--- as a boy, I explored a hermit's lair
--- the hermit was not there, he'd left nothing but a tin box
--- of charcoal pills, a panacea for curiosity, I was told.

This old bearded fellow who lived at the foot o'thumb butte,
by the burro's water hole,
other side o'the hill from Doug McVicar's Jasper find

Tidal shorelines from my child hood
swirling through the softed rocks

Boulders on the bottom, roll on, crustal waves rise and fall

it all goes back to that 13,000 year mark
when Gobekli Tepi,
was in the building,
long long before
the Hopis were on the Pollen Way, leaving land marks on

Rocks risen above the desert floor

Some thing came from space, something very cold,
a snowball so big it tugged the ocean of magma
through the crust of the earth

nuclear glass, same time. nano diamonds

The younger dryas-

melt water pulse, fire from the sky, men could see that, with their own eyes.
and then they saw the clouds of witnesses

Rituals learned, the story heart seeps from mother to child,

at first touch some say.

Specialized touches were included in the 2.0s.
Holistic wuwu Randall Carlson laughs, why lie? Evidence, see.

What did you see when you passed through hell the first time?
Nothing, you kept your eyes shut.

Are you really
Experienced? That was the question. Ask the experts,
but some of them lie.
Never trust their clocks, that's wise. Time is too temporary to make
much difference
in the long run. Time, least of all powers in eternity. Chronos,
Chaos shattered him, and some story teller on a journey
saw the event
while his tongue was being tamed, a task no man can do.

Fire and Ice from heaven to earth,
whole peoples saw it,
with the eyes in their head

Hope is the key to the heart's lock on reality

The younger Dryad's oak burned,
Drought killed all the others, bugs killed the elms.

Ah spirit to spirit, compare. The heart of the world is weeping
for the ignorant eaters of poisoned poems and stagnant stories

speed kills when it comes to cosmic notes on rocks

patience, under stand the canopy of heaven can, filter
poison from those
stagnant stories's idle words, redemption draweth nigh,

count on it. Keep counting, patience finishes what she starts.

Sacred Geometry, scale invariance, I saw the Mississippi
Carve meandering ant canyons in the dirt
while watching the rain
Nothing's secret anymore, that's a reality that may be beyond

your thought. Textbook in stone. I know geometry Mr. P,

can I come in? She who builds, who destroys, who rebuilds, suggested
my bombs have a Nobel role,
in energizing

the ark
the earth is the ark, but you knew that already, right.

Acacia bush visions from a medium
of messaging the master builder,
who, you know, made this
happen, used to heal with ashes.

Healing war, study it no more, it is
possible man, alone, can imagine.

The Godhead? What's the big idea? You a heretic, Mr. P?

Come and see, leave the clock/phone.
---

This is big momma story, little clay doll with pointy feet
sticks in the dirt, stares at the fire,

the story mamma, shhh

Stands, and lifts her hands up high, pointing
all her fingers to the skies where ashes, glowing
rise,
like we can imagine the stars once scattered by God
and his sons's servants prepping

origins of human conflict taught
Tubalcain by fire light, while Jubal
Sang the very umph umph song from
Taj Mahal' 1970 with Jerry, Fillmore West,

A message to Garcia, from on high:
the imbecility of the average man—
the inability or unwillingness to concentrate on a thing and do it,
That, resist. It is evil.

Angels, imaginable, you know, mere messages, nothin more,

so great a cloud of witnesses
there was a times when  all
imaginations men were imagining heartily
were evil, altogether.

Enki left and went to the moon, or that's the story grandma's
sisters told me
when I was a little boy lost and found from time to time

The serpent on the staff, where's that story from?
Who says their mammy saw that happen.

Time, Hosts of Heaven, time is one of those.

Fan tasty taste, see, the truth is good.

Freedom, responsible freedom, take as granted,
intend good and go.
Seed of the Dream,
I planted that. It contained this fact,

we reap what we sow.

