Fragile egg-shell mind on dawn’s highway bleeding the segue between times traversed only in momentary dreams or in enduring excursions

We drag our droll and quaint 60s baggage like the luggage of a safari made of concrete girding a cavernous expanse of unheralded ground

With our ears oriented to the floor, we leap out of body never to deplore….never to ignore….never to miss the blue bus of our drafted imaginations, so carefully culled from brash elitism

I trounce the intervening time between being friendless and an ironic end, and an irenic comrade becoming the dearest amazed but always aplomb friend

We simper in our glorious traversal, and though bedraggled through an ornamented cavern we linger just long enough to be celebrated

Then a blues riff emanates from a vapid bar, and finally someone heralds my exhumed memory still rusty with the pavement of encased concrete on an empty or full tomb

So I wander in my mind to that roughshod Paris glassy tincture a romanticized gild of proper sensibility crafted in the tongues of lizards emulating the tongues of serpentine Anglicans

As the power of love transcends the love of power, both are afforded serendipitously upon the stately occasion of a fitful revolt where heads literally rolled and deaths still unfurl from the slippage of a violent malevolent eternity, crafting a new creative way to expedite the smite of preventable scourge

So, I see your picaresque side and your wide-eyed love for a listless ship anointed of a crystal blip just detectable long enough on RADAR to become the statistic to crack the slim WHIP

No wigs are needed at this formality, no figs grow from trees forty-five years buried and almost a full month unsung

Pitiable cretins of an invented insanity, they scoff at my ravenous and portentous heart for its excess and for aligning with an upstart verging on only a specious insanity

Why in all humanity could a month be mustered with every defense of history and yet for it to be so widely flouted as a risible exercise in futility

The irony that the artistic glamor of a past vogue becoming a revival that is often toked only to one song but never to the memorial of great cavernous and commodious imaginations, staggers with dismay where otherwise the mayday would be a disaster but still a great day

Then I look at a triggered-fingered omen of a death so ominous yet so brazenly confronted as the ambassadors of time provide plaudits to a fearless martyrdom

Why such a sad spate, why such a stringent but malevolent fate a malediction on a family whose crest is not crestfallen like rolling waves but ornamented with gravity impounding its own weight

A fugacious tomb, an eternal flame, a swan song announcing an independent authority on a prescient demise mashed and deprived

A single shot rippling through the broadened space between clasped eternity and a histrionic disgrace as a psychological confederate pays lip service to a reiterative applause

A cousin hardly American in a defected record of incendiary plumes of a hoarse hatred of waxen discs and flying discs alike,  climbs out of a bonfire mounted purely out of vindictive spite

Then upon a great white buffalo a wrapped package of Californian love before California ever alighted like something beyond an avaricious dove, saw a rocky park and a hearth of illuminated darkness the singular spark

Captain Morgan knows the jackknife applause of a botched deal morphing into a disbelieved spiel. A shibboleth of enormous mystical weight crashing down from an ethereal abode and heaven heavily saddened cannot hardly appeal

Then a loving spoonful of crystal blue persuasion led me to Ethel’s regimented keepsake and for once in my life nobility and I became a grateful waif. But temerity laughed, splintered spacecraft, and the wooden paws of a bearish applause led to resurgent clarity

Blinking stars shattered by knighted and raw applause punctured the liberated might of a sentient hortatory savior grasped by the internecine wrench of a waxen time

An indie track slides by unnoticed in an aleatory time, and the threadbare whine of centuries of lament becomes a dastardly barn set ablaze with the fury of ancients and the scurry of faineant patents

Perfidy slides in recess, and in gentle forbearance the winged angel lingers like a halo on conifer and spring above a remedial ring

I dial frisky celerity tingling the dangling claws of a raven’s screed and in plunder of all history’s pilfer secrets I eagerly weave a tapestry Indiana Jones himself would be proud to watch

Not the riotous ruin of a mystery tour of verdure crippled by genocide but overcome by the revived life of raised rain razing the moments of indelible pain

But the culmination of a proffered time taken at its word for its every careened bird, for its every brazen gird. The manger of proctored stars calls us home tonight and home forever. Life in quaked timorous stumbles suddenly no longer so fitfully absurd.

