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Who would not laugh, if Lawrence, hired to grace
His costly canvas with each flattered face,
Abused his art, till Nature, with a blush,
Saw cits grow Centaurs underneath his brush?
Or, should some limner join, for show or sale,
A Maid of Honour to a Mermaid’s tail?
Or low Dubost—as once the world has seen—
Degrade God’s creatures in his graphic spleen?
Not all that forced politeness, which defends
Fools in their faults, could gag his grinning friends.
Believe me, Moschus, like that picture seems
The book which, sillier than a sick man’s dreams,
Displays a crowd of figures incomplete,
Poetic Nightmares, without head or feet.

  Poets and painters, as all artists know,
May shoot a little with a lengthened bow;
We claim this mutual mercy for our task,
And grant in turn the pardon which we ask;
But make not monsters spring from gentle dams—
Birds breed not vipers, tigers nurse not lambs.

  A laboured, long Exordium, sometimes tends
(Like patriot speeches) but to paltry ends;
And nonsense in a lofty note goes down,
As Pertness passes with a legal gown:
Thus many a Bard describes in pompous strain
The clear brook babbling through the goodly plain:
The groves of Granta, and her Gothic halls,
King’s Coll-Cam’s stream-stained windows, and old walls:
Or, in adventurous numbers, neatly aims
To paint a rainbow, or the river Thames.

  You sketch a tree, and so perhaps may shine—
But daub a shipwreck like an alehouse sign;
You plan a vase—it dwindles to a ***;
Then glide down Grub-street—fasting and forgot:
Laughed into Lethe by some quaint Review,
Whose wit is never troublesome till—true.

In fine, to whatsoever you aspire,
Let it at least be simple and entire.

  The greater portion of the rhyming tribe
(Give ear, my friend, for thou hast been a scribe)
Are led astray by some peculiar lure.
I labour to be brief—become obscure;
One falls while following Elegance too fast;
Another soars, inflated with Bombast;
Too low a third crawls on, afraid to fly,
He spins his subject to Satiety;
Absurdly varying, he at last engraves
Fish in the woods, and boars beneath the waves!

  Unless your care’s exact, your judgment nice,
The flight from Folly leads but into Vice;
None are complete, all wanting in some part,
Like certain tailors, limited in art.
For galligaskins Slowshears is your man
But coats must claim another artisan.
Now this to me, I own, seems much the same
As Vulcan’s feet to bear Apollo’s frame;
Or, with a fair complexion, to expose
Black eyes, black ringlets, but—a bottle nose!

  Dear Authors! suit your topics to your strength,
And ponder well your subject, and its length;
Nor lift your load, before you’re quite aware
What weight your shoulders will, or will not, bear.
But lucid Order, and Wit’s siren voice,
Await the Poet, skilful in his choice;
With native Eloquence he soars along,
Grace in his thoughts, and Music in his song.

  Let Judgment teach him wisely to combine
With future parts the now omitted line:
This shall the Author choose, or that reject,
Precise in style, and cautious to select;
Nor slight applause will candid pens afford
To him who furnishes a wanting word.
Then fear not, if ’tis needful, to produce
Some term unknown, or obsolete in use,
(As Pitt has furnished us a word or two,
Which Lexicographers declined to do;)
So you indeed, with care,—(but be content
To take this license rarely)—may invent.
New words find credit in these latter days,
If neatly grafted on a Gallic phrase;
What Chaucer, Spenser did, we scarce refuse
To Dryden’s or to Pope’s maturer Muse.
If you can add a little, say why not,
As well as William Pitt, and Walter Scott?
Since they, by force of rhyme and force of lungs,
Enriched our Island’s ill-united tongues;
’Tis then—and shall be—lawful to present
Reform in writing, as in Parliament.

  As forests shed their foliage by degrees,
So fade expressions which in season please;
And we and ours, alas! are due to Fate,
And works and words but dwindle to a date.
Though as a Monarch nods, and Commerce calls,
Impetuous rivers stagnate in canals;
Though swamps subdued, and marshes drained, sustain
The heavy ploughshare and the yellow grain,
And rising ports along the busy shore
Protect the vessel from old Ocean’s roar,
All, all, must perish; but, surviving last,
The love of Letters half preserves the past.
True, some decay, yet not a few revive;
Though those shall sink, which now appear to thrive,
As Custom arbitrates, whose shifting sway
Our life and language must alike obey.

  The immortal wars which Gods and Angels wage,
Are they not shown in Milton’s sacred page?
His strain will teach what numbers best belong
To themes celestial told in Epic song.

  The slow, sad stanza will correctly paint
The Lover’s anguish, or the Friend’s complaint.
But which deserves the Laurel—Rhyme or Blank?
Which holds on Helicon the higher rank?
Let squabbling critics by themselves dispute
This point, as puzzling as a Chancery suit.

  Satiric rhyme first sprang from selfish spleen.
You doubt—see Dryden, Pope, St. Patrick’s Dean.
Blank verse is now, with one consent, allied
To Tragedy, and rarely quits her side.
Though mad Almanzor rhymed in Dryden’s days,
No sing-song Hero rants in modern plays;
Whilst modest Comedy her verse foregoes
For jest and ‘pun’ in very middling prose.
Not that our Bens or Beaumonts show the worse,
Or lose one point, because they wrote in verse.
But so Thalia pleases to appear,
Poor ******! ****** some twenty times a year!

Whate’er the scene, let this advice have weight:—
Adapt your language to your Hero’s state.
At times Melpomene forgets to groan,
And brisk Thalia takes a serious tone;
Nor unregarded will the act pass by
Where angry Townly “lifts his voice on high.”
Again, our Shakespeare limits verse to Kings,
When common prose will serve for common things;
And lively Hal resigns heroic ire,—
To “hollaing Hotspur” and his sceptred sire.

  ’Tis not enough, ye Bards, with all your art,
To polish poems; they must touch the heart:
Where’er the scene be laid, whate’er the song,
Still let it bear the hearer’s soul along;
Command your audience or to smile or weep,
Whiche’er may please you—anything but sleep.
The Poet claims our tears; but, by his leave,
Before I shed them, let me see ‘him’ grieve.

  If banished Romeo feigned nor sigh nor tear,
Lulled by his languor, I could sleep or sneer.
Sad words, no doubt, become a serious face,
And men look angry in the proper place.
At double meanings folks seem wondrous sly,
And Sentiment prescribes a pensive eye;
For Nature formed at first the inward man,
And actors copy Nature—when they can.
She bids the beating heart with rapture bound,
Raised to the Stars, or levelled with the ground;
And for Expression’s aid, ’tis said, or sung,
She gave our mind’s interpreter—the tongue,
Who, worn with use, of late would fain dispense
(At least in theatres) with common sense;
O’erwhelm with sound the Boxes, Gallery, Pit,
And raise a laugh with anything—but Wit.

  To skilful writers it will much import,
Whence spring their scenes, from common life or Court;
Whether they seek applause by smile or tear,
To draw a Lying Valet, or a Lear,
A sage, or rakish youngster wild from school,
A wandering Peregrine, or plain John Bull;
All persons please when Nature’s voice prevails,
Scottish or Irish, born in Wilts or Wales.

  Or follow common fame, or forge a plot;
Who cares if mimic heroes lived or not!
One precept serves to regulate the scene:
Make it appear as if it might have been.

  If some Drawcansir you aspire to draw,
Present him raving, and above all law:
If female furies in your scheme are planned,
Macbeth’s fierce dame is ready to your hand;
For tears and treachery, for good and evil,
Constance, King Richard, Hamlet, and the Devil!
But if a new design you dare essay,
And freely wander from the beaten way,
True to your characters, till all be past,
Preserve consistency from first to last.