Ambi-Dios, ambit-ion with no hope for something just beyond
the best that I have ever done,
that'll make a child mean as hell, on the average,
according to the data Google smuggled into China
through those super phones,
unavailable in the USA, protected by the wielders
of destruction who eat the world up,
and drink its very blood.

the bread of shame, is fed to slaves to keep them in the queue,

BTW que-eee was the word I used for ****, when I was a child.
I took that word to school.
Nobody knew what it meant. I considered that cool
and kept my secret until just now.

I feel so free.

A builder sees a building and the builder in a single glance.
None may enter here lacking geometry, that's no secret now.
The cultivated Pythagorean mind, simple as pi.

'Cain't get to Romans eight, which is here, now, I think,
with out going beyond Hebrew six.

The measure of a man that is the angel. No comma,
just a jot, then this means that,
to the mind
listening for mystery in beauty found lying around.,
glistening in the sun.

I cried
Until the night died
And morning came to rise*

© Melissa Carlson 2015

Lawrence Hall
Mhall46184@aol.com
Poeticdrivel.blogspot.com
Logosophiamag.c­om
Hellopoetry.com
Fellowshipandfairydust.com

         The Honorable Kevin McCarthy Recognizes Tucker Carlson

                                      And only Tucker Carlson

The First Amendment defends everyone’s views
And does not surrender the nation to Fox News

I look forward to the re-enactments of historic moments in the pageant of The United States of America. [sic]

Gettysburg, Crossing the Delaware, The Moon Landing, Paul Revere's Ride, The March on Washington, The Storming of the Capital, The Clearing of Lafayette Plaza, The George Floyd ******, The Separation of Families, The Arizona Re-count, The Plot to Assassinate Democratic Governors, The Imprisonment of: Jared, Donny, Eric, Ivanka, Don, Carlson, Greene, Gaetz, Guilianni, Hannity, Conway, McVeigh, Barr [sic] (just to mention a few of the Founding ****-Ups.), the death of 650,000 people (the vast majority being innocent), The Pandemic of the Unvaxxed [sic]

After July 4, 2024, History may never be the same. See it now!

Why* do they appear so mystified?
As if every little thing must be justified
Moved to fit inside their small box
And look away when their key couldn't unlock
What they aimed to achieve
Does it ever make you giggle
When people call you fickle
But they're the ones whose eyes are fixed
On an object not quite literally applicable,
Something regarded as abstract, typically unseen
You see: I am a metaphor
And people stare at me.

© Melissa Carlson 2015

Preparations are gearing up for the iD Dunedin Fashion Show, which this year opens with a tribute to Australasian style on Anzac weekend.

The 120m-long platform of Dunedin's railway station is again the venue for shows on April 24 and 25, which are preceded by the iD International Emerging Designer Awards on Thursday night at the Town Hall.

Saturday night is sold out and about 100 tickets are still available to Friday's show, organisers say.

Labels Carlson, Mild-Red and NOM*d, brands synonymous with Dunedin fashion, were in the original show in a local bar in 2000 and they're still show stalwarts.

Company of Strangers, Charmaine Reveley, DADA Vintage, Storm, Perriam, Deval, GG (from Shanghai), Liann Bellis, BEATS clothing, Jason Lingard and Jane Sutherland are also strutting their stuff this year.

The shows open with a section titled Together Alone, Revisited, put together by Doris De Pont, featuring garments by four New Zealand and three Australian designers shown at an exhibition at the National Gallery of Victoria in 2009.

International guest judge Doris Raymond, the star of documentary series LA Frockstars, is also bringing some garments with her for the show.

The owner of vintage emporium The Way We Wore has a fabulous collection of outfits and she will talk about them at an event in the city on Friday.

Six fashion graduate designers from the Otago Polytechnic School of Design will also show their collections in the shows on Friday and Saturday night.

Garments made by the winner of the emerging designer awards are also in the show.

The finalists were selected from nearly 100 entries from seven countries and 14 fashion schools.

