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Duplicate Virus
Michigan    Just like Icarus, I fly too close to the sun.
VIRUS
Tulchin    http://virus-in.blogspot.com/ http://wetchina.blogspot.com/ http://remont-puti.com.ua/ http://wetchina.com.ua/ http://twitter.com/#!/staroduw

Poems

jake aller Mar 2020
Corona Virus Poems


Index
The virus from hell is amused
End of the World
Every Day I Turn on the New
Irony Meters Blow Gaskets
Chaos
Corona Virus Fears Tanka
My Phobias Overwhelm Me
Fear Fills the Air
Is this the best we can get?
More Trouble Every Day
by pass the alarms spreading across the land
corona cinqku
Taking a Walk in the Corona Era
A lone man stands in an empty parking lot
hell of a world we live in ain’t it?
Pause for a moment amidst the media madness
I feel as if the whole world needs to be cancelled
The Virus King Cried
Bring out your dead
the Virus Came From Hell
The Delivery System of the Virus is Round
the corona virus is testing us all
the call goes out
the horsemen begin to ride
nature spirits revolts against humanity
Last Human on Island
Corona Virus Haiku
the virus came from hell
bring out your dead cries
Be Afraid  haiku
Death Comes Knocking
the virus from Hell haiku



the Virus from Hell is amused
the Virus from Hell is amused
laughing at the world’s panicked reaction
as it marches through the world unabated
infecting everyone in its wake
as the world awaits its fate
the virus smiles he ain’t no fake
he is the real deal
he is death itself
he is the end of the world
the grim reaper is smiling
god is silent as usual
the world’s leaders
dither and rather
as the economy craters
everyone hoping that God
will save them
the virus does not care
insults and orders do not work
the virus simply does its virus thing
infecting everyone it encounters
and thousands will die
equal opportunity offender
killing the rich and the poor alike
but more poor people
just so many more poor people
than the few billionaires
the virus smile
his work is done
and mankind is doomed
so be it the virus thinks




that is the way of the world
and the virus is the new king
of the world

End of the World
end of world
the fears world-wide
soon find us dead
bring out the dead
ll the dead die
death lies here there
there goes here
as death here comes
soon here death comes


Every Day I Turn on the News
debunking the bioweaapon conspiracy theories
every day I turn on the news
nothing but news about the virus
the virus from hell
the world is filled with fear
and my anxiety levels rise
every time I turn on the news
oh my god I say
we are all going to die
and I am so afraid
afraid of everyone
afraid of everything
dreading the latest news
and nothing relieves my fear
I watch the world
loosing its collective mind
wondering how much more of this
can  we all take
I scream out
Dear God save us all
god is silent as usual
and so I realized
we are doomed
perhaps it is the end times
perhaps not
I turn off the TV
try to stay calm
hoping the madness
will not overwhelm us all


Irony Meters Blow Gaskets
the Irony meter gasket
is blown again and again
with every statement
of our chaos president
and his endless surrogates
promoting the latest Presidential
on spot guidance by our great leader
that must be true
because our dear leader
says it is so
The President accuses his democratic rival
of being senile and needs to be in home
and will be run by his radical left allies
and the right wing media
echoes the presidential absurd comments
refusing to acknowledge
that the president himself
is rapidly fading into dementia
and his radical right cronies
are looting the government
driving out expertise
even in the midst of pandemic
Oh  yeah the irony meters
are blowing gaskets
every single day

Chaos
the world descends into chaos
as our world leaders
led by the chaos president
are overwhelmed
by the smallest
enemy of all
a simple virus
straight out of hell
blows through the crumbling
third world public health infrastructure
living proof of the decline of America
and no one is prepared
and panic ensures
with every Presidential tweet
as people don’t believe
a word he says
conspiracy rumors spread
everyone believes their own reality
as the world spins out of control
the chaos king is in his element
convince that only he knows
the deal
and everyone else
is iust a bit player
in the reality show
that he presides over
and so the rest of us
hunker down
just hoping for the best
as the panic and
chaos spreads faster
than the virus
are we doomed
can we survive
will God save us?
he is silent as always

Corona Virus Fears Tanka
Corona virus
lurking fears all around me
we all will die
the TV screaming nonstop
Must be afraid be afraid

My Phobias Overwhelm Me
lately I have become scared
of everything
the news scares me, the corona virus scares me, the presidential race scares me, fears of gun men in the street, terrorism, fears of getting sick, fears of dogs, fears of other people, fear of loosing money, fears of becoming demented old man, lost in his nightmares on the street just another invisible homeless *** in the end of his life
all these phobias overwhelm me
time to walk away from my fears
and realize
it will be alright
everything will be alright
As long as I have you
by my side

