recombinant, 3antigen, Al(OH)3

Havrix

Vaqta

Heplisav ? B Twinrix PreHevbrio

58160-0826-52 00006-4096-02 00006-4841-41 43528-0003-05 58160-0815-52 75052-0001-10

90632

GlaxoSmithKline ? SKB 52

Merck - MSD

90739 90636 90759

189 Dynavax, Inc - DVX 104 GlaxoSmithKline ? SKB 220 VBI Vaccines - VBI

Hep B, Adult

Engerix ? B

58160-0821-11 58160-0821-52

90746

43 GlaxoSmithKline ? SKB

Td (adult), 5 Lf tetanus toxoid, PF, adsorbed Td (adult), 2 Lf tetanus toxoid, PF, adsorbed

Zoster, Recombinant

Influenza Vaccines ? see the Influenza Vaccines table above

Tenivac

49281-0215-10 49281-0215-15

90714 113

Tdvax

13533-0131-01 90714 09

Shingrix

58160-0819-12 58160-0823-11

90750 187

Sanofi-Pasteur ? PMC Grifols - GRF 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 December 2022

Washington State Immunization Information System

IIS Codes for Common Vaccines in Washington

Travel & Other Vaccines

IIS Vaccine Name Anthrax

Cholera Japanese Encephalitis

Rabies

Vaccinia, smallpox monkeypox vaccine live PF, JYNNEOS Typhoid, Oral

Typhoid, ViCPs Yellow Fever

Trade Name BioThrax VaxChora

IXIARO

RabAvert Imovax Rabies

JYNNEOS

Vivotif Typhim Vi YF-Vax

NDC Number 64678-0211-01 70460-0001-01

42515-0002-01

58160-0964-12 49281-0252-51

50632-0001-02

69401-0000-02 50090-2292-00 49281-0790-51 49281-0915-01

CPT Code 90581 90625 90738

90675

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

90611 206 Bavarian Nordic A/S - BN

90690

90691 90717

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 December 2022

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