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FluMist Quadrivalent

Pronunciation: FLEW-mĭst Kwä-drə-VĀ-lənt
Generic name: influenza virus vaccine (nasal)
Brand name: FluMist Quadrivalent 2023-2024
Dosage form: nasal spray
Drug class: Viral vaccines

Medically reviewed by Philip Thornton, DipPharm. Last updated on Aug 17, 2023.

What is FluMist Quadrivalent?

FluMist Quadrivalent is a nasal spray flu vaccine used to prevent infection against four strains of the influenza virus. FluMist works by exposing you to a small dose of the weakened influenza virus, which helps your body to develop immunity to the disease. FluMist Quadrivalent can be used for people from 2 to 49 years of age.

FluMist Quadrivalent 2023-2024 Formula contains two influenza A subtype viruses (A/H1N1 strain,  A/H3N2 strain) and two influenza B strains (B/Yamagata/16/88 lineages, B/Victoria/2/87 lineages). The vaccine is redeveloped each year to contain specific strains of activated (live) flu virus that are recommended by public health officials for that year.

Influenza (commonly known as "the flu") is a serious disease caused by a virus. Influenza virus can spread from one person to another through small droplets of saliva that are expelled into the air when an infected person coughs or sneezes. The virus can also be passed through contact with objects the infected person has touched, such as a door handle or other surfaces.

FluMist Quadrivalent side effects

Nasal flu vaccine is made from "live viruses" and may cause you to have mild flu-like symptoms. You may have flu-like symptoms at any time during flu season that could be caused by other strains of the influenza virus.

Common FluMist Quadrivalent side effects include:

Other possible side effects are:

Serious FluMist Quadrivalent side effects 

Get emergency medical help if you have signs of an allergic reaction to this nasal spray: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

You should not receive a booster vaccine if you had a life-threatening allergic reaction after the first shot.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.

Who should not get FluMist Quadrivalent?

You should not use this nasal spray if you:

Please talk to your healthcare provider if you are not sure if the items listed above apply to you or your child.

Children under 2 years old have an increased risk of wheezing (difficulty with breathing) after getting this vaccination. 

Who may not be able to get FluMist Quadrivalent? 

Tell your healthcare provider if you or your child: 

You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until you get better before receiving this vaccine

 If you or your child cannot take FluMist Quadrivalent, you may still be able to get an influenza shot. Talk to your healthcare provider about this.


Talk to your doctor if you are pregnant or planning a pregnancy, you may not be able to have the nasal spray. FluMist Quadrivalent is not absorbed systemically following intranasal administration and is not expected to result in exposure to the vaccine to the unborn baby.


Talk to your doctor if you are breastfeeding. FluMist is not absorbed systemically by the mother after being given in the form of a nasal spray, and breastfeeding is not expected to result in the exposure of the child to this vaccine.

How is FluMist Quadrivalent given?

FluMist is given as a nasal spray, one spray into each nostril.

Children ages 2 to 8 years old may need a second dose at least 1 month after the first nasal vaccine. Follow your doctor's instructions or the schedule recommended by your local health department.

Since the influenza virus vaccine is redeveloped each year for specific strains of influenza, you should receive a flu vaccine every year.

Dosing information

Usual Dose 9 years to 49 years for Influenza Prophylaxis:
A single dose = One spray (0.1 mL) into each nostril. 

Usual Pediatric Dose (2 to 8 years): for Influenza Prophylaxis:
1 or 2 doses Use Advisory Committee on Immunization Practices annual recommendations to determine the number of doses.
First dose = One spray (0.1 mL) into each nostril.
Second dose (if required) = One spray (0.1 mL) into each nostril at least one month after first dose.

What happens if I miss a dose?

Call your doctor if you forget to receive your yearly vaccine in October or November or if your child misses a booster dose.

What happens if I overdose?

An overdose of FluMist is unlikely to occur.

What to avoid?

