hereunder is served some poetry pouches full of love,
dear reader, stir them as you like,
if you wish you may crack them to pour into mouth,
you may smear them on your body
or you may sprinkle them on the ground
and then chant the name of god
with love and enjoyment

1.
the simplicity that rolls down
from the body of the sweet-meat
made by my mother

let it brings light
to our radish-red love-story

to hear or to notice
love
does not need
putting an ear on the wall
of the wall-street journal

the bottle could be filled
from the voice

when you go to fill the bottle
you would see that everywhere
the arrangement of picnic is ready

when i want to take part in that feast
my neighbours would drive me towards
the home  

although i’ve spent all my life
running behind the love

2.
who’s won the muddy-battle
was yesterday’s politics

my addiction is actually to cater
the pouch of love
to develop all vitamins
and all bathrooms

people say you don’t love
the claps of the rats

yet i’ll come down
from the branch of a guava-tree
as a wave-of-shopping-mall
to the lake of your love

now i’ll jump out
from this computer screen
to register a kiss
on your lips

don't miss to applaud
by clapping the hands


3.
the heart is half-sunk
in the window

to some extent
in the lipstick too

on the dinner-plate
there is the feelings of the lord

that means
i’ve to be burnt more
i do agree

i would become
the sculpture of khajuraho

this happenings may have been
the right search for love

on either-side of which  
a green is being worked out
by the nostalgic-cycle

whose colour-texture is very much harappa
which has too many geometric-memories

4.
an undertone is speaking
from within the solitude

now i’m in very much
distress

or i’m in love

i don’t know my love is what-for
may be that’s an arrangement only

so easily are those interactions
stitched with words

strenuous or effortless
in flight
initiated
with seclusion

but when in the sinking of the playfulness
i  write the games of the street-charmers


the birds again and again
pierce the archery

thus becoming ashes
through travelling

in time-gaps still
the audacity to compose poems
on you

5.
is it true love
or i do take it granted
that i’m in love

or i do love to think
that i’m loving

and there is
neither any welcome address
nor any opening song
in my love

my experience with heat of fire
and with burning pain
in the flames of water
is nothing less

6.
in course of burning
i look around

the chilly-plant  in the tob
planted in my won-hand
producing green-chillies

oh-** how sweet they are

it is no chilled-body
that has earned
my life or death

no remarkable mark
is endorsed
on the lotus-leaf

now easily some words
can be written
on you

i don’t know whether
those would be at all
some lines of a poem


7
someone falls in loves
someone makes love
love comes to some another

there is the far-off
whispering

at first she constructs me
then destroys rightly

i notice her
for the first time in six weeks  

the love
that writes
in the footnote of the tennis-ball
a desperate struggle for existence

within our skull
there is the love

or the midnight of the orion

the little squirrel asked now
are you in your seventies
or eighties

those houses with the coating of
the sky the air the light-and-shade
provide me with the presentation of
a wig and
a set of artificial teeth
8.
the love
that touches the hand
in drizzling

the love
that gets lost in the brandishing
grasses

would they want to inform
that the flowers don’t have any skyscraper

in the layers of the flesh and blood
of the detergents
as if  a whole human civilisation has been suffering
from suppressed pain

within it with the dry spell of
anger and cough
the time

had there been no feeding from the love
does the human civilisation stagger

9.
do you think those words
or it’s myself

whatever may you say now
i’ll travel within a great death
to die

rather after my demise i may tell
i’ve informed everyone …look

beneath the large evergreen flower tree
the game of light and shadow continues

beside those simple households
besides a high-head mobile-tower
what else would you like to be

is it a bath in the ganga-river is it a leaf
of the water-lily or it’s a king-cobra  
tell me

i would now make love
with that idea from you

10.
the  apparent golden *** that i thought
to be the underneath of a kadam-tree

in the dim light i can notice that
the stars in the sky are disappearing  

this session of poetry
is coming to an end

now where would i
go

to that little home

the home
a tiny word of 4 letters

within that home
the children are giggling
playing … and making funs

when i entered
with a tri-cycle in hand
for them

i have been perplexed
many old persons are waiting there
to shake hands with me

10.
almost most of my desires  
are very much hurt

to show it publicly
i wrap bandages
around all over my body

i keep on the stage-drama  

in our programme of reading poetry
tea is served twice
current has gone off for three times
for four times the mobiles ring

