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Online Vaccine Order Form

Act HIB®/Hiberix

Used for high risk - ≥ 5 years - see Ontario Publicly Funded Schedule for criteria

Order as needed.

ADACEL® / BOOSTRIX

14 – 16 year old booster/ one time adult booster.

Recommended doses - 5 doses per HCP.

ADACEL®-POLIO / BOOSTRIX®-POLIO

4 -6 year old booster.

High Risk - travellers, see Ontario Publicly Funded Schedule for criteria.

Recommended doses - 5 doses per HCP.

IMOVAX® Polio

Used for catch up only - see Ontario Publicly Funded Schedule for criteria. Order as needed for client

Menjugate®/Neis Vac C®

One time dose at 12 months (after first birthday).

Publicly funded for those born on or after 2003/09/01 and ≥1 year of age or if born between 1986/01/01 and 1996/12/31.

Recommended doses - 5 doses per HCP.

Prevnar®20

Routine - 65 years and older only.

High Risk – 6 weeks to 4 years who are at increased risk for IPD and 5 to 64 years of age with certain medical and non-medical conditions that increase their risk for IPD.

Recommended doses – 10 doses per HCP

Vaxneuvance®

Routine – primary series only (2, 4, and 12 months)

Recommended doses – 5 doses per HCP

Priorix-Tetra® / ProQuad® & Diluent

Routine – 4 to 6 years of age. Can be used up to the age of 13 as catch up.

Recommended doses - 5 doses per HCP (need room for 5 doses of diluent with this vaccine).

M-M-R® II / PRIORIX® & Diluent

Routine – given after first birthday, two doses are needed after the first birthday.

High Risk - 6 – 11 months and older than ≥26 years, see Ontario Publicly Funded Schedule for criteria.

Recommended doses - 5 doses per HCP (need room for 5 doses of diluent with this vaccine).

Pediacel®

Routine – primary series (2, 4, 6, and 18 months).

This product is also used in some catch up & high-risk schedules for children up to age 7.

Recommended doses – 10 doses per HCP.

Rotarix ®

Primary series at 2and 4 months.

The first dose of RV vaccine should be given starting at 6 weeks of age and before 15 weeks of age. Vaccination should not be initiated in infants aged 15 weeks or older.

Recommended doses - 5 doses per HCP.

TUBERSOL®

Publicly funded for clients who are entering school (day care, preschool, elementary/secondary school, and post-secondary school).

This includes testing required for school placements.

Is not publicly funded for employment purposes.

1 vial (10 doses) per HCP.

VARILRIX® / VARIVAX® III & Diluent

Routine immunization at 15 months.

Publicly funded for those born on or after 2000/01/01 and ≥1 year of age.

Two doses required for school if born after 2010.

High Risk - please see Ontario Publicly Funded Schedule for criteria.

Recommended doses - 5 doses per HCP (need room for 5 doses of diluent with this vaccine).

SHINGRIX & Diluent

Publicly funded for those 65 to 70 years of age.

Recommended doses - 5 doses per HCP.

(Seniors born in 1949,1959,1951,1952 and 1953 remain eligible till Dec. 31, 2024)

Td Adsorbed®

Routine adult booster every 10 years (if not needing Tdap).

Recommended doses - 5 doses per HCP.

Hep A

High Risk Eligibility

  • Intravenous drug user
  • Liver disease (chronic), including Hepatitis B and C
  • Men who have sex with men

Hep B

High Risk Eligibility

  • Household and sexual contacts of chronic carriers and acute cases (3 doses)
  • History of a sexually transmitted disease (3 doses)
  • Intravenous drug use (3 doses)
  • Liver disease (chronic), including hepatitis C (3 doses)
  • Awaiting liver transplants (2nd and 3rd doses only)
  • Men who have sex with men (3 doses)
  • Multiple sex partners (3 doses)
  • Needle stick injuries in a non-health care setting (3 doses)
  • On renal dialysis or those with diseases requiring frequent receipt of blood products (e.g., haemophilia) (2nd and 3rd doses only)

Hep B Renal

High Risk Eligibility

Dialysis, chronic renal failure, and some immunocompromised clients (Immunocompromised defined as: congenital immunodeficiency, hematopoietic stem cell transplant, solid organ transplant recipients, HIV-infected.)

