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Mohd Arshad  Jun 2017
evi
Mohd Arshad Jun 2017
evi
Swim out of social evils
Life will be a butterfly amid roses
Maimoona Tahir Sep 2024
To debark the root of evi,
l was lead to myself,
Was in ecstacy at that time so it was hard to tell,
I had fallen below that of an ****,
My loyalties had changed and so had my heart
No matter how much I weave it again
This spiders web Is in distain
Turned an tossed, left to rot
My selfish desires invoke no guilt
Now that I can not flee from the web that I have built
RJ Days May 2014
Alison and I walked together in cold European December
Seeking a modest dose of culture & enlightenment
in some grand dead palace where we could pass judgment
on the decadence of queens and puddlejump around
from surrealist paintings to Mexican food to picking up
Evi at the airport. We found the time.

We'd gone out on the first night and been the only two
speaking English at the bar, until we were interrupted
by a hot Australian bartender who joined us and agreed
to play Country Roads to our delight. We lost the time.

It wasn't lost on either of us how foreign it had become
to be with each other like that, and happy I hope:
We were instantly caught up as I kept bumping into her
intentionally, and shouting "Entschuldigung!" because
it was the only word I knew. We'd lost no time.

She told me about her piano search and looking after
the Ambassador and hobnobbing with former presidents
and dignitaries with all the uptight flair of the affairs
of state, and her own shining searching lost loneliness
that has come to mirror my own. We knew the time.

On the last night we stayed up playing checkers and rummy
and chess until she could win, sipping wine as we ignored
the gardens and museums that surrounded us, and taunted
each other about how we were ready to party all night
if only the other hadn't grown so old. We still had time.
Michael Marchese  Jun 2022
Evi
Michael Marchese Jun 2022
Evi
How could someone so far
Feel so close
Within reach
Like I’m already next to her
Down on the beach
And each day
Through destabilized life
Disarray
She is my equilibrium
Song that I play
The insightful awareness
Her fairness
Inherent
She sees me in ways
Not so often
Apparent
Unerring
Assessing
The depths of my mind
And repairing
Its faulty
Default
Out of time
For with her
There is more to be spent
In progressing,
Improving,
Correcting
Recursive transgression
A reason to stay
When I’d much rather leave
Broken dreams
She awakens
As yet to achieve
Not aggrieved,
Nor consigned
To no chance to attain
And as long as she’ll have me
With her
I remain
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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Muzaffer  Feb 2019
Geciktirici
Muzaffer Feb 2019
Alta Gracia’da akşam oluyor
ve hala gitarımda bir telim eksik
Adabel’de kesti veresiyeyi
kapısına tekme attığım için
son paramla mama almıştım Lorenzo’ya
kafayı bulmadan önce azgın kedime
kim bilir nerde düzüşüyor bunak
bense pinekliyorum küf kokan pencerede
Mercedes geçse bir ıslık çalmam kafi
ama o’da geceleri çıkıyor işe
evi beş blok ötede gitsem
ama ya müşteri varsa içerde
Mercedes bir fahişe
aseksüel arkadaşız
yani ilişkimiz o minvalde
üfleyip püflüyorum son sigaramı
kafam karışık
bir G teli yüzünden
gitarı mı vursam
kolundan savurup duvara
küçük Miguel nerdesin velet
onun zulası vardır keman sepetinde
Miguel oniki yaşında benim öğrencim
Pado çalıyor beynimde her gece
oysa ben Blues üstü Jazz severim
çöküyorum olduğum yere
bir iki damla kalmış
dün geceki şişede
dikiyorum kafaya
ilk defa geç kalıyorum işe
Si’yi Sol’a
tak diyor temiz ruhlar
E’yi B’ye
üst perde’den çal
kleptoman şarkıları
sabahta vur tekmeyi kapısına
say eline mangırları...



