SEQIRUS FLU VACCINE QUOTATION REQUEST FORM FOR 2019/20 SEASON
If you wish to receive a FLUCELVAX® TETRA influenza vaccine (surface antigen, inactivated, prepared in cell cultures) quotation, please complete this form or contact our sales team at flu.salesuk@seqirus.com or alternatively call 03450 093804. Please be advised that this is not an order form, but a request for a quotation of your proposed order. A member of our team will contact you shortly after receiving this form.
Vaccine Name Licensed for (prescribing information overleaf) NHS List Price (excl. VAT) Please provide number of doses* required for 2019/20 season
FLUCELVAX® TETRA influenza vaccine (surface antigen, inactivated, prepared in cell cultures) Adults and children from 9 years of age £9.94
*Please provide number of
doses in multiples of ten
(Pack contains 10 doses)
CONTACT INFORMATION (PLEASE USE CAPITAL LETTERS WHEN COMPLETING THIS FORM):










 
*By completing and submitting the quotation form, you hereby give
Seqirus (and their representatives) permission to contact you.
Copyright © Seqirus UK Limited 2019 UK/XQIV/0119/0013 January 2019
FLUCELVAX® TETRAPRESCRIBING INFORMATION:
Flucelvax® Tetra suspension for injection in pre-filled syringe Influenza Vaccine (surface antigen, inactivated, prepared in cell cultures). Presentation: Each 0.5ml of Flucelvax® Tetra contains 15 micrograms of each of four purified virus strains propagated in Madin Darby Canine Kidney (MDCK) cells that comply with the World Health Organization quadrivalent vaccine recommendations (Northern Hemisphere) for the current season. Indications: Prophylaxis of influenza in adults and children from 9 years of age. Dosage and Administration: Adults and children aged 9 years and over: single 0.5ml dose by intramuscular injection in the deltoid muscle of the upper arm. The vaccine must not be injected intravenously, subcutaneously, or intradermally. Contra-indications: Hypersensitivity to the active substance, to any of the excipients (sodium chloride, potassium chloride, magnesium chloride hexahydrate, disodium phosphate dihydrate, potassium dihydrogen phosphate), or to possible trace residues (beta-propiolactone, cetyltrimethylammonium bromide, and polysorbate 80). Warnings and Precautions: Appropriate medical treatment and supervision should be readily available in case of an anaphylactic event following administration. Immunisation should be postponed in patients with acute febrile illness until fever is resolved. As with all injectable vaccines, Flucelvax® Tetra must be administered with caution to individuals with thrombocytopenia or a bleeding disorder since bleeding may occur following an intramuscular administration. Syncope (fainting) can occur following or before any vaccination as a psychogenic response to the needle injection. This can be accompanied by several neurological signs such as transient visual disturbance, paraesthesia, and tonic-clonic limb movements during recovery. It is important that procedures are in place to avoid injury from faints. Endogenous or iatrogenic immunosuppression may result in insufficient antibody response. Interactions: No clinical data on concomitant administration with other vaccines are available. Based on clinical experience with cell-based trivalent influenza vaccine (TIVc), Flucelvax® Tetra can be given at the same time as other vaccines. Pregnancy and Lactation: There are limited data from the use of Flucelvax® Tetra in pregnant women. 
However, inactivated influenza vaccines can be used at all stages of pregnancy. It is unknown whether Flucelvax® Tetra is excreted in human milk. No effects on breast-fed newborns/infants are anticipated. Flucelvax® Tetra may be used during lactation. Effects on Ability to Drive and Use Machines: Flucelvax® Tetra has no or negligible influence on the ability to drive and use machines. Side Effects: The most common reactions are injection site pain, headache, fatigue, myalgia, erythema, and induration. Commonly reported adverse reactions include loss of appetite, nausea, diarrhoea, vomiting, arthralgia, ecchymosis, and chills. Uncommon reactions include fever. The following have been reported post-marketing: extensive swelling of injected limb, allergic reactions (including anaphylactic shock), paraesthesia, and generalised skin reactions (including pruritus, urticaria, or non-specific rash). Paediatric subjects generally reported higher rates of local and systemic reactions compared to adults aged 18 years and over. Overdose: There are no data for overdose with Flucelvax® Tetra. Legal Category: POM. Package Quantities: Packs of 10 pre-filled syringes. Marketing Authorisation Number: EU/1/18/1326/001. Basic NHS Cost: £9.94 per 0.5ml pre-filled syringe, £99.40 per 10-pack. Marketing Authorisation Holder: Seqirus Netherlands B.V., Hullenbergweg 89, 1101CL Amsterdam, Netherlands.

For full prescribing information and details of other side effects see the Summary of Product Characteristics at www.medicines.org.uk/emc

Date of preparation: December 2018

UK/XQIV/1218/0001

Flucelvax® Tetra is a registered trademark of Seqirus UK Limited

Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard. Adverse events relating to Seqirus products should also be reported to Seqirus UK Limited on 01748 828816