to pick up love  
some people think about returning back
from today’s dais to the ancient stage
of performing folk-drama

then they are also sympathetic
to my sufferings

12.
everyday
on my way to return home from the school
when my mom took hold of my hands

i could see in my body
the dancing of an unforgettable
aura

even now that mystical halo is walking
on the leaves of the trees
to fulfil my mornings

that wayfaring along the road
is ringing far and far-off

thus taking bath in every day’s  
dust smoke hue and cry

many such love
gradually gets aged

is it true
in the long run
i too
would be the ingredient
of a fairy-tale

just because i love
that paddy field

some time later
she will also become
human

13.
then she will make all of us  
join her walking

those inmost feeling
those memories meditations

the loneliness  and solitude…

sans the touch of the imagination of
a crater…
a creator…

this blunder…
this socially outcast white …

this type of uneven…
and irrelevance…

sume words
when peep in the mind
i surprise to see that
it’s ten to 2 at night

then in the balcony
my father is crying

he always notices some grave-yard men
in front of him

and sheds tears  

14.
after the dry leaves of the winter
fall in innumerable drops
the spring comes

the cover-face of spring means
a note-book of the rain-tree
letting float in the sun-water

and mr harry says that
this question of change
is a major pull

because all the unreal talks
you are delivering one by one

to keep pace with it
the ambulance comes at 10am
with a stale dead-body

in it’s shirt
is written the spelling of myself

i then sat on the grey volume
of the college-campus

in the front
a beggar from the war of waterloo
is passing by

over the dust of myself
with a faster pace
blowing is the thoughts of

ataraxia  
in the air… and air… and air…
    

15.

if your wishes colour silver
then do return back to the x-mass dancing
of the autumn

sound of whose far-off hoof-steps
digging so much soil of
story-weeds

i went into the nail-polish
with the proof of tea-cup
in my hand

there in the midst of lot of snow-flakes
and in the bed soft with the light of the candle
is now that honey-name more tarnished

now the atomic-howling
does not follow the rules of nature

so the rain-tree that seeks a-field-more-sky
with the hope to become king after the sun-rise

so that king is now waiting
in the grocer’s shop
at a stretch  for an hour

16.
does her well-wisher esse then thinks
to escape from the love-making whirl-wind

on the dry branches of the axis power
the new generation of the birds

rather stop a while there silently and listen
which song is hidden in the bronze-buddha

or in the school of the terracotta-horse

i’m now opening the coating
of the night-enamel to read this home

and behind the coo of dove
is smiling

the god of the penalty-kick

17.
sitting on an orange-coloured balcony
in an outsider lane
the green is writing poems
  
better than the face-powder

from this side all long the famine
i’m the priest of the
agro-based civilisation

still-then i think
why so much light of partiality
is on the body of the chrysanthemum

within the monsoon
in collusion with the  hair-band
now thousands of birds are born  

they can hear my
dry straws and twigs

whose hearing is the police
in so depth of the forest

don’t move the
dreadful resorts

one such photograph of the girls
who wakes up in the midnight

speechless…
unmindful …
destruction…

that is you now

i’m then in the spore
of the perfume-bounded body
of match-making

18.

who has lied in the box
made up of the temperature
of god

all on a sudden
there is a hue and cry
in the abdomen of the time
wearing a ***** pajama

actually that has been filtered up
from the voices of rock-songs

the roaming
of a fatigued traveller …

the lies
within their wishes
write my existence

and then run
to buy vegetables
from the station-market

so many lay-offs
come to the body of paper-weight

to listen to all those
is not improper

walking through the traffic-jam
gradually
this home becomes solely my home

one day the golden of
human

then it is i
who is you

and walking through the
monsoon

on either side of the field
it is all autumn

19.
when borrowing the religion of
the night-queen  
i fall in love

then is it real
that our mangos and jack-fruits  
can make the perfumed-soap
vigorously from the light of the
blood-line

i count the bells of the churches
ringing repeatedly

and piercing the image
of your prominent face

rounding through lots of old
the love becomes exhausted

and the love comes back
in the form of college-classes

there are you myself
and so many notes
of the body

Only Juliet drinks poison
Only Juliet likes to fall asleep
Last weekend,
Traded my bed for a coffin
Stuck both our hearts in the oven
We can fry together in heaven,
Pray to God your soul to keep,
I don’t want it following me.  
Cause,
  
