Bright yellow lights at dusk
Floating along as if they must
Cheer me up, They do. They do.
And the stars are out, so are you
We can lay and forget our problems
Under the moon, I'll forget when
June finally makes it's entrance
Replacing my feelings in May's absence
Camp fires, bon fires, fireworks.
They light my summers, Oh how it hurts
When will I see you again?
My sweet summer love, when?
Let us not worry about that now
We will see each other, don't ponder how
Now it is unbearable, August
Soon you were swept up in a windy gust
Into the hands of a forgotten season
I hope he makes you happy for any reason
September, screams the calendar
Haven't found anyone worth your caliber
I tell myself I must erase
The image in my mind, your face.

July purposely was skipped,
As it was the time, you and I ripped.

syllables tracing periphery,
lips cascading, chasing
the lyrics of one’s soundless
voice gone hoarse with
the melody of a name;
might i perchance remember
the flight of your lashes’
flutter against skin and
flush, hearing my echoes
reverberate along your frame?

Among thee, desperation paints
Sallow cheeks and shaking palms
In the temple in which every child
Consecrates a rebirthing, rejoicing Psalm
Are the steadfast oaths of ages past
Belittled with the present ecstatic gestures?
And upon mine, my chest is pounded
In lieu of papyrus padded scriptures

He walks, the offender, through the halls
While burnt offerings are singed with frankincense
And pulls the steeple’s steel bells
In ode to the sorrowful April shower’s Lent
And finally, the King sits upon his throne
Ad clerum, to the clergy, and nods with respect
When eyed, the child burns inside a dress
Whilst he forgot to genuflect

Mine eyes have seen the glory of the coming age
In which thine beloved empire crumbles
And the voice of fire breathes out like winter breath
In response to those insidious mumbles
In a world where the ox and *** are slain
For charity to make light of a bleary spring
While He still whispers in my conscience
Still exists their soul in everything

Rusty axe in hand, cold air on the face
Holding down with a single damp hand
Recoiled in place
Slammed down with a thud and a crack
Another in rapid succession
And then another still in a dark progression
Pain racks the mind, disgust sights the eyes

The twilight moon covered by clouds
Refusing to witness what has transpired
Mind dulled, and heart torn
Eyes front, recoil once more
With a final throw a shatter rings out
The land convulses, the wind cries out
Something beautiful is thrown throughout

It was a cold dark night when it came to pass
That from out of the dark and into the light
I shattered my soul to keep you alight

Language is an intricate map. One that we've collectively agreed upon as a means of communicating about the 'territory', or experience. Life.

We can draw a tree, and we can write the word "Tree", but neither are  trees.
We can draw a pipe, and we can call it a pipe, but it is still only an image of a pipe.
http://www.exoticexcess.com/wp-content/uploads/2008/06/this-is-not-a-pipe-by-rene-magritte.jpg

Language is not the territory.

Language is but a toolbox. A toolbox filled with lots of cool toys and fun sounding words and some interesting etymologies.
But sometimes the task at hand requires a tool we've not yet conceived of, let alone one we have in our toolbox.
Different languages have different tools, but many will suit similar tasks, even if not exactly the same.
This is no reason to assume that, because our particular map is imperfect, that the territory is somehow more absurd.

The absurdity arises when we fail to recognize and respect the fallacies of language. A spiritual person will understand this notion immediately.
This, however, isn't necessarily to say a religious person will grasp it, and likewise is also not to say that a totally secular person won't.

In fact, I find that many of our conflicts with ourselves and others only arise because we squabble about our interpretations of the maps instead of realizing that the maps are in fact tools to achieve an end, but not the end itself.

Once we can step back from our ego
Once we can admit that we can be wrong
Once we realize we've been deceived
Can we begin to again grow strong.

Borders are maps. Humanity is a territory.
Dogma is a map. Reality is a territory.
Education is a map. Life is a territory.

We mustn't allow our perceptions of maps to occlude our ability to live as we are, an interdependent family of meat-bags twirling around a rather uncaring furnace in space.
This is where dogma comes in, and tends to ruin it for the 'little' people.
This is where money comes in, and substitutes itself for value.
This is where entertainment comes in, and substitutes itself for truth.
This is where ACTA, SOPA, PIPA, the Patriot Acts, and the NDAA come in
And move us one step further towards the Vierte *****. (Fourth kingdom. The Nazis fancied themselves to be the Dritte *****, or Third Kingdom).