The quixotic plundered of pirates and emperors in direct emulation of some crooned pastiche of whittled integrity, surges above any encased blurb and any vain testament to a pyramid rigid in destiny and ragged in desultory and sturdy sincerity

Multiplying the ineffable by the division of arable divorced from edible is too creative to be eaten as pabulum when sparks curdle flickered moonlight crimson and that become golden only to the last laugh of ennobled ragamuffins

Frankly the desert of melliferous gorillas abetting the lark of a heavily vetted camarilla engaged in the sinecure of a rigged wall on a main street to block the tall from the lame bleat. Stocks grazed, costs engaged on a littoral beach at the end of a Bossy promenade

This prayer is a cutthroat collapse of a merry spare, a ribbed ****** waiting to plunge into the antithesis of female despair, but sincere in its restraint that vixens courted in love aren’t courted in litigation of a wagered dare

Ambulances chase Deloreans through the desolate moon-stricken skies of a time agape with fleets of phantasmagoria on a Cliffside too wise to ever mince words or excise cries

Skulking the red-teared caverns of entombed films and lampooned tinctures on a passion vetted only for certain and utter deracinated disguise, I wallop with winged men in a single soul Armed to the Teeth with inveterate tithes to eternal internments of poached and endangered gazettes

As growth older in wizened skin bets on epithets rather than epitaphs for rinsed peace and triumphant clefts we leap above in orbit of only the bellowing nether of blown tolls and untold souls aggregating the esoteric grasp of Alexandrian tomes

The denumeration of certainty is a carousel of wonder, a splurge of time ripped asunder with majesties of paparazzi scuttled impacts a throttled iniquity of regalia’s indicted blunder frenchified but still clean with inestimable sheens

With twenty-five dollars, a dime an assist and a nickeled reiteration of currency already so personable it is divine and sublime in crazed desist I watch the embroiled natives clash in denatured violence with the warriors of a crossed repast hearkening to an old land much of ire but too much of grandstand to ultimately last

Itching for a holy field husk of peerless ties listed as rumpus and beer, a two-packed smoked by bludgeoned blokes careless in irascible sputters of a muffled doom, a Vegan becomes the author of too many sacrosanct homilies becoming defiled witchcraft brooms dead on arrival too many lionized tombs

In plaudits and the scause of an amplified “what if?” of an olfactory nightmare of petrified fog of effluvium bogged in Wade and in heat it is always clogged, sinewy libations of toasted preemptive revenge become a powerballed hog

A castle in the sky founded on Franklin but scourged of wineskins brimming with a distilled time, a swift repartee becomes the whispered ladder of saints blather becoming not rather other than a Dan Rather spatter

A door breeched by a broached inconvenience of amphigory beyond common reach, I clamber excess and whisk the lingered love into destiny beyond any word other than a beseeched preach of nothing tired but everything inspired of noble love with abundance often to teach

Fireworks of turned tides of fallow tithes to aliens beyond any conceivable bribe the bushwhacker writhes but survives Stayin' Alive without even a hint of garbled jive a 27th floor glass elevator is quite a resplendent ride

Wellsprings knowing radical rolled tides of errant dice also themselves guilty of confessional tithes to the monolith of avarice at the nooked cranny of an evaporated time we whine as the police sting the album rained with songs too lugubrious to sing but in their elegy every lonely heart has a propinquity phone of souled resonance ring

Iterative mastery of a mathematics of love, loss decay and the dross of a dental Occidental floss, the sweep of screened queues become questions of inestimable importance to foreign dues on A Horse With No Name but so consumed with fumes

A fright occultist Thriller prowls in a waylaying daylight, masquerading an innocent confection for a rescued triage of a dawn stabbed with knives in our last dying days of trembled plight

He resurrects only the wraiths of detest, squinted at by the putrefaction of summoned cardiac arrest and littered with bullets that somehow can penetrate even impregnable bullet proof vests the wrapped carcass of the mummified husk of ready despair offers itself a ghoulish and raspy prayer

Synchronized in a low roaring swathe of rollercoasters too immersive to ride, the terpsichorean obscurantism of deliberately shattered fragments becoming blurbs dismissed with hijacked deride the carnival of a summer sun becomes the ocean of limitless love becoming endless fun

We forget the drawl of the droll old tales that haunt like specters in the closet and beneath the bedridden valetudinarian of an effrontery of shackled fright, we sprawl the innumerable caverns of prophetic insight afforded by the pantheon of history enter stage left, depart stage right

And with their insight I write and write, I grasp the tusk of democracy and wage an insurrection against the doubt of plodding limitations in otherwise immaculate sight

*** and tyrannosaurus rex, of litigable offenses leading to pardonable arrests, the gated entryway of a poetic splurge leads to the demiurge of a demotic enlightenment and suddenly the frank becomes the frazzled retirement and that haunting hounding bunny transmogrified by a shattered eye averts the car crash that careens ponderous engines out of limitless twilight blue skies.

Diamond lightning in pristine skies escorts the telegraphic totems of riddled modems from distant forbearance to nescient ultimatum and suddenly all venerable personages converge on a teeming scene of a union unified by a universal dream. To become everything and yet nothing and out of light and darkness to become a beatific beam

Mixing tea, let's say lavender with something as simple as milk
Must sound silly and weird at first glance, as both come with their
own tastes and flavors which seem to not match at all.
Even the most unmatching couple can find bliss, harmony and
perfection in their very relationship, however.
Such as for the tea;

The milk manages to soften, embrace, advertise the taste of lavender
while leaving a pleasant aftertaste which is alike a ghost poorly
detectable, but present nonetheless after all.
With some sugar to sweeten this experience, it becomes divine,
something I would never have thought of, of such an odd couple.
The image of the lavender becomes overdrawn by the milk,
Engaging in a pure, creamy, brief white which reflects light just
in a majestic sense.
This is a taste to become lost in whilst reading a book in the best
of lightings, together with someone who causes your heart to race
and just turn ablaze

~ Umi

I don’t care,
That you don’t care,
About caring about
What I care for.