    I haven’t been sleeping
I’m weak and defeated
A point of exhaustion
So lost that I can’t even think
I relied on you often
I’m starting to see
You come through the darkness
In the form of a banshee
Walk away would be progress
I’m just not really there yet
Sick of feeling like garbage
Chewed up gum; stuck under your feet
      Am I some type of rodent?
That you could step over?
A slab off the meek
Who breaks his back for your cheese?
Condemn me a burden.
This just isn’t worth it
We’re not picture perfect?
If you put down those matches
Then this fire would stop burning
But You’ll always be thirsty
I’ll always be hungry
You’re out their flirting
I’m home doing nothing.
      Unfulfilling the filth on the streets
The detergents’ not working
You’ll always be *****
No I won’t help you clean.
God’s gift to the earth
That thought is disturbing  
A hearts that’s discerning
The curse of the free.
Stay strong in my searching
The light is approaching
Keep moving forward
We’re permanently,
Finally over,
Juliet R.I.P.

Only Juliet drinks poison
Only Juliet likes to fall asleep
Dug her grave, had black emotions
Pray to God her soul to keep,
Sent her back to this earth,
Now I’m cursed,
I have Juliet’s ghost—following me.
Only in my dreams, why I never sleep
Finally Over, Juliet R.I.P.

I tried those dish-washing detergents, the ones that have "super grease-removal"
but I felt like I was scrubbing off all the days we had worked, together, with metaphorical drills and wrenches, to fix what was irrevocably broken.
I used lotions, but freesias reminded me of the smell of your hair, and coconut oil left this residue that would feel like your hand was in mine.
I thought maybe covering them would be the solution, but my hands in gloves felt like the way your arms closed in around me and held me, suffocated me.

Scrub as I might, I cannot get clean
No matter how hard I rub with all my might
The detergents and cleansers cannot do it right
I am sure you know what I mean

No matter how hard I try I cannot clean my soul
My life is filled with filth I cannot rub out
Like the ***** chairs I scrubbed I didn't have the clout
To take my broken life and make it whole

All covered in a slime that won't wash away
My body inside and out will never be pure
Only through the grace of God can there be a cure
Through His love  He will show me the way

Clawing and rubbing till I am raw
No matter how  hard I try I cannot clean me off
Inside and our I am never clean enough
In wonder of it all I stand in Awe

There's this thing you know
have tried million ways
to clean
hard detergents, dry wash
home and laundromat
and other ways
tried to erase
to delete
but know not
what will work
on this stain, a mark
its so deep
inside
somewhere in my heart.

Advice please,
do you know
how marks of betrayal
can fade? ©

Chapter XXIII
Invisible Eclectic Portal

Installed in the Eclectic and invisible portal of the Evangelist Saint John levitates in his sacred basaltic cavern Katapausis, in the Patmos archipelago (Koumeterium Messolonghi, Chapter 16 / page 114. Editorial Palibrio - USA). They would be in communion with the clan archery, who would resemble them as their proper ectoplasm; Thus, each one will form a unique part of the masonry that will dictate to redirect them in their messianic tasks from this stage of ascension.