Recognize the signs. Fabricate your own map. Then learn to leave it on the shelf.

Don Juan Rodríguez Fresle... sabréis quién fue Don Juan,
No aquel de la leyenda, sevillano galán
Que escalaba conventos, sino el burlón vejete,
Buen cristiano, que oía siempre misa de siete,
La ancha capa luciendo, ya un poco deslustrada,
Que le dejó en herencia Jiménez de Quesada;
Que fue amigo de Oidores, vivaz, dicharachero,
Que escribió muchas resmas de papel, y «El Carnero»;
Que de un tiempo lejano, casi desconocido,
Supo enredos y chismes, que narró y se han perdido;
Tiempo dichoso, cuando (lo que es y lo que fue)
tan sólo tres mil almas tenía Santa Fe,
Y ahora, según dicen, casi 300.000,
Con «dancings», automóviles, cines, ferrocarril
Al río, clubs, y todo lo que la mente fragua
En «confort» y progreso, verdad... ¡pero sin agua!
Tiempo de las Jerónimas, Tomasas, Teodolindas,
De nombres archifeos, pero de cara, lindas,
Y que además tenían, de Oidores atractivo,
Lo que en todas las épocas llaman «lo positivo»;
Cuando no acontecía nada de extraordinario,
Y a las seis, en las casas, se rezaba el rosario;
Días siempre tranquilos y de hábitos metódicos,
Sin petróleos, reclamos de ingleses ni periódicos,
Y cuando con pañuelos, damas de alcurnias rancias
Tapaban, en el cuello, ciertas protuberancias,
Que alguien llamó «colgantes, molestos arrequives»,
Causados por las aguas llovidas o de aljibes;
Cuando como en familia se arreglaban las litis
Y nadie sospechaba que hubiera apendicitis;
Cuando en vez de champaña se obsequiaba masato
De Vélez, y era todo barato, muy barato,
Y tanto, que un ternero (y eso era «toma y daca»)
Lo daban por un peso y encimaban la vaca;
Cuando las calles eran iguales en un todo
A éstas, polvo en verano, y en el invierno, lodo,
Por donde hoy es difícil que los «autos» circulen,
Y esto, cual muchos dicen, por culpa de la Ulen,
Mas afirman (en crónicas muchas cosas yo hallo)
Que entonces las visitas se hacían a caballo,
Y hoy ni así, pues es tanta la tierra que bazucan
Que en tan grandes zanjones los perros se desnucan.

Pero basta de «Introito», porque caigo en la cuenta
De que esto ya está largo...
                                                    Fue en 1630
O 31. A veces se me va la memoria
Y siempre quitan tiempo las consultas de Historia,
Y en años -no habrá nadie que a mal mi dicho tome-
Una cuarta de menos o de más no es desplome.
(Y antes de que los críticos se me vengan encima
Digo que «treinta» y «cuenta» no son perfecta rima,
Pero tengo en mi abono que ingenios del Parnaso,
Por descuido, o capricho, o por salir del paso,
Que es lo que yo confieso me ocurre en este instante,
Hicieron «mente» y «frente», de «veinte» consonante).

Diré, pues: «Hace siglos». Mi narración, exacta
Será, cual de elecciones ha sido siempre una acta,
Y escribiendo: «Hace siglos», nadie dirá que invento
O adultero las crónicas.
                                            Y sigo con mi cuento.
Don Juan Rodríguez Fresle (así yo di principio
A esta historia, que alguno dirá que es puro ripio);
Don Juan, en aquel día (la fecha no recuerdo
Pues en fechas y números el hilo siempre pierdo,
Aunque ya es necesario que la atención concentre
Y de lleno, en materia, sin más preámbulos entre).

Don Juan, el de «El Carnero», yendo para la Audiencia,
Donde copiaba Cédulas, le hizo gran reverencia
Al Arzobispo Almansa, que en actitud tranquila
A los trabajadores en el atrio vigila.
(Se decía «altozano», pero «atrio»
escribo, porque
No quiero que un «magíster» por tan poco me ahorque).

Debéis saber que entonces, frente a la Catedral
El agua de las lluvias formaba un barrizal,
Y para que los fieles cuando entraban a misa
Evitaran el barro de las charcas, aprisa
Puentecitos hacían frailes y monaguillos
Con tablas y cajones y piedras y ladrillos.