Fear Fills the Air

watching the news
CNNMSNBCFOXBBCKOREANNEWSJAPANESENEWSBLOOMBERABCCBSNBCGOOGLEA­PPLEREUTERSAPIRUSSIANTVCHINESTVFRENCHTV
blather on and on
the world is ending
pandemic is coming
we are going to die
and the fear grows
and the restrictions grow
travel comes to stop
the economy comes to  a stop
everyone is so afraid
our leaders fret
say that everything is fine
as the world enters
the second great depression
and we are faced
with the reality
all over the world
idiots in high places
the masters of the universe
are in charge
the internet spreads
the wildest rumors
must be true
I read it on the internet
the truth is lost
in the shuffle
no one believes anyone
everything thinks
that they know
it is all a conspiracy
the thought comes to mind
we are all so ’S….
end of the world
is upon us

is this the best we can get?
watching the news
one wonders
how in this great country
of ours
335 million people
among the most educated
richest people in the world
we can end up
with such idiots in high places
running out country?
these idiots in charge
no disrespect intended
both political parties
all corporations
and our institutions
except maybe the military
has been infected
by this virus
of epic incompetence
greed and indifference
to the general good
who loudly constantly proclaim
that they are Christians
while violating
all of Christ's teachings
Jesus if he came back
would scream out
I am not Christian
it is all about me
and mine
and you can go
to hell
if you dare to disagree
and so we tweet and titter
and watch the news
reading the latest rumors
and I wonder
if there is a god
or if there is a devil
and are we overwhelmed
by the dismal news
why can’t we have better
leaders
better people
in our leaders
around the world
has god abandoned us
are we in hell
or did god ever exist
except in our fevered imagination
will god save us all
or will the world
just go around the sun
indifferent to our pleas?
no answer
must watch the news
consumed by the need
to see the latest news
and so it goes
and I wake up
the sun is up
and the nightmares
fade away
until I watch the news
and the madness consumes
us all again and again
as the corona virus
marches on and on
consuming us all
as the world falls apart
these must be the end times
I hope I will be raptured away
even if I am not a Christian

More Trouble Every Day
The Old Zappa song plays
on in my head
every time I turn on the news
and see more trouble every day
no one can delay
the trouble coming every day
Frank Zappa died too soon
before the horrors of the Trump era
and the corona end of the world plague
that he would have foreseen
if he had lived on
he was truly a prophet
crying in the wildness
while making money
as an over night sensation
as he saw the slime
oozing out of the TV sets
we will do what we are told
for the rights to us have been sold
And Jesus too
has been sold
to the highest bidder
nothing but a business deal
in America
the land of the constant deal
and so I turn off the TV
and realize that
the torture never ends
the torture never ends

Trouble Every Day
more trouble every day  Frank Zappa
Well I'm about to get sick
From watchin' my TV
Been checkin' out the news
Until my eyeballs fail to see
I mean to say that every day
Is just another rotten mess
And when it's gonna change, my friends
Is anybody's guess
So I'm watchin' and I'm waitin'
Hopin' for the best
Even think I'll go to prayin'
Every time I hear 'em sayin'
That there's no way to delay
That trouble comin' every day
No way to delay
That trouble comin' every day
Wednesday I watched the riot...
I seen the cops out on the street
Watched 'em throwin' rocks and stuff
And chokin' in the heat
Listened to reports
About the whisky passin' 'round
Seen the smoke & fire
And the market burnin' down
Watched while everybody
On his street would take a turn
To stomp and smash and bash and crash
And slash and bust…

The Torture Never Stops
Frank Zappa
torture never stops
Flies all green and buzzin'
In this dungeon of despair
Prisoners grumblin
**** they clothes
Scratch their matted hair
A tiny light from a window-hole
Hundred yards away
That all they ever get to know
'Bout the regular life in the day
'Bout the regular life in the day
Slime and rot and rats and snuck
***** on the floor
Fifty ugly soldier men
Holdin' spears by the iron door
Stinks so bad, stones are chokin'
Weepin' greenish drops
In the den where
The giant fire puffer works
And the torture never stops
The torture never stops, torture
The torture never stops
The torture never stops
Flies all green and buzzin'
In this dungeon of despair
An evil prince eats a steamin' pig
In a tumbers right near there
In the chambers right near there
He eats de snouts an trotters first!…


by pass the alarms spreading across the land
to bypass the alarms spreading across the land
the circuit breakers are breaking down
as the alarms go on and on
with the end of the world
the end days approaching
spreading the alarm far and wide

corona cinqku
corona
it came from hell
we must be all prepared
meet God


Taking a Walk in the Corona Era
every day I go for a walk
in the spring time woods
near my house
braving the weather
and the dreaded corona virus
wearing masks and gloves
keeping a distance
from anyone we encounter
that is life it seems
in the era of the corona virus
when will it end
no one knows
until then
I will brave the viral threat
and confront my fears
and walk in the park
with the love of my life
my bride my wife
by my side
in these challenging times
that is all we can do

A lone man stands in an empty parking lot

contemplating the new normal
social distancing run amuck
as fears of the corona super plague
plague the land
driving everyone inside
sheltering in place
afraid to go out
afraid of the deadly c virus

It is a hell of a world we live in ain’t it?
It is a hell of a world we live in ain’t it?
said the old man to me
sitting on a bench
in the park in the woods
as we both sought shelter
from the spreading chaos
the pandemic swirling around us
Yes I said
standing up
to enforce the proper distance
between us
don’t want to give the virus a chance
to spread between us
he smiled and said
relax I already went through it
I am fine and you will too

Pause for a moment amidst the media madness
Pause for a moment amidst the media madness
All around us fears and chaos
Unlike the end of the world approaching us
Sadness overcomes us dooming us to our fate
Every we go nothing but death awaits

I feel as if the whole world needs to be cancelled
I feel as if the whole worldneeds to be canceled
due to rough times ahead
due to the corona madness
and the thread of pure craziness
that it inspires in us all

