iv. storage & handling - north carolina...replace storage units that do not meet the minimum...

IV. Storage & Handling

North Carolina Immunization Program (NCIP)

Minimum Required Vaccine Ordering, Handling, and Storage Procedures* *Storage procedures apply to both private and state vaccine stocks

Updated November 15, 2017 Detailed information available at http://www.cdc.gov/vaccines/recs/storage/toolkit/

Vaccine Personnel

❖ Designate one staff member as the primary vaccine coordinator and at least one back-up vaccine coordinator. Staff must participate in

yearly, documented training/education on proper storage and handling practices and VFC program requirements. All changes to key staff

must be communicated to the NCIP

Storage and Handling Plans

❖ Maintain and update (with signature) annually or as needed written Routine Vaccine Management and Emergency Management Plans.

Ensure all staff read and understand the plans, especially what to do in the event of a unit malfunction, power failure, natural disaster, or

other emergencies. The routine plan must include guidance on: a) proper vaccine storage and handling practices, b) vaccine shipping and

receiving, c) vaccine ordering, d) inventory control, e) vaccine expiration, spoilage, and waste prevention. The Emergency Plan must

include: a) name, contact information, and how to notify staff responsible for preparing and transporting vaccine, b) alternative vaccine

storage facility information, c) how to pack vaccine for transport, and d) how to document steps taken

Vaccine Storage Equipment (NCIP strongly recommends contacting the branch prior to the purchase of new equipment (data

loggers/storage units) to ensure equipment meets program requirements)

❖ DO NOT store vaccine in a dormitory or dorm-style refrigerator/freezer at any time

❖ Dedicate refrigerators and freezers to the storage of vaccines only. Units must be able to maintain required vaccine storage temperatures

year-round and be large enough to hold the year's largest inventory, along with sufficient room to store water bottles in the refrigerator and

frozen coolant packs/frozen water bottles in the freezer

❖ Place the storage unit in a well vented room with space around the sides and at least 4 inches between the back of the unit and the wall

❖ Do not plug storage units in power strips, ground fault interrupters outlets, or outlets that are activated by a wall switch. These can be

tripped or switched off, resulting in loss of electricity to the storage unit

❖ Post a “DO NOT UNPLUG” sign on the refrigerator, freezer, and circuit breakers

❖ Replace storage units that do not meet the minimum requirements or that have malfunctioned (new purchases must be stand-alone units)

❖ Maintain one back up data logger thermometer with a current certificate of calibration on hand (not stored in unit)

Vaccine Storage Practices

❖ Rotate vaccine stock weekly and use shorter-dated vaccines first. Remove expired immediately and contact the NCIP for wastage

instructions. Notify NCIP at least four months before the expiration date to avoid restitution for improper inventory management. Keep

vaccines in their original packages and store similar looking vaccines on different shelves to avoid confusion and medication errors

❖ Place vaccine in the central area of the storage unit to allow for proper air circulation around the vaccine. Do not store vaccines in the door,

vegetable bins, on the floor of the unit or near the cooling vents at the top of the unit

❖ Store water bottles against the inside walls, on the top shelves, and in the doors of the refrigerator

❖ Keep frozen coolant packs (as well as frozen water bottles) in the freezer along the walls and floor and inside the freezer door

❖ Store MMR in the freezer

❖ Do not store food and beverages in the unit; Store other medications and biologic products in a separate storage unit

Temperature Monitoring (As of January 1, 2018 All Thermometers Must be Digital Data Loggers)

❖ Read and manually record the current temperature twice each day, once when the clinic opens and once when the clinic closes (including

half days), from a data logger with a probe inside the unit. Record and clear the min/max reading once a day (when the clinic opens).

Recorded temperatures must include time of reading, name and/or initials of the person assessing temperature

❖ Download and review data logger readings weekly

❖ Data logger probes should be placed centrally, near vaccine and have a current certificate of calibration issued by an ILAC-accredited

laboratory

❖ Post the temperature log on the vaccine storage unit and maintain copies of all temperature logs for 3 years

❖ Refrigerator temperature must be maintained between 2°C and 8°C (36° and 46° F) with an optimum of 5°C (40°F)

❖ Freezer temperature must be maintained between -50°C and -15°C (-58°F and +5°F) with an optimum of -20° C (-4°F)

❖ Take immediate action when temperatures are out-of-range. Call the NCIP at 877-873-6247 for assistance and document on the

temperature log any actions taken. Isolate the affected vaccine vials or packages, mark "DO NOT USE,” and store the vaccines under

appropriate conditions in a properly functioning vaccine storage unit

Vaccine Shipments and Transfers

❖ Immediately unpack vaccine deliveries, examine quantity, lot number, and expiration dates of the vaccine order against the invoice, and

store appropriately. Call NCIP if cold chain monitor was activated; Never refuse delivery of a vaccine shipment

❖ Arrange for deliveries only when the vaccine coordinator or back-up will be available. Consider holidays, vacations, staff schedules, and

changes in hours of operation when designating vaccine delivery date and time

❖ Do not transfer or borrow vaccine from other providers without prior approval from the NCIP

Vaccine Ordering and Inventory Management

❖ Order and administer all ACIP-recommended vaccines based on actual population served

❖ Draw up vaccine only at the time of administration

❖ Physically distinguish between public and private vaccine stock and maintain complete, accurate, and separate stock records

❖ Store vaccine in their original containers. Use only the specific diluent provided by the manufacturer

❖ Multi-dose products may be used until the expiration date stamped on the vial unless otherwise indicated in the manufacturer’s package

insert. Vaccine with expiration dates on the vial with only the month and year may be used through the last day of that month. As doses are

used, mark multi-dose vials to keep an accurate inventory

http://www.cdc.gov/vaccines/recs/storage/toolkit/

NORTH CAROLINA IMMUNIZATION PROGRAM (NCIP) ROUTINE VACCINE MANAGEMENT PLAN (update February 2, 2018)

Page 1 of 4

Person Completing Plan: Signature:

Date: County:

Key Staff • Designate one staff member to be the primary vaccine coordinator and at least one back-up coordinator. The primary

vaccine coordinator is responsible for provider oversight for all vaccine management within the office and ensuring all vaccines are stored and handled correctly. The back-up coordinator can assume oversight responsibilities in the absence of the primary coordinator.

• All changes in key staff must be communicated to the NCIP as they occur. • All staff must complete annual training on the VFC program requirements (You Call the Shots: Modules 10 and 16

at http://www.cdc.gov/vaccines/ed/youcalltheshots.htm). All training must be documented on the NCIP Employee Immunization Education Roster.

• Staff training should include (but is not limited to) the following topics: screening for VFC eligibility, procedure for receipt of vaccine delivery, daily storage and handling procedures, administering vaccine, and transportation of vaccine in an emergency.

Clinic Name

Address

Role Name Job Title Home Phone Cell Phone Primary

Secondary

Lead physician

Office staff

Duties of key staff members Lead Physician

• Complies with all federal vaccine management requirements • Designates one employee as the practice’s Primary Vaccine Coordinator • Designates one employee as the practice’s Back-up Vaccine Coordinator • Reports changes in key staff to NCIP • Conducts and documents required orientation and annual training for vaccine management personnel at least

annually and as necessary • Ensures practice’s vaccine storage units meet NCIP requirements • Ensures practice’s vaccine inventory is consistent with NCIP requirements • Updates and revises vaccine management plans at least annually and as necessary

Primary Vaccine Coordinator • Completes required NCIP and VFC trainings • Oversees the practice’s vaccine management for routine and emergency situations • Monitors vaccine storage units • Maintains NCIP-related documentation in an accessible location

Back-up Vaccine Coordinator • Completes required NCIP and VFC trainings • Meets all responsibilities described in the Primary Vaccine Coordinator duties when s/he is not available

http://www.cdc.gov/vaccines/ed/youcalltheshots.htm)


Page 2 of 4


Date: County:

Vaccine Storage Units: Locations and Maintenance • Refrigerator vaccines must be maintained between 2°C and 8°C (36°F and 46°F) with an optimum of 5°C (40°F)

at all times. • Freezer temperatures must be maintained between -50°C and -15°C (-58°F and +5°F) with an optimum of -20°C (-

4°F) at all times. • Vaccines should be stored in separate, stand-alone refrigerator or freezer units. However, if a combination

(household) unit is being used, it should have separate controls for the refrigerator and freezer sections. • Providers may no longer purchase combination units for vaccine storage. All new purchases must be stand-alone

units. • Provider must notify the NCIP immediately upon discovering vaccine (state or private) has been involved in a cold

chain failure. If a cold chain failure is suspected, providers must: o Store vaccine under correct storage conditions in a properly functioning and monitored vaccine storage

unit o Quarantine vaccine. Label vaccine “DO NOT USE” so the vaccine is not administered o Notify the NCIP immediately after discovery of the incident at 877-873-6347 for assistance o Document any actions taken on the temperature logs regarding out of range temperatures o Do NOT discard any vaccine unless directed to do so by the NCIP

• Post a “DO NOT UNPLUG” sign on the vaccine storage units and circuit breakers. Do not plug unit into ground fault interrupter (GFI) outlets, power strips, or outlets that are activated by switches.