(Pobres santafereñas: tendrían malos ratos
Cuando allí se embarraban enaguas y zapatos,
Y también los tendrían los pobres «chapetones»
Porque sabréis que entonces no había zapatones.
Que yo divago mucho, me diréis impacientes;
Es verdad, pero tengo buenos antecedentes,
Como Byron, y Batres y Casti, el italiano,
A quienes en tal vicio se les iba la mano;
Mas sé que al que divaga poca atención se presta,
Y os prometo que mi última divagación es ésta).

Y sigo: El Arzobispo con el breviario en mano,
El atrio dirigía -que él llamaba «altozano».
Aquéllo a todas horas parecía colmena:
Unos, la piedra labran, traen otros arena
Del San Francisco, río donde pescando en corro
Se veía a los frailes, y que hoy es simple chorro.
Apresurados, otros, traen cal y guijarros.
Grandes yuntas de bueyes, tirando enormes carros
Llegan.
              El Arzobispo, puesta en Dios la esperanza,
Ve que es buena su obra. Y el altozano avanza.

Don Juan Rodríguez Fresle, la tarde de aquel día,
«Estas misas parece que acaban mal», decía.
Luego se santiguaba, pues no sé de qué modo,
De la vida de entonces era el sabelotodo.

El Marqués de Sofraga, Don Sancho; a quien repugna
Santa Fe; con Oidores y vasallos en pugna
Y con el Arzobispo, sale al balcón, y airado,
Airado como siempre, viendo que el empedrado
A su palacio llega cerrándole la entrada
A su carroza, grita con voz entrecortada
Por la cólera: «¡Basta! Se ha visto tal descaro?
Al que no me obedezca le costará muy caro.
Quiero franca mi puerta!»
                                                  Todos obedecieron,
Y dejando herramientas, aquí y allá corrieron.

Viendo esto los Canónigos que salían del coro,
Tiraron los manteos, y sin juzgar desdoro
El trabajo, que sólo a débiles arredra,
La herramienta empuñaron para labrar la piedra.
Luego vinieron frailes, vinieron monaguillos;
Y sonaban palustres, escoplos y martillos.

Don Juan Rodríguez Fresle, la tarde de aquel día,
De paseo a San Diego, burlón se sonreía,
Pensando en los Canónigos que en trabajos serviles
Estaban ocupados cual simples albañiles.

Ya de noche, a su casa fue y encendió su lámpara.
Cenó, rezó el rosario, después apartó el pan para
Su desayuno. (Advierto como cosa importante
Que «pan» y «para», juntos, son un buen consonante
De «lámpara». Es sabido que nuestra lengua, sobre
Ser difícil, en rimas esdrújulas es pobre,
Mas cargando el acento sobre «pan», y si «para»
Sigue, las dos palabras sirven de rima rara).

(Y el pan guardaba, porque con el vientre vacío
No gustaba ir a misa, y entonces por el frío
O miedo a pulmonías, en esta andina zona
Eran los panaderos gente muy dormilona;
Y Don Juan que fue en todo previsor cual ninguno,
No salía a la calle jamás sin desayuno).
Prometí los paréntesis suprimir, y estoy viendo
Que en esto de promesas ya me voy pareciendo
A todos los políticos tras la curul soñada:
Que prometen... prometen, pero no cumplen nada.

«¿Y qué fin tuvo el atrio?» diréis quizás a dúo.
Es verdad. Lo olvidaba. La historia continúo,
Sin que nada suprima ni cambie, pues me jacto
De ser de viejas crónicas siempre copista exacto,
Y porque a mano tengo de apuntes buen acopio
Que en polvosos archivos con buen cuidado copio.
Y como aquí pululan gentes asaz incrédulas,
Me apoyo siempre en libros, o Crónicas o Cédulas;
Y para que no afirmen que es relumbrón de talco
Cuanto escribo, mis dichos en la verdad yo calco,
Pues perdón no merece quien por la rima rica
A pasajero aplauso la Historia sacrifica,
La Historia, que es la base del patrimonio patrio...