Vaha
Michael Marchese May 2024
Cut the head off
The snake
‘Fore its many
Temptations
She’d hopelessly sate
My reptilian cold
To the sickness
Afflicted
My sheerest indifference
To pain I
Inflicted
All must be met
Swiftly
With lessons in empathy
By her own words
This is action’s
Peremptory
Testament’s
Genesis
Thee most decisive
Discourse
Instrumentalist
Musing his final
Attempt to be brave
To remind her
His love
Was designed for the grave
And embossed in
Conceding
To her
It was made
That exhausted,
Defeated
His body be laid
At her feet
Once again
To unrest
In his shame
Mateuš Conrad Jul 2021
-Your take on casual *** and **** is interesting. My take on casual *** is that it's self-gratifying more so than gratifying the other person. As you stated, the thirty party versus the party selling water. The closest I've come to casual *** is when I once gave a former student (a man by this time) a ******* (don't judge me). Poor guy never got over it, though. It was never repeated to his utter devastation. His begging made it pathetic and, hence, no longer flattering since he's ten yeas my junior (Again, don't judge me). I agree that **** should be watched in silence. I barely do that, either. I'd rather be having *** than watching it.

- whether it's self-gratifying is debatable... you can always find the "alternative"... the less-ushered in "conundrums" of sexuality to be made appealing... i know that's only verbiage... but there can't be anything alien for us to... given the totality of all that's human... you keep repeating this mantra about not being judged... are you dabbling in more fiction than reality? i can understand you wanting to compete with me when it comes to making casual *** as graphic as possible: teasing me with fetishes of the teacher-student conundrums... you made it implicit that i shouldn't judge you: i won't... because... something... "something" doesn't fit the narrative... i don't know what: i like to think of you as suspect... although i have no clear reasons to do so... i'm not going to have a hard-on through the mere scribble of script with what you ciphered... you want me on a leash: no? we are... playing a game of your choosing... or has literally soured our brains to the point of being so uninhibited as to ****** honesty and trust onto strangers? i'll give you the benefit of the doubt... you want me to... imagine you as a *******... it's a complete and utter: hilarity... how certain topics exist in: best expressed with images, bodies and sign language: but god-forbid the deecration of them being turned into verbiage... Braille... the new Christian H'American way of dealing with a European heritage... no? i'm not judging i'm just...  Bronzino... cupid venus folly & time... i did a "counter" masterpiece on that one... given the fact that i was equipped with the antithesis of not being prescribed the m.g.m. of circumcision... i'm not judging... but we're playing poker at this point... i don't watch **** because: i rather be having ***... i'm watching it because: i don't really have two kids... or a story of having underage students... i give ******* to! come on... it's not like i have scented candles... a reclining armchair waiting... for me to... delight others in the vain hope of reclaiming the *******... i like that little scribble of yours... sorry: i was snoozing when you didn't awake my... non-existent fetishes... then again: am i pursuing a line of thought that might: demean your authenticity as having made such feats in... oh wait... you said you didn't have casual ***? you know... when i was younger... hide & seek... made a load of sense... these days? truth & lie... the old proverb stands... lies have short... ****** legs to stand on... you're coming across as sort of... creased... i'm still not judging... you're barking up the wrong tree attempting to even attempt to get me aroused... i'm not from north ******* H'America where going to a disco strip-bar is some barometer of what happens between two naked bodies expedite consent! this persistent north american... puritanism! how the Mayans were invoked: i will never ever want to bother to know... i'm not judging you... i'm just thinking: i mentioned that i don't mind seeing you as your Avatar... although you sent me a picture of yourself... so... you're trying to reconvene my impression of you... i don't need north american ***** fetishes... i''m glad by simply reimagining milking a cow... i too would rather be having *** than watching it: but i'm not exactly watching it... the English girls of Rotherham prefer Pakistani "tenderness"... of... what's that word... ah! GROOMING... mea culpa up to what, point?! i'm not judging... but you have enough inconsistencies in your narrativ that... well... there was once a dalmation... there was once a polka dot print on a girl's skirt... there was once a "thing" known as a Swiss cheese... how's that?!


