| VACCINE CODE |
VACCINE TYPE |
|
VACCINE CODE |
VACCINE TYPE |
| |
|
|
|
|
| 28 |
DT
(PEDIATRIC) |
|
15 |
INFLUENZA 6 MO & OLDER |
| 20 |
DTaP |
|
88 |
INFLUENZA - NOS* |
| 106 |
DTaP,
5 PERTUSSIS ANTIGENS (DAPTACEL) |
|
111 |
INFLUENZA LIVE INTRA-NASAL
(FLU MIST) |
| 110 |
DTaP
- HEP B - IPV
(PEDIARIX) |
|
32 |
MENINGOCOCCAL (MENOMUNE) |
| 50 |
DTaP
- HIB (TRIHIBIT) |
|
114 |
MENINGOCOCCAL CONJUGATE (MENACTRA) |
| 120 |
DTaP - HIB - IPV (PENTACEL) |
|
3 |
MMR |
| 130 |
DTaP - IPV (KINRIX) |
|
94 |
MMR-V |
| 9 |
Td
(ADULT - 7 YRS & OLDER) |
|
10 |
POLIO IPV (INJECTION) |
| 113 |
Td
(ADULT - 7 YRS & OLDER PRESERVATIVE FREE) |
|
2 |
POLIO OPV (ORAL) |
| 115 |
Tdap
(BOOSTRIX OR ADACEL) |
|
89 |
POLIO,
NOS* |
| 83 |
HEPATITIS A, PED/ADOL,
2 DOSE |
|
33 |
PNEUMOCOCCAL
POLYSACCHARIDE (PNEUMOVAX) |
| 52 |
HEPATITIS
A - ADULT |
|
100 |
PNEUMOCOCCAL
CONJUGATE
(PREVNAR) |
| 85 |
HEPATITIS
A, NOS* |
|
116 |
ROTAVIRUS,
PENTAVALENT (ROTATEQ) |
| 8 |
HEPATITIS B - PEDIATRIC OR ADOLESCENT |
|
119 |
ROTAVIRUS, MONOVALENT (ROTARIX) |
| 943 |
HEPATITIS B, 2 DOSE ADOLESCENT (11-15 YRS MERCK ONLY) |
|
71 |
RSV-IGIV
(RESPIRATORY SYNCYTIAL VIRUS) |
| 43 |
HEPATITIS B - ADULT |
|
93 |
RSV-Mab |
| 45 |
HEPATITIS B, NOS* |
|
|
|
| 30 |
HBIG (HEPATITIS B IMMUNE GLOBULIN) |
|
25 |
TYPHOID
- ORAL |
| 104 |
HEPATITIS
A - HEPATITIS B (TWINRIX) |
|
41 |
TYPHOID
- PARENTERAL (IV) |
| 46 |
HIB
- PRP-D (PROHIBIT - AVENTIS PASTEUR) |
|
91 |
TYPHOID,
NOS* |
| 48 |
HIB
- PRP-T (ACTHIB & HIBERIX) |
|
21 |
VARICELLA
(CHICKENPOX) |
| 47 |
HIB
- HBOC (HIBTITER - WYETH LEDERLE) |
|
36 |
VZIG (VARICELLA ZOSTER IMMUNE GLOBULIN) |
| 49 |
HIB
- PRP-OMP (PEDVAXHIB MERCK) |
|
121 |
SHINGLES (ZOSTAVAX) |
| 17 |
HIB
- UNSPECIFIED |
|
|
|
| 51 |
HIB
- HEP B (COMVAX) |
|
|
|
| 62 |
HUMAN PAPILLOMAVIRUS (HPV), QUADRIVALENT (GARDASIL) |
|
|
|
| |
| *NOS - NOT OTHERWISE SPECIFIED (USE FOR VACCINE HISTORY ONLY) |
| |
|
|
|
|
|
|
MANUFACTURER CODES |
| |
|
|
|
|
| V01 |
Special Projects/Non-VFC |
|
PMC |
Sanofi Pasteur |
| V02 |
VFC Medicaid |
|
WAL |
Wyeth |
| V03 |
VFC Un-insured |
|
MED |
MedImmune |
| V04 |
VFC American Indian/
Alaskan Native |
|
SKB |
GlaxoSmithKline |
| V05 |
VFC Under-insured |
|
MSD |
Merck |
| V06 |
CHIP |
|
|
|
| H01 |
Self Pay/Insured Deduct Payment |
|
|
|
| H03 |
Insured |
|
|
|
| UT01 |
Primary Care Network
(PCN) |
|
|
|
| UT02 |
Medicare |
|
|
|
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