Vernarth; being aware that he will have to enter the cave, after having ceased his work on hold for three months. Skinny from the myriads of wars and parapsychological regressions, he remains dazzled to dedicate himself to the beautiful places open towards the horizon ..., neighbor to cave painting and astronomy. In the colors of his mathematical prayer, capturing the spiritual intensity that inspired Saint John to build the temple near his cave of the Apocalypse on the island of Patmos. The saint appears only certain days looking at him from afar to encourage him in his progress, he is seen as a beautiful young man dressed in a robe of delicate pink tones, whose delicacy repeats psalms of the angel that normally accompany this Evangelist around him, with the colors Greens and blues of the landscape in the square of the sky that appears in redemption beyond the glory of the resurrection, rather super spiritual intelligence. In Skala's water, a shipwreck indicates the confusion of the men of its prophetic light, and on the ground a small pierced demon manages to divert the attention of Etréstles overwhelmed by digging it, so as not to stop the movements of the splendor of the effusions of storms in sacred sentence. This demon could be Tytillinus, who according to legends provoked bad thoughts in the clergy during religious services, and is the one feared by Saint John, who would not give them safe passage to enter and be able to entrust them with the task that they had predicted for him for the services in Katapausis.

Vernarth; he was with everyone working in the masonry of the Temple near the extramural wall of the Cavern of San Juan, he was Etréstles Eurídice, Raeder, Petrobus and Alikanto imbued with the flutes that sounded, over exciting his ears with royal denotes, which he always had of a special quality when he remained in Kalimnos. Everyone knowing that the threshold of proximity to the cavern was flooded by the enigma of the gloomy presence of Tytillinus, all rearranged themselves towards the poles of the tangible etherization of the psalms from 120 to 132, thus giving fire to the antipode of Divine Mercy, to repair the crown of the fifteen hours in the afternoon, thus disintegrating those that coincide with that of fifteen hours in the morning. Somehow abstaining from the northern confrontation with Tytillinus, center of the hooks of bewilderment and evil thoughts. Thus, the best way is to be swallowed by him and reside in his caustic stomach, making him believe that you will be consumed by him, and then fall close to himself when vomited, confusing him so that you yourself are one of his calves.

Vernarth manages to capture the upstart image near the grotto, seeing that of Tytillinus; where all attentive listened to the words textured by the saint.

Narrating Saint John: “He was also and will be a God of the Bressans in Italy, his image was disfigured and unearthed near Bresse. Le Rossi, who had it engraved on his Brassian memorials, says that the statue of this divinity was smashed in 840 by Rampat, Bishop of Bresse, and that it only had the name of the god in whom it was consecrated. This statue was made of iron, with the head crowned with laurel, resting the right cake on the skull of a dead man, and holding in his left hand an iron pike, finished at the top by an open hand, in which we see between track and thumb the egg that a snake entwined in his hand that got to bite: these are symbols as dark as they are mysterious. Is he resting on a skull and on a gloomy laurel potion, marking as certain defeated conjectures of Father Montfaucon, that Tillynus triumphed over death? But who will be the antiquarian or mythologist brave enough to explain the meaning of the serpent that throws itself into the egg that holds the hand that is on top of the pike? Let's admit that mainly among the topical gods they were hardly known, except in some particular cities that had chosen them for their patrons, there are always inexplicable symbols.

Saint John continues, in the face of the unmerited event, I will protect you here in my shed so that everyone is released first before entering my sanctuary, where everything is obsessed with visions after those of the Roses of the ultimatum, full of aspirations rather than subjugating in the aroma of purity and righteousness. Diverting the lurking Calluses and Dans (desquamation epidermis) of the eyelids, itchy in which its internal part is ulcerated, with cracks and callous hardness. Tyllinus the symptomatic form of the demon Tytillinus begins at the edge of the eyelids, although this edge then ulcerates; but generally it begins with a heat and itching that increases day by day, until they become  uneven and rough, and eventually end up causing stiffness, cracks, hardness and small ulcers. It is then because this demon not personified declares latent and obstinate disease of very difficult to cure. Not allowing before the scant light of the cavern, not being able to erase what is clarified in a look of solemn meditation and sacred silence. In its healing, general remedies are required, a soft and refreshing diet, bloodshed, if there is a large amount, as well as purging, when the disease is habitual. Regarding topical remedies, we will first use those that moisten, soften and moderate the acrimony of humor contained in the eyelids; then we come to those who are detergents and dry the ulcers, essentially, seeing him hesitate with our deep meditations digging his dark fermented soul.