"you" really have no more reason to "invade":
perhaps assimilate...
buzz-word: ethno-masochism of the west...
and there it hangs... on the cross...
"you" really have no more reason to "invade":
migrate... whatever you want to call it...
i have nothing to defend...
do i think that the Christianity project
is nothing more than
a Greco-Judaic conspiracy theory to undermine
the Roman rule...
looks like the Latin alphabet will not be conquered
by the Semites or: the Greeks...
the Greeks sought out a Molotov-Ribbentrop pact
with the Slavic tribes
by sending St. Cyril to decipher some
Croat Church graffiti of the Glagolitic script...
so the Hebrews became abandoned...
and Christianity became a creature unto its own:
a chimera... a hydra...
a Protestant reinvigoration... for a while...
but i have nothing to defend:
i don't understand the concept of
Judeo-Christian ethics...
i understand: you slap me... i slap you back...
you punch me: i punch you back...
it is so ingrained in me that entertaining
something counter to the argument:
to pacify: to enlarge the citizenry corpus
is... abhorring to me: inherent nature
of seeking like for like...
it's not that i simply despise Christianity...
it's that i'm sick of it leeching on
vitality for what's left of life...
unless the promise of a 2nd coming is
a tickling aside imitation of a sling-shot...
but i doubt that: doubt...
oh doubt... the plethora of emotions bundled up
with something to combat gambling
addictions...
i have nothing left to be conquered...
saying that: when i watch these genius
video marshals i think to myself:
abhorring being ridiculed when i was
younger was one thing...
being prompted... being spoon-fed
subject matters that...
don't necessarily need me to be invited...
between res cogitans
& res vanus... it's hard to keep up with
one's "solipsistic" narrative...
hence the perils of being sponge-esque:
empty...
propagandist are a bit like advertisers:
to hell with journalists...
propagandists want you to think about
what they're saying...
that's just plain dandy: unnerving...
if you meditate: honestly...
a priori as res vanus
rarther than a priori res cogitans:
you see it... you hear it...
i don't want to think about what other people
speak of... hence the luxury of writing:
it's hardly intrusive... it can't be intrusive...
it must be... digested... there has to be
an invested effort: that's subsequently shared
by both the writer of the script:
and the reader of the script...
it's not... the engaged voice leaning into
the ear of the passive listener...
            is it?
            i'm glad to have discovered this sieve...
i'm not going to juggle a bunch of maxims
to begin: or end with...
i don't like to be prompted with what
i'm to think...
but i'm suddenly getting the idea that:
some people want me to think about things
that are either unimportant...
impossible to change or:
well the OR of... the tides of time...
the collective fate... if there's  collective
unconscious then there's the collective fate...
i can't go against it...
or i might: stick my head up from the current
like some Horace...
because even he didn't bother
with tightly-knit pockets of rhyme pingpong
when he wrote...
         he wrote what he wrote:
as i'll write what i write...

nice metaphors: turning water into wine...
feeding a throng with two loaves of bread
and... what's the fraction 5 to 2 worth of oily fish?
perhaps the magic still works
in South America and Africa...
i'm not even going to defend the European
secular alternative...

i'm thinking on the lines...
if Beelzebub be the lord of the flies...
there must have been a Semitic god for...
title: lord of the mosquitos...
who changed water into wine
and wine into blood and blood into wine
and wine into water?
magic tongue choked on itself
when the ******* Giza cat purred?!
like i said:
i have nothing to defend...
the women of these lands are on their
****-lashing out mantra of anti-racism /
ethno-masochism...
good luck anticipating me throwing more
into the roulette with
a replacement rate of 2.1+ to keep
a future gene culprit with an ** 21st...
up to speed on the joyride...

it's good to be out of the whole game...
by choice...
             i have nothing to defend therefore:
hell! we're building a post-racial
Europe... a vision of Brazil!
oh i'm all for it: a nation of mulattos...
Turkic-German mulattos...
   Anglo-Saxon-Afro-Saxon-Caribbean
mulattos...
everyone a middle-easterner!
it's going to be great...
the towers are here: here's to rekindling
the metaphors of the tower of Babel
and the flood:
i simply can't abhor what is:
in-evi-table... inevitable...
i have my hands either tied behind my back
while i walk casually imitating the folded
wings of a crow pecking at dust...
or there's something of a Pontius Pilate in me...