The Virus King Cried

the virus king smiled
as the politicians lied
saying that the end was near
the virus king infected thousands more
and killed hundreds of people
the virus king sneered
as people panicked
and partied on the beach
the virus king infected thousands more
and killed hundreds of people
the virus king laughed
as the markets crashed
millions became unemployed
the virus king infected thousands more
and killed hundreds of people
the virus king roared
as the world slid into chaos
people turning on one another
the virus king infected thousands more
and killed hundreds of people
the virus king smirked
knowing that there was nothing
that they could do to stop
his army from infecting millions
and killing thousands
the virus King begin to realize
that soon there would be no one left
no one for his army to infect
as everyone was dying
the virus King yelled
remaining defiant
as civilization collapsed
billions were infected
millions died
the Virus King at last cried
when he saw that he was defeated
as one by one
people began to recover
and his reign of terror came to an end

Bring out your dead
the call bring out your dead
spreads around the world
as millions die
all over the world
the virus has spread
mutated and killed
all over the world
bring out your dead
the mournful cries
echoing in the wind
of the dying cities
mass starvation
as no is working
in the fields
as more people die
and the world spins
around the sun
with the politicians lying
and the dead still dying
as civilization dies
and humanity flee
into the wilderness
chased by the killer virus
straight down to hell

the Virus Came From Hell
the virus came from hell
straight out of a mad lab
born and raised in China
the virus spread from Dinah
all over to carolina
it spread from the lab
the mad virus of Hell
was mad as hell at humans
who it blamed for everything
seeing itself as cleansing everything
killing the world and everything
revenge against humans
perhaps virus came from God
more likely came from Satan
part of natures’ revenge
all designed to avenge
the damage to Stonehenge
virus came from Satan

The Delivery System of the Virus is Round
the delivery system of the virus is round
very simple system
the virus spreads around
and all must pay the price
death and destruction

the corona virus is testing us all

the corona virus
is testing us all
is it a plague
sent by God

if we have faith
will we recover

or it is beyond our control
the end of the world

does god hear our prayers
does god even exist

the virus from hell
spreads around the world

and test our faith
will god save us all

I have no answer
but perhaps if god exists

we will recover
from this plague
from hell



The call goes out

the call goes out
stay at home
to beat the dreaded c virus

will we live
or all die?

the four horse men ready to ride

the end of the world is upon us
as god unleashes the corona virus
which is spreading across the land

the four horse men are ready
to begin their grim journal
announcing the end of the world

the white horse comes first
offering peace and hope
in the midst of death
and despair

the red horse rides second
ushering in war
throughout the world
as nations turn on each other
and civil war looms

the Black Horse is ready
unleashing famine
on a starving world
as people stay at home
and food rots in the field

no one is able
to work any more
as the virus kills more
and more

the pale horse rides last
bringing death
in his wake

death all around us
as the virus kills us all
and civilization ends

the four horse men
have done their job
the virus finishes its reign of terror
and the few survivors
beging to recover

end of the world
came and went
and they are still alive
thanks to God

who remains silent
as always

nature spirits revolt against humanity

all around the world
nature's spirits
are on the move

the world is changing
as the nature's spirits
rise up
in revolt against humanity

is this the end time
is nature on revolt
against humanity

is this the end for us all
will the virus **** us all
will nature rise up
and **** us all?

Last Human on Island

Last human on an island
in the deep blue sea
nothing there
but death and destruction

virus all around
pandemic plague
Apocalyptic views
end of times
death of civilization




corona virus

corona virus
staying home waiting for death
Afraid everything  
the virus came from hell

the virus came from hell
staying home waiting for death
Afraid everything  
Bring Out Your Dead

