POLY-VI-SOL- vitamin a, vitamin d, .alpha.-tocopherol, thiamine, riboflavin, niacin, pyridoxine, and cyanocobalamin liquid 
Central Texas Community Health Centers

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Enfamil® Poly-Vi-Sol

Liquid multivitamin supplement

Last updated: Tuesday, November 18, 2014

Indication

Multivitamin supplementation for infants and children.

Enfamil Poly-Vi-Sol Liquid Multivitamin Supplement is recommended for infants around 4–6 months of age who are transitioning to solid foods.

• Rationale and Special Characteristics

• Nutrients

Per 1 mL% DV Infants% DV Children under 4 years
o Note: Enfamil Poly-Vi-Sol Liquid Multivitamin Supplement does not include folic acid
Vitamin A, IU7505030
Vitamin D, IU400100100
Vitamin E, IU510050
Vitamin C, mg3510088
Thiamin, mg0.510071
Riboflavin, mg0.610075
Niacin, mg810089
Vitamin B6, mg0.410057
Vitamin B12, mcg210067

• Osmolality

• Product Form

Item #: 040265
Description: With Dropper
Unit Size: 50 mL
Cal./Unit: N/A
Prod. Yield / Unit (fl oz): N/A
Case: 12 bottles per case
Reimbursement Code: 00087-040203

Usual Daily Dose

Drops: 1.0 mL

• Composition

• Administration

• Storage

• Precautions

• References

1. Wagner CL, Greer FR, and the American Academy of Pediatrics Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142-1152.
2.
Testing was conducted in September 2009 by Mead Johnson Nutrition, Quality Control.

Above information found at:

Enfamil Poly-Vi-Sol. On Mead-Johnson Nutrition website. Available at: https://www.meadjohnson.com/pediatrics/us-en/product-information/products/vitamins/enfamil-poly-vi-sol-drops#references. Accessed 9/7/17.

PRINCIPAL DISPLAY PANEL - 50 ML Bottle Box Label

CommUnityCare Federally Qualified Health Centers

Poly-Vi-Sol
#50 ML

Date:

Name:
Dr.

Take as directed on package.

1/1/11

123456

Poly-Vi-Sol #50 ML NDC 76413-337-01

Batch: 123456
Lot: 123456
Exp: 1/1/11
MJN

Federal law prohibits the transfer of this drug to any other person than the patient for whom prescribed.

Principal Display Panel - 50 ML Bottle Box Label
POLY-VI-SOL 
vitamin a, vitamin d, .alpha.-tocopherol, thiamine, riboflavin, niacin, pyridoxine, and cyanocobalamin liquid
Product Information
Product TypeDIETARY SUPPLEMENTItem Code (Source)NHRIC:76413-337
Route of AdministrationORAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
Vitamin A (UNII: 81G40H8B0T) (Vitamin A - UNII:81G40H8B0T) Vitamin A750 [iU]  in 1 mL
Vitamin D (UNII: 9VU1KI44GP) (Cholecalciferol - UNII:1C6V77QF41, Vitamin D - UNII:9VU1KI44GP) Vitamin D400 [iU]  in 1 mL
.ALPHA.-TOCOPHEROL (UNII: H4N855PNZ1) (.ALPHA.-TOCOPHEROL - UNII:H4N855PNZ1) .ALPHA.-TOCOPHEROL5 [iU]  in 1 mL
THIAMINE (UNII: X66NSO3N35) (THIAMINE ION - UNII:4ABT0J945J) THIAMINE0.5 mg  in 1 mL
Riboflavin (UNII: TLM2976OFR) (Riboflavin - UNII:TLM2976OFR) Riboflavin0.6 mg  in 1 mL
Niacin (UNII: 2679MF687A) (Niacin - UNII:2679MF687A) Niacin8 mg  in 1 mL
PYRIDOXINE (UNII: KV2JZ1BI6Z) (PYRIDOXINE - UNII:KV2JZ1BI6Z) PYRIDOXINE0.4 mg  in 1 mL
CYANOCOBALAMIN (UNII: P6YC3EG204) (CYANOCOBALAMIN - UNII:P6YC3EG204) CYANOCOBALAMIN2 ug  in 1 mL
Inactive Ingredients
Ingredient NameStrength
glycerin (UNII: PDC6A3C0OX)  
water (UNII: 059QF0KO0R)  
polysorbate 80 (UNII: 6OZP39ZG8H)  
sulfuric acid (UNII: O40UQP6WCF)  
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NHRIC:76413-337-011 in 1 BOX
150 mL in 1 BOTTLE
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
DIETARY SUPPLEMENT01/01/2009
Supplement Facts
Serving Size : Serving per Container :
Amount Per Serving% Daily Value
color
Labeler - Central Texas Community Health Centers (079674019)
Establishment
NameAddressID/FEIBusiness Operations
Central Texas Community Health Centers079674019REPACK, RELABEL
Establishment
NameAddressID/FEIBusiness Operations
Mead Johnson & Company, LLC006370092MANUFACTURE

Revised: 10/2017
Document Id: 68be5929-275f-4074-8246-6050089cf91d
Set id: 1f914273-1e08-4d8a-b950-c503d9f51347
Version: 1
Effective Time: 20171020
 
Central Texas Community Health Centers