  Tis hard to venture where our betters fail,
Or lend fresh interest to a twice-told tale;
And yet, perchance,’tis wiser to prefer
A hackneyed plot, than choose a new, and err;
Yet copy not too closely, but record,
More justly, thought for thought than word for word;
Nor trace your Prototype through narrow ways,
But only follow where he merits praise.

  For you, young Bard! whom luckless fate may lead
To tremble on the nod of all who read,
Ere your first score of cantos Time unrolls,
Beware—for God’s sake, don’t begin like Bowles!
“Awake a louder and a loftier strain,”—
And pray, what follows from his boiling brain?—
He sinks to Southey’s level in a trice,
Whose Epic Mountains never fail in mice!
Not so of yore awoke your mighty Sire
The tempered warblings of his master-lyre;
Soft as the gentler breathing of the lute,
“Of Man’s first disobedience and the fruit”
He speaks, but, as his subject swells along,
Earth, Heaven, and Hades echo with the song.”
Still to the “midst of things” he hastens on,
As if we witnessed all already done;
Leaves on his path whatever seems too mean
To raise the subject, or adorn the scene;
Gives, as each page improves upon the sight,
Not smoke from brightness, but from darkness—light;
And truth and fiction with such art compounds,
We know not where to fix their several bounds.

  If you would please the Public, deign to hear
What soothes the many-headed monster’s ear:
If your heart triumph when the hands of all
Applaud in thunder at the curtain’s fall,
Deserve those plaudits—study Nature’s page,
And sketch the striking traits of every age;
While varying Man and varying years unfold
Life’s little tale, so oft, so vainly told;
Observe his simple childhood’s dawning days,
His pranks, his prate, his playmates, and his plays:
Till time at length the mannish tyro weans,
And prurient vice outstrips his tardy teens!

  Behold him Freshman! forced no more to groan
O’er Virgil’s devilish verses and his own;
Prayers are too tedious, Lectures too abstruse,
He flies from Tavell’s frown to “Fordham’s Mews;”
(Unlucky Tavell! doomed to daily cares
By pugilistic pupils, and by bears,)
Fines, Tutors, tasks, Conventions threat in vain,
Before hounds, hunters, and Newmarket Plain.
Rough with his elders, with his equals rash,
Civil to sharpers, prodigal of cash;
Constant to nought—save hazard and a *****,
Yet cursing both—for both have made him sore:
Unread (unless since books beguile disease,
The P——x becomes his passage to Degrees);
Fooled, pillaged, dunned, he wastes his terms away,
And unexpelled, perhaps, retires M.A.;
Master of Arts! as hells and clubs proclaim,
Where scarce a blackleg bears a brighter name!

  Launched into life, extinct his early fire,
He apes the selfish prudence of his Sire;
Marries for money, chooses friends for rank,
Buys land, and shrewdly trusts not to the Bank;
Sits in the Senate; gets a son and heir;
Sends him to Harrow—for himself was there.
Mute, though he votes, unless when called to cheer,
His son’s so sharp—he’ll see the dog a Peer!

  Manhood declines—Age palsies every limb;
He quits the scene—or else the scene quits him;
Scrapes wealth, o’er each departing penny grieves,
And Avarice seizes all Ambition leaves;
Counts cent per cent, and smiles, or vainly frets,
O’er hoards diminished by young Hopeful’s debts;
Weighs well and wisely what to sell or buy,
Complete in all life’s lessons—but to die;
Peevish and spiteful, doting, hard to please,
Commending every time, save times like these;
Crazed, querulous, forsaken, half forgot,
Expires unwept—is buried—Let him rot!