And you know what?
I don’t care that
You won’t care for
the only thing that I really
care for.

What if I care about
cake? Would you not
care about cake?

Would you not care
ABOUT CAKE?

You care about cake, of course you do.
I can see it in your eyes and by
that tell tale dribble at your mouth.
Cake is something that will
make your legs quake with
butter cream goodness.

A good cake baked,
makes you proud to be
a cake baking citizen in
a country that will let you
bake cake.

So what if I care about
democracy. Would you not
care about democracy?
Would you let people live
in fear of the **** of a gun,
Would you care that there
are those who are on the run
from tyranny and violence
who know pain and loss,
that you could only
wake up from,
in a cold sweat?
As you turn and toss
in your memory foam bed.

There is more happening on this Earth
Then cake.
There are greater causes
than choosing between
Thortons Double Chocolate Celebration
and that traditional Victoria Sponge your
Mother-in-law won in a raffle last week.

The struggle humanity faces, is to live
in harmony with each other.
It cannot be resolved with cake.
You cannot bring democracy
to a country with cake.
Or can we?

What if we swapped,
Non radar detectable aircraft
For dairy delectable foodcraft,
What if we swapped
12inch shells for
12 thousand babybels?
What if we stole
RPGs and gave back
MSG’s (they’re less harmful
in the long run, if thrown at you).

What if, for once, everyone cared.
And then we’d get somewhere.
Every voice in every home
Would not be a voice alone,
And for once, we’d all agree about the fact
we like cake and democracy for all.

Say hello to the monsters.
The ones that bed in you,
The ones that reveal themselves
The ones that turn into one
And the ones that find you.

Monster n°1 / The Fake One
This monster would want to prove itself and will use you because it can't depend on itself due to its insecurities. It's easily detectable.
This one is the least harmless.
All you have to do is simply lose contact - it won't need you twice.

Monster n°2 / The Backstabber
The one that crawls behind your back and leaves prints with every step it takes.
This one is the most vulnerable.
All you have to do is turn around, catch it and watch it tremor in-between your fingers.

Monster n°3 / The One That Dances With Your Demons
This monster dancer would do anything to get under your skin and show you what you'd wish to see.
This one is the most naive.
All you have to do is notice how it agrees with you on everything that comforts you instead of everything that makes you step forward.

Monster n°4 / The Puller
This one acknowledges itself as a monster and would show you, with all its ways, a road that meets your eye, but effectively, this road would eventually lead them to their goals.
This one is physically the strongest.
All you have to do is be mentally stronger and K.O. it.

Monster n°5 / The Choker
This one is an alpha monster. Its aim is to destroy you. It knows your power well and would do anything to stop you. It will make you love it as it poisons you. It would wrap itself around your neck and you wouldn't even notice.
This one is the most dangerous.
You can do nothing about it but seek help from people that can save you from all of what that monster has drained you from.

Say hello again to these monsters.
Now that you know them, don't become one and don't let them in.



- LynnAA

The *** with match, lit the fire
scolding kettle with burnt goaless ambition.
claiming snobbish golden prowess
paid in wanton , savage, screaming tuition.
"It is I" said ***
"Who has sent aromas of worlds
preperations in lifes gluttonous lust
smiling rewards genorously hailed
with slothed culanary trust..."
"tis true" whispered kettle
"It is I, the ***,
forged in iron clad
who in laborious toil
so generously cast my sweet savory scraps
amongst your soot and soil..."
"tis true" hissed kettle,
"For I, the ***,
adapt in multiple arrangement
of compliment and comfort where you lack
with singular solitary function
wailing, seared and scarred in black..."
"Tis true" whistled kettle
"I, the ***,
filled in glorious substance and magnificant sustenance
praised in lifes delicate, vital, victuals and viands
in with which I do enhance..."
"Tis true" howled kettle
"Yet it is I, Kettle,
in further fashion of design
than copious function in fare
do not heed your song and dance..."
"Blah" clammered ***
"For it is I, the lowly kettle,
sing to each melodious morning
to begin the days
unknown magical soaring..."
"Pishaw" growled ***
"It is I, kettle,
bestowed in somber, modest truth of fact
nakedly express that
you too, my dear ***
are simply black..."
"humbug" steamed ***
*** humbled... kettle mumbled...
"It is in each honorable day
we serve our distinguishable stay
in detectable unadorned identicle way.
"Tis true" said ***...