Maintenance/Repair Company Contact Name Phone Number

Unit Type Location Brand Model Serial Number Date Received Refrigerator

Refrigerator

Freezer

Freezer

Maintenance Log

Unit Type Location Make/Model Type of Service Date Refrigerator

Refrigerator

Refrigerator

Freezer

Freezer


Page 3 of 4


Date: County:

Thermometer Maintenance and Temperature Monitoring • Providers must have a calibrated digital data logger with a probe in glycol with a current certificate issued by an

ILAC- accredited laboratory. All certificates must contain: model number, serial number, date of calibration, measurement results indicating unit passed testing, and the documented recommended uncertainty within ±1°F (0.5°C).

• All new purchases are required to digital data logger thermometers with ILAC-accredited laboratory certification. • The digital data logger must be placed in a central area of the unit directly with the vaccine in order to properly

measure vaccine temperature. Thermometers should not be placed in the doors, near or against the walls, close to air vents, or on the floor of the unit.

• Data logger temperatures must be downloaded and reviewed weekly.

Location Brand Model Serial Number

Issue Date Calibration Due Date

Replace Battery Date

Refrigerator

Freezer

Calibration Company/Laboratory Contact Name Phone Number

Location of certificate of calibration:

Location of back-up thermometer(s): Temperature Logs

• Provider must manually record temperatures on paper temperature logs, regardless of continuing monitoring systems that may be used. The following requirements apply:

o Appropriately trained staff must record finding on a paper temperature log twice a day on all days the clinic is open

o The log must include the time, date, temperature, and initials of the staff member o The log must be posted on each vaccine storage unit door or nearby in a readily accessible and visible

location o Providers must maintain an ongoing file of paper temperature logs for 3 years

Location of completed temperature logs:


Page 4 of 4


Date: County:

Routine Vaccine Maintenance • Vaccines should be stored in their original packaging, placed in the middle of the unit with space between vaccine

and the sides/back of the unit. Providers may use plastic organizational boxes for inventory control, provided there are holes to allow for circulation.

• Open only one vial or box of a particular vaccine at a time to control vaccine use and allow easier inventory control. On each opened vaccine vial, indicate on the label the date and time it was reconstituted or first opened. Use tick marks on multi-dose vials to keep track of doses.

• Order, stock, and administer all ACIP-recommended vaccines for the population served. • Draw up vaccine only at the time of administration. • Practices that serve both VFC and non-VFC children must maintain separate public and private vaccine inventories. • All instances of borrowing between VFC vaccine and private vaccine must be recorded, documented, and paid back

within 30 days. • Expired vaccine must be removed immediately from the storage unit with viable vaccine. • Weekly tasks:

o Rotate stock so that newer vaccines are stored towards the back of the unit, while those soonest-to-expire are stored in the front. Providers must notify the NCIP of any vaccine doses that will expire before they can be administered at least 4 months before the expiration date to avoid restitution for improper inventory management. Providers must coordinate with the NCIP to transfer and document the transfer of vaccine between providers. Vaccine transfers between providers can occur only after receiving NCIP approval.

• Monthly tasks: o Check the North Carolina Immunization Program website for updates. o Conduct an inventory count to reconcile any differences between physical count and NCIR. o Check door seals of refrigerator and freezer. o Check borrowing and replacement reports to ensure all borrowed vaccine has been replaced within 30 days

of the borrowed date. Receiving and Unpacking Shipments

• Arrange for shipments only when the Primary Vaccine Coordinator or Back-up Coordinator is available. • Keep reception staff current regarding vaccine delivery and train staff to respond to a vaccine delivery appropriately. • Upon receipt of vaccine shipment, providers must:

o Open vaccine package immediately o Check the temperature monitor readings o Inspect the vaccine and packaging for damage o Determine length of time the vaccine was in transit by looking at the packing list o Immediately store at appropriate temperatures

• If there is an issue with the vaccine shipment or there is a problem with the temperature monitors, providers must contact the NCIP at 877-873-6247.

NORTH CAROLINA IMMUNIZATION PROGRAM (NCIP) EMERGENCY VACCINE MANAGEMENT PLAN/DISATER RECOVERY PLAN (update September 4, 2019)


Date: County:

Clinic Name

Address

Role Name Job Title Home Phone/ Cell Phone Email Address

Primary

Secondary

Lead physician

Office staff

In an emergency, contact the following people in the order listed:

Role Name Job Title Home Phone/ Cell Phone Email Address

1.

2.

3.

4.

Useful Emergency Numbers

Service Contact Work Phone Emergency Phone Email Address

Regional

Immunization Nurse

Regional

Immunization

Consultant

Electrical Power

Company

Building Maintenance

Building Alarm

Company

Refrigerator/Freezer

Repair

Refrigerator/Freezer

Alarm Company

Generator Repair and

Maintenance

Back-up location

Alternate facility Address Contact Work Phone Emergency Phone

Page 1 of 2

NORTH CAROLINA IMMUNIZATION PROGRAM (NCIP) EMERGENCY VACCINE MANAGEMENT PLAN/DISATER RECOVERY PLAN (update September 4, 2019)


Date: County:

Emergency Supplies

Item Location Item Location

Doors Keys

Flash lights/batteries Locks

Circuit breakers Alarms

Light Switches Packing Materials

Instructions for entering the building and floor plans:

Before an emergency

• Identify an alternative storage facility with a generator where vaccine can be stored (i.e. hospital, health department, fire

department, etc.). Obtain verbal or written consent to use the facility as a backup location and ensure the facility has

appropriate storage capabilities per NCIP requirements.

• Ensure the availability of staff to pack and move vaccine, and the availability at back up location

• Ensure a means of transport for the vaccine to the back-up facility and review transportation guidelines

• Fill the empty space in your refrigerator with water bottles and line the sides and bottom of the freezer with frozen

coolant packs

• Whenever possible, suspend vaccination activities BEFORE the onset of emergency conditions to allow sufficient time to

pack and transport vaccine

During an emergency

• Assess the situation. Keep all refrigerators and freezers closed and if possible, continue to monitor temperatures. If not,

record the temperature as soon as possible after the power is restored and the duration of the outage and report this

information to the NCIP

• Determine the cause of the power failure and estimate the time it will take to restore power. If a timeframe for the

restoration of power cannot be determined, do not leave vaccine in a non-working unit

• Notify key staff as listed on this Emergency Plan

• If the outage is expected to be long term (greater than 2 hours), transport the vaccine to back-up facility

Emergency transportation

• Conduct an inventory before beginning transport and keep all vaccine in original packaging

• Package refrigerated vaccine in a well-insulated container in the following order: 1) conditioned frozen water bottles at the

bottom of the cooler, 2) 1 sheet of corrugated cardboard 3) insulating material (2-3 inches of bubble wrap, packing foam, or

Styrofoam™) 3) vaccine with digital data logger, 4) insulating material, 5) another sheet of cardboard for support 6) layer of

conditioned frozen water bottles 7) closed lid with DDL display and temperature log on top of lid

• Package freezer vaccine in a well-insulated, hard-plastic cooler in the following order: 1) frozen coolant packs at the

bottom of the cooler, 2) vaccine layer directly on top of coolant pack, 3) Digital Data Logger probe with top layer of

vaccine 4) layer of frozen coolant packs to cover vaccine 5) fill cooler to top with insulation material (bubble wrap) 6)

close lid and place digital data logger display on top cooler lid with temperature log. Diluent should be transported with

the vaccine at the appropriate storage temperatures

• Upon arrival to back-up facility, document transportation time, temperatures in cooler, and temperatures at the facility

• Do not transfer vaccines in the NCIR for temporary storage at back-up locations

After an emergency

• Do not discard or administer any affected vaccine. Mark vaccine with “DO NOT USE” sign and call the NCIP for

further instruction about the viability of the vaccine

• Record the temperature in the unit as soon as possible after power is restored. Continue monitoring until units are in range

• Record the duration of the outage and maximum temperature observed on temperature logs

Page 2 of 2

PIN __________________

VACCINE

DOSES

ON

HAND

LOT NUMBEREXP.

