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The wicked never rest
Tset eht ssap yeht fi
For they scream this night
Thgis morf edih yeht dna
They come to close your eyes
Seirc rieht era esruc a
They come for you, be assured
Drawer ruoy eb llahs htaed rof
The wicked will come at last
Tsac eb lliw lleps rieht dna
You can not run if you try
Eid si od won nac uoy lla
copyright
Htims Sirhc
2010
Eid reven nac taht eno... Latrommi ma I
Thgil eht gniruoved... Ssenkrad eht ma I
Edisni lived eht, sraef ruoy... Eramthgin ruoy ma I
Thgin yreve peels ot og uoy nehw, luos ruoy gnilaetS

Mrah yna morf uoy stcetorp taht eno... Ruoivas eht ma I
Nus lanrete eht ekil gninrub... Tghil eht ma I
Dnal esimorp eht ot egdirb a... Ediug ruoy ma I
Dnah efas ni er'uoy erus gnikam, Peels ouy sa ouy gnidrauG

Erif lanrefni eht em ni eveileb... Lived eht ma I
Erised uoy lla gnitnarg ni em etivni, eman ym maercS
Thgif ew lived eht rof htaif yb deneprahs thgil fo drows a...Legna na ma I
Thgink gninihs a, rotcetorp ruoy em otnu llac ythgimla eht fo rewop eht htiW

One may contemplate, doubting their faith,
For some reason with a little suffering they started to hate;
Easily clouded their minds with deception and lies!
That's what devils do before plotting your demise...

One may keep holding on, no matter what is thrown;
For they believe in the almighty, and the coming salvation;
A walk through hell, a test of their own will and faith
For never a moment the devil tried blinding their sight

We are our own angels and devils
With free will we live a life with choices
A path through darkness where the devil lies
A stairway to heaven where the almighty shines

You need a mirror to talk to your self
Ask something that you will not regret
What kind of person soon you'll become
A soldier of God or an army of satan...
sdrawkcab lla si ti
semitemos
sgniht  ta kool ot yap t’nseod
eb dluohs yeht yaw eht
ytilibats pu evig  ot nrael
ytiugibma fo ssenteews eht ecarbme
ekil-gurd si rewop sti
sevird ti  sa sessessop ti
shpmuirt taht ssendam a
  tniop noitanimluc eht ta
ytivitaerc fo ecand eht
egru na ;regnuh a si ti
tcepser a sdnammoc taht
lausunu eht ,euqinu eht rof
!ylpmoc ohw esoht staiwa dlrow wen elohw a
-em evig
noitanimreted emos noissap emos
!ylf dna sgniw eht hcterts ot ssengnilliw emos
- em ekam
seil dna sevil taht sselraef a
ytirucesni nwo sti yb detrofmoc

- Vijayalakshmi Harish
27.08.2012
Copyright © Vijayalakshmi Harish
Brumous Jun 2021
uoy ot gnis I
seuh derettahs fo yballul a
htrow dna ytilaudividni fo snoitcarfer

kni gniyrc neeb ev'uoy
em revo lla deraems
ynnuf s'ti, das os gnikool


                           
I sing to you
a lullaby of shattered hues
refractions of individuality and worth

you've been crying ink
smeared all over me
looking so sad, it's funny

'sit scriptor aspiret invicem'

       Should we?
              we already are.
                     Each other we paint;
                                  "blood from thee."
original look here -> https://hellopoetry.com/poem/4362712/one/
I don't think
Brumous Jun 2021
one
uoy ot gnis I
seuh derettahs fo yballul a
htrow dna ytilaudividni fo snoitcarfer

kni gniyrc neeb ev'uoy
em revo lla deraems
ynnuf s'ti, das os gnikool

mecivni teripsa rotpircs tis

                            ?ew dluohS
                 ;era ydaerla ew
          tniap ew rehto hcaE
eeht morf doolb
SoVi Sep 2018
Admirame
O mejor largate
No mas te queria ver
No sabia que tenias mal humor