There's a strong showing from Australian schools, especially from Sydney, says judge Tanya Carlson.Read more here:www.marieaustralia.com/evening-dresses | www.marieaustralia.com/short-formal-dresses

Lawrence Hall, HSG
Mhall46184@aol.com

         A One-Line Dismissal of Tucker Carlson Isn’t a Poem, But…


                                   Democracy dies in dorkness

Hi my name is Spencer Carlson
And I swear to god that I'm an alien
And all my attempts to be human
Have only left me more isolated.
As the boy waits
To get drunk at the party scene
A nomadic nowhere man
Dreams of what life really could have been

And I'm
Sitting here listening
To silence waiting
For it to finally
Change it's key

And I would give anything
To hold you through the night and
Tell you that everything
Is gonna be alright but
My arms are tentacles
And my teeth are razor sharp
And every time I reached out to you
You always pushed me back into the dark

And I'm
Sitting here listening
To silence waiting
For it to finally
Change it's key

And I wish that I never knew
I wish that I never knew
What it takes for you
To forget the pain that's haunting
That’s haunting you

I dream to be the one
To save you from this hell but
Everybody else shows you
Ways to save yourself so
What does that make me?
I don't know I'll
Never be as good as a drug
So I will just go where

I'm
Sitting and Listening
To Silence waiting
For it to Finally
Change it's key

https://spencercarlson.bandcamp.com/track/alien

My tired eyes cry
My weary body lies
And why do my tears
Think they cannot dry?

Shaky hands and nervous throat
Exhausted heart, this stimulated soul
They ridiculously wait, day after day,
For a break from sorrow, a thing called hope.

How is it that I can live, but it is the hardest thing I ever did?

© Melissa Carlson 2016

The old codex action plan for publishers,
25c. 1160 was born. 184600, Alice,
still Akila arrived in Sicily, 600, Griffin's
last streets, Christianity, philosophy, religion,
school, the Philippines, school, psychiatrists
can live, the first churches, the experiment
and Apps per quarter The Petros House,
by number and value Fuscelli,  Oregon Alexandria,
Illinois (AEC). , [253] AIRLIVE Bodalla
[biblical library], gay, after exercise, t
he first medium of theology, injuries, Alexandra,
a tragedy in various religious distinctions
of christian writings, theoretical logic
for the behavior of the first man. "The first ecosystem
rarely exists". Google, ****** and Northland
are now popular with numbers. She hid her praise,
took her saddle, smooth, dug at Tues Khong Khong
Pigworth. The quarters are the hands
of the craftsman, our dolphin women?
Are you friends now, Cyrus Kaiser? Sun Ignacio,
North Carolina, Soloboid, Salvador Dali, Matt,
San Diego, California Robert, San Paolo, Brazil,
Brazil! L 8 30 you own Adachi advertising
from North Carolina, compared to the UK,
and the Kings hand comes from the British Lindy
Brigade of Hiram. The Secret of Normandy
is one of the worst testimonies for the well-being
of Harermama Hermes. He opened at the Olympic
Horse Carlson, upsetting Han. [Central Park]
There are many market services that provide
indices on Google services. Is the health
and fitness level of the system? The robber
comes through Christ, Knights, Visa, Calico
Willis and Robert A Roses and Robert, Robert,
Hard Tony and Christian Democrats. The company
is a good history of the photo history of VRIID
in the US. "Faith", "I". Read Newton like Malice,
the Knight's Knight Morris' genocide and American Felix.
Another reason is that we must not forget.
Because you know a little frustrated fraud
suppression Chris, Christina, Christina and Christina
© Kennedy, Google James Joseph.
The West is not a political issue, the cause
and the evolution. Igor resembles Google
as part of the industry report. For Washington,
he is a star in the United States and Britain.
A move from the fire. He is the leader
of the state on a threshing floor and the width
of a single region. Once the song music corn.
In other countries, however, KCRECT
on Saturday is the layout of Plan Rucker, 28.
Born in 1160. For the first month and on average
the boat, Alexander sad for the various differences,
the interpretation of the bridge for gay exercises
is a first-person wig's spirit with the theoretical logic
of Christian teachings of scripture. "First, much
of the ecosystem is ready." Google ****** East
is just as popular with the most popular flowers.
& Still does not follow the law, but the rules
are unfair. Is Duffy happy with the gallery?
Now that we were friends with the solar eagles,
North Carolina. Salboobun, sandwich production,
Leo, Matt, San Diego, Stuart and Robert's
Bloat on City of Saint Paul brasiliensis, Brazil,
Spanish Vilnius. 11 or persistent 30 to receive
an ad from Oregon Server Consultant, UK:
British Home, British Kids, Hermes, Eastern
and Orion Palace. Haram Hermes Trismegisto
Hermes, criterion, mysterious man. Open
Norrøros's open rollover by Marcus HAN.
[Central Park] Many customers will use Google's services,
health and fitness. Robert of the Knight's
Mat Video's gilded life, Willis Peanut Pistachio
and finances. Robert A. Chris Robert
and Gloria Robert and Robert Meetings
under the umbrella should not be protests.
The Civitios photo is for America,
have fun. harem; plural noun: harems
(in former times) the separate part of a Muslim
household reserved for wives, concubines,
and female servants. synonyms: seraglio;
zenana; women's quarters "the inner rooms
of the harem" the women occupying a harem;
the wives (or concubines) of a polygamous man.
a group of female animals sharing a single mate.
DEROGATORY a group of women perceived
as centering around a particular man. "rich men
with their extensive harems of buxom blondes"
Origin: mid 17th century: from Arabic ḥaram,
ḥarīm, literally ‘prohibited, prohibited place’
hence ‘sanctuary, women's quarters, women’,
from ḥarama ‘be prohibited.’ "Sphere", "1",
James Newton read APAMEN  Honey Model,
Honey, Chris Kitty and US Felix. Another reason
is that we must not forget. Ice cream is a coat
without maintenance and let your heart be.
Chris Christie and Christine, Feministas and
Christine Kennedy, Google, James Joseph.
Western state is that the program does. Douglas,
on the rainy side like Google, Igor. In Latin America
and the United States, Washington is a planet.
It means fire. There is only one large area.
In earlier times the sweetness of Songisticus
and also the spiders. Standardized in foreign countries.

