Seasonal Vaccines – COVID-19, Influenza, RSV Internal Form Search Submit Search Print this Page Home » For Professionals » Vaccine Ordering & Guidance » Orders and Returns – Vaccines » Seasonal Vaccines – COVID-19, Influenza, RSV Internal Form This form is for Health Unit staff. Holding Point Number - see yellow sticker on vaccine fridge(Required)LGL_BR_00011 - AlmonteLGL_BR_00004 - BrockvilleLGL_BR_00009 - KemptvilleLGL_BR_00012 - GananoqueLGL_BR_00007 - Smiths FallsLGL_BR_00131 - Schools - NorthLGL_BR_00005 - Schools - SouthRequisition Date(Required) Month Day Year Health Unit Office Pick Up Location(Required) Brockville Gananoque Kemptville Smiths Falls Almonte Vaccine ContactVaccine Contact Name(Required) First Name Last Name Phone(Required)ExtensionEmail(Required) CommentsType of Seasonal Vaccine(s) you would like to order(Required) COVID-19 Vaccines Influenza Vaccines RSV Vaccines (for older adults and infant program) Please check all that apply.COVID-19 VaccinesWhich COVID-19 Vaccine(s) would you like to order?(Required) Comirnaty (Pfizer) Adult – for ages 12 and older Comirnaty (Pfizer) Children – for ages 5 – 11 years Spikevax (Moderna) Adult – for ages 12 and older Spikevax (Moderna) Children – for ages 6 months – 11 years Comirnaty (Pfizer) Adult (for ages 12 and older) Doses Currently in our Vaccine Fridge(Required)6 doses per vialComirnaty (Pfizer) Adult (for ages 12 and older) Doses Required(Required)6 doses per vialComirnaty (Pfizer) Children (for ages 5 – 11 years) Doses Currently in our Vaccine Fridge(Required)Single dose vialsComirnaty (Pfizer) Children (for ages 5 – 11 years) Doses Required(Required)Single dose vialsSpikevax (Moderna) Adult (for ages 12 and older) Doses Currently in our Vaccine Fridge(Required)5 doses per vialSpikevax (Moderna) Adult (for ages 12 and older) Doses Required(Required)5 doses per vialSpikevax (Moderna) Children (for ages 6 months – 11 years) Doses Currently in our Vaccine Fridge(Required)10 doses per vialSpikevax (Moderna) Children (for ages 6 months – 11 years) Doses Required(Required)10 doses per vialInfluenza VaccinesOrder may be completed with prefilled syringes or multi-dose vials, depending on vaccine availability.Influenza Vaccines(Required) Trivalent Vaccine – for ages 6 months to 64 years High Dose Trivalent vaccine – for 65 years and over, other eligible high risk recipients Trivalent Vaccine (for ages 6 months to 64 years) Doses Currently in our Vaccine Fridge(Required)MDV 10 doses per vialTrivalent Vaccine (for ages 6 months to 64 years) Doses Required(Required)MDV 10 doses per vialHigh Dose Trivalent vaccine (for 65 years and over, other eligible high risk recipients) Doses Currently in our Vaccine Fridge(Required)MDV 10 doses per vialHigh Dose Trivalent vaccine (for 65 years and over, other eligible high risk recipients) Doses Required(Required)MDV 10 doses per vialRSV VaccinesFor older adults and infant program.Infant Program – Starts October 1, 2025 Beyfortus – for Infants less than 5kg: 50 mg in 0.5 mL (100 mg/mL) IM – primarily in hospital Beyfortus – for Infants ≥ 5kg: 100 mg in 1 mL (100 mg/mL) IM – infants born since April 1, 2025 and less than 8 months of age Abrysvo vaccine – for pregnant women only when Beyfortus will not be administered to infant Older Adult Program – starts mid September, one time dose RSV Vaccine – (Arexvy or Abrysvo will be provided) Beyfortus – for Infants less than 5kg Vaccine Doses Currently in our Vaccine Fridge(Required)50 mg in 0.5 mL (100 mg/mL) IM – primarily in hospital Beyfortus – for Infants less than 5kg Vaccine Doses Currently in our Vaccine Fridge(Required)50 mg in 0.5 mL (100 mg/mL) IM – primarily in hospitalBeyfortus – for Infants ≥ 5kg Vaccine Doses Currently in our Vaccine Fridge(Required)100 mg in 1 mL (100 mg/mL) IM – infants born since April 1, 2025 and less than 8 months of ageBeyfortus – for Infants ≥ 5kg Vaccine Doses Required(Required)100 mg in 1 mL (100 mg/mL) IM – infants born since April 1, 2025 and less than 8 months of ageAbrysvo Vaccine (pregnant woman) Doses Currently in our Vaccine Fridge(Required)For pregnant women only when Beyfortus will not be administered to infant.Abrysvo Vaccine (pregnant woman) Doses Required(Required)For pregnant women only when Beyfortus will not be administered to infant.RSV Vaccine (older adults) Doses Currently in our Vaccine Fridge(Required)1 dose per box/vial Must be reconstituted 0.5 ml dose I.M.RSV Vaccine (older adults) Doses Required(Required)1 dose per box/vial Must be reconstituted 0.5 ml dose I.M.CAPTCHA