HAND SANITIZER- alcohol liquid 
Forms Plus Inc

Disclaimer: Most OTC drugs are not reviewed and approved by FDA, however they may be marketed if they comply with applicable regulations and policies. FDA has not evaluated whether this product complies.

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This is a hand sanitizer manufactured according to the Temporary Policy for Preparation of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency (CoViD-19); Guidance for Industry.

The hand sanitizer is manufactured using only the following United States Pharmacopoeia (USP) grade ingredients in the preparation of the product (percentage in final product formulation) consistent with World Health Organization (WHO) recommendations:

  1. Alcohol (ethanol) (USP or Food Chemical Codex (FCC) grade) (80%, volume/volume (v/v)) in an aqueous solution denatured according to Alcohol and Tobacco Tax and Trade Bureau regulations in 27 CFR part 20.
  2. Glycerol (1.45% v/v).
  3. Hydrogen peroxide (0.125% v/v).
  4. Sterile distilled water or boiled cold water.

The firm does not add other active or inactive ingredients. Different or additional ingredients may impact the quality and potency of the product.

Active Ingredient(s)

Alcohol 80% v/v. Purpose: Antiseptic

Purpose

Antiseptic, Hand Sanitizer

Use

Hand Sanitizer to help reduce bacteria that potentially can cause disease. For use when soap and water are not available.

Warnings

For external use only. Flammable. Keep away from heat or flame

Do not use

When using this product keep out of eyes, ears, and mouth. In case of contact with eyes, rinse eyes thoroughly with water.
Stop use and ask a doctor if irritation or rash occurs. These may be signs of a serious condition.
Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.

Stop use and ask a doctor if irritation or rash occurs. These may be signs of a serious condition.

Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.

Directions

Other information

Inactive ingredients

glycerin, hydrogen peroxide, purified water USP, Peppermint Oil

Package Label - Principal Display Panel

3785 mL NDC: 77242-100-01 3785ml front label3785ml back label1010700 mL NDC: 77242-100-02 Tote label

18927 mL NDC: 77242-100-03 Pail Label

HAND SANITIZER 
alcohol liquid
Product Information
Product TypeHUMAN OTC DRUGItem Code (Source)NDC:77242-100(NDC:75569-100)
Route of AdministrationTOPICAL
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
ALCOHOL (UNII: 3K9958V90M) (ALCOHOL - UNII:3K9958V90M) ALCOHOL77.7 mL  in 100 mL
Inactive Ingredients
Ingredient NameStrength
GLYCERIN (UNII: PDC6A3C0OX) 3 mL  in 100 mL
HYDROGEN PEROXIDE (UNII: BBX060AN9V) 2 mL  in 100 mL
WATER (UNII: 059QF0KO0R) 17.25 mL  in 100 mL
PEPPERMINT OIL (UNII: AV092KU4JH) 0.05 mL  in 100 mL
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:77242-100-013785 mL in 1 JUG; Type 0: Not a Combination Product04/17/2020
2NDC:77242-100-021010700 mL in 1 TANK; Type 0: Not a Combination Product04/17/2020
3NDC:77242-100-0318927 mL in 1 PAIL; Type 0: Not a Combination Product04/17/2020
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
OTC monograph not finalpart333A04/17/2020
Labeler - Forms Plus Inc (131325953)
Registrant - Forms Plus Inc (131325953)
Establishment
NameAddressID/FEIBusiness Operations
Forms Plus Inc131325953relabel(77242-100)

Revised: 5/2020
Document Id: a62cb62a-fa03-9ac6-e053-2995a90a69de
Set id: a62cb62a-fa11-9ac6-e053-2995a90a69de
Version: 1
Effective Time: 20200521
 
Forms Plus Inc