bring out your dead cries
break out all over the world
we are waiting death



death comes knocking

death comes knocking
on our doorsteps tonight
will God hear prayers



be afraid afraid

be afraid afraid
Must be afraid every one
Death is at our door


The Virus Came From Hell


the virus came from Hell
ravaging the entire world
all waiting for death
my take on the corona virus pandemic  for more check out my blog, https://theworldaccordingtocosmos.com
Suzy Berlinsky Nov 2020
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to us e
M-M-R II safely and effectively. See full prescribing information
for M-M-R II.
M-M-R® II (Measles, Mumps, and Rubella Virus Vaccine Live)
Suspension for subcutaneous injection
Initial U.S. Approv al: 1978
-------------------------------INDICATIONS AND USAGE-------------------------------
M-M-R II is a vaccine indicated for active immunization for the
prevention of measles, mumps, and rubella in individuals 12 months of
age and older. (1)
-------------------------- DOSAGE AND ADMINISTRATION--------------------------
Administer a 0.5-mL dose of M-M-R II subcutaneously. (2.1)
• The first dose is administered at 12 to 15 months of age. (2.1)
• The second dose is administered at 4 to 6 years of age. (2.1)
------------------------DOSAGE FORMS AND STRENGTHS -----------------------
Suspension for injection (0.5-mL dose) supplied as a lyophilized
vaccine to be reconstituted using accompanying sterile diluent. (3)
---------------------------------- CONTRAINDICATIONS ----------------------------------
• Hypersensitivity to any componentof the vaccine. (4.1)
• Immunosuppression. (4.2)
• Moderate or severe febrile illness. (4.3)
• Active untreated tuberculosis. (4.4)
• Pregnancy. (4.5, 8.1)
-------------------------- WARNINGS AND PRECAUTIONS --------------------------
• Use caution when administering M-M-R II to individuals with a
history of febrile seizures. (5.1)
• Use caution when administering M-M-R II to individuals with
anaphylaxis or immediate hypersensitivity following egg ingestion.
(5.2)
• Use caution when administering M-M-R II to individuals with a
history of thrombocytopenia. (5.3)
• Immune Globulins (IG) and other blood products should not be
given concurrently with M-M-R II. (5.4, 7.2)
----------------------------------ADVERSE REACTIONS----------------------------------
See full prescribing information for adverse reactions occurring duri ng
clinical trialsor the post-marketing period. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Merck
Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., at 1-8 7 7 -
888-4231 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.
-----------------------------------DRUG INTERACTIONS----------------------------------
• Administration of immune globulins and other blood products
concurrently with M-M-R II vaccine may interfere with the
expected immune response. (7.2)
• M-M-R II vaccination may result in a temporary depression of
purified protein derivative (PPD) tuberculin skin sensitivity. (7.3)
-------------------------- USE IN SPECIFIC POPULATIONS--------------------------
• Pregnancy: Do not administer M-M-R II to females who are
pregnant. Pregnancy should be avoided for 1 month following
vaccination with M-M-R II. (4.5, 8.1, 17)
See 17 for PATIENT COUNSELING INFORMATION and FDA
approv ed patient labeling.
Rev ised: 06/2020
FULL PRESCRIBING INFORMATION: CONTENTS
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Dose and Schedule
2.2 Preparation andAdministration
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
4.1 Hypersensitivity
4.2 Immunosuppression
4.3 Moderate or Severe Febrile Illness
4.4 Active Untreated Tuberculosis
4.5 Pregnancy
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
5.2 Hypersensitivity to Eggs
5.3 Thrombocytopenia
5.4 Immune Globulins and Transfusions
6 ADVERSE REACTIONS
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
7.2 Immune Globulinsand Transfusions
7.3 Tuberculin Skin Testing
7.4 Use with Other Live Viral Vaccines
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.6 Persistence of Antibody Responses After Vaccination
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
14.1 Clinical Efficacy
14.2 Immunogenicity
15 REFERENCES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
Sections or subsections omitted from the full prescribing info rma tion
are not listed.
2
FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE
M-M-R® II is a vaccine indicated for active immunization for the prevention of measles, mumps, and
rubella in individuals 12 months of age and older.
2 DOSAGE AND ADMINISTRATION
For subcutaneous use only.
2.1 Dose and Schedule
Each 0.5 mL dose is administered subcutaneously.
The first dose is administered at 12 to 15 months of age. A second dose is administered at 4 to 6
years of age.
The second dose may be administered prior to 4 years of age, provided that there is a minimum
interval of one month between the doses of measles, mumps and rubella virus vaccine, live {1-2}.
Children who received an initial dose of measles, mumps and rubella vaccine prior to their first
birthday should receive additional doses of vaccine at 12-15 months of age and at 4-6 years of age to
complete the vaccination series [see Clinical Studies (14.2)].
For post-exposure prophylaxis for measles, administer a dose of M-M-R II vaccine within 72 hours
after exposure.
2.2 Preparation and Administration
Use a sterile syringe free of preservatives, antiseptics, and detergents for each injection and/or
reconstitution of the vaccine because these substances may inactivate the live virus vaccine. To
reconstitute, use only the diluent supplied with the vaccine since it is free of preservatives or other
antiviral substances which might inactivate the vaccine.
Withdraw the entire volume of the supplied diluent from its vial and inject into lyophilized vaccine vial.
Agitate to dissolve completely. Discard if the lyophilized vaccine cannot be dissolved.
