TERE LABO KO CHUMANE KO JI CHAHATA HAI
TUJHAME KUDKO BHUL JANE KO JI CHAHATA HAI
CHAHAT HAI KI CHAHU ES KADAR TUJHAKO
MUJHAME TU OR KUD ME SAMALE TU MUJHAKO………………………..♥

Bakit sadyang mapagbiro ang tadhana?
Hinayaan na ikaw ay makilala.
Mabihag ang puso ko'y 'di inakala.
Nang lumaon, ako sayo'y nahalina.

Ikaw ay sinubukan na makausap,
At aking sinambit ay "Hi! Hello! What's Up?"
Inakala na ika'y sadyang mailap.
Pagkat mga salitang iyo'y ang saklap.

Dyahe, napaka-labo nga naman diba?
Maging ikaw at ako, 'ika ng iba.
Subalit 'di nagpadaig sa mga duda,
Hanggang loob mo'y tuluyan ng makuha.

Ang hangin ay malakas na umiihip,
Sa labas habang ako ay nag-iisip.
Kung pwede nga lang sana ito i-skip,
Ngunit ang dibdib ay lalo lang sisikip.

Sabi mo sa akin tumingala ako sa langit
At tingnan ang mga talang kaakit akit
Nang ako'y tumingin sa kalangitan
Ni isang ningning ay wala akong namataan
Nasan ang sinasabi mo?
Bakit ang labo mo?

Sabi sa isang dyaryong aking nadampot
Ang mundo'y puno na ng poot
Simoy ng hangi'y hindi na presko
Pagsasa walang bahala, eto ang epekto

Puro nalang kasi AKO AKO AKO
Wala manlang SILA SILA SILA
Paano na nga ba ang iba?
Parati nalang sila ang taya
Kelan ba sila makakalaya
Tila ang tadhana'y maramot at madaya

Mga walang kamalay malay
parati nalang nadadamay
sa mga bagay bagay na tayo ang may gawa
Tila hindi na nagsawa
Sa ilang ulit nang pagmamaka awa

Sila ang nagbigay,
bumuhay
and nagpalago
sa ating ekonomiyang nagduduwal ng daan daang salapi
at nagbibigay sa atin ng gatas na naiiwan pa sa ating mga labi

Tayo? Kelan kaya tayo makapagbibigay?
Kanilang pangangailangan
parati nalang "mamaya na yan"
Kung kelan huli na ang lahat
Kung kelan tayo na'y salat
Saka lang mapapansin
na malapit na tayong mag dildil ng asin

Hindi ba pwedeng baliktarin?
Baliktarin ang pamamaraan natin
Sila naman ang pagbigyan
Uhaw na sila sa kalayaan

Kailangan ko lang ilabas kasi nakita ko tong picture sa Facebook. Inaamin ko madalas sumasayad sa isip ko to. Sino ba naman ang hindi maiisip to kung marealize mo kung gaano ka kahelpless at powerless na baguhin ang paligid mo. Sino ba naman ang hindi makakaisip na baka may mas magandang lugar para sa ating lahat na kung saan masaya tayo. Yung feeling of guilt kung bakit ako nasa loob ng kotse, naka-aircon tapos may batang kakatok sa bintana mo at siya ay walang makain, tapos pag inabutan mo magsasabi padin ng "Thank you po.", sabay bibili ng sundae sa Mcdonald's. Tangina lang diba, kasi bata lang din sila at gusto nila maenjoy ang buhay. Tapos, magmaneho ka lang sa Quezon ave, may kakatok sa bintana mo humihingi pagkain or limos. Tingin ka sa Quiapo may mga matatandang nanlilimos, tapos, masayang masaya pagka binigyan mo ng pagkain, nakakaputangina. Nung nag Davao kami, yung mga nagbebenta ng perlas dun alam **** isang kahig isang tuka ang buhay nila, isang tingin mo lang alam **** sobrang hirap ng buhay. Nakakagago pala talaga ang pakiramdam ng pribelehiyo no? Kasi andun ka lang para mag lamyerda at gumastos ng madaming pera. Yung feeling na nagiinstagram ako ng walang kakwenta-kwentang bagay tapos may namamatay sa gutom sa ibang lugar, may naaabusong ofw sa middle east, yung mga nasa Mindanao napapagitnaan ng gulo. Yung nakikita **** sales lady sa SM na alam **** todo kayod para kumita ng pera sa Maynila pero tangina hindi nabibigyan ng tamang benepisyo at kontraktwal padin. Ang swerte ko. Ang sarap ng buhay ko. Sa sobrang sarap, napakaunfair na at nakakagago na dahil di ko din masabing ayaw ko ang buhay ko, pero ayaw ko din ang mga nakikita ko. Ang labo no? At bilang isang ordinaryong tao, wala kang magagawa para matulungan sila na maglalast sakanya. Hanggang abot ka lang ng barya kasi di mo pwede isacrifice sarili **** kapakanan para sa iba. Dahil ganun na ang mundo ngayon, sarili ko muna bago iba. Pero masisisi mo ba yung pagiisip na ganun kasi may kanya kanya tayong mga problema na dulot ng pagiging myembro ng society? Duwag tayong lahat. Duwag na tumulong sa abot ng makakaya natin kasi takot tayo na baka tayo naman ang mapunta sa ganung kalagayan kapag binigay natin ang lahat. Tulad ko, pasuicide suicide pa pero duwag akong gawin, hanggang sagi lang sa isip ko, tangina ko eh no? Dahil yung nakakatulong lang talaga yung may tunay na tapang. Katulad ni Mother Teresa ang daming tinulungan at inalagaan, pero ironic dahil nawala ang paniniwala nya sa Diyos dahil sa nakita nya nasobrang hirap na dinadanas ng mga taong inaalagaan nya. Putangina ng Mundo. Bakit ba tayo nandito? Pagtapos nito balik na ko sa normal. Tangina nyo.