I would like to think of myself as an intellectual, but really I’m just a regurgitation of the adolescent caste system with academic anxiety and a learned fear. Well, I suppose that is a bit harsh. I used to be social *****; now I am a lowly intrapersonal custodian (let us never mind my inter-personal mess-managing, please?), though I am far from clean. __ I have found myself flitting back to this page from time to time and mentally inserting here a terse, self-degrading statement that could re-catalyze my pitiful little verse, but never actually writing it. I hold it heavy in my head where it shall remain, apparently. Apparently I don’t feel the need to read my flaws, transgressions, and fallibilities back to me. Perhaps I haven’t yet articulated them, and they’re just skulking around—hunched apparitions haunting my subconscious. (Death smells like dog treats: perplexing, but you want to touch your tongue to it so long as no one will know). I must slay them all, eventually, or else perish. But! It is not the transgression itself that I fear—my behaviors are observable, even tangible, I can stare at them for hours. It is the dark implication of the transgression—the churning matter only detectable for its outline of illumination—that gives me trepidation. How will I move-on? How will I grow-here? Like an impossible little spur that nestles between resistant skin and unknowing fabric? Can I penetrate the protection? My security is maniacal; it is evidence of crazed disillusion. I am the raven clawing through infinite veneers; I am tangled…

Out ****** spot! Out, I say!

I must regress to becoming the white blanket.
I must know nothing but God.
A simple cloth.
A towelette.
Rags!
Rags!
Rags!

…

….

…God?

…Hello?

         …Is it too late to become

…plain?

Sport has turned words like animal, beast, freak, and super human into words of endearment.

History has regarded these words as fearful, nightmarish, strange,  and blasphemous.

Yet mecidal advancements have made these words. clone able, detectable, observed, and revered.

Kinda made me think.

In 82
words, I add 6
locks for 88
keys, then wait!

In a perfect world,
the skin of these 10
fingers would be gloves for the sinews beneath.
In a perfect world,
my 32
teeth would sing psalms to the brush.
In a perfect world,
my 2
eyes and 1
heart would beat and blink in unison,
and behind the ashen sky
the majesty of interstellar space
is almost detectable.

And in these 82
words, the world
becomes perfect,
albeit briefly.

The house is full of horrors,
This house, it owns no love.
The air is filled with madness,
The floor boards moan in sadness.
The sounds it makes at night,
And the walls, blood red and white,
Represent the turmoil that’s going on inside,
But everything is perfect on the outside.
The grass is trimmed,
The flowers bloomed,
The hedges cut,
The paint renewed,
So people walking by they smile,
And continue on their way.
But the house it cannot move,
For a house wasn’t built with feet to run,
Or a mouth or eyes,
To tell you something’s wrong.
This house it carries on,
It has to stand up strong,
To support the demons ruining
All the paint work.
They will rip it all to shreds,
Tare it up until it’s nearly dead,
Without a detectable scratch upon the surface.
The house it cannot show
The scars it bares inside,
And its figured that’s all it’ll ever deserve.
There’s no way to break the cycle
trust me it’s tried,
And all it’s done is made itself cry,
Which resulted in a leak down from the roof.
The house was beat
And still no outward proof.
There never was,
Nor will there ever be,
Someone there to help it carry on.

The taste of tension, like water, plain but there
Invisible, but felt
A faint undercurrent, a barely detectable wave

Physically, fine, well most of us
But mentally, a little shaky
Slightly off
Not easily detectable

Our lips graced by bald faced sugary sweet smiles
Don't look at the mouth, look at the eyes
Where the truth screams out at you
If, you can detect it

His antics, a little over the top
Her quirks, just slightly more enhanced
But even then,
You can't truly know what's going on behind the curtain
Unless you forcefully lift
But
That could possibly damage it
Completely

How do you sleep at night
All the stuff you did ain’t right
You cheated and you lied
It’s known about far and wide
Every day more comes to light.

How do you hold up your head
You should be ashamed instead
You’re the cause of many quarrels
You have few detectable morals.
Your honesty balance is in the red.

We all know all we get from you
Is promises that won’t come true,
You don’t care about any one else
All the matters to you is yourself.
You’re outrageous trash in all you do.

So how do you live with yourself
As Santa Claus’s very nastiest elf?
Every rule you choose to break
Is based on whatever you can take
Regardless of hurting someone else.

Wishing you bad usually isn’t cool
But in your case I’ll break that rule
Since you so often serve up hate
What you deserve is that same rate.
I’m polite, but I am nobody’s fool.

So, I hope you get exactly what
The people you have cheated got
That you end up with just a stone
And spend your time all alone
With your hopes and dreams all shot.