i believe the old gods: i'll bypass the Siamese
plagiarism of Greek into Roman...
after all... what become of Troy...
Zeus turned into Jupiter...
Hades became Neptune... and later the planets...
i believe in the phonetic stressors of
the Hebrew deity:
                                      vowel-catcher: ah... oh...
i believe in the vowel-multiplier:
the origin of laughter: ha ha ha...

         i believe in the imploded Y
that became Δ (st. peter's cross implosion)...
    why: it's not exactly nonsense if it doesn't
have to be rhyming: therefore suggesting
that via rhyme it might be more easily memory-erosive...
i don't require a... Julien Sorel
or a hafiz...
                    i despise all that rhymes:
bad rhyme: the seas' invasion / nibble at land...
the echoes of ping-pong...
knock-knock... who's there?
a Seljuk Turk... from the 11th century...
knock-knock... who's there?
an Ottoman Turk... from the 17th century...
knock-knock... who's there?
a timid Serb about to consecrate
himself upon the altar of
the genocide of Muslims in Europe
the remains of the Ottoman Empire...
as the concept of Yugoslavia dissolved...
funny that... when the Soviet Empire dissolved...
it was done so peacefully...
what were the chances that the Soviet Union
might have dissolved down the Yugoslavia route?
high... low? no chance in hell?

scrutinising a concern of identity theft that
began in the 19th century: and still persists...
i don't take it lightly: an identity was proposed
by some HANS...
the Silesian Hanys...
not the old Prussian Kashubian:
that so many people decided to congregate:
i'll buy the economic benefits...
but there's also the paraphernalia of secrets:
in the tides of man:
time... great emblem of this hearth...
alias of earth...
fluctuations of space between
here and... Pompeii...

   can't exactly entertain the people while
staging chess-matches on imitation
4D boards of pyramids...
how we reinvented the coliseum
and rewarded the wait with the English joke
of the guillotine...
for a people that can boast Empire building...
if only the Spanish Armada succeeded...
for a people who haven't been invaded
for so long by their kindred neighbours:
to now be... overflowing with so much... "love"...
for an abstract of a "fellow" man...
the citizen of the world is always
welcome in England...
he wasn't... back in 1997... i remember
being deported from England...
i remember being deported from England...
goods can transcend nationhood...
it's economics: good, proper... honest labour
is somehow frowned upon...
brain-drain is acceptable...

no... i have a head of a macaque monkey:
sized so...
the words can't simply be stitched into
my numb-skull so easily as to leave
me lob-sided heavily nodding with agreement...
i'll be on the nod: from
the amount of wine i'll be drinking...

his cherished prizes...
the architecture can topple...
"his": everyone seems to be playing
a grammatical game these days:
why can't his not be a dis-possessive
articulation of a multiplied ownership:
paradox...
his?? whom?
             shadows of ghosts...
i like that...

- what i don't like is thinking that: men hunt
for ***: the mammoths are extinct...
what isn't readily available:
is not worth the hunt...
                i would be expected to find ****?
if **** don't come round most
agreeably submissive...
i'll go find something else to... ahem... "hunt"...
**** this stereotypical bogus load of
*******!
Karma Nov 2024
It’s hard to decipher
What’s real, and what’s fake,
When I spend my time sleeping,
Afraid of the wake.

It’s easy to tell
Of the future that waits,
When deep in my slumber,
My dreams show my fate.

Can’t seem to decide
If love can be felt,
When indifference consumes me,
And hatred just melts.

Can’t tell what I’m feeling.
In patience, I fall.
My logic can fail me
When in conscience, I call.

I feel my voice slipping
When my thoughts become evi,
My desires start dreaming,
And my eyes become heavy.
The world is screaming out.
Can you hear it?
It it's moment of crisis
The world is asking me
Who I am.
I suppose,
I suppose it's time I answer.

— The End —