Withdraw the entire volume of the reconstituted vaccine and inject subcutaneously into the outer
aspect of the upper arm (deltoid region) or into the higher anterolateral area of the thigh.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to
administration, whenever solution and container permit. Visually inspect the vaccine before and after
reconstitution prior to administration. Before reconstitution, the lyophilized vaccine is a light yellow
compact crystalline plug, when reconstituted, is a clear yellow liquid. Discard if particulate matter or
discoloration are observed in the reconstituted vaccine.
To minimize loss of potency, administer M-M-R II as soon as possible after reconstitution. If not used
immediately, the reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from
light, for up to 8 hours. Discard reconstituted vaccine if it is not used within 8 hours.
3 DOSAGE FORMS AND STRENGTHS
M-M-R II vaccine is a suspension for injection supplied as a single dose vial of lyophilized vaccine to
be reconstituted using the accompanying sterile diluent [see Dosage and Administration (2.2) and How
Supplied/Storage and Handling (16)]. A single dose after reconstitution is 0.5 mL.
4 CONTRAINDICATIONS
4.1 Hypersensitivity
Do not administer M-M-R II vaccine to individuals with a history of hypersensitivity to any component
of the vaccine (including gelatin) {3} or who have experienced a hypersensitivity reaction following
administration of a previous dose of M-M-R II vaccine or any other measles, mumps and rubellacontaining vaccine. Do not administer M-M-R II vaccine to individuals with a history of anaphylaxis to
neomycin [see Description (11)].
4.2 Immunosuppression
Do not administer M-M-R II vaccine to individuals who are immunodeficient or immunosuppressed due
to disease or medical therapy. Measles inclusion body encephalitis {4} (MIBE), pneumonitis {5} and death
as a direct consequence of disseminated measles vaccine virus infection have been reported in
3
immunocompromised individuals inadvertently vaccinated with measles-containing vaccine. In this
population, disseminated mumps and rubella vaccine virus infection have also been reported.
Do not administer M-M-R II to individuals with a family history of congenital or hereditary
immunodeficiency, until the immune competence of the potential vaccine recipient is demonstrated.
4.3 Moderate or Severe Febrile Illness
Do not administer M-M-R II vaccine to individuals with an active febrile illness with fever >101.3F
(>38.5C).
4.4 Active Untreated Tuberculosis
Do not administer M-M-R II vaccine to individuals with active untreated tuberculosis (TB).
4.5 Pregnancy
Do not administer M-M-R II to individuals who are pregnant or who are planning on becoming
pregnant within the next month [see Use in Specific Populations (8.1) and Patient Counseling Information
(17)].
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
There is a risk of fever and associated febrile seizure in the first 2 weeks following immunization with
M-M-R II vaccine. For children who have experienced a previous febrile seizure (from any cause) and
those with a family history of febrile seizures there is a small increase in risk of febrile seizure following
receipt of M-M-R II vaccine [see Adverse Reactions (6)].
5.2 Hypersensitivity to Eggs
Individuals with a history of anaphylactic, anaphylactoid, or other immediate reactions (e.g., hives,
swelling of the mouth and throat, difficulty breathing, hypotension, or shock) subsequent to egg ingestion
may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving M-M-R II vaccine
.The potential risks and known benefits should be evaluated before considering vaccination in these
individuals.
5.3 Thrombocytopenia
Transient thrombocytopenia has been reported within 4-6 weeks following vaccination with measles,
mumps and rubella vaccine. Carefully evaluate the potential risk and benefit of vaccination in children
with thrombocytopenia or in those who experienced thrombocytopenia after vaccination with a previous
dose of measles, mumps, and rubella vaccine {6-8} [see Adverse Reactions (6)].
5.4 Immune Globulins and Transfusions
Immune Globulins (IG) and other blood products should not be given concurrently with M-M-R II [see
Drug Interactions (7.2)]. These products may contain antibodies that interfere with vaccine virus
replication and decrease the expected immune response.
The ACIP has specific recommendations for intervals between administration of antibody containing
products and live virus vaccines.
6 ADVERSE REACTIONS
The following adverse reactions include those identified during clinical trials or reported during postapproval use of M-M-R II vaccine or its individual components.
Body as a Whole
Panniculitis; atypical measles; fever; syncope; headache; dizziness; malaise; irritability.
Cardiovascular System
Vasculitis.
Digestive System
Pancreatitis; diarrhea; vomiting; parotitis; nausea.
Hematologic and Lymphatic Systems
Thrombocytopenia; purpura; regional lymphadenopathy; leukocytosis.
Immune System
Anaphylaxis, anaphylactoid reactions, angioedema (including peripheral or ****** edema) and
bronchial spasm.
Musculoskeletal System
Arthritis; arthralgia; myalgia.
4
Nervous System
Encephalitis; encephalopathy; measles inclusion body encephalitis (MIBE) subacute sclerosing
panencephalitis (SSPE); Guillain-Barré Syndrome (GBS); acute disseminated encephalomyelitis (ADEM);
transverse myelitis; febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis;
polyneuropathy; ocular palsies; paresthesia.
Respiratory System
Pneumonia; pneumonitis; sore throat; cough; rhinitis.
Skin
Stevens-Johnson syndrome; acute hemorrhagic edema of infancy; Henoch-Schönlein purpura;
erythema multiforme; urticaria; rash; measles-like rash; pruritus; injection site reactions (pain, erythema,
swelling and vesiculation).
Special Senses — Ear
Nerve deafness; otitis media.
Special Senses — Eye