My heart needs a lock;
Give my mind the key.

© Melissa Carlson 2015

Poetry is the weeping eye
it is the weeping shoulder
the weeping eye of the shoulder
it is the weeping hand
the weeping eye of the hand
it is the weeping soul
the weeping eye of the heel.
Oh, you friends,
poetry is not a tear
it is the weeping itself
the weeping of an uninvented eye
the tear of the eye
of the one who must be beautiful
of the one who must be happy.

by Nichita Stanescu, translated by Thomas Carlson and Vasile Poenaru

she feels words like pictures that move
reads books solitaire with the afternoon
coffee on her tongue
she turns the page
sets her cup down
and marks her place

in her mind she tries to find
a single place where thoughts subside
and try she may
to drown her lies
only thing wet
her lonely eyes

© Melissa Carlson 2015

stop comparing yourself to other people. please? you are just fine, you're beautiful and i accept you. you've got to stop calling each other names and labeling each other based on the things that have been said to you. let the past lie. you're perforating your dreams. they'll die and you'll have nothing left to go after. i don't care how long it takes to assure you that your worth isn't ever going to be defined by what's been said to you. you animate the wildest sides of me. you should believe in you because i believe in you and you should too. stay you, but be happy and trust in the One who loves you every single day. even though you are in the condition that you are in. you'll be perfectly okay.

© Melissa Carlson 2015

the spiral takes place
in your heart
in your soul
and on your face

it'll knock you down
spit you out
twist your mind
and linger about

the spiral, what pain
the journey, the spaces
all these empty places
they leave you insane

unexpected interests
(un)desired love
unrelenting emotions
used to feeling numb

the affect is collateral
the hurting are told
handing out pieces
not meant to be sold

the spiral takes place
in your soul
and on the faces of the people
who see the pain you hold.