DATEBRAND/ MFG

NDC

NUMBER

Unit

Shipping

Size Do

ses

Use

d

Do

ses

X3

# D

ose

s

Re

qu

est

ed

58160-

0812-11

58160-

0810-11

10 pack -

1 dose

vials

10 pack -

1 dose

vials

Infanrix®-GSK10 pack -

1 dose

syringes

Pediarix®-GSK58160-

0811-52

10 pack -

1 dose

syringes

5 pack - 1

dose vials

DTaP/IPV/

HIB

***By Federal law, a current Vaccine Information Statement must be given prior to administration

of the vaccine, and it must be given each time vaccine is given.

Fridge Temp this am? ___________ Freezer? __________

Will you be closed in the next 30 days? If yes, when?

Dates: ___________________________________________

Business Hours: __________________ Lunch: __________

VACCINES STORED IN THE REFRIGERATOR

NEW VACCINE ORDER

DT-Peds Generic -Sanofi49281-

0225-01

2 pack - 1

dose vials

FACILITY NAME ____________________________________________________ DATE __________________

CONTACT ___________________________ ______ FED ID # ____________________

SHIPPING ADDRESS ______________________________ CITY ________________ ZIP CODE ____________

PHONE # ______________________________ EXT _____________ FAX # ____________________________

DTaP/Hep

B/IPV

10 pack -

1 dose

vials

49281-

0286-10

58160-

0810-52

Daptacel®-Sanofi

VACCINE ORDER FORM

Quadracel®-

Sanofi

49281-

0562-10

10 pack -

1 dose

vials

CURRENT VFC INVENTORY

North Carolina Department of Health and Human Services

Division of Public Health - Immunization Branch

VACCINE REQUISITION/INVENTORY FORM

DTaP

58160-

0812-52

10 pack -

1 dose

syringes

Kinrix®-GSK

DTaP/IPV

49281-

0510-05

Call 1-877-873-6247 if you have questions about ordering,

Fax completed form to 1-800-544-3058

***Before giving any state supplied vaccines, see the most recently updated NCIP Coverage

Criteria for proper administration. The criteria can be found on our website at

www.immunizenc.com/providers.

Pentacel®-Sanofi

Updated 5/4/18 by TC

VACCINE

DOSES

ON

HAND

LOT NUMBEREXP.

DATEBRAND/ MFG

NDC

NUMBER

Unit

Shipping

Size Do

ses

Use

d

Do

ses

X3

# D

ose

s

Re

qu

este

d

PedvaxHIB®-

Merck

00006-

4897-00

10 pack -

1 dose

vials

HIBERIX®-GSK58160-

0818-11

10 pack -

1 dose

vials

HPV

00006-

4981-00

5 pack - 1

dose vials

Gardasil®9-Merck00006-

4119-03

10 pack -

1 dose

vials

Engerix B®-GSK

Recombivax HB®-

Merck

Menactra®-Sanofi

10 dose

vial

49281-

0860-10IPOL®-Sanofi

5 pack - 1

dose vials

49281-

0589-05

49281-

0545-05

10 pack -

1 dose

vials

00006-

4831-41

CURRENT VFC INVENTORY

10 pack -

1 dose

syringe

Vaqta®-Merck

10 pack -

1 dose

syringe

5 pack - 1

dose vials

46028-

0208-01Menveo®-GSK

00006-

4095-02

00006-

4093-02

10 pack -

1 dose

vials

10 pack -

1 dose

syringes

58160-

0820-52

58160-

0820-11

10 pack -

1 dose

syringes

58160-

0825-52

10 pack -

1 dose

vials

58160-

0825-11

NEW VACCINE ORDER

IPV

MCV

Hib

Hep B

Peds

10 pack -

1 dose

vials

Havrix®-GSK

ActHIB®-Sanofi

Hep A-

Peds

Hep A-

Peds


VACCINE

DOSES

ON

HAND

LOT NUMBEREXP.

DATEBRAND/ MFG

NDC

NUMBER

Unit

Shipping

Size Do

ses

Use

d

Do

ses

X3

# D

ose

s

Re

qu

este

d

Td Pres-Free -

Mass Bio Labs

13533-

0131-01

single

dose vial

Td

00005-

0100-10

10 pack -

1 dose

syringes

MENB

NEW VACCINE ORDERCURRENT VFC INVENTORY

PCV

RotaTeq®-Merck

Rotarix®-GSK58160-

0854-52

10 pack -

1 dose

vials

Rota

10 pack -

1 dose

syringes

Pneumovax® 23 -

Merck

00006-

4943-00

single

dose vial

00006-

4047-41

10 pack -

1 dose

tubes

00005-

1971-02

Prevnar 13® TM-

Pfizer

25 pack -

1 dose

tubes

00006-

4047-20

49281-

0215-15

single

dose

syringe

Trumenba®-Pfizer

58160-

0842-52

10 pack -

1 dose

syringes

Boostrix®-GSK

49281-

0400-10

10 pack -

1 dose

vials

5 pack - 1

dose

syringes

49281-

0400-15

Adacel®-Sanofi

MENB

10 pack -

1 dose

syringes

Tenivac®-Sanofi

58160-

0842-11

10 pack -

1 dose

vials

TDAP

49281-

0215-10

single

dose vial

Bexsero®-Novartis46028-

0114-01

Bexsero®-Novartis46028-

0114-02

single

dose

syringe


Purpose: To request vaccine from the North Carolina Immunization Program

Preparation: Complete original and retain one copy for your records

Distribution: Vaccine orders may be faxed or mailed to:

Fax: 1-800-544-3058

Immunization Branch

1917 Mail Service Center

Raleigh, NC 27699-1917

If an order is faxed, do not mail the order!

Additional forms may be ordered from the above office, as well as printed online.

How to use this form:

1. Review your doses administered data by taking the following steps:

a. Total all doses administered from the previous month for each vaccine type. Enter the number

in Previous Month Doses Used column.

b. Multiply Previous Month Doses Used column by three and enter this number in the Doses X 3

column.

2. Inventory current stock.

a. Rotate stock to ensure vaccines with the shortest expiration dates are used first.

b. Enter inventory amounts in the Doses on Hand column, by type, lot number and expiration date.

c. If you have more than three lot numbers to record for a vaccine please use the supplemental

inventory form provided.

* Orders missing Doses on Hand information may result in processing delays.

3. Complete your vaccine order:

a. Subtract Doses on Hand column from the Doses X 3 column.

b. Enter the difference in the # Doses Requested column. Round up to the unit shipping size.

c. Fax or mail your order to the Customer Service staff.

Disposition: Retain a copy of the completed form for three years or destroy when agency need ends.

Remember: Your Vaccines Administered Logs (VALS) are due to the Immunization Branch by the 10th of every

month. Failure to send those in could delay the processing of your vaccine order.

00006-

4681-00

10 pack -

1 dose

vials

VACCINES STORED IN THE FREEZER

M-M-R®II-Merck

10 pack -

1 dose

vials

00006-

4827-00Varivax®-MerckVaricella

MMR-V

MMR

10 pack -

1 dose

vials

00006-

4999-00ProQuad®-Merck


VACCINEDOSES

ON HANDLOT NUMBER

EXP.