Mirame
Darme vueltas
En la oscuridad del cuarto
Contra el corriente del abanico

Dando circulos me hace mariada
Casi me quiero vomitar
Pero no hay nada adentro

Te do
Puro puro chantaje
Puro puro verguenzas
Quiero verte sufrir en mi sombra

Puro puro burlas
Puro puro mentiras
Y te veo en esquina
Quiriendo ganar te la vida



© Sofia Villagrana 2018
Poem inspired by the song Chantaje by Shakira
tender beatings
delicate bones
beautiful tears
comforting pain
consented ****
willing victim

.esnes sekam lla ti dna
Bergen Franklin May 2015
I am singing a song of singing!
it a song of singing a song!
you sing when you sing a song of singing
because you are singing!
a song!
lla lalaaallaalalalaala'
that is singing a song
for singing has doe,
which are dear
and deer are dear
and dear have no dough so
they are pointless to rob.
unless your name is ray,
who is singing
a song of singing
becuase he is a singing a song of dough, on doe,
and this song it makes doe dough grow
with the sing of the singing of the song!
singing like me
who i call myself
since ray is not me, he is a ***!
a *** who is singing a song, a song about being sung!
i am singing a song of singing!
it a song of singing a song!
you sing when you sing a song of singing
because you are singing!
a song!
2/22/07
SoVi Sep 2018
Admire me
Or better take off
No more I wanted to see you
I did not know you had a bad mood

Look at me
Go around
In the darkness of the room
Against the current of the fan

Giving Circles Makes Me Marry
I almost want to throw up
But there is nothing inside

I give you
Pure pure blackmail
Pure pure shame
I want to see you suffer in my shadow

Pure pure teasing
Pure pure lies
And I see you in the corner
Wanting to win in life



© Sofia Villagrana 2018
Poem inspired by the song Chantaje by Shakira
shayla ennis Jul 2014
the ground lies bare
(lanc i dalaf)

as death moves in fading light
(bad gurth vi ngalad firiel)

my heart sings to see thee
(cormamin lindue ele lle)

i will follow thee to deaths door and beyond
(amin khiluva lla a gurtha ar thar)

may the leaves of your tree that is life never turn brown
(Aa lasser en lle coia ornn omenta gurtha)

sweet tears of water and light till next we meet
(lissen ar maska tenna lye omentuva)

with laughter to guide us
(yassen lalaith a' "guide" lye)

till land and sun consume us
("till" ndor ar' anar "consume" lye)

when heaven turns crimson flames
(iire Arvandor "turns" agaru "flames")

the sea bares the moon
(i' ear "bares" i' ithil)

valiant blades seeped in blood forged
(astald "blades" "seeped" e' agar "forged")

by black rose
date: July 7,2014
aragon who is a character in this movie his name means elfstone. arwen who is a character in this movie her name means evenstar. by this i got my title. This poem was made do to the  research and watching of the movies called, "Lord of the Rings Trilogy".
the words in a maker are elven, it is a translation of the English words above. the words may be slightly incorrect or different. i did my best to get as close as i could to the true meaning. this is the sight i used for the translations.
www.angelfire.com/empire2/angora5/Translator.html
Jaymisun Kearney Nov 2013
If I saw you coming at me I would growl
at first sight of your woodland form
at that beard that hides the face of a lion
GROWL
You're standing here so close that I smell your breath
a thick cloud from your pearly mouth
a strangling reminding me I missed my chance
ROAR

Beat your chest in your defense, you know I know you won't back it up
(You were caught purring too many times to be a threat)
Stare at my eyes like you'll lunge, lash out at this pout and rip right through
(You were silent for so long and in all ways plain gone)

Mon
key maybe
go
ri
lla
More
like spineless
hu
man
boy

Should you see me slinking to you I should think
at first sight of storm incarnate
at last your chance to cement your meaty fist
HOWL

How is this anything? You just stand there.
How is this anything? You take me in.
How could you now, with tools to prevent, invite the catalytic tempest?
YOUR HOUSE IS MINE

