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Flu/RSV/COVID Vaccine Order Forms

Reporting Immunization Poster for Parents

Reporting Immunization Poster for Parents

Report Your Child's Immunization Tear Pad

Report Your Child's Immunization Tear Pad

  • Place orders by Wednesday at 3:00 p.m. for pick up the following Wednesday
  • Orders must include the previous 4-week temperature log for all fridges
  • Coolers must be between 2 - 8ᴼ C for vaccine to be released
  • If the email address is incorrect, you will not receive an email confirming your order has been submitted; however, your order will be received and processed.
  • If your total uploaded documents exceed 30 MB, your order cannot be completed and you'll get a popup displaying the total size of your file(s) selected for upload.
  • Vaccine order inquiries ext. 8808.

 

The Flu/RSV/COVID Vaccine Order Forms is being updated and will be available later this morning.

Please note required fields are marked with an * Asterisk.

* Vaccine Order:


Numbers (digits) only
* Fridge Type:


Please confirm you have read the following statements:

  • That the fridge storing publicly funded vaccines, at the location listed below, maintains cold chain temperatures (between +2.0°C to +8.0°C),
  • That the temperatures of the fridge(s) storing publicly funded vaccines, at the location listed below, have been checked and recorded twice daily (maximum, minimum and current temperatures),
  • That the fridge storing publicly funded vaccines, at the location listed below, meets Vaccine Storage & Handling Guidelines.
  • That the temperature logs remain on-site for a minimum of 3 years and agree to provide the log upon request.
  • That when picking up vaccines, I will be using a hard sided transport cooler(s) containing all required packing materials that has been correctly prepared and; I will be using a digital minimum/maximum thermometer to ensure cold chain temperatures are maintained between +2.0°C to +8.0°C during transport. Refer to the Vaccine Storage & Handling Guidelines (pages 14-17) for more information.
  • That I will only store a 2-week supply of vaccine as per the Ministry of Health's Vaccine Storage and Handling Guidelines.
*

Order Information

* Location:

Numbers only. i.e., 12345
 
e.g., L4M 6K9
e.g., 705-721-7520
Numbers only. i.e., 12345

Please call 1-877-721-7520 ext. 8806 if any of the above information has changed.

* Pickup Location:






Addresses - Simcoe Muskoka District Health Unit Offices Address

* Premise Type:








Vaccine Name

Product Description

Current Vaccine Inventory # of doses

Requested Vaccine # of doses
(If zero, please leave blank)

High Dose Fluzone®

High-Dose Trivalent (pre-filled syringe)
Publicly funded for only 65+ living in congregate living & in community with multiple co-morbidities

FluAd®

Adjuvated Trivalent (pre-filled syringe)
Publicly funded for only 65+

Fluzone®/Fluviral®

Trivalent (multi-dose vial)
Publicly funded for those 6 months and older

Fluzone®

Trivalent (pre-filled syringe)
Publicly funded for those 6 months and older

Flucelvax®

(Egg Protein-Free)
Trivalent (prefilled syringe)
Publicly funded for those 6 months and older

Beyfortus® 100 mg

Beyfortus® 100mg
(100 mg in 1.0 mL)
For infants ≥5 kg

High-risk in 2nd season receive 200 mg
(2 x 1.0 mL injections)

*5 doses per office/order (If your office requires more than the maximum, please call ext. 8806 to speak with a Public Health Nurse)

Abrsyvo™

Pregnant Individuals:

  • 32 to 36 weeks gestation based on recommendation of health care provider

Abrsyvo™/Arexvy®

High Risk Adult Formulation

Moderna XFG Formulation
(SPIKEVAX®)

  • 6 months and older
  • Stable in fridge at +2°C to +8°C for up to 60 days prior to first use
  • Store between +2°C to +8°C for up to 24 hours
  • 5 doses per vial (up to 10 if using pediatric doses)

Moderna XFG Formulation (Pre-filled Syringes)
(SPIKEVAX®)

  • 12 years +
  • Stable in fridge at +2°C to +8°C for up to 60 days prior to first use
  • Store between +2°C to +8°C for up to 24 hours
  • 10 Prefilled syringes per box

Pfizer XFG Formulation
(COMIRNATY®)

  • 12 years +
  • Stable in fridge at +2°C to +8°C for up to 10 weeks prior to first use
  • Store between +2°C to +25°C for up to 12 hours
  • 6 doses per vial

Pfizer XFG Formulation
(COMIRNATY®)

  • 5 to 11 years of age
  • Stable in fridge at +2°C to +8°C for up to 10 weeks prior to first use
  • Single-dose vials store between +2°C to +25°C for up to 12 hours
  • Single-dose vials available only

Based on Ministry’s distribution and supply of vaccine, the health unit cannot guarantee the amount or type of vaccine released to facilities, therefore HCPs should be prepared with appropriate supplies.

PLEASE NOTE: most of our product supply is in single dose format and the packages are large (Beyfortus®: 14.4 x 5.1 x 2.4 cm & Abrysvo™ 10/pack: 8.15 x 3.15 x 5.15 inches (L x W x H) and Abrysvo™ 1/package: 4.2 x 1.45 x 2.9 inches (L x W x H). Consider this when ordering based on fridge capacity and cooler capacity when picking up. You may need to bring more than one cooler.

If you require prefilled syringes, please call us directly at 705-721-7520 ext. 8808

To store and administer COVID-19 vaccine, facility staff must be set up as users in COVAXON and someone with signing authority for the agency must sign off on our External Partner Agreement. If you need assistance with these, please email [email protected] and someone will contact you.

Separate order forms are required for the following vaccines:

  • Special Vaccine Orders
  • Grades 8 – 12 Student Men -C-ACYW
  • High School Student Hep B & HPV Vaccine Catch Up
  • Respiratory Season Vaccine Order Forms

Forms are available at the Health Unit's website for Primary Care Providers: Here.

For clients that require 50 mg formulation, please fill out the following form and fax or email back to the health unit.

The link to the form: Infant Respiratory Syncytial Virus (RSV) Prevention Program form

Separate order forms are required for the following vaccines:

  • Special Vaccine Orders
  • Grades 8 – 12 Student Men -C-ACYW
  • High School Student Hep B & HPV Vaccine Catch Up
  • Respiratory Season Vaccine Order Forms

Forms are available at the Health Unit's website for Primary Care Providers: Here.

Separate order forms are required for the following vaccines:

  • Special Vaccine Orders
  • Grades 8 – 12 Student Men -C-ACYW
  • High School Student Hep B & HPV Vaccine Catch Up
  • Respiratory Season Vaccine Order Forms

Forms are available at the Health Unit's website for Primary Care Providers: Here.

Please Note: If your total uploaded documents exceed 30 MB, your order cannot be completed and you will get a popup showing the size of all files selected. Please reduce the size of the files uploaded or complete additional form submissions. If the email address is incorrect or your IT department is not permitting unknown emails through, you will not receive an email confirming your order has been submitted; however, your order will be received and processed.

* Upload vaccine temperature logs here:
Only Images (jpg, jpeg, & png) or Documents (pdf, docx, & xlsx) can be uploaded and the extension must be lowercase.
Yellow Cards:

Reporting Immunization Poster for Parents

Report Your Child's Immunization
 

The Health Unit collects personal information in the course of doing business. Personal information about you is collected directly from you or from the person acting on your behalf. Personal information collected may include, for example, your name, address, contact information, and information you provide during visits or calls to the health unit.