DATEVACCINE

DOSES

ON HANDLOT NUMBER

EXP.

DATE

Reviewed 6/2014

Supplemental Inventory Form

CURRENT VFC INVENTORY CURRENT VFC INVENTORY

IF YOU ARE A NCIR USER DO NOT USE THIS FORM

Date of Transfer: _____________ YOU NEED TO COMPLETE ALL TRANSFERS IN NCIR

Street Address: City:

Phone Number: Pin #:

Street Address: City:

Phone Number: Pin #:

Vaccine(s) being transferred:

Vaccine Type Vaccine Type

Manufacturer/Lot # Manufacturer/Lot #

Expiration Date Expiration Date

# of doses transferred # of doses transferred













Please call 1-877-873-6247 if you have any questions.

Provider Receiving Vaccine: ________________________________________________________________________

____________________________

____________________________

________________________

________________________

________________________

________________________

________________________

________________________

________________________

____________________________

____________________________

____________________________

____________________________

____________________________

________________________

________________________

________________________

____________________________

____________________________

______________________

______________________

____________________________

____________________________

____________________________

(For Immunization Branch Use Only)

______________________

____________________________

North Carolina Department of Health and Human Services

Division of Public Health

NC IMMUNIZATION PROGRAM (NCIP) VACCINE TRANSFER FORM

Person Completing Form: ________________________________________________________________________

Provider Transferring Vaccine: ________________________________________________________________________

________________________

7/3/2003

20 doses

____________________________

________________________

EIPV

__________________________________________________

(_______)_________________________________________

____________________________

____________________________

(For Immunization Branch Use Only)

__________________________________________________

(_______)_________________________________________

______________________

Aventis T0697-2

DHHS 4058 Immunization Branch - Reviewed 6/2014

Purpose:

To provide a generic method for immunization providers to report vaccine transfers between NCIP

participants to the North Carolina Immunization Branch.

Preparation:

1. Complete the demographic data including provider name and street address for both the transferring

and receiving facilities.

2. Report all doses transferred, including multi-dose vials, single-dose vials, and manufacturers pre-filled syringes.

Include vaccine type, manufacturer, lot number, expiration date and number of doses transferred.

3. Make a copy for your records.

Distribution:

Mail form to: Immunization Branch

1917 Mail Service Center

Raleigh, NC 27699-1917

Fax form to: 1-800-544-3058

Email form to: [email protected]

Disposition:

Retain a copy of the completed form for three years or destroy when agency need ends.

Reordering:

User may copy form as needed or call 1-877-873-6247 or fax 1-800-544-3058 for more copies.

DHHS 4058 Immunization Branch - Reviewed 6/2014

mailto:[email protected]

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ting

____

____

____

____

____

_

Is y

our

faci

lity

on a

sta

ndar

d U

PS

Rou

te? □

Yes

□

No

Fax

Num

ber

P

leas

e re

turn

all

un

op

ened

was

ted

/exp

ired

vac

cin

es t

o M

cKes

son

. D

o n

ot

retu

rn d

raw

n v

acci

ne

or

op

en m

ult

i-d

ose

via

ls.

See

rev

erse

fo

r fu

rth

er in

stru

ctio

ns.

VA

CC

INE

T

YP

E

D

OS

ES

TO

BE

R

ET

UR

NE

D

D

OS

ES

D

ISP

OS

ED

OF

A

T F

AC

ILIT

Y

T

OT

AL

DO

SE

S

W

AS

TE

D

R

EA

SO

N W

AS

TE

D

D

AT

E

WA

ST

AG

E

OC

CU

RR

ED

M

AN

UF

AC

TU

RE

R

NA

ME

L

OT

#

EX

PIR

AT

ION

D

AT

E

EX

AM

PL

E

EIP

V

1 vi

al x

10 d

ose

s =

10

3 d

ose

s

13

do

ses

Tra

y fe

ll o

n t

he

flo

or

and

via

ls b

roke

.

Vac

cin

e d

isp

ose

d o

f at

fac

ility

.

2/23

/14

A

ven

tis

T06

97-2

7/3/

14

Doc

umen

t bel

ow w

hat p

reca

utio

ns y

our

agen

cy is

taki

ng to

ens

ure

that

vac

cine

will

not

be

was

ted

in th

is m

anne

r in

the

futu

re.

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

____

__

DH

HS

#39

74

IMM

UN

IZA

TIO

N B

RA

NC

H R

evie

wed

6/2

014

VT

rck

s ID

Vac

cin

e R

etu

rn I

D #

Pu

rpo

se:

To

prov

ide

a ge

neric

met

hod

for

imm

uniz

atio

n pr

ovid

ers

to r

epor

t was

ted/

expi

red

vacc

ine

to th

e N

orth

Car

olin

a Im

mun

izat

ion

Bra

nch.

P

rep

arat

ion

: T

he fo

llow

ing

step

s ne

ed to

be

follo

wed

in o

rder

to r

etur

n w

aste

d/ex

pire

d va

ccin

e:

1.

Co

mp

lete

all

info

rmat

ion

req

ues

ted

on

th

is f

orm

:

-in

dic

ate

in D

OS

ES

TO

BE

RE

TU

RN

ED

co

lum

n t

he

# o

f d

ose

s b

ein

g r

etu

rned

;

-in

dic

ate

in D

OS

ES

DIS

PO

SE

D O

F A

T F

AC

ILIT

Y c

olu

mn

th

e #

of

do

ses

dis

po

sed

of

at f

acili

ty.

2. S

end

rep

ort

to

NC

Imm

un

izat

ion

Pro

gra

m a

t 1-

800-

544-

3058

or

you

may

em

ail t

o n

cirh

elp

@d

hh

s.n

c.g

ov.

3.

Wai

t fo

r fa

xed

or

emai

led

was

ted

/exp

ired

vac

cin

e re

po

rt w

ith

VT

rckS

ID a

nd

Vac

cin

e R

etu

rn ID

fro

m Im

mu

niz

atio

n P

rog

ram

, th

is w

ill t

ake

1-2

bu

sin

ess

day

s.

Dis

trib

uti

on

: A

fter

you

have

com

plet

ed s

teps

1-3

you

will

then

com

plet

e th

e fo

llow

ing

step

s:

4.

On

ce y

ou

hav

e re

ceiv

ed t

he

faxe

d o

r em

aile

d w

aste

d/e

xpir

ed r

epo

rt f

rom

th

e

Imm

un

izat

ion

Pro

gra

m w

ith

yo

ur

VT

rckS

an

d V

acci

ne

Ret

urn

ID’s

, yo

u w

ill p

lace

th

e fo

rm w

ith

th

e v

acci

ne

to b

e re

turn

ed

(co

ld p

acks

no

t n

eed

ed)

insi

de

any

bo

x th

at y

ou

may

hav

e re

ceiv

ed v

acci

nes

in.

Y

ou

can

reu

se v

acci

ne

bo

xes

that

are

fro

m M

cKes

son

Sp

ecia

lty

Dis

trib

uti

on

.

Th

e va

ccin

es a

re t

o b

e re

turn

ed t

o M

cKes

son

Sp

ecia

lty

Dis

trib

uti

on

.

Ret

urn

on

ly s

po

iled

or

exp

ired

vac

cin

e in

its

ori

gin

al v

ial o

r p

refi

lled

syr

ing

e.

NE

VE

R s

hip

US

ED

syr

ing

es o

r a

syri

ng

e n

ot

pre

-fill

ed b

y th

e m

anu

fact

ure

r.

5. W

ait

for

ship

pin

g la

bel

s fr

om

McK

esso

n –

wh

ich

th

e Im

mu

niz

atio

n P

rog

ram

will

hav

e se

nt

to y

ou

r fa

cilit

y,

t

his

will

tak

e 7-

10 b

usi

nes

s d

ays

.

7.

If

on

sta

nd

ard

UP

S r

ou

te g

ive

vacc

ine

to d

rive

r o

nce

lab

el h

as a

rriv

ed.