Nighttime session, the troops gathered in the barracks
I am the early bird waiting while I think of words
See the sorry *** in the glass start to mutate
My face scrambles in a madman’s flash of brilliance
I shake in disbelief, making my supposed normal return
The last of many flashbacks to a freaky fungus festival
My companions enter the stomping ground unaware
A trace of spasm in my body, of light refraction in my gaze
Within ten seconds I went from stagnant and stationary
To drunkenly wobbling, blind-deaf-mute-terrified
My vision was the first, flooding steadily with snowy diamonds
I noticed a distinct detachment from myself and my location
Head began to throb and ears shot jets of sound
Like a pulsar detectable to keen eye on rampage
Bright white light, increasingly suffocated by diamonds blinding
Sick and driven to escape, my face drained of all color
My surprise became overwhelming and unbearable to me
I made a hopeless barge through blurry barrier
Dive into the bed that will bring me sane comfort
Curl in ball, pathetic and fetal, waiting for the war to end

You.
You lay there.
You act as if everything is as it should be,
"..should be.."
Why can't I walk away from this stage? ..from this performance? ..from us?
Must the show go on?
Her heart's crying out for me to end this charade.. but we stopped following the script a long time ago,
Yet here we are,
Naked,
Nothing to hide ..only our sins,
No clothes on either of us with a closet full of skeletons,
I traded my soul for pleasure ..my ship for treasure ..her best for better,
Or what I thought was,
I indulged further than I should have,
You became a pest,
We gave no F's & now without them she's left with our lies,
There's only so much pain one can deal,
The more I think-I feel,
The urge to reveal the truth we struggle to conceal,
While juggling discretion & desires,
This game isn't easy for me.. then again I played along,
Don't make me have to choose,
To lose,
Our slice of heaven was delectable ..detectable,
"All good things must come to an end"
So blue. So true.
One plus one can’t equal three,
Subtract you ..divide me
-Isaac.Tanielu

If Dexter's Parents had not divorced and he had not moved away with his mother,
Who was beautiful as I recall, today would have played out or worked out or turned out
Differently. Very differently, considering that little twist in my six-degrees of separation base pattern
Hapt seventy-years ago, or so,
----
Watch starlings, if you have starlings, or watch congregations of kippers on Netflix.
Their steering is on auto. Do you agree? Then we are in Agreement, which is an odd place to find one's self in the midst of so great a cloud of witnesses.
-----
'e goes a gain a ginning, grinning all the while
Aye, and radioman turned on just
Now listen -Radio Mumbai

I meant, you and I agree schools of sardines and flocks of gulls are all on auto-pilot-propulsion-maintenance programs,
Right?
I thought so. The code in a gnat must be so much more elegant than the vast terabytes of programming in the GPS constrained self-drivers evolving on earth. Gnats never collide and are nearly impossible to hit, unless you have bat tools, which you don't. Nobody wrote that gnat code, right?
Of course not, evidence of programming only appears to be programming, evidence of design only looks like design it's not design. Right? So says Carl Sagan, Richard Dawkins, and all the people so called to win the battle for the minds of **** Sapiens Augmentatious, lest, as the confusion of Babel subsides, those minds should begin to reason together more clearly in light left after the lies standing on men's minds are revealed inferior to what our senses sensationally acknowledge. Whew. Long thought.

I meander, but you do as well. That is how things flow.
Not over immovable objections, around.

One life that was connected to mine in boyhood friendship was severed about half-way through my sixteenth year.
He died. I don't remember how. Alcohol-related, I can imagine. I did not attend the funeral, though some acquaintances did; one of whom was later my lover. She is dead now as well, too late to tell me anything. She had a baby less than a year after I returned from Vietnam, more than nine months later. That is a heavy thought, but not one I think does much good now.

So little of history is noted. So few lives function to trigger generational unctions that devolve into wars against imbalance, iniquity, slavery and death.
Fraternity, Egality, ******* *** the mob all riled-up, burn , baby, burn.
Whole people die in history's whims,
If whims they were.

Rebellions…

Watch the starlings steer through 4-d patterns eternally random,
fueled by bugs they convert to food for the soil itself.
Their life is their work and they do it beautifully. As one.

Can Boeing-Raytheon-L3 et al build a self-propelled, self-refueling drone that can fly at top-speed, maneuvering millimeters in each direction from other self-propelled, self-refueling drones while dropping their payloads without a single friendly-fire crash, ever?

Starlings don't **** on each other.

If war-profiteers could build such things, would you watch such things perform and wonder at the minds that built them, or deny such minds played any role from concept to creation, and ask who authorized development and deployment of such an expensive fertilizer distribution system that fertilizes wild weeds as well as gentled weeds?
Which would you say: "Wow, how did those get made, who paid?" or "Wow, look what billions of years and energy alone can do against absolutely insurmountable odds and impossible physics, with chaos and corruption always on the job?" Holy entropic bad moon.

Are ye not more precious than starlings, or sardines, or gnats. Would a sense pertaining to immediate locational proximity, evident in birds and fish and bugs, not be apparent in Adamkind, at least as a metaphor regarding benefits gained in knowing where you are relative to your own environment, regardless of any sense of personal purpose?