Vernarth, insinuating to continue with his labors, sees with optimism to escape from this calamity, calls everyone to be close to the law ..., once they continued taking the steps towards the cavern. Tremors appear to them by all the edges of the cave, leaving everything dark and with airs of end of the world. In the intermission, Saint John towards the response of Psalm 120 to 132, interfering the fiery bellow of the playful Tytillinus, banishing the movement of his tail to outlaw the serpent egg, avoiding creating a pseudo monarchy on them prostrating them, as almost being being beheaded repentant.

They all open their arms and surrender to this pseudo demon, being swallowed entirely, to later reside in the intestines of this pseudo monster. Subsequently everything happens as predicted by the hermit, who would be expelled from his ruminant stomach, believing to be creatures of their own nature, confused by how their children from beyond for their intro demonizations. Thus it would have existed in mythologies to tempt and dismiss the work of any unit, essentially of San Juan. It will inhabit them from the hierarchy of Evil, as it appears in grimoires and occult texts, each demon has a precise name and function. Transfigured will be the epochs in dowries for the naive people, carrying them out for rituals to protect themselves from them, since it was believed at that time that every individual who was harassed by them, would continue to stalk them waiting for a moment of weakness to attack .
Saint John is and will be an egregious demonologist, collecting thick volumes with the names and attributions of each of the demons of the infernal hierarchy. This in perfect symmetry with that of Aion, interconnecting sublime times where the concept is lost on the human temporal scale and the genotype of Satanism or satagenesis, in austere precision ranging from Satan, head of all demons, to Ukobach, in charge of maintaining Long live the infernal flames. So that freedom of slavery finally reigns before one's own demonized moral individuality. The price of such an invocation is always the soul of the individual, who will end up going to hell, the demons invoked themselves and they will invoke themselves as a light to walk on their own darkness, in the past, present and future through Special enchantments found here on the Invisible Eclectic Portal.

Under edit / continue

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Relate Articles:

twice
i washed my black sweater

still  
when i put it on  
it smelled like you

i have been through
hundred times worse

bleed my heart out
on a wet concrete floor
picked every daisy
ruthlessly
rootlessly

just recently
parted
from a lifetime

but you
and your scent
in under my skin

i think somehow
you represent
time
and how it changes
everything

what have i lost
what have i gained

i am older now

pull my sweater off
chuck it back into the washer
drown it with laundry detergents
and perfume

when i put it back on
it better not smell of
broken dreams
and anxiety

You are born with a pure heart, white like snow. Keep it clean with the eternal detergents of kindness and humanity.

Hussein Dekmak

The air was painted.

Inside the chain link fences
were clouds;
brushstrokes
that could’ve been
proffered by
Van Gogh
or
*******
as they dissipated
into the early, cold
morning air,
pausing only for a
few moments to allow
some of the particulates
to freeze;
the hydrogen, the oxygen,
the lye,
&
detergents that
make up whatever
is used in
a prison laundry.

The effluvium is rich,
the odor of a passable
cleanliness in what is largely
a rather fetid domain.

The scent of bleach,
harsh, chlorinated,
removal of that which
stains.

Yet,
something stays,
an acrid, sour smell;
an unpleasantness
which seems to have chosen
to remain
unwashed.

It is concluded,
that this emanation,
is the opposite of
emancipation,
it is a olfactive reminder
that
Building # 7
serves up
freshly washed sorrows,
rages, or regrets
as well as
whiter whites,
releasing
stains from grays
more often than the wearers
of
these wardrobes are released
themselves.


With this in mind,
swirling, shifting,
moving, motivating
marching upward,
toward
Building # 1,

It is breathed in,
and out, and in
again,

renewal,
like clean laundry
washed in industrial
soaps, rinsed in disinfectants,
delousers, deodorants
unknowable.

Starting over.
Today.
Tomorrow.
Overmorrow,
And,
Everafter.

Amen.

*
-J­BClaywell
©P&ZPublications 2021

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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Karmageddon


Even the innocent will rejoice.

