Complete List of Vaccine Names and CPT/CVX Codes

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A list that matches the vaccine name or s in CHILD Profile with the brand name or other s of the vaccines you use most often. Combination Vaccines Pediarix DTAP/HepB/IPV 6 weeks + Pentacel DTaP/HIB/IPV 6 weeks - 5 yrs ProQuad MMR/V 1 yr + SQ Kinrix DTaP/IPV 4-6 yrs Comvax HEPB/HIB 6 weeks + Twinrix HepA/HepB 18 + yrs Diphtheria, Tetanus and Pertussis Diphtheria and tetanus toxoids adsorbed DT (Pediatric) 6 weeks + Daptacel DTaP 6 weeks + Infanrix DTaP 6 weeks + Tetanus and diphtheria toxoids adsorbed Decavac Tetanus and diphtheria toxoids adsorbed Boostrix Tetanus Diphtheria & Acellular Pertsussis Adacel Tetanus Diphtheria and Acellular Pertussis Td Adult, Preserv free 7+ yrs Td Adult, Preserv free 7+ yrs Tdap 7-65+ yrs Tdap 7-65+yrs NDC: 58160-0811-52 NDC: 49281-0510-05 NDC: 00006-4999-00 NDC: 58160-0812-11 NDC: 00006-4898-00 NDC: 49281-0278-10 NDC: 49281-0286-10 NDC:58160-0810-11 Massachusetts Biological Labs MBL NDC: 14362-0111-03 NDC: 49281-0291-83 NDC:58160-0842-11 NDC: 49281-0400-10 90723 110 90698 120 90710 94 90696 130 90748 51 90636 104 90702 28 90700 20 90714 113 90718 09 90715 115

Diphtheria, Tetanus and Pertussis (conti.) Tripedia DTaP 6 weeks + Whenever DTaP was given, even if the brand name is unknown Diphtheria, tetanus toxoids, & whole cell pertussis vaccine (will be from historical records) Hepatitis A Havrix (2 doses for pediatric/adolescent) Vaqta (2 doses for pediatric/adolescents) Havrix (3 doses for pediatric/adolescent) 90700 20 DTaP 90700 20 DTP Hep A 2 dose - Ped/Adol Hep A 2 dose - Ped/Adol Hep A 3 dose - Ped/Adol 12-18 yrs 12-18 yrs 12-18 yrs Vaqta (2 doses for adults) Hep A 2 dose - Adult 19+ yrs Havrix (2 doses for adults) Hep A 2 dose - Adult 19+ yrs Hepatitis B Engerix-B Ped/Adol (3 dose schedule) Recombivax HB Ped/Adol Engerix-B (4 dose schedule) Recombivax HB for adults Engerix-B for adults Recombivax HB for adults HepB Ped/Adol Preserv. Free HepB Ped/Adol Preserv. Free Hepatitis B - dialysis Hep B 2 dose Adol/Adult Hep B Adult Birth - 19 yrs Birth - 19 yrs 11-15 years 20 + yrs 20 + yrs (720 EL.U) (25 U) (360 EL.U) (50u) (1440 EL.U) 10µg 5µg 2.0 ml 40µg Two X 20 µg in 1 or 2 injections 10µg 20µg 10µg NDC: 58160-0825-11 90633 83 NDC: 00006-4831-41 90634 84 NDC: 58160-0820-11 NDC: 00006-4981-00 NDC: 58160-0820-11 90632 52 90744 08 90747 44 90743 43 90746 43 2/7 Updated: 11/01/2011 V4.11.5.3

Hepatitis B (conti.) Various dosages depending on specific individual cases, such as high risk or dialysis. HIB Note: there are various choices available to reflect the specific situation ActHib Hib-PRP-T PedvaxHib Hib-PRP-OMP Hiberix OmniHib HibTITER ProHIBit (discontinued) Human Papilloma Virus Hib-PRP-T Hib-PRP-T Hib-Hboc Hib-PRP-D 2-2 - 12 4 years 2-2 - Gardasil HPV, quadrivalent 9-26 yrs Cervarix HPV, bivalent 10-2 Immune Globuline Products HyperHEP B S/D or HepaGam B (Hepatitis B Immune Globulin) GamaSTAN S/D (Immune Globulin) HyperRAB S/D (Rabies Immune Globulin) (This list is not comprehensive by brand name or manufacturer) HBIG (Hepatitis B Immune Globulin) IG (Immune Globulin ) RIG NDC: 49281-0545-05 NDC: 00006-4897-00 90648 48 90647 49 90648 48 Wyeth Ayerst WAL 90645 47 NDC: 00006-4045-41 NDC: 58160-0830-46 Biotherapeutics TAL OR Cangene Corp - CNJ Biotherapeutics - TAL Biotherapeutics - TAL 90649 62 90650 118 90371 30 90281 86 90375 34 3/7 Updated: 11/01/2011 V4.11.5.3