Cower
As I howl
howl
howl
Annees Apr 2023
fingers harming hair,
hot fillers *******
open horizontal chair,
hovering blonde slots,
spot scent 'n sound mix,
set in stone carving X,
crack o' clock lingers,
cranked foreign giver,
converting reign leader

ground control to major
ships of implied delusion,
delusionships in fusion
never co-depending,
neither co-developing
deeply- delving, daunting,
open-ended forming,
TRANS-
           CULT-IVATING
                                 EVADING
                                                [R]URAL
rotating­ out of orbit,
falling prey to rotting,
bits of gums soaring,
bites of arms Taste -ing
                          Test sting
                            Test stink
                              Test  sink-ing
                                Test   sink in
                                  Test   sin king
                                    Tes   singing:
                                       La lal lala la la lla
Someday maybe                         |                gnitiaw fo derit worg ll'I
As I wonder about of you            |         ?yhw wonk t'nod i sselpleh oS
Hear my heart that say...          |                 ...enola lla ereh m'I taht
Of our sweet memories             |                 yawa spils tsuj ti tsaf oS
That is here to stay,                   |             ,emit ni eud nettogrof tuB
Of my love to you, Forever        |     og tel ot esoohc uoy evol ruo fo
It's been sitting in draft for years, so as the memories that comes with it.
(Origin date)
03/28/2011 8:15-AM

(CC BY-NC-ND 4.0)
elle Mar 2012
Why do I do this?
To both you and myself?

Why do I crave your approval?
Why do I need your respect?

Can't I just be strong?
And move on?

Nope. I still need someone to tell me I have potential.
            I still need someone to let me know i'll make it big one day.
            I still need someone to give me that little but of encouragement when I'm too ******* myself.
            I still need someone to sit me down and say, "I believe in you".
            I still need someone to give me advice.
            I still need someone to look up to.
I respect you so much.
We had our differences but all in all, you're still my role model.

But to you, I'm nothing.
Hurtful words roll off your tongue so beautifully.
                     I don't understand!
One day you think I'm amazing
                                                         The next, you're telling me im just mediocre

I may say your words are empty to me
....But I hang on to every last
**Sy-lla-ble
Arjun Tyagi Nov 2016
Bone needle,
Jarred in wooden skin.
Silver thread glistens
In murky crimson sap, blood-akin.

Disciple Ajörn,
Squints beyond yonder.
Sap oozing in steady streams,
Into High Witch Åy'lla's beaker.

'Dryad, dryad, come
Foundling lost in Mireswamp.
Bless the Father of Lies,
Solitude begone.
Breathe fluid,
This wound I inflict.
Seep, drench, drown me
Beside you this moon I sit'

Seven quarters turned,
Blighted, glazed and dead.
Moon spanned all skies,
While Ajörn lay in a stranger's bed.

Reckoning came,
As sudden as his unfortunate arrival.
Witch and Dryad stirred ,
This night the moon, in denial.

'Stop, please?'
Hungry cackle, a shift of pose.
Needle removed, so gently
Soulsap collected in whole.

Åyll'a's bones, deft, finger blades
Nipping and knotting,
Slipping and sliding,
Silver of her thread, red of his being.

'Now we begin'
Sap and thread entwined.
Needles countless descended,
Pain silencing her whines.

Elder craft, this magick,
Dirge of the deathless.
Blood-bone colour of threads
Weaving over her *******.

Weave, weave, my gentle love
What was two can be one.
Bounds known not to sentient life
Awake once more beyond ****** strife.

Through her skin, by her hand,
His sap she sewed unplanned.
Rivulets and lanes of High Witch blood,
Danced black and dark over skin, bland.

A tiara made flesh,
A finger bound in rings,
Ruby fluid flowed freely
Dancing with it's silver twin.

Moans ensued,
Pursuing now departed cries.
The Ritual of The Weave,
One death from being complete.

Like sawdust, he fell,
Strong disciple Ajörn.
Soul, sap, life taken in turns,
An undead Warlock was born.

Not corporeal, fatally surreal,
An existence wrought in threads
Strung by unearthly hands,
A partner in despair and dread.