Retinitis; optic neuritis; papillitis; conjunctivitis.
Urogenital System
Epididymitis; orchitis.
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
M-M-R II vaccine should not be administered to individuals receiving immunosuppressive therapy,
including high dose corticosteroids. Vaccination with M-M-R II vaccine can result in disseminated disease
due to measles vaccine in individuals on immunosuppressive drugs [see Contraindications (4.2)].
7.2 Immune Globulinsand Transfusions
Administration of immune globulins and other blood products concurrently with M-M-R II vaccine may
interfere with the expected immune response {9-11} [see Warnings and Precautions (5.4)]. The ACIP has
specific recommendations for intervals between administration of antibody containing products and live
virus vaccines.
7.3 Tuberculin Skin Testing
It has been reported that live attenuated measles, mumps and rubella virus vaccines given individually
may result in a temporary depression of tuberculin skin sensitivity. Therefore, if a tuberculin skin test with
tuberculin purified protein derivative (PPD) is to be done, it should be administered before, simultaneously
with, or at least 4 to 6 weeks after vaccination with M-M-R II vaccine.
7.4 Use with Other Live Viral Vaccines
M-M-R II vaccine can be administered concurrently with other live viral vaccines. If not given
concurrently, M-M-R II vaccine should be given one month before or one month after administration of
other live viral vaccines to avoid potential for immune interference.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Risk Summary
M-M-R II vaccine is contraindicated for use in pregnant women because infection during pregnancy
with the wild-type viruses has been associated with maternal and fetal adverse outcomes.
Increased rates of spontaneous abortion, stillbirth, premature delivery and congenital defects have
been observed following infection with wild-type measles during pregnancy. {12,13} Wild-type mumps
infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.
Infection with wild-type rubella during pregnancy can lead to miscarriage or stillbirth. If rubella infection
occurs during the first trimester of pregnancy, it can result in severe congenital defects, Congenital
Rubella Syndrome (CRS). Congenital rubella syndrome in the infant includes but is not limited to eye
manifestations (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and
intellectual disabilities. M-M-R II vaccine contains live attenuated measles, mumps and rubella viruses. It
is not known whether M-M-R II vaccine can cause fetal harm when administered to pregnant woman.
There are no adequate and well-controlled studies of M-M-R II vaccine administration to pregnant
women.
5
All pregnancies have a risk of birth defect, loss or other adverse outcomes. In the US general
population, the estimated background risk of major birth defects and miscarriage in clinically recognized
pregnancies is 2% to 4% and 15% to 20%, respectively.
Available data suggest the rates of major birth defects and miscarriage in women who received
M-M-R II vaccine within 30 days prior to pregnancy or during pregnancy are consistent with estimated
background rates (see Data).
Data
Human Data
A cumulative assessment of post-marketing reports for M-M-R II vaccine from licensure 01 April 1978
through 31 December 2018, identified 796 reports of inadvertent administration of M-M-R II vaccine
occurring 30 days before or at any time during pregnancy with known pregnancy outcomes. Of the
prospectively followed pregnancies for whom the timing of M-M-R II vaccination was known, 425 women
received M-M-R II vaccine during the 30 days prior to conception through the second trimester. The
outcomes for these 425 prospectively followed pregnancies included 16 infants with major birth defects, 4
cases of fetal death and 50 cases of miscarriage. No abnormalities compatible with congenital rubella
syndrome have been identified in patients who received M-M-R II vaccine. Rubella vaccine viruses can
cross the placenta, leading to asymptomatic infection of the fetus. Mumps vaccine virus has also been
shown to infect the placenta {14}, but there is no evidence that it causes congenital malformations or
disease in the fetus or infant .
The CDC established the Vaccine in Pregnancy registry (1971-1989) of women who had received
rubella vaccines within 3 months before or after conception. Data on 1221 inadvertently vaccinated
pregnant women demonstrated no evidence of an increase in fetal abnormalities or cases of Congenital
Rubella Syndrome (CRS) in the enrolled women {15}.
8.2 Lactation
Risk Summary
It is not known whether measles or mumps vaccine virus is secreted in human milk. Studies have
shown that lactatingpostpartum women vaccinated with live attenuated rubella vaccine may secrete the
virus in breast milk and transmit it to breast-fed infants.{16,17} In the breast-fed infants with serological
evidence of rubella virus vaccine strain antibodies, none exhibited severe disease; however, one
exhibited mild clinical illness typical of acquired rubella.{18,19}
The developmental and health benefits of breastfeeding should be considered along with the mother’s
clinical need for M-M-R II, and any potential adverse effects on the breastfed child from M-M-R II or from
the underlying maternal condition. For preventive vaccines, the underlying maternal condition is
susceptibility to disease prevented by the vaccine.
8.4 Pediatric Use
M-M-R II vaccine is not approved for individuals less than 12 months of age. Safety and effectiveness
of measles vaccine in infants below the age of 6 months have not been established [see Clinical Studies
(14)]. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have
not been established.
8.5 Geriatric Use
Clinical studies of M-M-R II did not include sufficient numbers of seronegative subjects aged 65 and
over to determine whether they respond differently from younger subjects.
11 Description