Ek arsaa ** gya h aabaadi dkhte dkhte
Ab khushal ped nhi patjhad lubhata h mjhe
Ab to there ishq mai khaak hona h mjhe
Ab to bas barbaad hona h mjhe

Ab suraj ki roshni nhi andhera pyara lgta h mjhe
Ab upar Jana nhi girna pyara lgta h mjhe
Ab to tere ishq mai raakh hona h mjhe
Ab to bas barbaad hona h mjhe

Ab to dil m pyar nhi dard accha lgta h mjhe
Is bejaan shareer mai khoon nhi nasha acha lgta h mjhe
Ab to tere ishq mai taaj hona h mjhe
Ab to bas barbaad hona h mjhe

Teri ek ek yaad apne ashko se bahani h mjhe
Teri ek ek hasi apne gum se chupani h mjhe
Ab to tere ishq mai zinda laash hona h mjhe
Ab to bas barbaad hona h mjhe

Ishq ki maala m vishwas k motiyon ko todna h mjhe
Duniya k jhoote riti riwazo ko todna h mjhe
Ab to tere ishq mai kisi shayar k labo ki awaz hona h mjhe
Ab to bas barbaad hona h mjhe

Sobrang labo ng mundo natin
Yung tipong
Andito ako
Andyan ka
Sayo umiikot ang mundo ko
Pero tumitigil sayo
Masaya ako sayo
Samantalang masaya ka sa iba
Bibitaw na ako
Pero minsan di ka man lang kumapit
Ang masaklap sa lahat
Mahal kita
Pero di mo ako mahal

Ang labo diba?
Ganyan ang mundo natin
Sobrang labo at baliktad
Kasi hanggang ikaw at ako na lang
Wala ng magiging tayo
Masakit man sakit na tayo'y hanggang dito na lang
Masaya pa din ako
Kasi dumating ka sa buhay ko
Di man naging tayo
Nagpapasalamat ako at nakilala kita

Isa, dalawa, tatlo
Pagbilang kong sampu, nakatago na kayo
Apat, lima, anim,
Magmadali, papatak na ang dilim
Pito, walo,
sa rimarim na ito sa’yo’y walang sasambot
siyam, sampu
pipindot na sila sa gatilyo

Naaalala ko pa noong matiwasay pa ang lahat
tahimik bukod sa sipol ng hangin na rinig na rinig
walang ingay sa paligid
puti ang sahig – linis hanggang gilid

Naalala ko pa noon,
walang pangambang tahi
sa bawat isa sa t’wing pumapatak ang gabi
Madilim ang lansangan,
ngunit may liwanag ang daan
Di mag-aalalang umuwi,
‘di magugulumihanan

Naaalala ko pa
nung una silang pumindot sa gatilyo
Nayanig ang paligid,
nagulo ang tahimik
Tintado na ang sahig na dating puti
ng dugo mula sa bago nilang kitil.