Dryad lost,
Witch no more.
Two lives threaded
As one, forevermore.


'I'
'I'
'am'
'am'
Wheezed two voices in unison
'we'
'are'
Chanted the Witchlock in delusion.
Daniel J Weller Jul 2018
Bus conversation
Brought rhythm to impeded
Speech like free-est jazz

Be-bop syllables
Legato then staccato
Neither with cadence

It sounded as if
Commas, were, splitting, each, word
Then, each, sy, lla, ble.
Bus journey through Lambeth, London, July 2018
Paul Hardwick Jan 2014
Mirror on the wall                                      llaw eht on rorriM
who is the maddest                                     tstddam eht si ohw
of them all                                      lla meht fo

PAUL                                     paul
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.
For patent information: www.merck.com/product/patent/home.html
Copyright © 1978-2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
All rights reserved.
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SoVi Apr 2018
En la oscuridad claro estoy sola
Única luz que hay son memorias.

Mi cuerpo nomas sabe el frío
En el trinchera nomas hay muerte.
Pero todavía estoy viva
Con mi corazón moviendo lentamente.

La ocean se va y me separa de mis sueños
Dejándome en este cruel mundo.
Cuando quise recordar el pasado
Siento un dolor en mi cabeza que me hace llorar.

No más quiero saber como nadar
Y poder salvarme de estas tinieblas.
Porque se que nadie va venir a sacarme
Me pregunto si realmente alguna vez importé.

Pensamientos suicidas me deja hundir
Tocando el califa al fondo del mar.
Pero no me sofoca la agua
Mi convicción aguante el respiracion.

La superficie del mar esta arriba
Playas afuera de mi alcanzo.
Ni puedo estirar mi manos en esperanza
Se quiebran con el pression de mis errores.

El infierno del mar es el único calor
Abrazando me como un amor perdido.
Calentando me fuertemente
Haciendo me convertir en vidrio.

Pronto el océano me soltara y abandonar
Y criaturas vendrá alrededor de mí a comer.
Lo que me queda de mí se hizo harena
Lla no tengo esperanza a poder regresar al pasado.



© Sofia Villagrana 2018
Inspired by the anime and manga Houseki no Kuni. Part 2 of the collection Memorias Fragmentados.
Leef on naip
Hsurc lla Simene
Evah on esromer
Andie Sep 2018
It sits at the base of the stairs
that lead to the attic;
It sits on the landing floor just
before the basement door;
It rests in a liminal space.

Big, person-sized, it fills the end of the hall
way in the very back.
Carved by an entrepreneur de pompes funèbres with
a knack for carpentry and a deep
undying love for her husband.

Glass inlaid reveals the gears
within, once plated in bronze
but now with only a dull luster.
They haven't been treated gently
by that which they keep.

Two massive pendula swing
back and forth, back and forth, alternating
currents, propelled by springs
set in motion long before
Louis XIV lost to William III

The children like to sit and
watch the hands spin with the
pendula "tick" "tock" "tick"
as the face and hands are a
mottled bronze to match.

During Black Mass it's best not to
watch though. For sometimes a smell
emanates from the spaces between
the gears, "kcit" "kcot" "kcit" si
lla uoy raeh, dna emit seog
                                       sdrawkcab.
When will it be Halloween?
Rocksteadylety Apr 2020
Ayer conosci el Poderoso Kambo
En una ceremonia, es veneno lo que te estan dando
Desde la espalda de una rana, tres puntitos a mi piel, vomito y me sana
Sana sana espaldita de rana
Te doy las gracias
Hoy me desperte con ganas
Y en mis sueños recorde esas memorias Lindas
Que atraves de trauma, tristesa, y abuso a ambos se nos olvida
Respiro profundo
Aire libre
Ranita venenosa tu medicina me sirve
Y por hoy vivire en el lla y en el presente
Algo que no e podido hacer ni tener en mente.
Despues de mi primer ceremonia de kambo
River Reed Feb 2020
Like a pendulum...
niaga kcab semoc lla ti

— The End —