8. I

f n

ot

on

UP

S r

ou

te –

McK

esso

n w

ill s

ched

ule

a p

ick

-up

fo

r th

e va

ccin

e w

ith

UP

S a

uto

mat

ical

ly.

Dis

po

siti

on

: R

etai

n a

copy

of t

he c

ompl

eted

form

for

thre

e ye

ars

or d

estr

oy w

hen

agen

cy n

eed

ends

. R

eord

erin

g:

Use

r m

ay c

opy

form

as

need

ed.

If yo

u ha

ve v

acci

ne y

ou c

an n

ot u

se b

efor

e its

exp

iratio

n da

te, c

all u

s at

leas

t fou

r (4

) m

onth

s pr

ior

to th

e ex

pira

tion

date

. D

o n

ot

retu

rn v

iab

le v

acci

ne.

Cal

l 1-8

77-8

73-6

247

if yo

u ha

ve a

ny q

uest

ions

.

North Carolina Immunization Program Refrigerator Vaccines Temperature Storage Log

Required to be maintained for 3 years Post on or near the vaccine storage unit and use to record required readings of AM and PM temperatures for vaccines

NCIP Temperature Log : Store vaccine on hand according to the most recent NCIP Minimum Required Vaccine Ordering, Handling and

Storage Procedures, which requires maintaining proper temperatures, using approved storage units, and immediately removing expired

vaccine from stock. Ensure an Emergency Vaccine Management Plan is completed, posted on the vaccine unit, updated annually, read

by current and new staff, and updated as staff change. (Update 02/20/2018)

Requirements:

o Read and manually record temperatures twice each day; once at the beginning and again at the end of the day

o Record from an interior digital data logger thermometer with a current certificate of calibration

o Refrigerator temperature must be maintained between 2°C and 8°C (36ºF and 46° F) with an optimum of 5°C (40°F)

o Normal readings are 2°, 3°, 4°, 5°, 6°, 7°, 8° C (36°, 37°, 38°, 39°, 40°, 41°, 42°, 43°, 44°, 45°, 46°F)

o Each temperature reading must be accompanied by the time of the reading and name (or initials) of the person who assessed and recorded the

reading

o CDC requires that providers record the minimum and maximum temperatures once each workday (preferably in the morning)

o Take immediate action when temperatures are out-of-range. Isolate the affected vaccine vials or packages, mark "DO NOT USE,” and store the

vaccines under appropriate conditions in a properly functioning vaccine storage unit. Call the NCIP at 877-873-6247 for assistance and document

on the temperature log any actions taken regarding the out of range temperatures.

Facility Name _________________________________ Location of Refrigerator_____________ Day Date AM Temperature PM Temperature Minimum/Maximum Temperature Comments

Mo/Day/Yr Reading Time Initials Reading Time Initials Minimum Maximum

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday Saturday Sunday

Monday

Tuesday

Wednesday

Thursday


Monday

Tuesday

Wednesday

Thursday


Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday Saturday

North Carolina Immunization Program (NCIP) Freezer Vaccines Temperature Storage Log

Required to be maintained for 3 years Post on or near the vaccine storage unit and use to record required readings of AM and PM temperatures for vaccines

NCIP Temperature Log : Store vaccine on hand according to the most recent NCIP Minimum Required Vaccine Ordering, Handling and

Storage Procedures, which requires maintaining proper temperatures, using approved storage units, and immediately removing expired

vaccine from stock. Ensure an Emergency Vaccine Management Plan is completed, posted on the vaccine unit, updated annually, read

by current and new staff, and updated as staff change. (Update 02/20/2018)

Requirements:

o Read and manually record temperatures twice each day; once at the beginning and again at the end of the day

o Record from an interior digital logger thermometer with a current certificate of calibration

o Freezer temperature must be maintained between -50°C and -15°C (-58°F and +5°F) with an optimum of -20° C (-4°F). Ex. Temperature readings

must be -15°, -16°, -17°, -18°, -19°, -20°, -21°, -22° C (5°, 4°, 3°, 2°, 1°, 0°, -1°, -2° F) but not colder than -50°C ( -58°F). o Protect MMR, MMR-V, and Varicella from light AT ALL TIMES o Each temperature reading must be accompanied by the time of the reading and name (or initials) of the person who assessed and recorded the

reading

o CDC requires that providers record the minimum and maximum temperatures once each workday (preferably in the morning)

o Take immediate action when temperatures are out-of-range. Isolate the affected vaccine vials or packages, mark "DO NOT USE,” and store the

vaccines under appropriate conditions in a properly functioning vaccine storage unit. Call the NCIP at 877-873-6247 for assistance and document

on the temperature log any actions taken regarding the out of range temperatures.

Facility Name _________________________________ Location of Freezer_________________ Day Date AM Temperature PM Temperature Minimum/Maximum Temperature Comments

Mo/Day/Yr Reading Time Initials Reading Time Initials Minimum Maximum

Sunday

Monday

Tuesday

Wednesday

Thursday


Monday

Tuesday

Wednesday

Thursday


Monday

Tuesday

Wednesday

Thursday


Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday Saturday

Vacc

ine

Labe

l Exa

mpl

es

Sta

ff ca

n ea

sily

bec

ome

conf

used

abo

ut v

acci

nes

with

in th

e st

orag

e un

it be

caus

e th

ere

are

so m

any

bran

ds a

nd fo

rmul

atio

ns

avai

labl

e. L

abel

ing

the

area

whe

re v

acci

nes

are

stor

ed c

an h

elp

staf

f qui

ckly

loca

te a

nd c

hoos

e th

e co

rrec

t vac

cine

—pe

rhap

s pr

even

ting

a va

ccin

e ad

min

istra

tion

erro

r. D

epen

ding

on

how

vac

cine

s ar

e or

gani

zed

with

in th

e st

orag

e un

it, la

bels

can

be

plac

ed

on c

onta

iner

s or

bin

s or

dire

ctly

atta

ched

to s

helv

es w

here

vac

cine

s ar

e pl

aced

. Oth

er h

elpf

ul s

trate

gies

to p

reve

nt v

acci

ne

adm

inis

tratio

n er

rors

incl

ude

colo

r-co

ding

labe

ls (e

.g.,

one

colo

r for

ped

iatri

c an

d an

othe

r for

adu

lt va

ccin

es) a

nd p

rovi

ding

ad

ditio

nal i

nfor

mat

ion

such

as

age

indi

catio

ns o

r oth

er in

form

atio

n un

ique

to th

e va

ccin

e.

In a

dditi

on, s

ome

vacc

ines

mus

t be

reco

nstit

uted

bef

ore

adm

inis

tratio

n. T

hese

vac

cine

s ha

ve tw

o co

mpo

nent

s—a

lyop

hiliz

ed

vacc

ine

and

a di

luen

t tha

t mus

t be

mix

ed to

geth

er. T

he ly

ophi

lized

vac

cine

sho

uld

only

be

reco

nstit

uted

or m

ixed

usi

ng th

e di

luen

t sup

plie

d by

the

man

ufac

ture

r. C

onsi

der p

ostin

g re

min

ders

or l

abel

ing

vacc

ines

to re

min

d st

aff t

o re

cons

titut

e ce

rtain

va

ccin

es p

rior t

o ad

min

istra

tion.

The

follo

win

g la

bels

are

exa

mpl

es th

at m

ay b

e us

ed to

hel

p or

gani

ze v

acci

nes.

Lab

els

are

base

d on

reco

mm

enda

tions

from

th

e A

dvis

ory

Com

mitt

ee o

n Im

mun

izat

ion

Pra

ctic

es (A

CIP

) and

may

incl

ude

indi

catio

ns d

iffer

ent f

rom

thos

e of

the

Food

and

D

rug

Adm

inis

tratio

n. T

he C

ente

rs fo

r Dis

ease

Con

trol a

nd P

reve

ntio

n (C

DC

) als

o re

com

men

ds v

acci

nes

be s

tore

d in

the

orig

inal

pac

kagi

ng to

pro

tect

the

cont

ents

from

ligh

t, to

hel

p m

aint

ain

the

reco

mm

ende

d te

mpe

ratu

re ra

nge,

and

to h

elp

prev

ent

adm

inis

tratio

n er

rors

.