Y os oigo ya impacientes decirme:
                                                              -«¿Pero el atrio?»
El atrio... Lo olvidaba, y hasta a Rodríguez Fresle;
Mas sabed que en Colombia, y en todas partes, esle
Necesario al poeta que busque algún remanso
En las divagaciones, y es divagar, descanso;
Porque es tarea dura, que aterra y que contrista,
Pasar a rima, y verso la prosa ele un cronista,
Que tan sólo a la prosa de diaristas iguala,
La que en todos los tiempos ha sido prosa mala;
Y aunque en rimas y verso yo sé que poco valgo,
Veré si de este apuro con buena suerte salgo...
Y en olla fío, porque... repararéis, supongo,
Que nunca entre hemistiquios, palabra aguda pongo,
Ni hiato, y de dos llenas no formo yo diptongo
Como hizo Núñez ele Arce (Núñez de Arce ¡admiraos!
Que en dos o tres estrofas nos dijo «cáus» por «caos»,
Y hay poetas, y buenos, de fuste y nombradía,
Que hasta en la misma España ¡qué horror! dicen
«puesía»,
Cual si del Arte fuera, para ellos, la Prosodia
De nuestra hermosa lengua, ridícula parodia);
Que duras sinalefas nunca en un verso junto
Y que jamás el ritmo, cual otros, descoyunto,
Porque eso siempre indica pereza o ningún tino,
Y al verso quita encanto, más al alejandrino,
Que es sin duela el más bello, que más gracia acrisola,
Entre todos los versos en Métrica española.
Que lo digan Valencia, Lugones y Chocano,
todos ellos artífices del verso castellano,
Y que al alejandrino, que es rítmico aleteo,
Dan el garbo y la música que adivinó Berceo.

Y sigo con el atrio.
                                Después de madrugada
Volvieron los canónigos a la obra empezada.

Al Marqués de Sofraga la ira lo sofoca.
Alcaldes, Regidores al Palacio convoca;
Y Alcaldes, Regidores, ante él vienen temblando,
Y díceles colérico: «¡A obedecer! Os mando
Que a todos los Canónigos llevéis a la prisión.
Mis órdenes, oídlo, mandatos del Rey son».

Don Juan Rodríguez Fresle rezó cual buen cristiano;
No escribió, y sin reírse se acostó muy temprano,
Porque muy bien sabía que el Marqués no se anda
Por las ramas, con bromas, y cuando manda, manda.
Mas desvelado estuvo pensando y repensando
En la noche espantosa que estarían pasando
Sin dormir, los Canónigos, en cuartucho sombrío
De la cárcel, sin camas, y temblando de frío.

La siguiente mañana no hubo sol.
                                                              Turbio velo
De llovizna y de brumas encapotaba el cielo.

Fray Bernardino Almansa llega a la Catedral.
Está sobrecogida la ciudad colonial.
Salmos penitenciales se elevan desde el coro,
Y en casullas y capas brilla a la luz el oro.
El Prelado aparece como en unción divina
En el altar, y toda la multitud se inclina;
Entre luces ele cirios destella el tabernáculo;
Hay indecible angustia y hay dolor. Alza el báculo,
Y mientras que en la torre se oye el gran esquilón,
Erguido el Arzobispo lanza la excomunión.
Alcaldes, Regidores, todos excomulgados
Porque al Cielo ofendieron.
                                                  Los fieles congregados
En la Iglesia, de hinojos, y en cruz oraban.

                                                                            Fue
Aquel día de llanto y duelo en Santa Fe.
Cerradas se veían las puertas y ventanas,
Y en todas las iglesias doblaban las campanas.

Don Juan Rodríguez Fresle se dijo: «¡Ya está hecho!»
Se dio, cual buen cristiano, tres golpes en el pecho;
Pero volvió de pronto su espíritu zumbón,
Y pensando en la hora suprema del perdón,
Vio a los excomulgados con sus blancos ropones,
Al cuello sendas sogas, y en las manos blandones,
Y murmuró: «Del cielo la voluntad se haga,
Donde las dan, las toman. Quien la debo la paga».

Y escribiendo, escribiendo, la noche de aquel día,
De los excomulgados, socarrón se reía,
Porque le fue imposible su sueño conciliar
Sin que viera en las sombras por su mente pasar
Regidores y Alcaldes, cada uno en su ropón,
Cual niños que reciben primera comunión.

Don Juan Rodríguez Fresle, siempre que los veía,
Del ropón se acordaba y a solas se reía.

Nacen puestos de gafas, y una piel de levita,
y una perilla obscena de culo de bellota,
y calvos, y caducos. Y nunca se les quita
la joroba que dentro del alma les explota.

Pedos con barbacana, ceremoniosos pedos,
de su senil niñez de polvo enlevitado,
pasan a la edad plena con polvo entre los dedos,
sonando a sepultura y oliendo a antepasado.