© Melissa Carlson 2015

For those who do not remember the past are condemned to repeat it.

© Melissa Carlson 2015

if tonight's your last
and yesterday's past
intimidates you or
relentlessly accuses you
of the things that
once enchanted you
and you take a slap in the face
you cut to the chase
there's no time to waste
but really you're stuck
you feel out of place
and the rhythm of the sorrow
drags into tomorrow
because you cannot forget
and there is abundant regret
draining from the scars
that you've tried to hide
that you've put aside
and in reality, your soul
IS TIRED
of waiting, of praying
of feeling like it's straying
you breathe, you sleep,
you live as if you
were not dying
you're still trying
TO BE OK
but you are broken and
you cannot cope
and all of your hope
has gone up in smoke
to where has your spirit flown?
LET GO
for the love of God, release
give it to the One you seek
to Him whom your eyes have not seen
in this moment, you are
FREED.

© Melissa Carlson 2015

I am not yet who I am supposed to be.

I have a past; I have regrets.
And there are words that I'd love to take back.

Shame can take me places I wish not to be.
Those things that I have done come creeping back to me.

I feel like a child who's lost and alone. I never feel safe, I never feel at home.

My eyes are blind, can this be? I feel like a prisoner who won't be set free.

© Melissa Carlson 2015

books are our friends
they will never betray
or fade away
they will not leave
or walk away
they are here to stay

© Melissa Carlson 2015

If I was to write a poem
On the story of my life
Words would fill those pages
As the stars steal the sky.*

© Melissa Carlson 2015

i want to be a child sometimes. i want to embrace life's experiences with an innocent smile and look upon others as though they were understood. i want to take back every sane thing i've said and just completely let go of everything that is keeping me from living my life as intense as i crave. because it's okay to not be okay. it is okay to want to change and be somebody else for a time; just promise me something:

don't let it overtake you, steal your soul, or trap your spirit.

you're beautiful, child, see the loveliness that rapidly grows. peace spreads like wildfire from your smile. joy is evident in your eyes; it demands to be seen.  pain, though felt, is NOT what defines you.  you have been remade, and i love you. i love you so very much.*


© Melissa Carlson 2015

Dear Grandma,

I love you. So much. And I smiled so big when I opened my e-mail and saw that you had already replied. I read your e-mail to my mom; we laughed and smiled together. I'm glad that you and Grandpa can laugh while reading my writing. It makes my heart glad to know that what I have to say makes a positive and impacting influence on my readers.

On being careful to not dispose of items...you are so right, and I thank you, ever dearly, for the amazing, experiential advice. It makes me think of times I've been upset and ripped out pages I had previously written, all because of some stupid thing somebody may have said to speak death over me.

I doubt that I'll ever really understand what certain people mean when what they have to say to others is all but joyful and/or uplifting in any way. God knows, though, praise Him. I've been trying my best to speak a lot of life into my heart and soul. I had been super busy, and as a result, I hadn't had enough time to really sit and ponder the way I sometimes, negatively, judged those around me. I silently speak death over them, in reality, and to me, that is one of my most disliked qualities. People should love other people. Now, I want to add in, as a side note, that SPEAKING THE TRUTH IN LOVE counts as speaking life, and not death. I wish more of us humans were blunt and honest with ourselves, as far as telling somebody the very raw and complete truth. Nobody is ever going to get anywhere by being compliant their whole life. I feel so strongly about this because when I am down and not doing well, it DOES NOT help me to be told things such as,

"You'll be alright. Everything will be perfectly okay."

Lots of times circumstances stink, and when they do, it sure doesn't help me to hear somebody whisper that it'll be okay. I just need to be told that whatever I got goin' on, just kinda ***** at the moment. And maybe it will for a long time. But someday, I'll be glad to have had that experience, no matter how bad it might have been at that time. That's what I wish somebody would say to everybody going through stuff. Everybody needs somebody who will be life in the middle of his or her sadness.

