When removing both pediatric (0.25 mL) and adult (0.5 mL) doses from a multi-dose vial of Fluzone Quadrivalent, we can get more than 10 doses from the 5.0 mL vial. Can we continue to remove doses from the vial until it is empty?

No. Only the number of doses indicated in the manufacturer’s package insert should be withdrawn from the vial. For a 5.0 mL vial of Fluzone Quadrivalent this is 10 doses. For Afluria Quadrivalent 5.0 mL multi-dose vial, the package insert states that the stopper can be punctured up to 20 times, allowing up to 20 doses of 0.25 mL dose for children age 6–35 months old. After the maximum number of doses has been withdrawn or number of punctures of the stopper has met the FDA-recommended limit, the vial should be discarded, even if there is vaccine remaining in the vial and the expiration date has not been reached.