Not because of dead fish belly

up In the river lay-by where they

almost learned to swim between

excrement releases from the

overflowing septic tanks due to

detergents prohibiting bacteria

disintegrating untreated faeces.


Not because their linen sheets

got flecked with particles of red

dust which was supposedly last

time attributed to a desert storm

in the Sahara transported by the

Sirocco then relayed to La Mistral

and eventually becoming alias before

making a landfall on their island coast.


Not because of a cumulus congestus

which replaced nimbus casting a dark

shadow on their glasshouses where

unripened tomatoes would have to

be fried green without the wild Paris

mushrooms which are impossible to

distinguish from blackberries growing

in hedgerows by the roadsides.


The innocent will rejoice because

despite they being the common

denominator to a pyrrhic solution

the final equation will end with a

mere = an aspiration of majorities

which had gone unheeded by all

of those who had been manipulating

figures on the hypothenuse square to

deceive those of their lesser neighbours.

On the bus, on the way back, he thought about his house and Dn's. Adolfo, being able to see one on the rise and the other on the decline, in the hands of a survivor. Ludwig ...: What a pity ..., I'm going to torture or I'm going to glory. I only have their memories, some of their belongings to talk with, and I myself have chosen not to be scared by what would make me forget all circulating waver and be a great achiever. This profession that alternates me with people and does not isolate me, complicates my conversion. It was not long ago in the unfortunate death of that trampled animal, it reminded me of other severed deaths, and without forgiveness. Or those vainly confessed by the one who in his concept of sin, no matter how great his nature, repentance that always languid at leisure, makes his act sinful. Definitely, there are several protectors of the conscious sinner, who in doing so re-crucifies that Lord. The bad must reach out to the good, even if betrayal lurks with his infidelity.

In the afternoon when he was hesitant to sneak out of his musings, some custom remained to ease him, more well-ventilated oxygen in his head, centrifuging the Free Radicals. And the dark stain that blinds the flow that dominates him, that makes him feel without language to describe the crushing that often ends him. For more than half an hour he was like this until he wanted to move his legs and was able to move them, but where ...?, Maybe very far, towards a place where he has to jump savoring the stained airs spread around. Anyway, everything could be there, but when he became disenchanted, he saw parts that indicated that he would arrive very soon to the field that in his abandonment was decolonize some bird legs and the fallen fruits ran on arid soil, manifesting a grandiloquent regret. Upon arrival, he looked at the surface and thought he had never been born, he walked out to the proximity of what had never been stained before, this immense Garden similar to the grasslands of South Africa, with its flowery steppes and its precocious warnings to reserve a continent for the future. Hunger, thirst, and sleep were withdrawn, only his eyelids moved. Up and down a window was hit by a wind that tried to unlock it. In addition, the walls were vigorously sheltered by tree elephants. I see myself laughing and I remember myself, maybe some wind is going to sway my hair, or I am going to touch the search for the not found.

Ludwig is overwhelmed, like an ahistorical identity, foreseeing any moment that spills over into his time and goes with all the silences in the world. His rigid complexion bends his sickly body at the incapacity. Everything smelled of subtlety and purity, the spirited detergents linked the beginning and the end in communion. The inevitable image of Antoinette with the encrusted pigment of her forms will hang from the top of love, towards the wakefulness of unspeakable dreams. He talked and laughed with her, he never ran out of her, not even when he got into any discussion because there was none of her and there will be none of her. If there is something necessary is to retain the beauty in remembering it ...? In that same instant, he left the memory of her and went to find her. He says that it must be kept for posterity, everything neatly in the neat white sheets that my superior members will caress. He walked to the outskirts of the Prehistoric Park, which at more than one moment appeared in his mind the present shadow of someone he loved, with his harmonious and veiled countenance. Long days of confinement, if he needed something in the kitchen, he ran out to buy what his mother in a hurry ordered him. And to this day he does, but now he is going to buy him shoots from the highest mountains, to reappear in him the height of his loving son.

