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I frequently eat noodles with a fork when I'm forking around
with a bowl of pork, fresh from a pig, a lifeless pig, a pig
of no consequence, a swine with no name. Oh Monster
Rogers! I never liked Joe Negri. He made
my grandmother's *** tired.
265 · Nov 4
HELP POE EAT TREE
HOW TO BE EXPOSED TO LIGHT DIRECTLY FROM THE SUN: (1) Move closer to a window where sunlight is streaming in. Position yourself so that you are lit up by the light. (2) Stretch out on a beach, roof or sidewalk where sunlight is well known to hit. (3) Do not attempt steps 1 and 2 at night.
231 · Sep 27
DON'T WORRY KYOKO!
The medium cost of whole-house gutter replacement is 445,000 pesos and rising. Recent advancements in Mexican gynecology have tripled the demand for synthetic slate roof panels & asphalt shingles! Men with small testicles have conquered 56% of Juรกrez. The time to buy gold is now!
226 · Oct 3
[a piece of cake]
THE ADVANTAGES OF STORING FOOD IN YOUR STOMACH (1) Easy accessibility. It only takes 1 finger pushed down your throat to trigger the gag reflex. (2) Fun. It's fun to puke up food. (3) Prestige. If your employer is willing to pay you to ***** on demand then finding women to sleep with you will be a piece of cake.
220 · Sep 3
The Shanghai Flu
I describe my baboon as baboon-shaped. Her name's Babs, which is
short for baboon. Sunday I pushed her to the library where we were
given a library balloon. It had snot on it, the balloon, because the li-
brarian had the Shanghai flu. I'll take my free-book-borrowing busi-
ness to Havana, Cuba, where snotty librarians are chippy chipper &
well & they never trim their dry quims & they're not bound for hell.
I frequently eat noodles with a fork when I'm forking around
with a bowl of pork, fresh from a pig, a lifeless pig, a pig
of no consequence, a swine with no name. Oh Monster
Rogers! I never liked Joe Negri. He made
my grandmother's *** tired.
174 · Sep 20
BILL GATES is so rich
that his toilet won't flush because it's clogged with hundred-dollar bills that he uses as toilet paper. He has so much money that he throws it out the window after using it as toilet paper because his toilet is clogged.
WITH MUNG BEANS - I've always hated my uncle and planned for years "to get even with him." 1 day, as I was loading 50-pound sacks of mung beans into my Ferrari, I hatched a plan to knock him insensate with a sack of mung beans suspended 15 feet above his hammock. Everything went accordingly and he was knocked unconscious. There was blood everywhere.
171 · Oct 26
1 fewer Terence
Fairy Terry Jones died for the good of all trollops because Heaven's
horrid at its north peak because sea snails freeze in an Arctic creek.
Terry Jones is dead & 1 fewer Terence is good because the world is
colder at the northern peak where no slush melts in an Arctic creek.
When Sheila Moon Glow was twenty-seven she had a large wart removed from her brother's nose. The money that it cost came indirectly from the Sheila Moon Glow Endowment for the Arts. After a brief recovery her brother went on to develop several other warts on his ****. Sheila made available money to have them frozen off.
147 · Oct 18
Pfizer
CBC News. Pfizer to Pay $142M for Drug Fraud. 2010. Mar 26, Retrieved April 9, 2010. < http://www.cbc.ca/health/story/2010/03/25/gabapentin-ubc.html?ref=rss>.
144 · Oct 24
Kammy Harris
"Dear Lover," Debbie whispered through a feeding-tube, "one day we'll make love in a motel room in France a lot." Suddenly, like a miracle, Kyle's eyes flew open like a helicopter stalling out over the Teton Dam. "Oh Kyle! God does grant prayer requests!" Debbie exclaimed like she was Kammy Harris opening a bag of new knee pads. Debbie, why are you crying? My mother was just eaten by cannibal Pygmies. Oh, is she going to be alright? Yes, I think so. Mom? Are you okay? Yes darling. I'm just a little sore.
