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Ava Valentine Aug 2015
My support for your dreams is
as long-lasting as zinc,
because your potential to shine
is as immense as unpolished platinum.

I do not care what others might say or think,
for a tiny spark will light you up
as bright as magnesium .
-j.w.//spark yo!
judy smith Apr 2015
Fashion show finales follow a familiar rhythm: after the models march along the catwalk for a last hurrah, the designer comes out to take a bow. Their demeanour is often telling, an indicator of their attitude to the collection they've shown – are they a bag of nerves, or grinning from ear to ear?

Also noteworthy is the look they choose to take their bow in. Are they even wearing their own work? One of the most celebrated designers of our time never wears his own designs. Karl Lagerfeld may create the occasional menswear look at Chanel and he designs a whole men's collection for his eponymous label but he has long been a customer elsewhere: Dior Homme.

Lagerfeld started wearing Dior Homme when he was in his late 60s, shedding 41 kilograms to fit into the skinny styles of the label's then designer, Hedi Slimane. Lagerfeld has stayed loyal to the brand ever since, even after Slimane, now creative director of Saint Laurent, quit in 2006. And although the label is known for its emphasis on youth, Lagerfeld, now in his 80s, remains one of Dior Homme's most visible clients.

Raf Simons, meanwhile, Dior's creative director of womenswear, is partial to Prada: his presence in the documentary film Dior & I (2014) is most clearly announced via his distinctive studded Prada sneakers and he often takes his catwalk bow in a head-to-toe Prada look. For his first Christian Dior ready-to-wear show he wore a vintage denim jacket with red stripes by Austrian designer Helmut Lang.

And yet many designers do wear their own work, especially if the brand carries their surname. Editors scan the wardrobe of Miuccia Prada for clues to her latest collection: is she feeling utilitarian, elegant or purposefully off-kilter? When Donatella Versace takes her bow, she often wears a look from the collection she's just shown – for autumn/winter 2015, it was a pinstriped, flared pantsuit. And even Simons has worn pieces from his own label collaboration with Sterling Ruby.

So if the name is on the label, does it mean the clothes will always be on the designer's back? Not necessarily. "I've never been into wearing clothing with my own brand name inside," says Jonathan Anderson, designer behind JW Anderson and now creative director of Loewe. "I find it odd and arrogant."

UNIFORM DRESSING

Anderson's own wardrobe is a familiar uniform: crewneck sweater, faded blue jeans, Nike sneakers. It's entirely opposite to the menswear looks he creates for his own label's catwalk presentations, which have included bandeau tops and frilled shorts. He seems to favour a clean-palette approach: keeping himself neutral so as to not deflect from his experimentation elsewhere.

This kind of wardrobe is common among fashion designers. Jack McCollough and Lazaro Hernandez of Proenza Schouler appear to have no desire to create menswear for themselves or others, dressing instead in a similar style to Anderson: crewnecks, polo shirts or button-downs, usually with jeans and sneakers.

Mary Katrantzou, meanwhile, recent winner of the 2015 BFC/Vogue Designer Fashion Fund, may have built her business on print and embellishment but she is usually found in a black knit dress by Azzedine Alaïa. Alaïa himself has perhaps the ultimate clean-palette wardrobe: for decades he has worn black cotton Chinese pyjamas, fastened by simple floral buttoning.

Each of these designers has a successful business with its own clear signature. So maybe it doesn't matter if they don't wear their own clothes. And yet when designers do, it can be so seductive. Men buy Tom Ford because they want to be like Tom Ford. Women buy Céline because they want to look like Phoebe Philo. Stefano Pilati, creative director of Ermenegildo Zegna Couture, is often said to be his own best model; Rick Owens, in his long draped vests and baggy shorts, is the perfect ambassador for his own alternate universe of otherness.

The style of Roksanda Ilincic is synonymous with her own brand. "I create pieces that embrace the female form," she says of her bold colour palette and silhouette. "Being a woman means I'm able to feel and test those things on a personal level … I tend to favour long hemlines and nipped-in waists, with interesting shades and textures, pared down with simple basics and outerwear." Does she ever wear anyone else? "Of course! Black polo necks from Wolford are an absolute staple and in winter I am rarely without my favourite black cashmere coat by Prada, which is on permanent loan from my husband."

