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public health > health professionals > influenza vaccine order request 2023/2024

Influenza Vaccine Order Request 2023/2024

Please note Influenza vaccine is not available at this time. Kindly revisit back at the end of September / beginning of October for the 2024-2025 Influenza season.

To help slow the rate of COVID-19, Meadowvale, Malton and the Davis Centre are closed until further notice. Visit affected services and facilities to stay up-to-date.

Before filling out this request, please confirm:

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 MOHLTC Vaccine Storage & Handling Guidelines and has sufficient space to safely store the vaccine being ordered.

That I understand that I may be required to provide accurate temperature logs upon request and that temperature logs must be kept on-site for a minimum of 3 years.

That I agree to prioritize influenza vaccine for high risk patients, as per the 2023-2024 NACI Recommendations.

Order Information

(*) Mandatory fields

*HP Code #: RMP_MS_

*Order Date (YYYY-mm-dd):
*Type of Practice:
* Specify Other Type of Practice: *Number of Providers administering vaccine in the facility:
*Your First Name:
*Your Last Name:
*Facility / Doctor Name:

Unit Number:
*Street Number:
*Street Name:
Street Type:
Street Direction:
*City:
*Postal Code:
PO Box:
STN:
RPO:
Rural Route:
Comments and additional Instructions:
*Has your address changed since your last order? Yes No

*Telephone Number: Ext.
*Fax Number:
*Email Address:

* Delivery or Pick-up Preference (Select One) Paid vaccine delivery (must be a registered participant, and available for delivery anytime between 9:00 AM and 4:30 PM on scheduled delivery days)
Orders must be submitted 5 business days prior to delivery

2024 Paid Vaccine and STI med delivery schedule January to June

Pick-up

Please choose a pick-up location:

NEW: Brampton - 10 Peel Centre Drive, Suite 101
Monday to Friday 9:00 AM – 4:00 PM
(closed from 12:00PM - 1:00 PM)

Fairview - 325 Central Parkway West, Unit 21, Mississauga
Monday and Friday 9:00 AM - 4:00 PM

Hurontario - 7120 Hurontario Street, Mississauga
(Monday to Friday 8:30 AM - 4:30 PM)

Type of Refrigerator

Influenza vaccine should be stored in the refrigerator approved for vaccine storage as per your annual inspection. Please choose only one of the styles indicated below.

Bar Style	Lab Grade (half size)
Household	Lab Grade (full size)

* Please order no more than a ONE month supply of vaccines

Please note the following:

Provide current stock of ALL flu vaccine products in fridge.
Due to high volumes of influenza vaccine orders being processed, you may experience delays in receiving your vaccine orders.
Your vaccine order may be reduced based on current available stock (both provincially and at Peel Public Health) and your facility's previous season's influenza vaccine use and wastage.

Influenza Vaccine Brand	Vaccine Formulation	Vaccine Eligibility by Age Group	Packaging
Fluzone® Quadrivalent Flulaval® Tetra	QIV	6 months and older	Multi-Dose Vial
*Fluzone® Quadrivalent Current Stock
*Flulaval® Tetra Current Stock
# of doses Required	Vaccine must be ordered in increments of:10

Fluzone ® Quadrivalent	QIV	6 months and older	Single Dose Pre-filled Syringes
* Current Stock
# of doses Required	Vaccine must be ordered in increments of:10

Fluzone ® High-Dose Quadrivalent	QIV	65 years and older	Single Dose Pre-filled Syringes

* Current Stock
# of doses Required	Vaccine must be ordered in increments of:5

Fluad ®	ADJ TIV	65 years and older	Single Dose Pre-filled Syringes

* Current Stock
# of doses Required	Vaccine must be ordered in increments of:10

Flucelvax Quad ®	QIV	2 years and older	Single Dose Pre-filled Syringes

* Current Stock
# of doses Required	Vaccine must be ordered in increments of:10

Ontario is launching a high-risk targeted RSV prevention program for individuals 60 years and older living in long-term care homes (LTCHs), including Elder Care Lodges and retirement homes (RHs) licensed to provide dementia care. The Vaccine eligibility has expanded to individuals 60 years and older in the following populations: 1. Hospital ALC patients 2. Dialysis patients 3. Transplant recipients 4. Homeless individuals 5. Indigenous individuals, including urban dwelling Please visit https://www.ontario.ca/page/respiratory-syncytial-virus for more information.
AREXVY, RSV	RSVPreF3 and AS01E	60 years and older

Number of Consents obtained from residents
# of doses Required

Comments:

Please Note FLUZONE-HIGHDOSE and FLUAD are out of stock and Unavailable to Order.

Vaccine Related Supplies
Temperature Logbook Quantity:
Vaccine Storage and Handling Guidelines Quantity:

If you have been advised to submit your vaccine refrigerator temperature logs with your vaccine orders, please note the following:

Submit your logs on the same day as your order.
Send logs from the date of your last order to todays date.
Orders missing temperature logs will not be processed.

Send by email or fax to:
VMPIOrderRequests@peelregion.ca
905-565-9874

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Revised:April 08, 2024

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