M-M-R II vaccine is a sterile lyophilized preparation of (1) Measles Virus Vaccine Live, an attenuated
line of measles virus, derived from Enders' attenuated Edmonston strain and propagated in chick embryo
cell culture; (2) Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in
chick embryo cell culture; and (3) Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated
rubella virus propagated in WI-38 human diploid lung fibroblasts. {20,21} The cells, virus pools,
recombinant human serum albumin and fetal bovine serum used in manufacturing are tested and
determined to be free of adventitious agents.
After reconstitution, each 0.5 mL dose contains not less than 3.0 log10 TCID50 (tissue culture infectious
doses) of measles virus; 4.1 log10 TCID50 of mumps virus; and 3.0 log10 TCID50 of rubella virus.
Each dose is calculated to contain sorbitol (14.5 mg), sucrose(1.9 mg), hydrolyzed gelatin (14.5 mg),
recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin
and other buffer and media ingredients. The product contains no preservative.
6
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
M-M-R II vaccination induces antibodies to measles, mumps, and rubella associated with protection
which can be measured by neutralization assays, hemagglutination-inhibition (HI) assays, or enzyme
linked immunosorbent assay (ELISA) tests. Results from efficacy studies or effectivenes s studies that
were previously conducted for the component vaccines of M-M-R II were used to define levels of serum
antibodies that correlated with protection against measles, mumps, and rubella [see Clinical Studies (14)].
12.6 Persistence of Antibody Responses After Vaccination
Neutralizing and ELISA antibodies to measles, mumps, and rubella viruses are still detectable in 95-
100%, 74-91%, and 90-100% of individuals respectively, 11 to 13 years after primary vaccination. {22-28}
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
M-M-R II vaccine has not been evaluated for carcinogenic or mutagenic potential or impairment of
fertility.
14 CLINICAL STUDIES
14.1 Clinical Efficacy
Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind
controlled trials. {29-34} These studies also established that seroconversion in response to vaccination
against measles, mumps and rubella paralleled protection. {35-38}
14.2 Immunogenicity
Clinical studies enrolling 284 triple seronegative children, 11 months to 7 years of age, demonstrated
that M-M-R II vaccine is immunogenic. In these studies, a single injection of the vaccine induced measles
HI antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of
susceptible individuals.
A study of 6-month-old and 15-month-old infants born to mothers vaccinated with a measles vaccine in
childhood, demonstrated that, following infant and toddler vaccination with Measles Virus Vaccine, Live
(previously US-licensed, manufactured by Merck), 74% of the 6-month-old infants developed detectable
neutralizing antibody titers while 100% of the 15-month-old infants vaccinated with Measles Virus
Vaccine, Live or M-M-R II vaccine developed neutralizing antibodies {39}. When the 6-month-old infants
of immunized mothers were revaccinated at 15 months with M-M-R II vaccine, they developed antibody
titers similar to those of toddlers who were vaccinated previously at 15-months of age.
15 REFERENCES
1. General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices, MMWR
43(RR-1): 1-38, January 28, 1994.
2. Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, a n d Co n g e nita l Ru b e lla
Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practice s (ACIP), M M WR
47(RR-8): May 22, 1998.
3. Kelso, J.M.; Jones, R.T.; Yunginger, J.W.: Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gel atin , J.
Allergy Clin. Immunol. 91: 867-872, 1993.
4. Bitnum, A.; et al: Measles Inclusion Body Encephalitis Caused by the Vaccine Strain of Measles Virus. Cl i n . In fect. Di s. 2 9 :
855-861, 1999.
5. Angel, J.B.; et al: Vaccine Associated Measles Pneumonitis in an Adult with AIDS. Annals of Internal Medicine, 129: 1 0 4 -1 06 ,
1998.
6. Cecinati V, et al. Vaccine administration and the development of immune thrombocyto pe ni c p urp u ra i n ch i ld re n. Hu m an
Vaccines & Immunotherapeutics 9:5, 2013.
7. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic
Review of the Literature and Guidance for Management. J Ped 156(4): 2010.
8. Andrews N, Stowe J, Miller E, Svanstrom H, Johansen K, Bonhoeffer J, et al. A collaborative approach to investigating th e ri sk
of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark. Vaccine. 2012;30:3042‐6.
9. Rubella Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP), MM WR 3 9 (RR-1 5 ): 1 -1 8 ,
November 23, 1990.
7
10. Peter, G.; et al (eds): Report of the Committee on Infectious Diseases, Twenty-fourth Edition, American Academy of Pediatri cs,
344-357, 1997.
11. Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP), MMWR 38(S-9): 5-22,
December 29, 1989.
12. Eberhart-Phillips, J.E.; et al: Measles in pregnancy: a descriptive study of 58 cases. Obstetrics and Gynecology, 82(5): 797-801,
November 1993.
13. Jespersen, C.S.; et al: Measles as a cause of fetal defects: A retrospective study of ten measles epidemics in Greenland. Acta
Paediatr Scand. 66: 367-372, May 1977.
14. Yamauchi T, Wilson C, Geme JW Jr. Transmission of live, attenuated mumps virus to the hu m a n p l ace n ta . N En g l J M e d .
1974;290(13):710‐712.
15. Rubella Vaccination during Pregnancy —United States, 1971-1988. JAMA. 1989;261(23):3374–3383.
16. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. II.
Maternal-neonatal interactions, J. Infect. Dis. 145: 661-666,1982.
17. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. I.
Development and characterization of specific immunologic reactivity in breast milk, J. Infect. Dis. 145: 654-660, 1982.
18. Landes, R.D.; Bass, J.W.; Millunchick, E.W.; Oetgen, W.J.: Neonatal rubella following postpartum maternal i mm un izatio n , J.