It seems like an industry divided between designers who wear their own work and those who don't. But sometimes things change. Backstage at Loewe earlier this season, Anderson said: "With Loewe, I have a detachment. I wear a lot of it. Now I'm more, 'Does this work?' I've got a bit of a love back for fashion."

Two months on, his interest in wearing his own designs has grown still further. He is the cover star of the new issue of menswear biannual magazine Fantastic Man, posing in a slash-fronted sweater and leather tie trousers. The pieces are both his work from current season Loewe. Womenswear. In for a penny, in for a pound.Read more here:www.marieaustralia.com/formal-dresses-2015 | www.marieaustralia.com/long-formal-dresses
Nina Nov 2015
Disgusting.
Is the way that I feel when I woke up to a text saying “make me ***”
Am I only here for ***?
Horrible.
Is how I thought of myself after saying no and you never talked to me again
I guess that’s all I’ll ever be to you
Cry.
Is what I want to do because your insensitivity shot down all my confidence
Angry.
Is how I felt when I figured out that all that time you had been using me
But then I realized that I don’t need you
and now
Beautiful.
Is the way I feel when I wake up and look at myself because I know only what I think matters
Proud.
What I think of myself now that I figured out that I don’t need you to be confident with myself
Laugh.
Is what I do when I look back and realize what a tool you were
Happy.
Is how I feel now knowing that because of you I discovered that i don't need anyone to make me feel wanted
Because now I know what I want
And being your "side chick" is definitely not it
Ava Valentine Aug 2015
All I ever wish was to make you smile
I would do anything, even the extra mile.

I would sit there gazing at you,
Thinking of what for you, I'll do.

Dreaming of you from morning 'till noon,
Dreams as big as the Midnight moon.

I may be a dreamer, but I'll do as I say,
And you will find yourself the happiest person someday
-j.w.//a promise
chris Jun 2016
jw

the dreams are just taking hold
and they just need time
Mateuš Conrad Aug 2024
JW
i had to wait for gaming to evolve: right now, the only evolution to speak of is the evolution of technology, which has exponential growth: the world around me burns and i burn with it, ingesting a liter of alcohol a day not knowing when to stop: is it painful: am i getting indigestion, heart-burns: yes... but i'm also more alive because of it: i'm not some wanderer, restless nomad with barbiturates: i understand alcohol: Nietzsche didn't... but i don't blame him... but gaming is so much more with the advent of the internet: now i can replenish my thirst for chess with Mech- -Arena ++, it is an imitation of chess it is vamped up chess... i get to orientate my ego, i get to sooth my ego in the abstract, beyond the reality of biology, i can fuse my background in chemistry and hope: to understand: but knowledge doesn't breed hope: understanding comes from hope but knowledge comes from fear... i understand and therefore hope: but i never quiet know whether there's any good to get involved for... but that spiral is a chaos whispering... i want to suckle at the beckoning: i want to speak a language on the border between sea and earth and earth and air: and air and water: and air and fire... i want you pluck my own eye out and give it unto you: dear Archetype: father... how gaming has changed: i was told to be resolute in not finding a PS2 instead settling on a PS1 console plugging it into the t.v.: but now the mobile reconstruction: it almost feels like a ***** colony with people aging to 70 exponentially straining the expected life frequency... are we talking the possibility of philosophy being not bound to youth? are we simply saying: philosophy owns up to old age is old age the new glorified gatekeeping strength of mundane experiencing: this blunt knife is no longer sharp... am i supposing a hammer ought to be sharp to nail nails in: am i speaking of spokes: those skeletal necessities of a bicycle wheel?

before the Hebrews and Jahweh came
to Poland:
it's a strange ordeal of think about it...
but before they came with
YHWH
there was a word: prior to the name of
their god
and in the mouths of the people of
the fields...
JAWA:   in English that's YAVA...
there's no need to implore the H to command
the vowels...
JW                  signature...
google translate just spews out jawa: as java...
it's not dzawa:
na jawie: on waking: awake...

   yavye...
                     i understand now...
no one is going to have a reasonable
conversation with me...

i can stand accused of speaking to her
while falling asleep...
also timid also slightly drunk
also testing marijuana
and that's just lazy...
but at least she's just rummaging
in her everyday and i'm in bed
this 11h time difference referential
is punishing...