Before the house of Antonieta, he is and struck with some nervousness. Very deeply she breathed herself, and when she rubbed the palms of her hands very wet, she more she became restless. Time passed and no one opened Ludwig insisted, but it was useless, no one opened. Then he knocked on the next house, opening a dark lord for him. The one with the cigar on his lips, almost swallowing it, told him that they had moved from the neighborhood. Actually, his mother suffered a lot from her cough. Ludwig, thanks him and says goodbye, before leaving he looked at the house and continued to his destination.

At no time did he expect a voice to appear, like the one he saw approaching at high speed, such as a racing car. As he resumed his march he turned his foot violently, emitting a noise similar to a nuance of Antoinette's voice. He looked around her, not seeing anyone like her. It was getting late, fatigue was taking him home. As he passed through the Park, he entered to see that famous Geysers Fountain. Clear reasons had such as being old-fashioned and a bit abandoned because she gave him the sense of friendship and love, and he did not want to lose once again a reason to live. He said to himself ...: That something positive is that here everything is in optimal conditions, just as Antonieta should be. And just the voice attacks ...: "What you can think, tell it, since what you have read was all recorded here ..."

Ludwig ...: So fast, you're here again ...!
The voice ...: Yes because you are more alone than before. I fear that your soul will be mute, and I will be seriously threatened!
Ludwig ...: This passage of life and the world is a powerful vice, wherever you go to take it; he will do with you what he wants.
The voice ...: Yes, ... Yes ... but you should not fear, you are big and strong. Don't let it scare us more.
Ludwig ...: Enough is enough, I only know that their quantities are excessive. I can no longer receive vices involved so that they finish us off.
The voice ...: You're dead, you've been like this for a long time. For this reason, you will not develop the vicious virals of the apocalyptic subsist, you will only digest food without flavor, and what is liquid will appear solid. Here's something about the feeling that you can't explain. A moment ago I feared the threat, now a difference is emerging.
Ludwig ...: What ...!, How to explain the dead? He ran out of the park to his house. When he relived that situation, he seemed greater than usual, he feared a greater fear, that is why he ran in terror. He came in saying ...: Dad ..., Mom ... Where are they ...?

When he reacts, he realizes his madness, it is that the black curtains plowed and frozen as if making him pay a debt. As usual, he lay down on his humus bed. Again the sunny awakening washed away the dirt. There was mercy, there was love on the part of his faithful and irreplaceable vegetable valley, of immeasurable goodness

A rent is what it is: a tear, a schism. Who can strike hotter than lightning? Who can stir faster than an electric mixer? Who can displace water without getting wet? Shadows are cast upon walls & trees, yet nobody's more cohesive in their appointed *******. A hole forms above my eye, a portal of enlightenment or a boil. A dangerous rupture threatens bending over to retrieve car keys --- there will be no ice cream cones for anybody now.
   “Would a dead photo of my cat be any
help? I have 6 angles: repose, face up.”
   A cat dead is no use to the live-cat community. They are
live wires: no ball of yarn's sacred. It's Newton's Laws of
Heavenly Bodies, the **** Test {for scarlet fever susceptibility}
& scads of things that keep dead cats thusly.
  Into the salt-sea I bury the remains in large sprinkle: sandy bottom, sand-paper & silica, foam & detergents, the oil what cuts the surface --- the depths of volcanic breaks with sherds of crusty parts. Chicken combs choke the weary, froggy warts & cloven hooves clog craws. John Rockefeller, junior, sleeps with girls. My mind's fettered, culling accusations, massing a cleric's defense.

Developing a personal shift in.
my personal prison
And this perfect existence
With worthless decisions..
Externally driven
Urges and girly decisions.
Worthy intentions
To leave  earthly possessions.
As long as my birth.
Is the learning curve in this lesson...
I'll keep serving up
Words. Like I ****** a sentence.
And cut my nerves
At the endings.
My surgeon mixes gas.
Straps on my mask
I go out.
Like a stain with certain
detergents....
Wake up a brand new person
Yeah right
Its never arriving...
I'm not worth it....
I have no courage...
And there's word
I might not survive it.....