Antiviral medicines. Avoid using antiviral flu medications (such as amantadine, oseltamivir, rimantadine, zanamivir, Flumadine, Tamiflu, Relenza) for at least 2 weeks after receiving FluMist,

Immunosuppressed individuals. Avoid close contact for at least 7 days after receiving a nasal flu vaccine, with anyone who has a weak immune system caused by a disease such as cancer or HIV, or by using steroids, chemotherapy, radiation, or other treatments that can weaken the immune system. People with weak immune systems can become ill if they are in close contact with you when you recently received a live vaccine.

What other drugs will affect FluMist?

Anyone 2 to 17 years old receiving this nasal spray vaccination should not take aspirin for at least 4 weeks after the vaccine. A possible interaction between the nasal flu vaccine and aspirin can cause a serious or fatal condition called Reye's syndrome.

Before receiving this vaccine, tell your vaccination provider about all other vaccines you have recently received.

Other drugs may interact with influenza virus nasal vaccine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all other medicines you use.


Active Ingredient: FluMist Quadrivalent contains 4 influenza virus strains that are weakened (A(H1N1), A(H3N2), B Yamagata lineage, and B Victoria lineage). 

Inactive Ingredients: monosodium glutamate, gelatin, arginine, sucrose, dibasic potassium phosphate, monobasic potassium phosphate, and gentamicin. 

FluMist Quadrivalent does not contain preservatives.


Store in a refrigerator between 35-46°F (2-8°C) upon receipt. 

FluMist Quadrivalent sprayer must be kept in the carton until use in order to protect from light. 

FluMist Quadrivalent must not be used after the expiration date on the sprayer label. If you would like more information, talk to your healthcare provider or visit


Manufactured by: MedImmune, LLC Gaithersburg, MD 20878 Issue date: August 2023

Popular FAQ

Yes, Flumist is made using an egg-based manufacturing process and contains a small amount of egg protein. If you or your child cannot use FluMist nasal spray, you may be eligible to get an influenza (“flu”) shot instead.

FluMist can be used in children and adults 2 through 49 years of age if they otherwise qualify for the nasal flu vaccine. FluMist is not used in children under 2 years due to a chance of wheezing (trouble breathing).

Yes, FluMist contains a live, but weakened (attenuated) flu virus. It will not cause or “give” you the flu, but you may have temporary, mild side effects like a runny or stuffy nose, headache, muscle aches, fever, or sore throat.

Don’t use FluMist if you’ve had a severe, life-threatening allergic reaction to any ingredient in FluMist, to egg proteins, or to any other flu vaccine; or if you are 2-17 years of age and take aspirin or medicines containing aspirin.

The flu shot is usually given as an intramuscular (IM) needle injection into the upper, outer arm muscle called the deltoid muscle in people 3 years of age and older. The preferred injection site for infants and young children is the front, outer area of the thigh. The CDC recommends that everyone 6 months of age and older receive a flu vaccine every year, typically in Sept. or Oct. Continue reading

Both FluMist nasal flu vaccine and the flu shot offer good protection against influenza when vaccines are well-matched to the year’s circulating virus. In 2022-2023, the flu vaccine was 54% effective in preventing influenza A in people less than 65 years of age and 71% effective in children. Continue reading

Egg-free vaccines include Flublok Quadrivalent, for people 18 years and older and Flucelvax Quadrivalent for people 6 months and older. The CDC now states that people with egg-allergy may receive any flu vaccine appropriate for their age and health status. Continue reading

Flu vaccination typically reduces the risk of flu illness by between 40% and 60% during seasons when the flu viruses are well-matched to the flu vaccine. But if you are infected with the virus, the vaccine reduces your chances of getting the flu and passing it on to others and lessens the severity of symptoms, hospitalizations and death. Continue reading

Options that are available for a needle-free flu vaccine are the FluMist Quadrivalent nasal spray and the Afluria Quadrivalent vaccine given with the Stratis needle-free jet injector. Check with your healthcare provider to see if you are eligible. Continue reading

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.