Born in October 1956, Janet Aimee Stephenson started out as a model and actress before moving into film-making. Do you have the 1980 Roxy Music album ๐‘ญ๐’๐’†๐’”๐’‰ ๐’‚๐’๐’… ๐‘ฉ๐’๐’๐’๐’… in your collection? The nearer of the two girls is Aimee Stephenson. In the 1980's Aimee and her boyfriend Tim Jackson (producer of "Dead Dog Blues") worked in the States on some Roger Corman productions although I donโ€™t know which ones. In 1991 they teamed up with a guy called Sean Manchester who had written a non-fiction book about the so-called "Highgate Vampire." The plan was to make a documentary, and possibly a narrative feature film, about the subject but it never came to anything for various reasons.

In 2001 Aimee and Tim were in Peru, researching a book. ๐—ง๐—ต๐—ฒ ๐—น๐˜‚๐—ด๐—ด๐—ฎ๐—ด๐—ฒ ๐—ต๐—ผ๐—น๐—ฑ ๐—ผ๐—ณ ๐˜๐—ต๐—ฒ ๐—ฏ๐˜‚๐˜€ ๐˜๐—ต๐—ฒ๐˜† ๐˜„๐—ฒ๐—ฟ๐—ฒ ๐˜๐—ฟ๐—ฎ๐˜ƒ๐—ฒ๐—น๐—น๐—ถ๐—ป๐—ด ๐—ผ๐—ป ๐—ฐ๐—ผ๐—ป๐˜๐—ฎ๐—ถ๐—ป๐—ฒ๐—ฑ ๐˜€๐—ผ๐—บ๐—ฒ ๐—ถ๐—น๐—น๐—ฒ๐—ด๐—ฎ๐—น ๐—ณ๐—ถ๐—ฟ๐—ฒ๐˜„๐—ผ๐—ฟ๐—ธ๐˜€ ๐˜„๐—ต๐—ถ๐—ฐ๐—ต ๐—ฐ๐—ฎ๐˜‚๐—ด๐—ต๐˜ ๐—ณ๐—ถ๐—ฟ๐—ฒ ๐—ฎ๐—ป๐—ฑ ๐—ฒ๐˜…๐—ฝ๐—น๐—ผ๐—ฑ๐—ฒ๐—ฑ. ๐—”๐—ถ๐—บ๐—ฒ๐—ฒ ๐—ฐ๐—ฎ๐˜‚๐—ด๐—ต๐˜ ๐˜๐—ต๐—ฒ ๐—ณ๐˜‚๐—น๐—น ๐—ฏ๐—ฟ๐˜‚๐—ป๐˜ ๐—ผ๐—ณ ๐˜๐—ต๐—ฒ ๐—ณ๐—น๐—ฎ๐—บ๐—ฒ๐˜€ ๐—ฎ๐—ป๐—ฑ ๐˜€๐˜‚๐—ณ๐—ณ๐—ฒ๐—ฟ๐—ฒ๐—ฑ ๐Ÿฐ๐Ÿด% ๐˜๐—ต๐—ถ๐—ฟ๐—ฑ ๐—ฑ๐—ฒ๐—ด๐—ฟ๐—ฒ๐—ฒ ๐—ฏ๐˜‚๐—ฟ๐—ป๐˜€ ๐˜๐—ผ ๐—ต๐—ฒ๐—ฟ ๐—ณ๐—ฎ๐—ฐ๐—ฒ, ๐—ฎ๐—ฟ๐—บ๐˜€, ๐—น๐—ฒ๐—ด๐˜€ ๐—ฎ๐—ป๐—ฑ ๐˜๐—ผ๐—ฟ๐˜€๐—ผ. ๐—ง๐—ถ๐—บ ๐—ฎ๐—ป๐—ฑ ๐Ÿญ๐Ÿณ ๐—ผ๐˜๐—ต๐—ฒ๐—ฟ ๐—ฝ๐—ฎ๐˜€๐˜€๐—ฒ๐—ป๐—ด๐—ฒ๐—ฟ๐˜€ ๐˜„๐—ฒ๐—ฟ๐—ฒ ๐—ฎ๐—น๐˜€๐—ผ ๐˜ƒ๐—ฒ๐—ฟ๐˜† ๐—ฏ๐—ฎ๐—ฑ๐—น๐˜† ๐—ฏ๐˜‚๐—ฟ๐—ป๐—ฒ๐—ฑ. ๐——๐—ฒ๐˜€๐—ฝ๐—ถ๐˜๐—ฒ ๐—ต๐—ฒ๐—ฟ ๐—ฎ๐—ฝ๐—ฝ๐—ฎ๐—น๐—น๐—ถ๐—ป๐—ด ๐—ถ๐—ป๐—ท๐˜‚๐—ฟ๐—ถ๐—ฒ๐˜€, ๐˜๐—ต๐—ฒ ๐—ฎ๐—บ๐—ฏ๐˜‚๐—น๐—ฎ๐—ป๐—ฐ๐—ฒ ๐˜„๐—ต๐—ถ๐—ฐ๐—ต ๐—ฎ๐—ฟ๐—ฟ๐—ถ๐˜ƒ๐—ฒ๐—ฑ ๐˜„๐—ผ๐˜‚๐—น๐—ฑ ๐—ผ๐—ป๐—น๐˜† ๐˜๐—ฎ๐—ธ๐—ฒ ๐—ฃ๐—ฒ๐—ฟ๐˜‚๐˜ƒ๐—ถ๐—ฎ๐—ป๐˜€ ๐˜„๐—ถ๐˜๐—ต ๐—ฃ๐—ฒ๐—ฟ๐˜‚๐˜ƒ๐—ถ๐—ฎ๐—ป ๐—บ๐—ฒ๐—ฑ๐—ถ๐—ฐ๐—ฎ๐—น ๐—ถ๐—ป๐˜€๐˜‚๐—ฟ๐—ฎ๐—ป๐—ฐ๐—ฒ. ๐—” ๐—ฝ๐—ฟ๐—ผ๐—บ๐—ถ๐˜€๐—ฒ๐—ฑ ๐˜€๐—ฒ๐—ฐ๐—ผ๐—ป๐—ฑ ๐—ฎ๐—บ๐—ฏ๐˜‚๐—น๐—ฎ๐—ป๐—ฐ๐—ฒ ๐—ป๐—ฒ๐˜ƒ๐—ฒ๐—ฟ ๐˜๐˜‚๐—ฟ๐—ป๐—ฒ๐—ฑ ๐˜‚๐—ฝ ๐˜€๐—ผ ๐˜๐—ต๐—ฒ ๐—ฎ๐˜๐˜๐—ฒ๐—ป๐—ฑ๐—ถ๐—ป๐—ด ๐—ฑ๐—ผ๐—ฐ๐˜๐—ผ๐—ฟ ๐—ฑ๐—ฟ๐—ผ๐˜ƒ๐—ฒ ๐˜๐—ต๐—ฒ๐—บ ๐—ถ๐—ป ๐—ต๐—ถ๐˜€ ๐—ฐ๐—ฎ๐—ฟ ๐—บ๐—ผ๐—ฟ๐—ฒ ๐˜๐—ต๐—ฎ๐—ป ๐—ฎ ๐—ต๐˜‚๐—ป๐—ฑ๐—ฟ๐—ฒ๐—ฑ ๐—บ๐—ถ๐—น๐—ฒ๐˜€ ๐˜๐—ผ ๐˜๐—ต๐—ฒ ๐—ป๐—ฒ๐—ฎ๐—ฟ๐—ฒ๐˜€๐˜ ๐—ต๐—ผ๐˜€๐—ฝ๐—ถ๐˜๐—ฎ๐—น. ๐—”๐—ณ๐˜๐—ฒ๐—ฟ ๐—ฎ ๐˜„๐—ฒ๐—ฒ๐—ธ ๐˜๐—ต๐—ฒ๐—ฟ๐—ฒ, ๐—”๐—ถ๐—บ๐—ฒ๐—ฒ ๐˜„๐—ฎ๐˜€ ๐—ณ๐—น๐—ผ๐˜„๐—ป ๐—ต๐—ผ๐—บ๐—ฒ (๐˜ƒ๐—ถ๐—ฎ ๐—ฆ๐˜„๐—ถ๐˜๐˜‡๐—ฒ๐—ฟ๐—น๐—ฎ๐—ป๐—ฑ) ๐˜๐—ผ ๐—ฆ๐—ฎ๐—น๐—ถ๐˜€๐—ฏ๐˜‚๐—ฟ๐˜† โ€“ ๐˜„๐—ต๐—ฒ๐—ฟ๐—ฒ ๐˜€๐—ต๐—ฒ ๐˜€๐—ต๐—ผ๐—ฟ๐˜๐—น๐˜† ๐—ฝ๐—ฎ๐˜€๐˜€๐—ฒ๐—ฑ ๐—ฎ๐˜„๐—ฎ๐˜†. I canโ€™t imagine the pain she must have gone through, or what Tim Jackson and her other friends and family must have suffered watching her agony.