If you are a Health Care Provider and require HepB renal vaccine, please see our Special Order Form

Reporting Immunization Poster for Parents

Reporting Immunization Poster for Parents

You must provide an email address for online orders so that we can send you a confirmation email for receipt of your order.

  • 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 - 8á´¼ C for vaccine to be released
  • Any file uploads over 2,000 KB (2 MB) per file will prevent your submission from reaching us. The total of all files uploaded cannot exceed 10,000 KB (10 MB)
  • Vaccine order inquiries ext. 8808

Please note required fields are marked with an * Asterisk.

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 one-month supply of vaccine as per the Ministry of Health's Vaccine Storage and Handling Guidelines.

*

Order Information

* Location:

Five (5) numbers only. i.e., 12345
Hidden Field with CSS
Hidden Field with CSS
e.g., L4M 6K9
e.g., 705-721-7520

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

Vaccine Ordering

For more information about vaccines, visit Ontario's Publicly Funded Immunization Schedules

Vaccine Name

Product / Desc

Doses/Package

Current Vaccine Inventory # of doses

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

Act HIB/Hiberix®

Haemophilus influenzae type b (Hib)

1

ADACEL® / BOOSTRIX

Diphtheria, Tetanus, Pertussis (Tdap)
*14-16 yr. booster and one dose/adult lifetime

5

ADACEL®-POLIO / BOOSTRIX®-POLIO

Tetanus, Diphtheria, Pertussis and Polio (Tdap-IPV)

10

IMOVAX® Polio

Inactivated Polio (IPV)

1

Menjugate®/Neis Vac C®

Meningococcal C Conjugate (MenC)

10

M-M-R® II / PRIORIX® & Diluent

Measles, Mumps, Rubella (MMR)

10

Pediacel®

Diphtheria, Pertussis, Tetanus, Polio and Act-HIB

5

Prevnar®20

Pneumococcal 20-valent Conjugate vaccine.
*Routine - 65 years and older only.
*High Risk – see eligibility criteria

10

Vaxneuvance®

Pneumococcal 15-valent Conjugate.
*Routine – primary series only (2, 4, and 12 months)

10

Priorix-Tetra® / ProQuad® & Diluent

Measles, Mumps, Rubella, Varicella (MMRV) *Only for 4-12 yrs. who received one MMR and one varicella or no prior doses of MMR and varicella

10

Rotarix ®

Rotavirus oral vaccine (2 dose series)

10

TUBERSOL®

Tb Mantoux Test (Tb)

10

Td Adsorbed®

Tetanus, Diphtheria (Td)

10

VARILRIX® / VARIVAX® III & Diluent

Varicella (Chicken Pox)

10

SHINGRIX & Diluent

Shingles *Only for those age 65-70

1

Hep A

For CORRECTIONAL FACILITIES ONLY *Eligible High Risk

1

Hep B

For CORRECTIONAL FACILITIES ONLY *Eligible High Risk

1

Hep B Renal

For HOSPITALS ONLY *Eligible High Risk

1

Separate order forms are required for the following vaccines:
  • Special Orders ( Bexsero®, Nimenrix®)
  • Grades 8 – 12 Student Men -C-ACYW
  • High School Student Hep B & HPV Vaccine Catch Up
  • COVID-19 Vaccine Order

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

Please Note: If your uploaded documents exceed 50 MB, you will receive a notice that the page was not displayed because the request entity is too large. Please reduce the sized of the upload and resubmit.

* 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

"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."

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