Immune Globuline Products (conti.) (This list is not comprehensive by brand name or manufacturer) Synagis (Respiratory Syncytial Virus Immune Globulin) HyperTET S/D (Tetanus Immune Globulin) Influenza Preservative Free (state supplied) Contains Preservative Flumist - Live attenuated Influenza Vaccine Fluvirin PF Afluria Contains Preservative Preservative Free Afluria Preservative Free FLUARIX Fluvirin Contains preservative Contains Preservative Agriflu RSV-IG TIG Influ Split, 6-35 mos, 6-35 mos Influ Split, 36+ mos 3-18 yrs Influenza Nasal Spray 2-18 yrs Influ Inact 48+ mos pres free Influ Inact 9 + yrs w/thimerosol Influ Split, 36+ mos, Influ Inact 9+yrs Influ Split, 36+ mos Influ Inact. 48+ mos, w/thimerosol Influ Split, 36+ mos Influ split, 18+ years, 3-18 yrs 9+ yrs 3+ yrs 9+ yrs 3+ yrs 4+ yrs 3+ yrs 18+ yrs FluLaval Influ split, 18+ years 18+ yrs 0.25 ml 0.2 ml PIS SDV; MedImmune MED 90378 93 IN Biotherapeutics - TAL NDC: 49281-0111-25 NDC: 49281-0388-15 MedImmune MED NDC: 66019-0109-10 NDC: 66521-0114-02 CSL Biotherapies, INC CSL Biotherapies, INC NDC: N/A 90389 13 90655 140 90660 111 90656 140 90656 140 90656 140 4/7 Updated: 11/01/2011 V4.11.5.3

Influenza (conti.) Flumist - Live attenuated Influenza Vaccine Influenza Nasal Spray 19 49 yrs High Influenza, High 65+ yrs 0.2 ml PIS IN MedImmune MED 90660 111 90662 135 Intradermal Influenza, Intradermal PF 18-64yr 0.1mL PFMS ID 90654 144 Japanese Encephalitis JE-VAX - Japanese Encephalitis IXIARO - Japanese Encephalitis Measles, Mumps & Rubella Japanese Encephalitis Japanese Encephalitis- 12-35 mos, 3 yrs + SQ 17 yrs + MMR II - Measles, Mumps & Rubella MMR 1+ yrs SQ Menactra Conjugate vaccine (Serogroups A, C, Y, W-135) Menveo Conjugate vaccine (Serogroups A, C, Y, W-135) Menomune A/C/Y/W-135 Polysaccharide vaccine Pneumonia (MCV4P) (MCV4O) (MPSV4) 2-55 yr 11-55 yr 3-18 (2 doses), 19+ ( 1 dose) SQ Intercell Biomedical INT NDC: 00006-4681-00 NDC: 49281-0589-05 NDC: 46028-0208-01 90735 39 90738 134 90707 03 90734 114 90734 136 90733 32 Prevnar 13 (Pneumococcal Conjugate, 13 valent) Pneumovax 23 (Pneumococcal, polyvalent) Pneumococcal, PCV-13 Pneumococcal, (PPSV) 2-59 2 yrs w/health risks SQ/ Wyeth Ayerst WAL NDC: 00005-1971-02 NDC: 00006-4943-00 90670 133 90732 33 5/7 Updated: 11/01/2011 V4.11.5.3

Pneumonia (conti.) Pnu-Imune 23 Pneumococcal, (PPSV) 65+ yrs, SQ/ Prevnar (Pneumococcal Conjugate, 7 valent) (Note: to be documented for vaccine given before 04/2010) Polio Pneumococcal, (PCV) 2-59 IPOL Poliovirus vaccine, inactivated IPV 6 weeks + SQ Poliovirus vaccine, live oral OPV 90732 33 Wyeth Ayerst WAL 90669 100 NDC: 49281-0860-10 90713 10 Rabies Imovax Rabies Rabavert Rabies Rabies, ID Rabies, Intradermal 0.1ml ID 90675 18 90676 40 Rotavirus Rotateq Rotarix Respiratory Syncytial Virus Rotavirus, pentavalent RV5 Rotavirus, monovalent RV1 2-32 2.0 ml ORAL 6-24 weeks ORAL NDC: 000006-4047- 41 NDC: 58160-0845-52 90680 116 90681 119 Synagis RSV-IG TB test Purified Protein Derivative (PPD) PPD Test 0.1 ml ID Typhoid Typhoid ViCPs Typhoid, ViCPs 2 yr + Parkdale Pharmaceuticals PD 86580 96 90691 101 6/7 Updated: 11/01/2011 V4.11.5.3

Typhoid (conti.) Typhoid, Oral Typhoid, Oral 6 yr + 4 tabs ORAL Typhoid, parenteral Varicella Typhoid, parenteral Varivax Chicken Pox Vaccine Varicella 1+ yrs SQ Yellow Fever Yellow Fever Yellow Fever 9+ SQ Zoster ("Shingles") Berna Products Corp.- BPC NDC: 00006-4827-00 90690 25 90716 21 90717 37 Zostavax Zoster 50 + yrs 0.65 ml SQ 90736 121 Notes On the Vaccination View/Add Screen: there are two places to look for the appropriate vaccine choice when entering a vaccination date. Always look FIRST at the vaccine names that appear on the screen. ALL routine vaccines will appear. For less common vaccines that you can t find on this list, go to the select box at the bottom of the vaccine list, and choose your vaccine from the drop-down list and enter the date istered. "Unspecified" vaccines should only be used for entering historical vaccines when the specific vaccine type is unknown. If your practice manages vaccine inventory in CHILD Profile: make sure the vaccine types you enter match the vaccine types your lot number manager has entered. If you don t see the correct lot number on your Vaccination Detail screen, you and your lot number manager may be entering different vaccines (i.e., DTaP vs. DTaP-5 pertussis antigen.) Be sure to speak with the person entering your lot numbers if you notice any issues/problems. FLU Notes to consider = Prefilled Syringe; = Multidose vial; SDV - Single vial CHILD Profile staff discourage the use of the vaccine type "Influenza Whole". This vaccines type has not been used in the U.S. for some time Pfizer purchased Wyeth Ayerst in 2010 but they are continuing to use the Wyeth Ayerst branding for a period of time. Pfizer will be added as a manufacture when the packaging changes. 7/7 Updated: 11/01/2011 V4.11.5.3