- Posted by M.J. Simpson
116 · Nov 25
FREE KUNG FU LESSONS!
Kick gangster- and homie-*** the easy way! Do you deplore violence?
Me too. But when a homie comes all up in your face, you got to
take him out and the easiest way is with ghetto-adapted Kung
Fu. Now (and till later), I'm offering free Kung Fu lessons in
Motel 6 by I-95 (room 27 where Big Bob & Tina were stay-
ing). Come early and receive a free demonstration!
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-Rยฎ 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)
โ€ข The first dose is administered at 12 to 15 months of age. (2.1)
โ€ข 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 ----------------------------------
โ€ข Hypersensitivity to any componentof the vaccine. (4.1)
โ€ข Immunosuppression. (4.2)
โ€ข Moderate or severe febrile illness. (4.3)
โ€ข Active untreated tuberculosis. (4.4)
โ€ข Pregnancy. (4.5, 8.1)
-------------------------- WARNINGS AND PRECAUTIONS --------------------------
โ€ข Use caution when administering M-M-R II to individuals with a
history of febrile seizures. (5.1)
โ€ข Use caution when administering M-M-R II to individuals with
anaphylaxis or immediate hypersensitivity following egg ingestion.
(5.2)
โ€ข Use caution when administering M-M-R II to individuals with a
history of thrombocytopenia. (5.3)
โ€ข 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----------------------------------
โ€ข Administration of immune globulins and other blood products
concurrently with M-M-R II vaccine may interfere with the
expected immune response. (7.2)
โ€ข 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--------------------------
โ€ข 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-Rยฎ 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 36ยฐF to 46ยฐF (2ยฐC to 8ยฐC), 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๏‚ฐF
(>38.5๏‚ฐC).
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-Barrรฉ 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-Schรถnlein purpura;
erythema multiforme; urticaria; rash; measles-like rash; pruritus; injection site reactions (pain, erythema,
swelling and vesiculation).
Special Senses โ€” Ear
Nerve deafness; otitis media.
Special Senses โ€” 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 motherโ€™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 Lynnโ„ข (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 (โ‰ค0.3 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 โ€” 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;30:3042โ€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):710โ€712.
15. Rubella Vaccination during Pregnancy โ€”United States, 1971-1988. JAMA. 1989;261(23):3374โ€“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 197:950โ€“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 199:552โ€“ 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 200:888โ€“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 โŽฏ 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 36ยฐF to 46ยฐF, (2ยฐC to 8ยฐC).
Store accompanying diluent in the refrigerator with the lyophilized vaccine or separately at room
temperature (68ยฐ to 77ยฐF, 20ยฐ to 25ยฐC). 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 36ยฐF to 46ยฐF (2ยฐC to 8ยฐC), 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:
โ€ข Provide the required vaccine information to the patient, parent, or guardian.
โ€ข Inform the patient, parent, or guardian of the benefits and risks associated with vaccination.
โ€ข 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.
โ€ข 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)].
โ€ข Inform the patient, parent, or guardian that vaccination with M-M-R II may not offer 100%
protection from measles, mumps, and rubella infection.
โ€ข 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
Copyright ยฉ 1978-2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
All rights reserved.
uspi-v205c-i-2006r009
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104 · Nov 15
89
89
BECOME COLDER day after day with BLOCK-ICE UNDERPANTS SEALER! Are you tired after riding a donkey to the bottom of the Grand Canyon every day? Are you full of beans after a major bean-eating contest? Fear not big bony one! Life's about to ingratiate you with 15 winning lottery tickets! Receive 60%-off on your next order.