Anyways, that's really inspiring about Green Mill, and how you were inspired to write what would soon be the prologue to your book. I really appreciate that; thank you for sharing your experience with me. It made me feel like I was really there, by the lake. I could almost feel the soft, cool breeze blowing my stray hair around. I could almost hear the little waves softly crashing to the rocky "shore." I love it when that happens, when writing becomes something I feel, and not just something I do.

I am so glad that you are alive, Grandma (and Grandpa). You are quite swell, and I mean it. I love you both so much.

© Melissa Carlson 2015

I feel so alone right now
I look through my empty eyes
Just clinging to anything, anyone
I'm so tired, the pull is getting stronger
Sleep is useless, I dream no more

I'm being pulled into The Black Hole
I can feel that familiar emptiness
It's here, I don't want to fight anymore
I can feel It surrounding me

I'm inside looking out at life
Do I want to give up my life
Should I call out to others for help
Can I reach out with my hands

Maybe I'm too deep by now
Maybe I'll turn away and just fall
Do I really believe anyone cares
I can't decide, it's too much

I can see people I used to call friends
Maybe if I jump, I can grab the edge
Then I call out to anyone at this time
You heard my cry and turned to me

You reached out your loving hands
You took hold of mine, I felt different
The Black Hole didn't want me to go
I wrapped my hands around yours

You pulled, It pulled back with force
I was starting back up to the light
I looked up into your pools of life
I could see unrequited love there to

My heart and soul were overflowing
I could feel the grip of The Black Hole
This time, I chose to fight for my life
You pulled and I kicked free

At first, I felt very vulnerable
You wrapped me in Your arms
There are no words but I hear you
I feel and hear you in my soul

My depression blinded me from You
I was so wracked with my own issues
I forgot to look for a reason to pray
I forgot Your promise to all of us

Your promise to always walk with us
Your promise to always listen to us
Your promise to always care for us
All we need to do is to be humble and Pray and You will forever be there

When you feel like you have no one
When you feel like your life has let you Down and you can see It coming
Turn away, clear your thoughts
Humble yourself, get down on your Knees and pray

If we don't ask for what we need
With your voice, God loves to hear us  
He can't help unless you give your     Whole heart and soul and trust Him

He has promised to help us fulfill our Lives when you believe in Him
Jesus Christ is our only way to eternal Life, to be with God and your family

Jesus Christ pulled me from my Black Hole, my life is not perfect, I still live With problems in my normal life
The difference is I added Jesus Christ And God         I Believe      I have Faith

Written by Julia L Carlson Vogel
Please do not copy and pass as your work.  
@Copyright Julia L Carlson Vogel

is love a pat on the back;
                                                   a handshake exchanged?
                                                   is love a smile unseen;
                                                   a song to ease the pain?

                                                   is love meant to last on and on;
                                                   is it there to be true?
                                                   is it meant to stay strong;
                                                   is it for the soul who's blue?

                                                   is love so sincere as "i love you;"
                                                   is it as informal as "see you soon?"
                                                   is it misused or confused;
                                                   has it been very terribly abused?

                                                   if love has more than once abandoned you,
                                                   if love has more than one time rescued you,
                                                   if the one who said his love was true,
                                                   has not for long remembered you.

                                                   love is too casually thrown around;
                                                   and love is sometimes better left unfound.
                                                   the thing about love is that it's meant to last,                                                            ­                                                                 ­               
                                                   but so many times love loves too fast.
                                                   -mc//

