Vaccine Order Form

Order Monday – Pick up Thursday or Friday of the same week - Transportation cooler must be between 2-8°C

Please submit (with this order) a copy of your temperature log book since your last order. You may provide a scan or photo of your logbook using the link at the bottom of the page. You may also present temperature logs in person when you come to pick up order.

Any temperature outside of 2 - 8°C MUST be reported immediately - 625-5900 or toll-free 1-888-294-6630

Tuberculin

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Components: Tuberculin purified protein derivative (5TU); Date when opened. TB skin testing solution.

Tdap-IPV 4-6 year booster

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Components: Tetanus toxoid, reduced diphtheria toxoid & Acellular pertussis vaccine adsorbed combined with inactivated Poliomyelitis vaccine.

DTap-IPV-Hiv (Pediacel)

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Components: Acellular pertussis vaccine & diphtheria & tetanus toxoids adsorbed combined with inactivated poliomyelitis vaccines & Haemophilus influenzae b conjugate vaccine (pentavalent)

Hib

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Components: Haemophilus influenza type b Vaccine.

IPV

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Components: Polio vaccine.

NeisVas-C (Meningococcal)

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Components: Meningococcal conjugate vaccine

Tdap

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Components: Tetanus & diphtheria toxoids combined with Acellular pertussis vaccine.

MMR

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Components: Measles, Mumps, Rubella vaccine, live, attenuated.

MMRV

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Components: Measles, Mumps, Rubella, Varicella vaccine, live, attenuated.

Pneu-C-13

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Components: Pneumococcal 13- valent conjugate vaccine.

Pneu-P-23

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Components: Pneumococcal polysaccharide vaccine.

RotaTeg

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Components: Rotavirus, live, ORAL.

Td

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Components: Tetanus & diphtheria toxoids adsorbed.

Varicella

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Components: Varicella vaccine.

Zoster Vaccine

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Herpes Zoster vaccine. Eligible for 65-70 yrs.

Hepatitis B

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Components: High-risk patients only.

Hepatitis A

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Components: High-risk patients only.
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