before YHWH came to Poland
there was the concept of consciousness
known as the JAWA...
YAVA...
not job to rob whales of:
strange creatures:
mammalian: prone to cult like suicide
pacts getting themselves
beached...
don't you think the whales are sort of saying:
the seas are boiling
we need to find our godhead
and get the **** out of this *******...
i feel that...
i don't intend to stay in England
for much longer:
England is not my BORN & BRED
i don't feel welcome:
i want to live in the kingdom of the oceans
on an island:
i want to live among Polynesians...
i want to ingest their tribal mentality
their tribal scrutiny their tribal security
of authority of loyalty of honor
i want to live among the Polynesians...
i'm going to do it:
even if before that i don't get my driving license
and sober up...
to raise: not my daughter:
my a child is still a child so...
i don't want to live among this bastardized
anti-racist pseudo-Europeans
these cuckold **** suckers!
i don't want to live among these people...
****** sandpit:
i'm taking my vocabulary and ******* off
into the sunset:
and even if that's the last thing i do
i know i'm stalling and assassinating myself
by a default of failing:
but then i'm also a fan of a quasi soap-opera
like i'm a big fan of opera and
especially a fan of ****** opera:
i love a ****** opera:
the type of opera that makes me leave
disgruntled like a phantom and saying:
nein nein nein benign!

thank you English: but i picked this language
for my own sake
it was nothing to be mediated
or explored with for the good of the people
who originated with it:
we can talk politics but we won't talk
politico:

a great wind came and swept me away...
my forefathers dreamed about
******* off to America:
well... i'm wanting to ******* way past
America:
i'll be saying hello and goodbye
while i enter the realm, the dimension,
the strict mental blockade of water with
the Polynesians...
these beyond the measure of the attitude
of the Mongols:
these former Taiwanese oar men
like vikings... hmm similitude...
what's a good broth of a soup on the islands
should you need soup?
so the base would be some meat:
carrots... **** no carrots that grow in the sea...
leeks... potatoes...
celeriac...    young celery stalks...
o.k. workable: not doable though...

**** me: the wicked talk of border-control:
on a ******* island...
you'd almost think if someone whispered
to ******: wait wait...
how about we invade England
by digging a tunnel...
but dwarf technology and innovation
was never part of the quick premature *******
mentality of the Nazis:
cheats... if they only waited and someone
said to them...
pst... hush hush:
let's dig a tunnel... rather than terrorize
from the air...
then again: why did they just drop bombs
avoiding St. Paul's cathedral...
why not just drop a bunch of hulkish manly
Aryan men into the mix?
clearly that wasn't the plan
because i don't know what the English feminine
is since i've been ostracized
and thank **** that i will never **** an English
woman: these days
exponent of foul mouth and neck tattoos
and something a Pakistani **** gang develops
a taste for...
well at least the Romanian prostitutes...
but **** is such a bad taste in a mouth wanting
violence...
how can you: ugh... unimaginable...
but i'm happy: to have lived in England
for... donkey's count of years and never actually
having ****** an English girl...
the grey skies ought to be turning blue at some point:
maybe if i was less able
maybe a Hapsburg jawline...
maybe my teeth are rotten:
maybe my father was right when he said:
are you are hunchback?
i'd return to him and say:
let me find out... but i'll need to fly over to
Hawaii to find out... i'll get back to you...

it almost felt like i was screaming into the night
when it fact i was having *******
explaining the importance of *******
on a man...
i have no respect for circumcised men:
in that i have no respect for the tradition
that thinks that circumcising men
will somehow keep the concept of monogamy
intact...
yes:
baby: i'll get circumcised: aesthetic?
no: i was thinking i'd get circumcised after you
put a ring on this finger...
so that i am no longer able to pleasure
myself:
so i did say: dream talk, borderline:
because i talk in my sleep i want to find
the person who talks falling asleep:

didn't i say that you can do one better
than giving me a *******?
didn't i say: kiss me while ******* me?
isn't that what *** ought to be:
something to work with
a transcendental conversation
a language barrier missing
just gone...
you kiss me while jerking me off
i'm pretty sure you don't have to ****
on that tool...
but that's a prerequisite of the *******:
******* sand-******* and their *****: ugh!
how about we cut the lips off
so that the smile might be more prominent?
it won't be a Chelsea grin:
but a Kenyan oopsie!
still showing teeth? barren *******...
and these are the people that are the spearheads
of all civilization? **** me...
but the ******* is so precious...
it's like that poisonous **** mentality
of inbreeding and the fetish for anti-pig...
what's wrong with the pig
what's the point of glorifying cow
when you know you can eat red
meat because the chances of ingesting parasites
from raw steak are so slim?!
cluck cluck cluck-oh-ooh!
chicken farts... blurp:        now i will have
my berserker fun!
   but i know how to contain alcohol: so i can
talk *** and not permit myself
to feeding off violence:
because i believe that the best sort of ***
is: an imitation of violence: contained...
measured:
deliberated: kept in strict of confines of
dialogue: beyond any measure:
attempted by Socrates...