I can see it in the fact that we can agree, for good or ill.

As generations mature and regenerate, might there be patterns in the tumbling of the powerful and the powerless populations. Patterns depicting group or herd preservation by fully mentally equipped populations of mature and maturing Adamkind are detectable. Facts now overflow the cup of knowns. These are those days when knowledge is increasing and increasing and increasing to the point of being a destructive force in tightly closed minds.

Name dropping, rather than restating, Helen Arendt, "The Origins of Totalitarianism"(1966), Bertrand Russell, "The Problems with Philosophy"(1912), Pankaj Mishra, "The Age of Anger"(2017).

These three books and some browsing of names and titles the authors drop, have spurred me over the top of a rise I had not seen coming. My path had become gradually uphill without my noticing. I was interested in other things and ignoring notices from my body that oxygen stores were being depleted more rapidly than current inventory of red blood cells and nurse lymphocyte-bots can recycle the quadra-monthly disassembly turnover, H2O stores for sweat heat-dispersal systems and plasma regeneration and digestion of what little remains to be digested are now at "caution, think about stopping" levels. But I saw that from the top I might see to the top of the next rise before I chose the downhill part of my path. The down hill path determines the uphill path.
In the desert, you can see trails marked in many ways, mosses grow in least-heat zones created by angular location relationships with the sun. Breezes whisper into shade puddles by ever slow slight temperature inequilibria shifting some heat to the triggering of my sweat system.

If you were compelled to reason about every step you take in life as if it were your responsibility to regulate and control every function of your flesh vehicle in which you abide in relationship to all around you that you could harm or that could harm you, you would be mad. {mad?} illusion of reality

assumes reality is friendly here. I'm okeh
with that improbability aside,

implied as self explicatory and unfolding life…
examined,
for what its worth in words redeemed may be,
in the future, when this is what they thought,
you think, and I say know,
I thought this,
on a bet. Or an oath, depends on the fret.

Crazy mad, but angry auch. That would be unfair, because you don't know how to do what you are being compelled to do. Reports of persons who can control ****** functions not commonly consciously controlled are easily found. Such persons spend their time so countering the rolling rhythms beat by heart doors slamming shut and swooshing open in response to electricity, that, we, Adamkind, have yet to truly understand. We've no need, that which concerns us was
to be perfected, not by us.

If my use of Adamkind offends you, the reality of my benefits, wrought from my comprehension of my relation to Adam, will likely make me your enemy, in your own mind, not mine.
Ax'em, do they love po' o'hate rich?

Believe one chance in practically infinity of current evolutionary-nontheistic thought being the way things must be, then multiply the number of times you make that bet by the number of insects on earth or even by the number of mitochondria in your kidneys.

Ignoring life's delicate imbalances in light of what can be known today, breaks our minds's ability to agree perfectly. The social dichotomy that seems to arrange adamkind's affairs over eons and eras: rich and poor, have and have not, mean and meek, is ego-driven, self-benefit seeking and not part of the original program.

Contemplate the sweet influences of Pliades, silently questing the truth of hope and matter. There is more power in this stream.

Chapter end.

We're on single bench,
across in a single mirror.
I'm learning by heart you're curve.
1,2,3,4,5
TURNED.
Staring  vacantly again,
5,4,3,2,1
LOOKED.
I smiled exclusively on my thought,
I can't make it detectable
Mirror will spy.
Gauged,angles estimated and quantified.
1,2,3,4,5 and STARED.
Our eyes bumped.
5,4,3,2,1

Ohh,beats accelerating
I am freezed.
My heart jumps out.
Sorry,I can't make it,
I am evaporating,
or falling to million microscopic pieces.

at the oddest moments
just at the brink of ennui
glimmers of eternity
ephemeral dancing joys
sideways slippings
just out of sight
moving fast
detectable
to the desiring ear...
to the attentive eye...
faint sighings
murmuring laughter
patter pit of little feet
contented laying of jowls
in a dabble of sunlight
carpet warm stretchings
closing of contented eyes
soft dog snores
laconic life in the moment
this Sunday afternoon....

My dream takes me on a journey- big dream, big sky,
sea all around. Silent as a galaxy.

Flying is easy- I have simply to think it.
I rise weightless into a wilderness of imagined blue,
hovering over the wrinkled beach of my bed,
my mind a white butterfly,

And there I find you, dizzy with excessive light,
floundering at the sky's edge, head in the clouds
looking for silver.

Drawing me close, I fall into the net of your arms,
that safe place you've always made for me,
your hands tightly clasped behind my back.
We feed from each others breath,
aware of the sudden gravity between us.

But you are not as I remember.
Your face smoothed of all detectable emotion,
your eyes, not as they were, but exquisite diamonds
piercing through wads of cotton cloud,
until you become part of them-
a neat trick!