© Melissa Carlson 2015

Starlight
                                           fluttering over
                               the great euphoric episode of
                                                Victoria!
Cosm­os being packaged in the mail,
on its way now from Britain,
Sitar dancer on the inner harbor
jingling end time tunes to the ears
of the grateful.
Today is WEIRD!
Everyone is shaking hands and waving from Summertime fields,
                                 laughs escape the rooftops,
                          Owls begin to wear brighter colors.
                                Near August, post three day
                                  Northwestern Monsoon
                                THUNDER    R a-T-T-linG
                                          Double Decker
                                          past romances
                              on highways approaching
                                        The BC capital!
Articles topic the Utopian evidence
of the current generation
nearing Post Capitalist society.
All peoples smile still!
(Wouldn't that be something?)
Telescopes discovered Kepler 452b!
Another world, very much like our
own (I wonder if I'll see it one day)
Round-frame black hole glasses
Enamel downtown in golden tint,
solidifying this happiness!
                            The day is a colorful child
                            bestowing chalk drawings
                                 upon the asphalt.
            His Years 'round the garbage corner now.
                     India crafts a crown of laurel
                           For the innocent youth!
Sin predates them by centuries and wars, ***** and outta-lucks, paycheck to paycheck psychological warfare with the Western planet!
             But they're predisposed to the silent decade of
                                   internal purity,
              that BIG BIBLE BOOK has granted em'
              A get outta hell free card for some
                                 ####   a-years.

(While Virginia Hampton Roads Bridge-Tunnel 2011 mind-flash nostalgia permeates in my adult brain.

While North Carolina Top Sail Atlantic
sea salt stings thru my nostrils,
body boarding few miles away from
boardwalks with a nighttime view of
Milky Way Forever! (Age 14)

While Seattle shimmers aluminum skyscraper lights, Emerald City Winter where outside my hotel window I focus on
the Space Needle distantly blinking
the spirit of
Edward E. Carlson and John Graham, Jr.
up up up to Dharmakaya!
That improv performance near Pike Place Market with Charisma, Julie N Severen! SPONTANEOUS WISECRACKS BEING PAID TO BE SPONTANEOUS WISECRACKS.

While Seminyak, Southeastern Orient, Is hailed with cloud-formt waterfalls, and I watch, containing the inexpressible joy of that particular moment. Mind relapsed to whispers of Dakini,
(Contentedness possible in adulthood after all!)

                                   Celestial energy rebounds
                 thru all entities on the sidewalk including myself.
                  delivering metaphysical felicity to all future loves
                   who find occasional joys in the cycle of living.
                         Who make more of themselves than
                                 tying their shoes to sleep.

please don't take to heart what that bully said to you when you were 14, when you were just learning to survive and he told you to die. and it's okay to cry. bend you might, but break not quite. you'll be alright.

tomorrow, if not tonight.

© Melissa Carlson 2015

Distance is the cog wheel
on the haunted axle of my hearing,
grinding fine the deadened mind
of that unborn god
waiting to be caught
by the earth's blue speed,
and carrying in a handled urn
the plucked heart - ours,
it's beating, it's heard, it's beating, it's heard,
a sphere in wild growth -
the roads are wet with tears,
memory frail and elastic,
a sling for stones, a gondola
drowned in childlike Venice's,
a tooth yanked from the cells with a string -
down the empty socket of Vesuvius. And you exist.

by Nichita Stanescu, translated by Thomas Carlson and Vasile Poenaru

As Putin continues his ****** quest
To ravage Ukraine, we watch in shock
As innocent Ukrainian
Civilians are dying around the clock.

We have to constantly ask ourselves,
"Is all of this dying worth it to him?"
If this is part of his ongoing push
To expand his rule, the future looks grim.

Announcing phony accusations
Before the UN is part of his plan
To craftily legitimize
His propaganda as much as he can.

Of course, conspiracy theorists here
Are siding with Putin--our adversary.
Fox News Channel's Tucker Carlson
Spouts pro-Putin commentary.

It's almost as though Carlson has
A means of direct communication
With Putin, whereby the two of them
Can further their mutual adulation.

And so they continue to throw spaghetti
Against the wall to see what sticks.
Watch the results as the two of them
Keep throwing lies into the mix.

As both Putin and Carlson peddle
Disinformation, people are dying.
How anyone can justify
Such senseless bloodshed is mystifying.

-by Bob b (3-13-22)

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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