Parecen candeleros infelices, escobas
desplumadas, retiesas, con toga, con bonete:
una congregación de gallardas jorobas
con callos y verrugas al borde del retrete.

Con callos y verrugas, y coles y misales,
la dignidad del asno se rebela en la enjalma,
mirando estos cochinos tan espirituales
con callos y verrugas en la extension del alma.

Alma verruguicida, callicida la vuestra.
Habéis nacido tiesos como los monigotes,
y vivís de puntillas, levantando la diestra
para cornamentar la voz y los bigotes.

Saludáis con el ano, no arrugáis nunca el traje,
disimuláis los cuernos con laureles de lata.
No paráis en la tierra, siempre vais de viaje
por un pais de luna maquinal, mentecata.

Nacéis inventariados, morís previa promesa
de que seréis cubiertos de estatuas y coronas.
Vais como procesados por el sol, que procesa
aquello que señala delito en las personas.

Os alimenta el aire sangriento de un juzgado,
de un presidio siniestro de abogados y jueces.
Y concedéis los pedos por audiencia de un lado,
mientras del otro lado jodéis, meáis a veces.


Herís, crucificáis con ojos compasivos,
cadáveres de todas la horas y los días:
autos de poca fe, pastos de los archivos,
habláis desde los púlpitos de muchas tonterías.

Nunca tenga que ver yo con estos doctores,
estas enciclopedias ahumanas, aplastantes.
Nunca de estos filósofos me ataquen los humores,
porque sus agudezas me resultan laxantes.

Porque se ponen huecos igual que las gallinas
para eructar sandeces creyéndose profundos:
porque para pensar entran en las letrinas,
en abismos rellenos de folios moribundos.

Sentenciosas tinajas vacías, pero hinchadas,
se repliegan sus frentes igual que acordeones,
y ascienden y descienden, tortugas preocupadas,
y el corazón les late por no sé qué rincones.

No se han hecho para estos boñigos los barbechos,
no se han hecho para estos gusanos las manzanas.
Sólo hay chocolateras y sillones deshechos
para estas incoherencias reumáticas y canas.

Retretes de elegancia, cagan correctamente:
hijos de puta ansiosos de politiquerías,
publicidad y bombo, se corrigen la frente
y preparan el gesto de las fotografías.

Temblad, hijos de puta, por vuestra puta suerte,
que unos soldados de alma patética deciden:
ellos son los que tratan la verdadera muerte,
ellos la verdadera, la ruda vida piden.

La vida es otra cosa, sucios señores míos,
más clara, menos turbia de folios, de oficinas.
Nadan radiantemente sus cuerpos en los ríos
y no usan esa cara de múltiples esquinas.

Nunca fuisteis muchachos, y queréis que persista
un mundo aparatoso de cartón estirado,
por donde el cartón vaya paticojo y turista,
rey entre maniquíes de pulso congelado.

Venís de la Edad Media donde no habéis nacido,
porque no sois del tiempo presente ni del ausente.
Os mata una verdad en el caduco nido:
la que impone la vida del siempre adolescente.

Yo soy viejo: tan viejo, que el primer hombre late
dentro de mis vividos y veintisiete años,
porque combato al tiempo y el tiempo me combate.
A vosotros, vencidos, os trata como a extraños.
Trapos, calcomanías, defunciones, objetos,
muladares de todo, tinajas, oquedades,
lápidas, catafalcos, legajos, mamotretos,
inscripciones, sudarios, menudencias, ruindades.

Polvos, palabrería, carcoma y escritura,
cornisas; orinales que quieren ser severos,
y se llevan la barba de goma a la cintura,
y duermen rodeados de siglos y sombreros.

Vilmente descosidos, pálidos de avaricia,
lo que más les preocupa de todo es el bolsillo.
Gotosos, desastrosos, malvados, la injusticia
se viste de acta en ellos con papel amarillo.

Los veréis adheridos a varios ministerios,
a varias oficinas por el ocio amuebladas.
Con el **** en la boca canosa, van muy serios,
trucosos, maniobreros, persiguiendo embajadas.

Los veréis sumergidos entre trastos y coños
internacionalmente pagados, conocidos:
pasear por Ginebra los cojones bisoños
con cara de inventores mortalmente aburridos.

Son los que recomiendan y los recomendados.
La recomendación es su procedimiento.
Por recomendación agonizan sentados
donde la muerte cómoda pone su ayuntamiento.