so before Jahweh and his He-brew crew found
their way to the odd sanctuary of
Poland where: i guess because the Poles
defended the last pilgrims of the winds
that were the Lithuanians... the last pagans of
Europe:
well: besides the Prussians who inverted
what wasn't Germanic...
come to think of it: the best way to digest
history is by treating is like a comic book script:
write the words:
the images come later...
so then the Hebrews came to Poland
(how the **** did they get there,
i don't ******* know)
it's almost mythical in the stance of: huh?
so many of them?

the moment i hear one Jew tell me about
the Polish collaboration with the Nazis:
it took...
**** Germany, Soviet Russia...
and the Slovaks to invade Poland...
and it took them... 2 weeks...
it took the same amount of time if not less
for only **** Germany to invade France...
*******...

yeah: well: some probably did:
but last time i heard...
there are more Polish names on the hall of flame
fame... flame... whatever somewhere
in Jerusalem...
but yo: you still circumcised!
i could understand doing a van Gogh's ear
but if these are the people we sow
to find spiritual guidance:
no wonder i'm hearing of Wōðanaz:
woovanaz...
  that's: ð of the
              and not the ᚠ of thought...

                   i think Nietzsche predicted he was
moving outside the Germanic realm
and into the Slavic realm by crying out:
i'm Polish! i'm Polish!
apparently "we" are the French of the Slavic people...

oh the brute:
that Malachi was so wrong: Malachi 4:5...
reincarnation goes against all the supposed
superiority logic of monotheism!
reincarnation of either Jesus or Elijah are
horrendous grievances against man's commitment
to monotheism!
it would have been best
to astound the world with the atheism
of China or the polytheism of India
than to succumb to this constipated and
circumcision frenzy mind ****!
cut an ear off! cut a ****** off!
how these people are not considered as bad
as the Pigme and the cannibals
who sharpen their teeth without having
any maulers i will never want to know!
how about cutting a toe off?
the ******* phallus aesthetic improved:
again!
if you want to truly fathom an unbreakable
bond of monogamy like
an imitation of swan... go for it:
sure thing gurl:
i'll snippet my hand movements off
when you decide to put a ring on this finger...
until then?
nein nein nein!

so now a circumcised **** and donning
the kippah is something of an elevated status?
outside the realm of a somewhat sensible
secularism:
at one point i didn't actually consider
myself a leftist liberal...
or rather a liberal:
but since i've aged i'm just agitated
about conservation projects...
beside wanting to be a gardener: in thought alone...
notably when you read:
oh thoughts are just thoughts
and actions speak louder than words
and words are no carriers of meaning...
actions:
hmm: so you would better understand
if i punched you in the face?
that's what it has culminated into:
words are not carriers of meaning...
spoken as a true dyslexic...
but images are ******* mesmerizing!
images convey meaning: words don't...
well then...
it only feels appropriate to speak
that sign language of a clenched fist:

                             clearly... what else is there?
but i shouldn't worry:
i hope to not live in England come October...
if i'm not on Kauai by December
then at least i'll be dead.
S R Mats Dec 2020
Try JW dot Org

Have you wondered about the meaning of life?
Is God to blame for our trouble and strife?
Do you have unanswered questions that make you sigh?
Do you ever wonder what happens when you die?

Yes - Life may trouble you
Bad news may trouble you
Questions trouble you as well they might.
If life troubles you - questions trouble you, try JW.org website.

Have you wondered; "Does God really care?"
“Does He listen when we pray - is He there?”
“Will war and suffering ever cease?”
“How can we find inner happiness and peace?”

Yes - Life may trouble you
Crime may trouble you
Questions trouble you as well they might.
If life troubles you - questions trouble you, try JW.org website.

The reasoning is clear - the answers are viable
They always adhere to God's word in the Bible

Yes - Life may trouble you
Doubt may trouble you
Questions trouble you as well they might.
If life troubles you - questions trouble you, try JW.org website.