Not

e: S

ome

vacc

ine

prep

arat

ions

are

bei

ng tr

ansi

tione

d fro

m v

ials

and

pre

fille

d sy

ringe

s th

at c

onta

in la

tex

(nat

ural

rubb

er) t

o vi

als

and

prefi

lled

syrin

ges

that

are

not

mad

e w

ith n

atur

al ru

bber

late

x. R

ead

the

pack

age

inse

rt th

at a

ccom

pani

es th

e pr

oduc

t to

chec

k fo

r the

pre

senc

e of

nat

ural

rubb

er o

r lat

ex.

Upd

ated

1/2

4/20

20

Dip

hthe

ria- a

nd T

etan

us-T

oxoi

d- a

nd a

cellu

lar P

ertu

ssis

-Con

tain

ing

Vacc

ines

DTa

P (D

apta

cel)

Age

s:

6 w

eeks

thro

ugh

6 ye

ars

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

DTa

P (I

nfan

rix)

Age

s:

6 w

eeks

thro

ugh

6 ye

ars

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Tip

cap

of p

refil

led

syri

nge

cont

ains

late

x

DTa

P-IP

V (K

inri

x)

Age

s:

4 ye

ars t

hrou

gh 6

yea

rs

Use

for:

DTa

P do

se #

5

IP

V d

ose

#4

Do

NO

T us

e fo

r D

TaP

dose

s 1

thro

ugh

4 O

R IP

V d

oses

1 th

roug

h 3

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n Ti

p ca

p of

pre

fille

d sy

ring

e co

ntai

ns la

tex

DTa

P-IP

V-H

epB

(Ped

iari

x)

Age

s:

6 w

eeks

thro

ugh

6 ye

ars

Use

for:

D

TaP

and I

PV: D

oses

#1, #

2, an

d/or

#3

Hep

B: A

ny d

ose

in th

e se

ries

Do

NO

T us

e fo

r H

epB

bir

th d

ose

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n Ti

p ca

p of

pre

fille

d sy

ring

e co

ntai

ns la

tex

Dip

hthe

ria- a

nd T

etan

us-T

oxoi

d- a

nd a

cellu

lar P

ertu

ssis

-Con

tain

ing

Vacc

ines

DTa

P-IP

V/H

ib (P

enta

cel)

Age

s:

6 w

eeks

thro

ugh

4 ye

ars

Use

for:

D

TaP

and

IPV:

Dos

es #

1, #

2,

#3, a

nd/o

r #4

Hib

: Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Rec

onst

itute

Hib

pow

der

ON

LY w

ith

man

ufac

ture

r-su

pplie

d D

TaP-

IPV

liqu

id d

iluen

t U

se im

med

iate

ly a

fter

rec

onst

itutio

n D

o N

OT

adm

inis

ter

DTa

P-IP

V w

/o H

ib

DTa

P-IP

V (Q

uadr

acel

)

Age

s:

4 ye

ars t

hrou

gh 6

yea

rs

Use

for:

DTa

P do

se #

5

IPV

dos

e #4

or #

5

D

o N

OT

use

for

DTa

P do

ses 1

th

roug

h 4

OR

IPV

dos

es 1

thro

ugh

3 R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Hae

mop

hilu

s in

fluen

zae

type

b-C

onta

inin

g Va

ccin

es

Hib

(Act

HIB

) A

ges:

6

wee

ks th

roug

h 4

year

s U

se fo

r: A

ny d

ose

in th

e se

ries

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n

Rec

onsti

tute

Hib

pow

der O

NLY

with

man

ufac

ture

r-su

pplie

d 0.

4% so

dium

chlo

ride d

iluen

t

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n, s

tore

at

2°C

to 8

°C (3

6°F

to 4

6°F)

and

dis

card

if n

ot u

sed

with

in 2

4 ho

urs.

Sh

ake

wel

l prio

r to

adm

inis

tratio

n.

Hib

(Ped

vaxH

IB)

Age

s:

6 w

eeks

thro

ugh

4 ye

ars

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Via

l sto

pper

con

tain

s lat

ex

Hib

(Hib

erix

)

Age

s:

6 w

eeks

thro

ugh

4 ye

ars

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Rec

onsti

tute

Hib

pow

der O

NLY

with

man

ufac

ture

r-su

pplie

d 0.

9% so

dium

chlo

ride d

iluen

t

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n,

stor

e at

2°C

to 8

°C (3

6°F

to 4

6°F)

and

dis

card

if n

ot u

sed

with

in

24 h

ours

. Sha

ke w

ell p

rior t

o ad

min

istra

tion.

Hep

atiti

s Va

ccin

es

Hep

A (H

avri

x)-P

edia

tric

Form

ulat

ion

Age

s:

12 m

onth

s thr

ough

18

year

s U

se fo

r: A

ny d

ose

in th

e se

ries

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n

Tip

cap

of p

refil

led

syri

nge

cont

ains

late

x

Hep

B (E

nger

ix-B)

-Ped

iatric

For

mul

ation

Age

s:

Birt

h th

roug

h 19

yea

rs

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Tip

cap

of p

refil

led

syri

nge

cont

ains

late

x

Hep

A (V

aqta

)-Ped

iatr

ic F

orm

ulat

ion

Age

s:

12 m

onth

s thr

ough

18

year

s U

se fo

r: A

ny d

ose

in th

e se

ries

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n

Via

l sto

pper

, syr

inge

plu

nger

stop

per,

and

tip c

ap

cont

ain

late

x

Hep

B (R

ecom

biva

x H

B)-

Pedi

atri

c Fo

rmul

atio

n

Age

s:

Birt

h th

roug

h 19

yea

rs

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Via

l sto

pper

, syr

inge

plu

nger

stop

per,

and

tip c

ap

cont

ain

late

x

Hep

atiti

s Va

ccin

es

Hep

A (H

avri

x)-A

dult

Form

ulat

ion

Age

s:

19 y

ears

and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Tip

cap

of p

refil

led

syri

nge

cont

ains

late

x

Hep

B (E

nger

ix-B

)-Adu

lt Fo

rmul

atio

n

Age

s:

20 y

ears

and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Tip

cap

of p

refil

led

syri

nge

cont

ains

late

x

Hep

A (V

aqta

)-A

dult

Form

ulat

ion

Age

s:

19 y

ears

and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Via

l sto

pper

, syr

inge

plu

nger

stop

per,

and

tip c

ap

cont

ain

late

x

Hep

B (R

ecom

biva

x H

B)-

Adu

lt Fo

rmul

atio

n A

ges:

20

yea

rs a

nd o

lder

U

se fo

r:

Any

dos

e in

the

serie

s A

ltern

ate A

doles

cent

Sch

edul

e for

11- t

hrou

gh 1

5 -y

ear o

lds:

Tw

o 1

mL

dose

s 4 to

6 m

onth

s apa

rt R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Via

l sto

pper

, syr

inge

plu

nger

stop

per,

and

tip c

ap

cont

ain

late

x

Hep

atiti

s Va

ccin

es

Hep

B (H

eplis

av-B

) A

ges:

1

8 ye

ars a

nd o

lder

Use

for:

Any

dos

e in

the

serie

s (tw

o 0.