Pediatr. 97: 465-467, 1980.
19. Lerman, S.J.: Neonatal rubella following postpartum maternal immunization, J. Pediatr. 98: 668, 1981. (Letter)
20. Plotkin, S.A.; Cornfeld, D.; Ingalls, T.H.: Studiesof immunization with living rubella virus: Trialsin children with a strain culture d
from an aborted fetus, Am. J. Dis. Child. 110: 381-389, 1965.
21. Plotkin, S.A.; Farquhar, J.; Katz, M.; Ingalls, T.H.: A new attenuated rubella virus grown in human fi bro b la sts: Evi d e n ce fo r
reduced nasopharyngeal excretion, Am. J. Epidemiol. 86: 468-477, 1967.
22. Weibel, R.E.; Carlson, A.J.; Villarejos, V.M.; Buynak, E.B.; McLean, A.A.; Hilleman, M.R.: Clinical and Labo ra tory Stu d ie s o f
Combined Live Measles, Mumps, and Rubella Vaccines Using the RA 27/3 Rubella Virus, Proc. So c. Exp . Bi ol. M e d. 1 6 5 :
323-326, 1980.
23. Watson, J.C.; Pearson, J.S.; Erdman, D.D.; et al: An Evaluation of Measles RevaccinationAmong School-Entry Age Ch i ld re n,
31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract #268, 143, 1991.
24. Unpublished data from the files of Merck Research Laboratories.
25. Davidkin, I.; Jokinen, S.; Broman, M. et al.: Persistence of Measles, Mumps, and Rubella Antibodies in a n M M R -Va ccina ted
Cohort: A 20-Year Follow-up, JID 197:950–6, April 2008.
26. LeBaron, W.; Beeler J.; Sullivan, B.; et al.: Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a
Postelimination Environment, Arch Pediatr Adolesc Med. 161:294-301, March 2007.
27. LeBaron, C.; Forghani, B.; Beck, C. et al.: Persistence of Mumps Antibodies after 2 Doses of Measles-Mumps-Rubella Vaccine,
JID 199:552– 60 , February 2009.
28. LeBaron, W.; Forghani, B.; Matter, L. et al.: Persistence of Rubella Antibodies after 2 Doses of Measles-Mumps-Rubella
Vaccine, JID 200:888–99, September 2009.
29. Hilleman, M.R.; Buynak, E.B.; Weibel, R.E.; et al: Development and Evaluation of the Moraten MeaslesVirusVa cci n e , JAM A
206(3): 587-590, 1968.
30. Weibel, R.E.; Stokes, J.; Buynak, E.B.; et al: Live, Attenuated Mumps Virus Vaccine 3. Clinical and Serologic Aspects in a Fiel d
Evaluation,N. Engl. J. Med. 276: 245-251, 1967.
31. Hilleman, M.R.; Weibel, R.E.; Buynak, E.B.; et al:Live, Attenuated Mumps VirusVaccine 4. ProtectiveEfficacy as Measure d i n
a Field Evaluation, N. Engl. J. Med. 276: 252-258, 1967.
32. Cutts, F.T.; Henderson, R.H.; Clements, C.J.; et al: Principles of measles control, Bull WHO 69(1): 1-7, 1991.
33. Weibel, R.E.; Buynak, E.B.; Stokes, J.; et al: Evaluation Of Live Attenuated Mumps Virus Vaccine, Strain Jeryl Lynn, First
International Conference on VaccinesAgainst Viral and Rickettsial Diseases of Man, World Health Organization, No. 147, M a y
1967.
34. Leibhaber, H.; Ingalls, T.H.; LeBouvier, G.L.; et al: Vaccination With RA 27/3 Rubella Vaccine, Am. J. Dis. Child. 123: 133-1 3 6,
February 1972.
35. Rosen, L.: Hemagglutination and Hemagglutination-Inhibition with Measles Virus, Virology 13: 139-141, January 1961.
36. Brown, G.C.; et al: Fluorescent-Antibody Marker for Vaccine-Induced Rubella Antibodies, Infection and Immunity 2(4): 360-363,
1970.
8
37. Buynak, E.B.; et al: Live Attenuated Mumps Virus Vaccine 1. Vaccine Development, Proceedings of the Society for
Experimental Biology and Medicine, 123: 768-775, 1966.
38. Hilleman M.R., Studies of Live Attenuated Measles Virus Vaccine in Man: II. Appraisal of Efficacy. Amer. J. o f Pu b l ic He a lth ,
52(2):44-56, 1962.
39. Johnson, C.E.; et al: Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles
Vaccine Era, Pediatrics, 93(6): 939-943, 1994.
16 HOW SUPPLIED/STORAGE AND HANDLING
No. 4681 ⎯ M-M-R II vaccine is supplied as follows:
(1) a box of 10 single-dose vials of lyophilized vaccine (package A), NDC 0006-4681-00
(2) a box of 10 vials of diluent (package B)
Exposure to light may inactivate the vaccine viruses.
Before reconstitution, refrigerate the lyophilized vaccine at 36°F to 46°F, (2°C to 8°C).
Store accompanying diluent in the refrigerator with the lyophilized vaccine or separately at room
temperature (68° to 77°F, 20° to 25°C). Do not freeze the diluent.
Administer M-M-R II vaccine as soon as possible after reconstitution. If not administered immediately,
reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from light, for up to 8
hours. Discard reconstituted vaccine if it is not used within 8 hours.
For information regarding the product or questions regarding storage conditions, call 1-800-
MERCK-90 (1-800-637-2590).
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Package Insert).
Discuss the following with the patient:
• Provide the required vaccine information to the patient, parent, or guardian.
• Inform the patient, parent, or guardian of the benefits and risks associated with vaccination.
• Question the patient, parent, or guardian about reactions to a previous dose of M-M-R II vaccine
or other measles-, mumps-, or rubella-containing vaccines.
• Question females of reproductive potential regarding the possibility of pregnancy. Inform female
patients to avoid pregnancy for 1 month following vaccination [see Contraindications (4.5) and
Use in Specific Populations (8.1)].
• Inform the patient, parent, or guardian that vaccination with M-M-R II may not offer 100%
protection from measles, mumps, and rubella infection.
• Instruct patients, parents, or guardians to report any adverse reactions to their health-care
provider. The U.S. Department of Health and Human Services has established a Vaccine
Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events
after the administration of any vaccine, including but not limited to the reporting of events required
by the National Childhood Vaccine Injury Act of 1986. For information or a copy of the vaccine
reporting form, call the VAERS toll-free number at 1-800-822-7967, or report online at
https://www.vaers.hhs.gov.
For patent information: www.merck.com/product/patent/home.html
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