Avoid excessive or vigorous agitation; do not shake. Td is indicated for active booster immunization against tetanus, diphtheria, and pertussis as a single dose; substitute 1- time dose of Tdap for Td booster, then standardly boost with Td every 10 years. Please refer to section 7.2 on the use of Td in this protocol . This study agent Td (Tetanus diphtheria toxoid adsorbed) is supplied b y Duke Pharmacy and stored at 4oC. 10.4 Dispensing, Preparation and Administration 10.4.1 Td The Td booster vaccine will be administered at the initial consent visit only after the subject has sig ned consent . Administration will be done as per standard of care and according to package insert instructions (please see appendices in Section 18) with 0.5 mL of Td (tetanus and diphtheria toxoids adsorbed) I.M. into the deltoid muscle . In addition, vaccine site pre- conditioning will be performed as a single dose of Td toxoid (1 flocculation unit, Lf, in a total volume of 0.4 mLs saline) administered i.d. to the RIGHT side of the groin one day prior to the first vaccine. 10.4.2 PEP IDH1M Vaccine with GM -CSF and Montanide ISA 51 The PEPIDH1M vaccine and GM- CSF will be mixed with Montanide ISA 51 (shortened to PEPIDH1M vaccine for the other sections of this protocol) in the investigational pharmacy and will be delivered directly to the bedside under the supervision of the research nurse. Vaccines will be administered according to Pro00054746: RESIST Study Version: 20171011 PT-PhI-II v05.22.12 Duke Cancer Institute Page 27 CONFIDENTIAL protocol . The patient’s name, Study ID, DOB, and MRN will be double verified prior to vaccine administration. PEPIDH1M will be co -administered with GM- CSF and mixed 1:1 with Montanide ISA 51. Lyophilized GM -CSF should be reconstituted with Sterile Water for Injection, USP. Bacteriostatic Water for Injection, USP (0.9% benzyl alcohol) should NOT be used. During reconstitution, the diluent should be directed at t he side of the vial and the contents mixed by gently swirling to avoid foaming during dissolution.