5 m

L do

ses 1

mon

th a

part)

Rou

te:

Int

ram

uscu

lar (

IM) i

njec

tion

Hep

A-H

epB

(Tw

inri

x)

Age

s:

18

year

s and

old

er

Con

tain

s: H

epA

= P

edia

tric

dosa

ge

Hep

B =

Adu

lt do

sage

Sc

hedu

le:

0, 1

, and

6 m

onth

s A

ltern

ate

Sche

dule

: 0,

7, a

nd 2

1 to

30

days

, fol

low

ed b

y bo

oste

r at 1

2 m

onth

s R

oute

: I

ntra

mus

cula

r (IM

) inj

ectio

n Ti

p ca

p of

pre

fille

d sy

ring

e co

ntai

ns la

tex

Hum

an P

apill

omav

irus

Vacc

ines

9vH

PV (G

arda

sil 9

)

Age

s: 9

yea

rs th

roug

h 45

yea

rs

Rec

omm

ende

d ag

es: 1

1 ye

ars o

r 12

year

s C

atch

-up

ages

: 13

year

s thr

ough

26

year

s Sh

ared

clin

ical

dec

isio

n-m

akin

g ag

es: 2

7 th

roug

h 45

yea

rs

Rou

te: I

ntra

mus

cula

r (IM

) inj

ectio

n

Mea

sles

, Mum

ps, R

ubel

la V

acci

ne

MM

R (M

-M-R

II)

Age

s:

12 m

onth

s and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: Su

bcut

aneo

us (s

ubcu

t) in

ject

ion

Rec

onst

itute

MM

R p

owde

r O

NLY

with

m

anuf

actu

rer-

supp

lied

ster

ile w

ater

dilu

ent

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n,

stor

e in

vac

cine

via

l in

dark

pla

ce a

t 2°C

to 8

°C (3

6°F

to 4

6°F)

an

d di

scar

d if

not u

sed

with

in 8

hou

rs.

Men

ingo

cocc

al V

acci

nes

Men

AC

WY-

D (M

enac

tra)

Age

s:

9 m

onth

s and

old

er

Use

for:

Any

dos

e in

the

serie

s (an

d ce

rtain

hig

h-ris

k gr

oups

) R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Men

AC

WY-

CR

M (M

enve

o)

Age

s:

2 m

onth

s and

old

er

Use

for:

A

ny d

ose

in th

e se

ries (

and

certa

in

h

igh-

risk

grou

ps)

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n R

econ

stitu

te th

e M

enA

lyop

hiliz

ed c

onju

gate

com

pone

nt O

NLY

with

m

anuf

actu

rer-

supp

lied

Men

CW

Y li

quid

con

juga

te c

ompo

nent

Do

NO

T ad

min

iste

r M

enC

WY

w/o

Men

A

Beyo

nd U

se T

ime:

Sho

uld

be u

sed

imm

edia

tely

afte

r rec

onst

itutio

n, b

ut m

ay

be s

tore

d be

twee

n 2°

and

25°

C (3

6° a

nd 7

7°F)

for u

p to

8 h

ours

. Do

not

free

ze.

Men

ingo

cocc

al V

acci

nes

Men

B-4

C (B

exse

ro)

Age

s:

10 y

ears

and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Bexs

ero

and

Trum

enba

are

NO

T in

terc

hang

eabl

e

Com

plet

e se

ries

with

sam

e va

ccin

e pr

oduc

t Ti

p ca

p of

pre

fille

d sy

ring

e co

ntai

ns la

tex

Men

B-F

Hbp

(Tru

men

ba)

Age

s:

10 y

ears

and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Bexs

ero

and

Trum

enba

are

NO

T in

terc

hang

eabl

e

Com

plet

e se

ries

with

sam

e va

ccin

e pr

oduc

t

Pne

umoc

occa

l Vac

cine

s P

olio

viru

s Va

ccin

e

PCV

13 (P

revn

ar 1

3)

Age

s: A

ll ch

ildre

n 6

wee

ks th

roug

h 5

year

s

Cer

tain

hig

h-ri

sk g

roup

s 6 y

ears

and

old

er

who

hav

e ne

ver r

ecei

ved

PCV

13

All

adul

ts 6

5 ye

ars a

nd o

lder

who

hav

e ne

ver

rece

ived

PC

V13

may

rece

ive

a do

se p

er sh

ared

cl

inic

al d

ecis

ion-

mak

ing

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n

PPSV

23 (P

neum

ovax

23)

Age

s: H

ealth

y ad

ults

65

year

s and

old

er

Cer

tain

hig

h-ri

sk g

roup

s 2 y

ears

thro

ugh

64 y

ears

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n O

R

Subc

utan

eous

(sub

cut)

inje

ctio

n N

o m

ore t

han

two

dose

s of P

PSV

23 re

com

men

ded

befo

re 6

5th

birt

hday

and

one

dos

e at 6

5 ye

ars o

r old

er

IPV

Age

s:

6 w

eeks

and

old

er

Use

for:

Any

dos

e in

the

serie

s

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n O

R

Subc

utan

eous

(sub

cut)

inje

ctio

n

Rot

aviru

s Va

ccin

es

RV

1 (R

otar

ix)

Age

s: 6

wee

ks th

roug

h 8

mon

ths,

0 da

ys

Max

imum

age f

or 1

st do

se is

14

wee

ks, 6

day

s M

axim

um ag

e for

last

dose

is 8

mon

ths,

0 da

ys

Rou

te:

Ora

l (PO

) R

econ

stitu

te R

V1

pow

der O

NLY

with

man

ufac

ture

r-su

pplie

d st

erile

wat

er/c

alci

um c

hlor

ide/

xant

han

dilu

ent

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n,

stor

e at

2°C

to 8

°C (3

6°F

to 4

6°F)

or a

t con

trolle

d ro

om te

mpe

ratu

re

up to

25°

C (7

7°F)

and

dis

card

if n

ot u

sed

with

in 2

4 ho

urs.

Do

NO

T in

ject

Ti

p ca

p of

pre

fille

d di

luen

t ora

l app

licat

or c

onta

ins l

atex

RV

5 (R

otaT

eq)

Age

s: 6

wee

ks th

roug

h 8

mon

ths,

0 da

ys

Max

imum

age f

or 1

st do

se is

14

wee

ks, 6

day

s M

axim

um ag

e for

last

dose

is 8

mon

ths,

0 da

ys

Rou

te:

Ora

l (PO

)

Do

NO

T in

ject

Teta

nus-

and

Dip

hthe

ria-T

oxoi

d-C

onta

inin

g Va

ccin

es

DT

(gen

eric

)

Age

s:

6 w

eeks

thro

ugh

6 ye

ars

Use

for:

Prim

ary

serie

s and

boo

ster

dos

es

ON

LY fo

r chi

ldre

n w

ith a

co

ntra

indi

catio

n or

pre

caut

ion

to

pertu

ssis

vac

cine

R

oute

: In

tram

uscu

lar (

IM) i

njec

tion

Td

(gen

eric

)

Age

s:

7 ye

ars a

nd o

lder

U

se fo

r: P

rimar

y se

ries a

nd b

oost

er d

oses

fo

r per

sons

pre

viou

sly

vacc

inat

ed w

ith T

dap

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n

Td

(Ten

ivac

)

Age

s:

7 ye

ars a

nd o

lder

U

se fo

r: P

rimar

y se

ries a

nd b

oost

er d

oses

fo

r per

sons

pre

viou

sly

vacc

inat

ed w

ith T

dap

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n

Tip

cap

of p

refil

led

syri

nge m

ay co

ntai

n la

tex

Teta

nus-

and

Dip

hthe

ria-T

oxoi

d- a

nd a

cellu

lar P

ertu

ssis

-Con

tain

ing

Vacc

ines

Tda

p (A

dace

l) A

ges:

7

year

s and

old

er

Use

for:

R

outin

e ad

oles

cent

dos

e at

11

to 1

2

y

ears

of a

ge

Eac

h pr

egna

ncy

P

atie

nts n

ot fu

lly v

acci

nate

d fo

r

per

tuss

is

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n Ti

p ca

p of

pre

filled

syri

nge m

ay co

ntai

n la

tex

Tda

p (B

oost

rix)

A

ges:

7

year

s and

old

er

Use

for:

R

outin

e ad

oles

cent

dos

e at

11

to 1

2

y

ears

of a

ge

Eac

h pr

egna

ncy

P

atie

nts n

ot fu

lly v

acci

nate

d fo

r

per

tuss

is

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n Ti

p ca

p of

pre

filled

syri

nge c

onta

ins l

atex

Froz

en V

aric

ella

-Con

tain

ing

Vacc

ines

VAR

(Var

ivax

)

Age

s:

12 m

onth

s and

old

er

Use

for:

Any

dos

e in

the

serie

s R

oute

: Su

bcut

aneo

us (s

ubcu

t) in

ject

ion

R

econ

stitu

te V

AR

pow

der

ON

LY w

ith

man

ufac

ture

r-su

pplie

d st

erile

wat

er d

iluen

t Be

yond

Use

Tim

e: D

isca

rd re

cons

titut

ed v

acci

ne if

not

use

d w

ithin

30

min

utes

.