104 · Sep 2
THE BLANKET FACTORY
Bob's homosex-themed blanket factory attracted a youthful lesbian of 30 named Donna to apply for a job. "I wanna make lesbian blankets to keep lesbians warm in Alaska," she told Bob with tears in her eyes. "Well then try this! It's our new Klondike blanket!" He exclaimed with a lot of passionate excitement in his voice.
100 · Nov 5
JOE BIDEN
TOOK 10 TESTS PER DAY FOR 8 MONTHS TO PROVE THAT HE'S NOT SENILE (not even a little bit). Jill was there and so was Hunter, each of them witnessed how well Joe did. He answered all of the questions with ease. He's very sharp, like a spinal surgeon or a Subaru mechanic.
98 · Sep 4
CRAZY LEZZIES!
What are you feeding these lezzies?! They're absolutely nutty! Horse
bile & chipmunk tongue! Is that what's got them so riled up?!
Maybe. Let me adjust their urinary bladder regulators.
If things don't change around here for the better, I'm
going to shut down this project and **** everyone!
Easy to set up! 2 separate rooms, each with an Olympic-sized
swimming pool that holds 660,000 gallons of water. Setting up
this tent is a breeze! Comes with plastic tent stakes and
commemorative Mark Spitz gold swimming metal.
96 · Sep 5
[an ape-scraped pate]
SLAY THE MONARCH & THE PROGRAM whilst ***** smokes
shadows upon walls indebting ***** to plucky seven vinegar strokes
I see no point projecting unlaid, lay-about chicks from routine coax
of Kabuki theater flim-flamming quackery that's a penny-ante hoax
wrecked banjaxed on grimy floors sudsed-in crap in which it soaks
I'll never see Cleveland alive as Mother is making it with some fly
whose stolen Detroit dives to hell under ***** bucks who are high
on fed cheese that is curdled & matured on the Chinese ****** lie
broadcasted across seas placid by radio hoo-hoo below half-life sky
tenting fortified wines blended with hops, barley and mildewed rye
in bath tubs devoid of naked wenches morally-wonked and gun-shy
working the angles on de-lousing Camden: old New Jersey's pig sty
because the sight of immorally-uncivil plans blind the Lutheran eye
Subhan Allah, David & Goliath, Samson & Delilah must wilt & die
as cities ***** & Gomorrah substituted fruit cake for pumpkin pie
legions of sodomites patrolled all alleyways as curfews didn't apply
when crusaders knighted moralistes Chrรฉtiens were in short supply
& negroids unarmed had no choice in whitey nations but to comply
'cause guns over butter win the body-count, nobody alive can deny,
while prisoners without tongues are so stuck-up, they will not reply
till they overcome their dispositions as amputees tongue-tied & shy
about swift kicks to those Chaz Bono regions that cause men to cry
in an ionospheric register that shouldn't emanate from a normal dye
except in incorporated Amรฌrฬƒkร  where each prison fry cook must fry
or suffer the fate that ruined commanding lieutenant William Bligh
whose sympathy was such that he'd have done better not to even try
tasteless breadfruit diplomacy upon a sweaty-palmed Christian guy
as it was a tipsy, get-go endeavor like herding cats & feeding slaves
or burying a whacked **** in any of Idaho's tourist-attracting caves
opposite a funky monument to governor Butch Otter making waves
without his buck teeth, quaffing ****** from barrels lacking staves
to enshrine an ape-scraped pate or picnicker's litany of close shaves
from the living, dying by demi-godlike, semi-doctors' clots & raves
in the bowels of the A.M.A. & the C.D.C. for Luciferian conclaves
while suppressing experiences of saving at Equibank in olden days
before gay Pittsburgh was inundated with homosexual lesbian gays
who imbibed ****-soaked chicory quenchers on pap-smeared trays
95 · Sep 3
GUIDED BY HOT DOGS
Till yesterday I kept my scary spellings to myselff (like spelling
MYSELF with two effs). Now (now that I'm a new woman)
I can express myself freely like cows do at a dairy
(even though they're tethered to an
automatic milking machine).
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