Life may trouble you
Doubt may trouble you
So try JW.org website.

Try J W dot Org Website Try J W dot Org
Try J W dot Org Website Try J W dot Org
- Brendan Vincent Owens


Have you wondered about the meaning of life?
Is God to blame for our trouble and strife?
Do you have unanswered questions that make you sigh?
Do you ever wonder what happens when you die?

Yes - Life may trouble you
Bad news may trouble you
Questions trouble you as well they might.
If life troubles you - questions trouble you, try JW.org website.

Have you wondered; "Does God really care?"
“Does He listen when we pray - is He there?”
“Will war and suffering ever cease?”
“How can we find inner happiness and peace?”

Yes - Life may trouble you
Crime may trouble you
Questions trouble you as well they might.
If life troubles you - questions trouble you, try JW.org website.

The reasoning is clear - the answers are viable
They always adhere to God's word in the Bible

Yes - Life may trouble you
Doubt may trouble you
Questions trouble you as well they might.
If life troubles you - questions trouble you, try JW.org website.

Life may trouble you
Doubt may trouble you
So try JW.org website.

Try J W dot Org Website Try J W dot Org
Try J W dot Org Website Try J W dot Org
- Brendan Vincent Owens
At times my heart breaks for some here.  I feel their pain.  How I wish that I could comfort them.  I came across this, which I have posted now, a long while ago.  Just recently it popped up again.  Maybe it can be a road map for those who want one.
Robert Wallace Apr 2017
So strangely hidden, love will seldom be found
Few grasp the true nature
Then promising nothing,
elation abounds

Caresses once here and then gone, will visit once more
The heart binds every moment While uncertainty pounds a souls shore

Two that are separate, yet equal, emerge
Immersed in love passion
Reflect sunlight that will swelter and surge

One will deepen the moment, the Other, change captive time
A new life uncovered, leaves memories behind

What was given by each will be nourished and grow
Ten fold they will render whatever they've sown

RW & JW
WickedHope Sep 2014
Mother, you were good to me. You loved me in your own way that I didn't always understand. Don't blame yourself.
Father, you loved me, I suppose. I can't say that you cared though, at least, not about me.
Brother, don't turn out like me, make something of yourself. Don't try to become anyone else, to impress people, to fit in, just be yourself. Stop being so violent, it will get you into trouble.
KB, I know you never really picked me and I didn't quite pick you, but I think maybe God did, picked us for each other. You were the best friend I could have ever hoped for. Thank you for everything. I wish I could have shown you what you meant to me.
EK and EC, you were the best friends who could be depended on even though you weren't properly appreciated. I'm sorry.
AJ, God, you re-instilled in me the hope that people can change, that people can be beautiful. Thank you for Fridays, for my birthday, for Brazil, and for picking up at 2 a.m.
AK and DF, you were the most inspiring and genuine friends I've ever known. Thank you for showing me friendship.
JW, don't stop singing, playing, and laughing- you are music people should dance to.
KJ and MG, my oldest friends, thank you for never leaving me long. You are both so lovely, only accept what you truly deserve, please, okay?
MO, try not to be too naive or too much of a smart ***, alright? And thank you, for being part of my 'theme' and proving a point.
Finally, AM, I haven't known you long, but thank you for letting me need you.

Don't miss me, but don't forget me.
I love you all.
Thinking about death lately. I think this is what I'd want to say in my note... No, I don't plan on actually killing myself, just, thoughts... too many thoughts.
Joe Hill May 2014
RH I should've listened to you more
JH I should've showed you more respect
AH I should've been kind instead of firing back
CH I should've reached out while you were still around
JW I should've been less competitive and more honest
EM I should've listened more than I lectured
MC I should've taken the chance
EW I should’ve been more open with you
ED I should’ve held on tighter
AW I should’ve given you more credit
EL I should've talked to you more
EG I should've tried harder
SW I should've been a better mentor
MG I’ll take care of you as much as you take care of me
RK I’ll motivate you more
AK I’ll be a more firm guide
JC I’ll try to love you anyway
TU I’ll tell you more how amazing you are
GB I’ll let you know how much I respect you
TC I won’t stop striving
AS I won’t let go
Part six of the "Simple Realizations" series
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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Robert Wallace Apr 2017
By a quiet peaceful stream, on a day like any other, a gentle child huddles close to inquire of his mother