MM

RV

(Pro

Qua

d)

Age

s:

12 m

onth

s thr

ough

12

year

s U

se fo

r: A

ny d

ose

in th

e se

ries

Rou

te:

Subc

utan

eous

(sub

cut)

inje

ctio

n

Rec

onst

itute

MM

RV

pow

der

ON

LY w

ith

man

ufac

ture

r-su

pplie

d st

erile

wat

er d

iluen

t Be

yond

Use

Tim

e: D

isca

rd re

cons

titut

ed v

acci

ne if

not

use

d w

ithin

30

min

utes

.

ZV

L (Z

osta

vax)

Rec

omm

ende

d ag

es: 6

0 ye

ars a

nd o

lder

U

se fo

r: S

ingl

e do

se

Rou

te:

Subc

utan

eous

(sub

cut)

inje

ctio

n

Rec

onst

itute

froz

en Z

VL

pow

der

ON

LY w

ith

man

ufac

ture

r-su

pplie

d st

erile

wat

er d

iluen

t Be

yond

Use

Tim

e: D

isca

rd re

cons

titut

ed v

acci

ne if

not

use

d w

ithin

30

min

utes

.

Ref

riger

ated

Var

icel

la-C

onta

inin

g Va

ccin

e

RZ

V (S

hing

rix)

A

ges:

5

0 ye

ars a

nd o

lder

U

se fo

r: Im

mun

ocom

pete

nt a

dults

age

50

year

s and

old

er

Imm

unoc

ompe

tent

adu

lts w

ho p

revi

ousl

y re

ceiv

ed

Zost

avax

(ZV

L)

Rou

te:

Intra

mus

cula

r (IM

) inj

ectio

n R

efri

gera

te b

oth

com

pone

nts;

do

NO

T fr

eeze

Rec

onst

itute

lyop

hiliz

ed v

aric

ella

zos

ter

com

pone

nt

with

man

ufac

ture

r-su

pplie

d ad

juva

nt su

spen

sion

Be

yond

Use

Tim

e: D

isca

rd re

cons

titut

ed v

acci

ne if

not

use

d w

ithin

6 h

ours

.

Hib

(Act

HIB

)

+ =

Lyop

hiliz

ed

Hib

com

pone

nt

Act

HIB

vac

cine

M

anuf

actu

rer’

s 0.4

%

sodi

um c

hlor

ide

dilu

ent

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n,st

ore

at 2

°C to

8°C

(36°

F to

46°

F) a

nd d

isca

rd if

not

use

d w

ithin

24

hour

s.Sh

ould

be

shak

en v

igor

ousl

y be

fore

inje

ctio

n.

Rec

onst

itute

d Va

ccin

es

DTa

P-IP

V/H

IB (P

enta

cel)

+ =

Lyop

hiliz

ed H

ib

com

pone

nt

Man

ufac

ture

r’s D

TaP-

IPV

liqu

id c

ompo

nent

Pe

ntac

el

vacc

ine

Shou

ld b

e us

ed im

med

iate

ly a

fter r

econ

stitu

tion

+ =

Lyop

hiliz

ed

MM

R c

ompo

nent

M

-M-R

II

vacc

ine

Man

ufac

ture

r’s

ster

ile w

ater

dilu

ent

MM

R (

M-M

-R II

)

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n, s

tore

in v

acci

ne v

ial

in d

ark

plac

e at

2°C

to 8

°C (3

6°F

to 4

6°F)

and

dis

card

if n

ot u

sed

with

in 8

hou

rs.

Hib

(Hib

erix

)

+ =

Lyop

hiliz

ed H

ib

com

pone

nt

Hib

erix

va

ccin

e M

anuf

actu

rer’

s 0.9

%

sodi

um c

hlor

ide

dilu

ent

Beyo

nd U

se T

ime:

If n

ot u

sed

imm

edia

tely

afte

r rec

onst

itutio

n,

stor

e at

2°C

to 8

°C (3

6°F

to 4

6°F)

and

dis

card

if n

ot u

sed

with

in 2

4 ho

urs.

Sh

ould

be

shak

en v

igor

ousl

y be

fore

inje

ctio

n.

RV

1 (R

otar

ix)

+ =

Lyop

hiliz

ed R

V1

Man

ufac

ture

r’s s

teri

le w

ater

-R

otar

ix v

acci

ne

com

pone

nt

calc

ium

carb

onat

e-xa

ntha

n di

luen

t D

o N

OT

inje

ct

Bey

ond

Use

Tim

e: If

not

use

d im

med

iate

ly a

fter r

econ

stitu

tion,

st

ore

at 2

°C to

8°C

(36°

F to

46°

F) o

r at c

ontr

olle

d ro

om te

mpe

ratu

re u

p to

25°

C (7

7°F)

an

d di

scar

d if

not u

sed

with

in 2

4 ho

urs.

Ti

p ca

p of

pre

fille

d di

luen

t ora

l app

licat

or c

onta

ins

late

x

Men

AC

WY-

CR

M (M

enve

o)

+ =

Lyop

hiliz

ed

Men

CW

Y li

quid

M

enve

o

Men

A c

ompo

nent

co

mpo

nent

va

ccin

e Be

yond

Use

Tim

e: S

houl

d be

use

d im

med

iate

ly a

fter r

econ

stitu

tion,

but

may

be

stor

ed a

t or b

elow

25°

C (7

7°F)

and

dis

card

ed if

not

use

d w

ithin

8 h

ours

.

Rec

onst

itute

d Va

ccin

es

MM

RV

(Pro

Qua

d)

+ =

Lyop

hiliz

ed M

MR

V

com

pone

nt

ProQ

uad

vacc

ine

Man

ufac

ture

r’s

ster

ile w

ater

dilu

ent

Beyo

nd U

se T

ime:

Dis

card

reco

nstit

uted

vac

cine

if n

ot u

sed

with

in 3

0 m

inut

es.

ZV

L (Z

osta

vax)

+

= Ly

ophi

lized

ZV

L

com

pone

nt

Zos

tava

x

vacc

ine

Man

ufac

ture

r’s

ster

ile w

ater

dilu

ent

Beyo

nd U

se T

ime:

Dis

card

reco

nstit

uted

vac

cine

if n

ot u

sed

with

in 3

0 m

inut

es.

VAR

(Var

ivax

)

+ =

Lyop

hiliz

ed V

AR

co

mpo

nent

Va

riva

x va

ccin

e M

anuf

actu

rer’

s st

erile

wat

er d

iluen

t Be

yond

Use

Tim

e: D

isca

rd re

cons

titut

ed v

acci

ne if

not

use

d w

ithin

30

min

utes

.

Rec

onst

itute

d Va

ccin

es

RZ

V (S

hing

rix)

+

= Ly

ophi

lized

var

icel

la

zost

er c

ompo

nent

Sh

ingr

ix

vacc

ine

Man

ufac

ture

r’s

adju

vant

susp

ensi

on

Refri

gera

te b

oth

com

pone

nts;

do

NOT

freez

e Be

yond

Use

Tim

e: D

isca

rd re

cons

titut

ed v

acci

ne if

not

use

d w

ithin

6 h

ours

.

Updated 02/02/2018

North Carolina Immunization Program Transportation Guidance for Vaccines Transportation of vaccines should be a rare occurrence and expected length of transport should be less than 30 minutes. If transport must occur, provider must use a thermometer with a current and valid certificate of calibration. It is strongly recommended that a digital data logger be used to transport vaccine.

Short-dated vaccine may be transferred to another NCIP provider with the approval of the NCIP and if the cold chain can be maintained. Providers must notify the NCIP of any vaccine doses that will expire before they can be administered at least four months before the expiration date to avoid restitution for improper inventory management. Providers must coordinate with the NCIP to transfer and document the transfer of vaccine between providers. Vaccine transfers between providers can occur only after receiving approval from the NCIP.

Updated 02/02/2018

iv. storage & handling - north carolina...replace storage units that do not meet the minimum...

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