Shuddering, wounded,
lightly I descend into weeping,
I spread the sails of my arms,
tacking on a downward draught
until I find my feet anchored,
eased into familiar sheets.

A new light dawns on me,
wipes dry the lids of my eyes.
The clock reads four,
acid, luminous,
and there you are, in the kitchen,
slurping coffee from a chipped cup,
your free hand rattling the slats of the window blind.

I reach out for you, but your image dissolves
like paper in rain.
Aware of the mind's deception,
I remain wreathed in sleep,
and though this is still a dream,
you will always be a part of it.


copyright © Caroline Grace 2014

Her life is a rollercoaster
Full of highs and lows.
Sometimes scream inducing or euphoria filled.
Sometimes mild, barely detectable.
High for a minute, a week, a year
Low for a moment, a sleepless night,
A lifetime, she feared.
Her life is a rollercoaster
Full of highs and lows.
And she is afraid of rollercoasters.

Beauty crawls into the rage
Gnawing it's way to center stage
Closing my eyes to see your face
I know why it is I've come to this place

My lips are drawn behind my teeth
As I walk with shadows far beneath
The only light I see at the end
Is that from your room where you lie in bed

My curse is as well my greatest gift
For there is only silence from the window I lift
Belly to the ground like the beast I am
I approach my prey, an innocent lamb

Moonlight flows across skin so soft
Taking my breath but I just can't stop
Your eyes so deep, blue and wide
Full of fear because I'm finally inside

You've never seen me like this
And I've never had even a kiss
I suppose we're both breaking new ground
Just trust me and please don't make a sound

Oh, when you start to cry
Quivering lips releasing a sigh
Clenching my fist in your hair
Why can't you ever play fair

Your fear makes you so delectable
A pounding heart so strongly detectable
Your lips are hot and streaked with tears
The pink in your cheeks draws me near

Your slender neck so pale, so exposed
Leaving all my logic fully desposed
My hands wander down your collarbone
Full of wonder as I'm sure you know

The first prize is better than I hoped
Warm and soft, they gently *****
Encased in pleasure from ears to nose
Pressing softly I feel at home

Your skin is sweet or so I imagine 
Across my tongue soft as satin
Firm but giving I can't help but squeeze
Maybe a nibble if I please

But there is more work left to do
So many places exciting and new
The bones of your hips hard as stone
Guiding my love to it's tender home

Your breathing has slowed as I work my way
I plant a kiss only to hear you say
Something of please, something of don't
But your body argues as you're far from cold

All the coddled advances
Ambiguous stances
Wasted chances
Intentional glances
Dead romances
Only enhances

Overwhelmed couldn't describe my senses
Having finally broken through your defenses
An end to unnecessary suspense
I will be sure to spare no expense

Like a fire amidst winter snow
I taste of your inner glow
All the want begins to flow
Seems like you're enjoying the show

Now it is time to see eye to eye
Leave your soul bare for I know your lies
I can see the need in your eyes
And you can see the rage in mine

Of all the things I ever deserved
I never spoke a single word
But now we know it's finally time
As we join together deep inside

Soon the sun begins to rise
Though I am left in eternal night
I wish I could stay by your side
But I know better of this life

Bruises will fade and minds will clear
And the noises you made will leave my ear
The sheets will dry and you will sigh
For I am gone with no goodbye

Because my world is what I've done and what I receive
But for you, who couldn't so much as believe
The world will be lonely and empty, as you are
Because it is our choices that leave the worst scars

each tree is
a sound soft-spoke

to unwheeled sky
perhaps

or passing
cloud ― i would set

mind as
these trees: closeset &

filigree
like something once hubbed

& radial staked
out : taken root & grown past

its paring
having absorbed what heat

comes in to build a year-by-
year body

encompassing body: mind so
still in its s-

hell as to
be

detectable
barely till my

tomb stone
deep in upward shadow

leaps upon
me like a child around my neck

Mario Petrucci from *i tulips

I am a collector. My trade is stories and human nature, and I barter with others to be at their most raw. I'm not sure when I began to be drawn to this side of people. I grew up being unbearably uncomfortable in my own anxieties and emotions, often feeling like I was suffocating in an empty room. Sometimes I felt like I was just so filled up with feelings that they ballooned up inside me and pushed my lungs and ribs and heart and spleen all into a corner. There’s not even enough room for a good, deep breath - just tightness. It’s a strange thing. I would often study others and how they comfortably lived their own lives without any detectable doubt of their choices, and wonder how the **** they could stand themselves. Didn't they know that nothing was for certain and how arrogant they were for trusting even themselves? Idiots.

So being vulnerable was not something I was good at, when just existing was hard enough. But now I revel in it. Gently reaching out and touching that side of myself is when I feel my most alive. I could easily (lazily) compare it to the hesitation and subsequent thrill of riding a roller coaster. But not everyone likes roller coasters. I know a few that would do anything to skirt away from being vulnerable. That's why there is value in those moments when I see your eyes flit up and look cautiously into mine and through me into my intentions before telling a secret; when your nerves carry your sheer excitement past your lips and into my hands - that's when I know I'm holding something sacred.