You've given me the wisdom he whispers, of Earth and things above, but yet I yearn to know life's secret... tell me what is love

She sweeps her hand so tenderly into the calming brook, come close my son, see what I hold, see what my firm grasp took

There's nothing here, no dream to hold, no essence to caress, love is like this water, a substance no one can possess

It can cool our thoughts and cleanse of fire and even bring us life, but water flows past steadily and quickly leaves our sight

We can drink it in and pour it out to Souls in need of Grace, give others drink, restore their hearts and show them Love's embrace

But it's only in love's sharing that we can truly know, that love is not ours to keep, to hold, it is not ours to own

And as it calls, our lives are changed, our Seasons wax and wane, so now give ear my dearest one, the knowledge is yours to gain

Like water flowing endlessly, when all is gone...

It's only Love that will remain


RW  &  JW
Mel Little Nov 2024
JW
Yanno

I think it’s really, at the end of the day, that you’re the only person I could ever truly unmask with. You’re probably the only person that knows every depraved, ****** up thing about my true personality.

Thanks.

Please try to be happy. For me.
Robert Wallace Apr 2017
The Angel Series

This is a series of poems about two Angels that find a new gentle love

DESERTED SOULS
Amid time turbulent from distant shores, cast down from the Forsaken life before
Two lovers lost begin the search, each hidden, not knowing their own Souls worth
Creatures Divine and Angels fair within their wings such misery bear
To find a life, the heart complete
to know Love's love a moment sweet
The eyes of each fill distant Stars, no longer loves embrace afar
A single thread becomes their song tied tightly to the heart grown strong
Within themselves and not the world the vision same was then unfurled
And now sprung forth the joy uncaged made manifest amidst griefs rage
A  promise born of Two Souls wed with hands entwined, their passion led
All fear removed they touch as one, the journey near is now begun
A spotless hope calls both to deep it's now the Vow the soft heart keeps
Arise Oh Love and greet the day the sun calls forth, our wings obey

Rw & JW
I actually played a rocker of a game of rugby league


You see I was on my way
To play with the raiders
I wasn’t sure how I will play
But I was very unsure
I was listening to YouTube playlist
On my iPhone
The song was bad bad Leroy brown
Making me think of a song I wrote
Called big bad Brian Allan
I ran into the field
To the bad and mean green machine
Fearsome men from the ACT
Don’t try and stop
The men in green
Because we will hit ya hit ha hit ya
Till you see green
The kickoff happened
Brian was tough
At present there was no ball
But a storm was erupting
Then the opposition kicked the ball toward Brian
The lightning hit him forcing him to tackle the opposition player
But after that Brian couldn’t control his actions
Running into the fence
But still Brian was a try saving hero
But the storm was an electrical storm
And the match was postponed
But nobody could stop Brian’s
Try saving tackle
Saying that will give them the 2
Brian was walking around the ground
Trying for people to congratulate him
You MR was there saying why did the raiders win
Brian couldn’t control the lightning
Then the game report was being written
And Brian went to have a look
The coach said Brian don’t look at this
They are very hurtful
Just go home and train
You couldn’t help what happened tonight
You can’t control the storm
So JW and JP took Brian home
Offering if Brian wants to train
But Brian was worried and decided
He wanted to go straight home
So Brian got home at 8-00
And had a nice lesagne
And as he cooked Brian turned on the radio
And then he found out they wanted
Their listeners to know my view of the
Try saving tackle I did
But they didn’t know my number
So they looked for all my namesake
On the internet and went through everyone
But still not me
I cracked open a can of coke
And went to bed
Then they finally got through
And I woke up in the real world
Realising the whole thing was a dream
When I saw 10 shake
Of people ringing their girlfriends
Jessica Aug 2020
You left without saying goodbye, you never gave me a reason, you made me cry,

Day and night I would wonder what I’d done, why I was no longer being called the one,

You used to share everything, a hug, a kiss, your whole self,
But you left me beaten, on my knees begging for my health,

You knew you were using it against me, you knew how much I cared
But were more than happy to destroy me, and the love that we once shared,

I still cry for you J, and I’m not sure if I will ever stop,
Despite the cheating, lying and games, I always put you on top
Of my list of priorities and the reasons why I’d belong,

But I have a voice inside my head, saying that I’m still strong
Enough to get over you, and the way you treated me

Goodbye JW, yours sincerely!

— The End —