Vaccine · BLA
Boostrix NDC 50090-1377
Clostridium tetani toxoid antigen (Formaldehyde inactivated) 5 [iU]/.5mL + 4 more ingredients · Suspension · Intramuscular · A-S Medication Solutions
NDC codes
FDA NDC Directory| Package NDC | 11-digit (billing) | Package | Copy |
|---|---|---|---|
| 50090-1377-0 | 50090137700 | 10 SYRINGE in 1 CARTON (50090-1377-0) / .5 mL in 1 SYRINGE (50090-1377-2)Marketed from Jul 24, 2009 | |
| 50090-1377-1 | 50090137701 | 1 SYRINGE in 1 POUCH (50090-1377-1) / .5 mL in 1 SYRINGEMarketed from Jul 24, 2009 |
How the 11-digit form is made: The package segment has 1 digit, so one leading zero is added to it (5-4-1 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules
Product information
- Brand name (proprietary)
- Boostrix
- Generic name (nonproprietary)
- tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed
- Active ingredients
- Clostridium tetani toxoid antigen (Formaldehyde inactivated) — 5 [iU]/.5mLCorynebacterium diphtheriae toxoid antigen (Formaldehyde inactivated) — 2.5 [iU]/.5mLBordetella pertussis toxoid antigen (Formaldehyde, Glutaraldehyde inactivated) — 8 ug/.5mLBordetella pertussis filamentous hemagglutinin antigen (Formaldehyde inactivated) — 8 ug/.5mLBordetella pertussis pertactin antigen (Formaldehyde inactivated) — 2.5 ug/.5mL
- Dosage form
- Suspension
- Route
- Intramuscular
- Labeler
- A-S Medication Solutions
- Product type
- Vaccine
- Marketing category
- BLA — Biologics License ApplicationApplication BLA 125106
- Marketing start
- Listing expires
- Other FDA classes
- Actively Acquired Immunity (Physiologic effect)Actively Acquired Immunity (Physiologic effect)Actively Acquired Immunity (Physiologic effect)Actively Acquired Immunity (Physiologic effect)Actively Acquired Immunity (Physiologic effect)Diphtheria Toxoid (Chemical structure)Pertussis Vaccine (Chemical structure)Pertussis Vaccine (Chemical structure)Pertussis Vaccine (Chemical structure)Tetanus Toxoid (Chemical structure)Inactivated (Chemical structure)Inactivated (Chemical structure)Inactivated (Chemical structure)Inactivated (Chemical structure)Inactivated (Chemical structure)
- Identifiers
- Product ID 50090-1377_2e2b4c6a-d397-41b8-babf-adc104e8fbefSPL ID 2e2b4c6a-d397-41b8-babf-adc104e8fbef
- Pharmacologic class
- Inactivated Bordetella Pertussis Vaccine; Inactivated Clostridium Tetani Vaccine; Inactivated Corynebacterium Diphtheriae Vaccine
Billing references
What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.
- HCPCS codeNo match
No drug-specific HCPCS code in Med-Code's directory for this product. The directory is curated and not complete — check the current CMS HCPCS file before billing.
- Administration
Immunization administration (CPT 90460–90474)
Giving a vaccine is reported separately from the vaccine product code, with an immunization administration code. Which code applies depends on the patient's age, the route and whether counselling was provided.
- NDC on a medical claim
N450090137700followed by a unit qualifier and the quantityPackage 50090-1377-00. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier
Product label
The FDA listing for this product does not reference a label (SPL) set.
Other NDCs under BLA 125106
Products listed under the same FDA application: other strengths and forms, and repackagers who relabel the same product.
| Product | Strength | Form · route | Labeler | Product NDC |
|---|---|---|---|---|
| Boostrixtetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed | Clostridium tetani toxoid antigen (Formaldehyde inactivated) 5 [iU]/.5mL + 4 more ingredients | SuspensionIntramuscular | GlaxoSmithKline Biologicals SA | 58160-842 |