But it's not easy to get there. In fact, it's near impossible.  I usually make the first move; I will bow and offer a sacrifice of character - an embarrassing story or some personal account. I expose my belly to rejection, and sometimes I get bit. Experiencing vulnerability that isn't my own is usually a heavily guarded bridge to cross. Strangely, hearing people talk about themselves gives me a better understanding of myself. I can see my reflection in others, when I usually feel so alone. The human connection is my currency. You seem to hold the same value in words. You keep them to yourself for the most part, but sometimes feel generous and I get to drink in your stories. Your words appreciate with time. To me, there is nothing in this world more precious.

I carry you in my intentions. I act on me and myself, but I would be lying if I didn't say that I also want to do what would make you proud.

So happy birthday, Dad. I think what I'm trying to say in all of this is that you inspire my driving forces in life, which is the most invaluable gift you've given me. I have built off of the parts of me that I don't like into the foundation of the person I am and always hoped I would become. My gift to you, in my own roundabout way, is working through my deeply rooted reservations to write you this and to let you know all that you mean to me and to who I am. I love you and I love your words.

The perks of texting
Is that the tone of voice
You're using
Is not detectable by some

However

This can also become
A bane

What is the correct option?
Which one is more devastating?
Which one takes more healing?
Which one holds the power to change someone's life?
Which one hurts the most?
Physical pain or internal pain.
Can they ever fade away?
The one which everyone carries and yet is non-detectable.

out of the billions of possibilities and endless amounts of ways to describe my affection for you, I could never string together a simple sentence of endearing words that could ever come close to conveying my message as fondly as i feel it.

out of the 3,500,000,000 men that are walking this earth, i could never imagine a life as fulfilling and heart warming as one i could have with solely, and only, you.

out of all of the places on this earth, all 57,308,738 square miles of land, the only place id like to be is laying next to you. I would follow you to the ends of the earth if it meant i could hold your hand in the process.

out of the 10,000,000 colors we can process, you out do the brightness of every single one imaginable. you are more vibrant than the sun's fiery colors, more mellow than the deepest ocean blues.

out of the billions and billions of textures we can touch, not one will ever come close to the euphoric feeling i get when your skin presses on mine. I tingle with every touch you give, even my skin crawls with excitement.

out of the trillions of smells detectable, not one can make me as happy as the smell of your cologne lingering on my clothes or the faint smell of your shampoo as you lay your head on my chest.

out of all of the thousands of tastes i have previously enjoyed, not one could possibly come close to the amount in which i crave the taste of you.

out of all the sounds in the world, out of all the things i wish to hear, your voice surpasses all else. It transcends the birds singing in the morning, and the sound of rain on a metal roof. It outdoes the sound of a fire burning and my favorite songs, it outdoes a cat's purr and the ocean's crash of waves. and of all the possibilities i'd wish to hear from you, "I love you" is really the only words i long for.

Before things turned to downfall and downcast,
Everything seemed so good to be true,
The days we cherished together,
Will never be mentioned nowadays,
Oh, take me back to the night we met.
Where a peaceful cast shadowed over us two,
When your soul was once mended whole with mine,
When we were unhurt and satisfied.
I crave the presence of our younger years; nostalgia appears.
The recollection of your smile remains,
The laughter, the whispers, take me back to the day we said our first hellos.
Walking side by side one another,
Discovering new facts about ourselves never deemed detectable,
I had most of you, unfortunately now, I have almost none of you.
Things change,
Time passes,
And we will never get back what we wanted ever again.

at the oddest moments
just at the brink of ennui
glimmers of eternity
ephemeral dancing joys
sideways slippings
just out of sight
moving fast
detectable only
to the desiring ear...
to the attentive eye...
faint sighings
murmuring laughter
patter pit of little feet
contented laying of jowls
in a dabble of sunlight
carpet warm stretchings
closing of contented eyes
soft dog snores
laconic life in the moment
this Sunday afternoon....

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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In the breakfast nook,
the sun falls aslant across
the paper, open to the puzzle,
scones and marmalade and butter,
coffee in white cups on saucers, steam rising,
motes dancing in the rays as he reaches
for the sugar
which is not sugar but stevia
in a pink glass bowl
shaped like an elephant's foot.
The smell of their exhausted *** lingers
like the motes,
detectable through aromas of the coffee,
the sage eggs and salsa fresca,
and the cut grass in the yard.
He feels his terry robe like a weight upon him,
dense and obscure, a yoke
or an anchor - safe
and brilliant white.
Her face never looks more radiant
than in the morning after
the Sunday ritual.
They could have been a sculpture
or a tableau vivant,
just breathing,
feeling the warmth of the sun
on the small hairs of their arms.