Transcription of VACCINES FOR CHILDREN (VFC) PROGRAM VACCINE …
1 California Department of Public Health, Immunization Branch IMM-1052 (6/17)DATE:REFRIGERATORFREEZERVACCINEBRA NDDOSESPER BOXLOT NUMBERSEXPIRATION DATELOT NUMBERSEXPIRATION DATE# DOSES ON HANDTOTAL DOSES ON HAND# DOSES ON HANDDTaPDTaP-HepB-IPVHepAHepBHibIPVMMRMM RVMCV4 MenBPCV13 PPSV23 TdTdapRVHPVK inrix vialsKinrix syringesQuadracel vials10510 Pediarix syringesVAQTA vialsHavrix vialsHavrix syringesActHIB vialsHiberix vialsPedvaxHIB vialsIPOL vialsMMR-II vialsProQuad vialsMenactra vialsMenveo vialsBexsero syringes* Trumenba syringes* Pneumovax 23 vials*Prevnar 13 syringesTenivac vials*Tenivac syringes*Td
2 VACCINE (Grifols) vials*Gardasil 9 vialsVarivax vialsEngerix-B vialsEngerix-B syringesRecombivax HB vialsAdacel vialsAdacel syringesBoostrix vialsBoostrix syringesDTaP-IPV/HibPentacel vialsDTaP-IPVD aptacel vialsInfanrix vialsInfanrix syringesRotarix vialsRotaTeq tubesRotaTeq tubesAdditional SpaceInstructions: 1. Complete this form before you order VFC VACCINE . 2. Transfer all lot numbers, expiration dates, and total doses on hand from this form to your VFC VACCINE FOR CHILDREN (VFC) PROGRAMVACCINE PHYSICAL INVENTORY FORM10 Highlights indicate special order VFC VACCINES *VAR