Naalala ko pa noong nagpasabog sila ng bomba
Nabingi ang lahat sa ingay na likha,
mga tarantang mukha,
mga takbong halos ikadapa
mga matang labong labo na
ng mga luha

Naalala ko pa noong kinuha nila si itay
lupa raw namin ay ayaw niyang ibigay
pinuno ng latay,
inuwing akay-akay -
muntik na siyang mamatay

- walang kamalay-malay
na kami’y unti-unting pinapatay

ni walang panahong
makinig saming salaysay

May dugo

ang bigas
na iginagatong ninyo

May bakas ng dahas
ang pagkaing hapag sa kainan ninyo

Mga sigaw
na busal ng kasadong gatilyo

May namamatay na dito
makinig naman kayo!

Isa, dalawa, tatlo
Pagbilang kong sampu, nakatago na kayo
Apat, lima, anim,
Magmadali, papatak na ang dilim
Pito, walo,
pipindot na sila sa gatilyo
Siyam, sampu

Bang! Bang!
The sounds of gun shots mid-day on Thursday,
Sirens getting closer to the crime scene,
Just two weeks ago a man's life was terminated for a cellphone,
More thugs and more gun fires,
the tragedy so bad it even appeared in the news.

But today i can feel fear creeping in my vains,
Another man shot dead today,
why do i have to live in this community?
For i am afraid.
Few months ago
it was just like an action movie,
people running and rolling
while the loud sounds from the police guns aiming over my
roof top kept on going
Bang! Bang!

I see the police patroling the streets by day,
having picnics in the park
while they watch their horses eroid away the soil.
They feast to some take away outlets
filling their sagging bellies by night.
While they letting the just go unpunished all year long,

Oh! It hurts.
I feel a bullet on my chest,
Oh! It hurts
for i cannot look through the dark
night anymore.
I sit on the side of this wide classroom window,
And i wonder,
What if one bullet comes straight to me. (God forbid)

Oh this township that i loved,
you are not safe anymore.
Where can i run to for i called you home?
There is no distance further gone  without any loud sounds;
Bang! Bang!

     Oh mam' ngiyalil'
     ngililel' labo abangasek'
     ikakhulukaz' imphil' yam'
     umphefumul' ongenacal'
     kungab' sewabayin' wena             dolobh' lami.

I called your name,
with so much pride and bragging,
but now i cannot even say your name
for you have groomed thugs,
gangsters,
vindals,
drug addicts and drug dealers,
harlots... And what else that we do not know?

Could it be blood sacrificies,
are these the 'EndTimes' proclaimed in the book of Revelations,
Why should i bother trying to think when all i hear in my head are ecoing sounds
Bang! Bang!

All i need to do  is to find a way out,
    Nyawozam' ngibeleth' !
    Ngob' inhliziy' ayisahlalisekang'
    qobo
when will that day be,
when crime will be stopped for good,
and police do justice to the community?

have you ever felt shot into space
with nothing to hold to without any trace
of the one who was always around
who could laugh really hard and without any sound

and you fear that someday he will see
that you're mind is a strange one indeed, yet it's free!
to be up in the air and then down
hear that music that plays like a carnival sound

and it's something that's deep in your soul
from the day you first met he's been making you whole
cause he won't let you feel afraid,
fix you up when you're ****** and knows his first aid

Five of us kids to take care of
and all within seven short years
Leno then Beano then Bonzo then Labo then Damo
all laughter and tears.

It seems that we share the same feelings
about our ol' dad, and it's said
much better to share them while we are alive
than to wait until after we're dead.
  
and so I will write about Daddy
and because I am long with my word
my poems I will say can go on for a day,
and a night or so that's what I've heard.

To Tony, Loretta would cater
she cooked for the man who would date her
they married and so, and what do you know
three children would come along later.

Born October two four, nineteen hundred
and twenty eighth year of our Lord
at home, the first child of Tony and Rhetts
baby Vinny, was cut from the cord.

This sweet little Vincent Morrone
raised up in by my Nonna and Tony
quickly stuck in his ways, from the start of his days
and could size up the truth from a phony.

He grew up in old Jersey City
where he polished the width of his witty
had a sister named Claire who remembers him there
dear old dad, handsome lad, and she's pretty.

Their brother was born sometime later
our sweet uncle Jerry Morrone
Handsome and good and well liked in the hood
got those genes and that same funny bone.

 After Highschool, staff sergeant in Air Force
guiding take offs and landings, his post
Four years of St Pete, put him smart on the street  
and he left for the likes of our coast.