Cuando van a acostarse, se quitan la careta,
el disfraz cotidiano, la diaria postura.
Ante su sordidez se nubla la peseta,
se agota en su paciencia la estatua más segura.

A veces de la mala digestión de estos cuervos
que quieren imponernos su vejez, su idioma,
que quieren que seamos lenguas esclavas, siervos,
dependen muchas vidas con signo de paloma.

A veces son marquesas íntimas de ambiciones,
insaciables de joyas, relumbronas de trato:
fracasadas de título, caballares de acciones,
dispuestas a llevar el mundo en el zapato.

Putonas de importancia, miden bien la sonrisa
con la categoría que quien las trata encierra:
políticas jetudas, desgastan la camisa
jodiendo mientras hablan del drama de la guerra.

Se cae de viejo el mundo con tanto malotaje.
Hijos de la rutina bisoja y contrahecha,
valoran a los hombres por el precio del traje,
cagan, y donde cagan colocan una fecha.

Van del hotel al banco, del hotel al paseo
con una cornamenta notable de aire insulso.
Es humillar al prójimo su más noble deseo,
y el esfuerzo mayor le hacen meando a pulso.

Hemos de destrozaros en vuestras legaciones,
en vuestros escenarios, en vuestras diplomacias.
Con ametralladoras cálidas y canciones
os ametralllaremos, prehistóricas desgracias.

Porque, sabed: llevamos mucha verdad metida
dentro del corazón, sangrando por la boca:
y os vencerá la ferrea juventud de la vida,
pues para tanta fuerza tanta maldad es poca.

La juventud, motores, ímpetus a raudales,
contra vosotros, viejos exhombres, plena llueve:
mueve unánimemente sus músculos frutales,
sus máquinas de abril contra vosotros mueve.

Viejos exhombres viejos: ni viejos tan siquiera.
La vejez es un don que cederá mi frente,
y a vuestro lado es joven como la primavera.
Sois la decrepitud andante y maloliente.

Sois mis enemiguitos: los del mundo que siento
rodar sobre mi pecho más claro cada día.
Y con un soplo sólo de mi caliente aliento,
con este soplo dicté vuestra agonía.

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.
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My humble apology
for inducing thee
to manure yourself
thru figurative following ****,
best flushed down the toilet
of the behavioral sink
why yours truly wretchedly reaches out
cuz I never experienced popularity
as witnessed like craze of yoyo hula hoop
impossible mission to categorize
one feeble hominid specimen as belonging
to **** sapiens group,

nor doth mine spiel attempt to dupe
luck hate, or sell thee anything
except the pleasure
of befriending, daring ye to risk
fondling me buttucks -
their shiny happy cheeks,
cuz that came fresh out of a shower
whatever twerks for flirting
maybe even an affectionate boop
thankfully me schnoz
just cute as a button
and said nosu not outsize nor adroop.

Yours truly solitudinarian by default;
Nevertheless, I recognize the necessity
to evince good humored nature.

I evince amazingly graceful social politesse,
whether non verbal acknowledgement
courtesy a genuine smile
or querying passerby
with cheery non-threatening risky
"how art thou?"

Hence a poem embedded
within aforementioned poem
Acta non verba... speaks volumes.

The above ad hoc Latin catchphrase,
which means 'Deeds not Words'
(concatenated with two English words),
I regale chance reader
immediately sets saddles ablaze
title of poem with timeless adage,
aptly suits this solitary
older male, whose daze
spent on planet Earth

aimless, colorless, goalless,
and objectless curriculum vitae
configures a zigzag maze
significant blocks of time
poorly aye now appraise
and rue so little forethought
wrought starry eyed glaze
amiss to any Amish,
colonial, horse drawn observer

passing by in their chaise
puzzled, asper my
doggone catatonic gaze
indicative as if me mind
lost in a foggy haze
yours truly attests,
concurs, he now flays
chastises, fulminates, lays
hard and heavy lament,

albeit cloistered frivolous,
lackadaisical, unproductive... ways
apathetic, estranged, indifferent...
ambivalent state comatose phase
toward life, when at young age
lacked joie de vivre evincing braise
zen lee oblivious zombie behavior
upon quick observation displayed craze
zee demeanor synonymous

with institutionalized craze
zee wardens of the state,
and at present realize futility to raise
hullabaloo, when 20/20 hindsight
shines figurative light on
how appeared to laze
about lost in space,
within outer limits
of my own twilight zone ways.