Vaccines, Blood & Biologics

June 7, 2013 Approval Letter - Fluzone Quadrivalent

DEPARTMENT OF HEALTH & HUMAN SERVICES                                                     Public Health Service

                                                                                                                            Food and Drug Administration
1401 Rockville Pike
Rockville, MD 20852-1448


Our STN: BL 103914/5574
Sanofi Pasteur Inc.
Attention: Mr. Joseph H. Quinn
Discovery Drive
Swiftwater, PA  18370
Dear Mr. Quinn:

We have approved your request to supplement your biologics license application for Influenza Virus Vaccine to include a quadrivalent influenza virus vaccine formulation (Fluzone® Quadrivalent) manufactured at your Swiftwater, PA facility for use in persons 6 months of age and older.

The review of this product was associated with the following National Clinical Trial (NCT) numbers: NCT01240746, NCT01218646, and NCT00988143.

Please provide your final content of labeling in Structured Product Labeling (SPL) format and include the carton and container labels. In addition, please submit three original paper copies for carton and container final printed labeling.  All final labeling should be submitted as Product Correspondence to this BLA at the time of use (prior to marketing) and include implementation information on FDA Form 356h.

In addition, please submit the final content of labeling (21 CFR 601.14) in SPL format via the FDA automated drug registration and listing system, (eLIST), as described at: Information on submitting SPL files using eLIST may be found in the guidance for industry titled, “SPL Standard for Content of Labeling Technical Qs and As at:

You may submit two draft copies of the proposed introductory advertising and promotional labeling with an FDA Form 2253 to the Center for Biologics Evaluation and Research, Advertising and Promotional Labeling Branch, HFM-602, 1401 Rockville Pike, Rockville, MD 20852-1448. You must submit copies of your final advertisement and promotional labeling at the time of initial dissemination or publication, accompanied by Form FDA 2253 (21 CFR 601.12(f)(4)).

All promotional claims must be consistent with and not contrary to approved labeling. You should not make a comparative promotional claim or claim of superiority over other products unless you have substantial evidence or substantial clinical experience to support such claims (21 CFR 202.1(e)(6)).

Please submit an amendment to all pending supplemental applications for this BLA that include revised labeling incorporating a revised content of labeling that includes these changes.

Postmarketing Studies Subject to Reporting Requirements of 21 CFR 601.70


Under the Pediatric Research Equity Act (PREA) (21 U.S.C. 355c), all applications for new active ingredients, new indications, new dosage forms, new dosing regimens, or new routes of administration are required to contain an assessment of the safety and effectiveness of the product for the claimed indication in pediatric patients unless this requirement is waived, deferred, or inapplicable.

We are waiving the pediatric study requirement in infants from 0 to < 6 months of age, because this product does not represent a meaningful therapeutic benefit over existing therapies for pediatric patients and is not likely to be used in a substantial number of infants < 6 months of age. Available data indicate that serum antibody responses to inactivated influenza vaccines in infants < 6 months of age are not as robust as in older children due to inherent immaturity of the immune system and interference from maternal antibody.

We note that you have fulfilled the pediatric study requirement for all relevant pediatric age groups for this application.


We acknowledge your written commitment as described in your letter of May 22, 2013, as outlined below:

To establish a pregnancy registry that will enroll women exposed to Fluzone Quadrivalent during pregnancy and collect data on their outcomes and newborn health status. Annual reports for this registry will be submitted with the periodic Benefit-Risk Evaluation Report (PBRER) for Fluzone® Quadrivalent. When the registry has collected data on the outcomes specified in the protocol for 6 years, Sanofi will submit a final study report. After submission of the registry report, Sanofi will continue enrolling in the registry pending CBER review of the report and determination that the registry can be discontinued.

Final protocol submission date: August 15, 2013

Study/trial completion date: June 30, 2019

Final Report Submission date: December 31, 2020

Please submit clinical protocols to your IND, with a cross-reference letter to this biologics license application (BLA), STN BL 103914/0. Submit nonclinical and chemistry, manufacturing, and controls protocols and all final study reports to your BLA STN BL 103914/0. If the information in the final study report supports a change in the labeling, the final study report should be submitted as a supplement. We may also request a supplement if we determine that labeling changes are necessary. Please use the following designators to label prominently all submissions, including supplements, relating to these postmarketing study commitments as appropriate:

  •  Postmarketing Study Commitment Protocol
  • Postmarketing Study Correspondence
  • Postmarketing Study Commitment – Final Study Report
  • Supplement Contains Postmarketing Study Commitments – Final Study Report

For each postmarketing study subject to the reporting requirements of 21 CFR 601.70, you must describe the status in an annual report on postmarketing studies for this product. Label your annual report an “Annual Status Report of Postmarketing Study Commitments.” The status report for each study should include:

  • information to identify and describe the postmarketing commitment,
  • the original schedule for the commitment,
  • the status of the commitment (i.e., pending, ongoing, delayed, terminated, or submitted), and
  • an explanation of the status including, for clinical studies, the patient accrual rate (i.e., number enrolled to date and the total planned enrollment).

As described in 21 CFR 601.70(e), we may publicly disclose information regarding these postmarketing studies on our Web site ( Please refer to the February 2006 Guidance for Industry: Reports on the Status of Postmarketing Studies – Implementation of Section 130 of the Food and Drug Administration Modernization Act of 1997 (see for further information. 

When you have fulfilled your commitment, submit your final report as a PMC Submission – Final Study Report or Supplement Contains Postmarketing Study Commitment – Final Study Report. 

We will include information contained in the above-referenced supplement in your biologics license application file.

Sincerely yours,


Wellington Sun, MD
Division of Vaccines and 
  Related Products Applications
Office of Vaccines
  Research and Review
Center for Biologics
 Evaluation and Research


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