He was offered a job down in Jackson
elementary dear Watson, it's said
he would fall for another young teacher, a screecher
whose sassiness got to his head

He married our mother, that's Jacquie
they really were some kind of a pair
she knew he was smart, liked his looks and his heart
and respected the good that was there.

So five days a week Dad would teach
and he liked those nine months of the year
but he lived for the summers at Jenkinson's beach
where that salt water pool was so clear.

in a torn old white sweatshirt and plaid shorts
he was sharing a Bud at the fence
loved his mower and pool, and that backyard was cool
much more like a park, you would sense.

we know how he hated the gurlic
and that onions would just make him hurlick
my mother would never use any such thing
he could drive her to sing like Steve Urlick.
( did I do that?)

No qualms about eating cold hotdogs
and cheddar in chunks from red foil
liked his eggplant cut thin, and his gravy could win
a blue ribbon, the secret? No spoil!!

Could deliver a joke like Bob Newhart
or a pun just for fun was sublime
he was always aware, but for crowds, didn't care
unless it was harmony time.

Best one on one at a party
but the life when it came to his cracks
made small talk okay, but preferred just to stay
to the side and be watching the acts.

Old Spice and that weekender stubble
did his thing and his speaking was soft
he was never a man to cause trouble
but he'd tell you when something was off.

McDonalds and corn on the cob
smoked a pipe, did not curse, and was never a slob
though I know he was not always neat
he was clean, never smelled, never spit in the street.

taught us never to take wooden nickels
and he loved a fresh jar of those kosher dill pickels
drove a large Orange bug in the day
with a driver side  SPEBSQSA

he wiped off my face with his thumb
that he'd lick first to clear away jelly and crumb
and he'd always be there in a pinch
if I needed his help, he was there, not a Grinch!

He was always the Good Humored one
bought us Ice cream and took us to places for fun
an occasional "word to the wise
you've cashed in your chips
and don't hand me your lies."

and the one who would walk me not once
but twice down the aisle of heartache and gloom
as a wife I have failed, a dunce
yet dismissing that elephant out of the room.

and tried not to laugh at my lot
at my barrenness, troubles and all of that snot
took me back to this place for some peace
never charged me a dime, not a landlord with lease
but a man with the mercy he knows
he understood sometimes that's just how life goes

and suddenly everything's changed
I am fifty two times around, feeling deranged
and it's not because I need a crutch
feeling lost in this world  
which I've lived in and such

but that I have been shot into space
having lost what I loved, it's my dad's loving face
and I'm here in the house that he bought
it's the one where we loved and the one where
we fought

and I cried here at length at the table
feeling shot into space, as if I am unable
to cope with the loss of my dad,
with the loss of his smile  and the voice that he had

and the place that he had in my life
in my heart....in my head...in my mind...So I climbed
to room where my dear daddy slept
and I laid on that bed and I wept and I wept
feeling shot into space I recalled that man's face
and I reached for the  tissues he kept in that place

and in one second flat, as I blew
from the nose of his likeness,  I knew and it's true
I was beamed back from space
into someone's embrace
and believe me, as if my dad knew...

For my father was known to be punny
always quick with the wit, such a honey
he would tell me to write, for it was his delight
that his children were his kind of funny.

I am never to think I am odder
for I am what I am, my dad's daughter
I hear distant strumming and now my dad humming
the theme song from Welcome Back Kotter.

http://youtu.be/5VlGyMG0ksg

Kapag hawak niya ang mga kamay ko, ikaw ang iniisip ko

Kapag sinasabi niyang mahal niya ako, ikaw ang naaalala ko

Kapag tinitignan niya ako, mukha mo ang nakikita

Kapag tumatawa siya, tawa mo ang aking naririnig

Ginusto niya 'to, pero tanga ako

Kasi hinayaan ko siyang masaktan

Oo, napapasaya niya ako. Pero ikaw pa rin talaga! Pinapaasa ko siya kada araw na lumilipas

Sinungaling ako, sinungaling din siya. Sinungaling ako kasi sinasabihan ko siya ng mahal ko siya, kahit ang totoo ay ikaw pa rin

Sinungaling siya kasi kunwari ayos lang siya, kunwari hindi siya nasasaktan

Hindi ako karapat dapat sa kanya, pero hindi ko alam kung paano tapusin

Ayokong tapusin kasi mahal ko na 'ata siya

ikaw yung pagasang ayoko ng asahan
ang sakit e
ang labo

I was drawn to you
Was it the conversation,
Irish accent,
or just Le Labo?

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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