Ministry of Health
and Long-Term Care
Ontario Government
Pharmaceutical
and Medical Supply Service
Tel:
Fax
1.
2.
3.
416 327-0837
416 327-0818
Non-Reusable Vaccine
(spoiled or expired) Return Record
Toronto Clients
Contact the Ontario Government Pharmaceutical and Medical Supply Service (OGPMSS) for a Return Authorization Number.
Attach completed form and/or non-reusable vaccine sticker to outside of package.
Give non-reusable vaccine to the OGPMSS driver when your next order is delivered.
Client Name
Client Number
Return Authorization No.
Returned by
Telephone No.
Date of return (yyyy/mm/dd)
Code name
Description
Pkg. size
Return
to
OGPMSS
*Return
code
Lot. No.
No.
of
pkgs.
Cat. No.
BID (Mantoux)
Tuberculin Purified Protein Derivative - 5 TU
FULL VIAL(S)
1 x 1 mL
(10 tests)

6506-3311-0
BID (Mantoux)
Tuberculin Purified Protein Derivative - 5 TU
INCOMPLETE VIAL(S)
1 x 1 mL
(10 tests)

6506-3311-0
DTaP - IPV
Acellular Pertussis, Diphtheria and Tetanus with
Inactivated Poliomyelitis Vaccine (quadrivalent)
5 x 0.5 mL

6571- 3343-0
DTaP - IPV - Hib
Acellular Pertussis, Diphtheria, Tetanus with
Inactivated Poliomyelitis and Haemophilus
influenzae type b Conjugate Vaccine
(pentavalent)
5 x 0.5 mL

6571-3346-0
HA (Adult)
Hepatitis A Vaccine (adult)
1 x 1 mL

6571-3257-0
HA (Paed)
Hepatitis A Vaccine (paediatric)
1 x 0.5 mL

6571-3256-0
HB (Adult)
Hepatitis B Vaccine (adult)
1 x 1 mL

6571-3243-0
HB (Paed)
Hepatitis B Vaccine (paediatric)
1 x 0.5 mL

6571-3251-0
HB (Ren)
(Recombivax®)
Hepatitis B Vaccine (renal dialysis)
1 x 1 mL

6571-3324-1
Hib
Haemophilus influenzae type b Conjugate
Vaccine
5 x 0.5 mL

6571-3255-0
Inf
Vaxigrip
1 x 5 mL

6571-3323-0
Inf
Fluviral
1 x 5 mL

6571-3323-8
Inf
Agriflu
10 x 0.5 mL

6571-3349-1
Inf
Fluad
10 x 0.5 mL

6571-3352-0
IPV
Inactivated Poliomyelitis Vaccine
1 x 0.5 mL

6571-3220-2
Men-C (Menjugate®)
Meningococcal C Conjugate Vaccine
5 x 0.5 mL

6571-3344-2
Men-C (NeisVac-C®)
Meningococcal C Conjugate Vaccine
10 x 0.5 mL
MMR
Measles, Mumps and Rubella Vaccine
10 x 0.5 mL


MMRV
Measles, Mumps, Rubella and Varicella Vaccine
10 x 0.5 mL

3296-64E (2011/12)
© Queen’s Printer for Ontario, 2011
6571-3344-3
6571-3230-0
6571-3604-0
Disponible en Français
page 1 of 2
Code name
Description
Pkg. size
Return
to
OGPMSS
*Return
code
Lot. No.
No.
of
pkgs.
Cat. No.
Pneu-C-7
Pneumococcal Heptavalent Conjugate Vaccine
10 x 0.5 mL

6571-2202-2
Pneu-C-10
Pneumococcal Conjugate Vaccine 10 valent
10 x 0.5 mL

6571-5010-0
Pneu-P-23
Pneumococcal Polysaccharide Vaccine
10 x 0.5 mL

6571-4010-2
Rab
Rabies Vaccine
1 x 1 mL

6571-3231-0
RabIg
Rabies Immune Globulin
1 x 2 mL

6571-3225-0
Rot-1
Rotavirus Vaccine
1 x 1.5 mL

6571-4232-0
Td
Tetanus and Diphtheria Vaccine
5 x 0.5 mL

6571-3240-0
Td-IPV
Tetanus, Diphtheria and Inactivated Poliomyelitis
Vaccine
5 x 0.5 mL

6571-3249-0
Tdap (Adacel®)
Tetanus, Diphtheria with Acellular Pertussis
Vaccine
5 x 0.5 mL

6571-2203-0
Tdap (Boostrix®)
Tetanus, Diphtheria with Acellular Pertussis
Vaccine
10 x 0.5 mL

6571- 2207-0
Var
Varicella Vaccine
10 x 0.5 mL

6571-3305-0
Var (Varilrix®)
Varicella Vaccine
10 x 0.5 mL

6571-3308-1
Var (Varivax III®)
Varicella Vaccine
1 x 0.5 mL

6571-3305-1
Vaccines not listed
*Return codes:
[XP] Cold chain break – physician office
[ER] Power outage
[OG]
[UP]
Outdated Goods
Unsuitable for use (e.g. broken)
Return to OGPMSS:
[X] DO NOT return vaccine to OGPMSS (dispose with biohazards)
Note: If no vaccines need to be returned, the form may be faxed to OGPMSS at 416 327-0818.
3296-64E (2011/12)
[] Return vaccine to OGPMSS
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