  But from the Drama let me not digress,
Nor spare my precepts, though they please you less.
Though Woman weep, and hardest hearts are stirred,
When what is done is rather seen than heard,
Yet many deeds preserved in History’s page
Are better told than acted on the stage;
The ear sustains what shocks the timid eye,
And Horror thus subsides to Sympathy,
True Briton all beside, I here am French—
Bloodshed ’tis surely better to retrench:
The gladiatorial gore we teach to flow
In tragic scenes disgusts though but in show;
We hate the carnage while we see the trick,
And find small sympathy in being sick.
Not on the stage the regicide Macbeth
Appals an audience with a Monarch’s death;
To gaze when sable Hubert threats to sear
Young Arthur’s eyes, can ours or Nature bear?
A haltered heroine Johnson sought to slay—
We saved Irene, but half ****** the play,
And (Heaven be praised!) our tolerating times
Stint Metamorphoses to Pantomimes;
And Lewis’ self, with all his sprites, would quake
To change Earl Osmond’s ***** to a snake!
Because, in scenes exciting joy or grief,
We loathe the action which exceeds belief:
And yet, God knows! what may not authors do,
Whose Postscripts prate of dyeing “heroines blue”?

  Above all things, Dan Poet, if you can,
Eke out your acts, I pray, with mortal man,
Nor call a ghost, unless some cursed scrape
Must open ten trap-doors for your escape.
Of all the monstrous things I’d fain forbid,
I loathe an Opera worse than Dennis did;
Where good and evil persons, right or wrong,
Rage, love, and aught but moralise—in song.
Hail, last memorial of our foreign friends,
Which Gaul allows, and still Hesperia lends!
Napoleon’s edicts no embargo lay
On ******—spies—singers—wisely shipped away.
Our giant Capital, whose squares are spread
Where rustics earned, and now may beg, their bread,
In all iniquity is grown so nice,
It scorns amusements which are not of price.
Hence the pert shopkeeper, whose throbbing ear
Aches with orchestras which he pays to hear,
Whom shame, not sympathy, forbids to snore,
His anguish doubling by his own “encore;”
Squeezed in “Fop’s Alley,” jostled by the beaux,
Teased with his hat, and trembling for his toes;
Scarce wrestles through the night, nor tastes of ease,
Till the dropped curtain gives a glad release:
Why this, and more, he suffers—can ye guess?—
Because it costs him dear, and makes him dress!

  So prosper eunuchs from Etruscan schools;
Give us but fiddlers, and they’re sure of fools!
Ere scenes were played by many a reverend clerk,
(What harm, if David danced before the ark?)
In Christmas revels, simple country folks
Were pleased with morrice-mumm’ry and coarse jokes.
Improving years, with things no longer known,
Produced blithe Punch and merry Madame Joan,
Who still frisk on with feats so lewdly low,
’Tis strange Benvolio suffers such a show;
Suppressing peer! to whom each vice gives place,
Oaths, boxing, begging—all, save rout and race.

  Farce followed Comedy, and reached her prime,
In ever-laughing Foote’s fantastic time:
Mad wag! who pardoned none, nor spared the best,
And turned some very serious things to jest.
Nor Church nor State escaped his public sneers,
Arms nor the Gown—Priests—Lawyers—Volunteers:
“Alas, poor Yorick!” now for ever mute!
Whoever loves a laugh must sigh for Foote.

  We smile, perforce, when histrionic scenes
Ape the swoln dialogue of Kings and Queens,
When “Crononhotonthologos must die,”
And Arthur struts in mimic majesty.

  Moschus! with whom once more I hope to sit,
And smile at folly, if we can’t at wit;
Yes, Friend! for thee I’ll quit my cynic cell,
And bear Swift’s motto, “Vive la bagatelle!”
Which charmed our days in each ægean clime,
As oft at home, with revelry and rhyme.
Then may Euphrosyne, who sped the past,
Soothe thy Life’s scenes, nor leave thee in the last;
But find in thine—like pagan Plato’s bed,
Some merry Manuscript of Mimes, when dead.

  Now to the Drama let us bend our eyes,
Where fettered by whig Walpole low she lies;
Corruption foiled her, for she feared her glance;
Decorum left her for an Opera dance!
Yet Chesterfield, whose polished pen inveighs
‘Gainst laughter, fought for freedom to our Plays;
Unchecked by Megrims of patrician brains,
And damning Dulness of Lord Chamberlains.
Repeal that act! again let Humour roam
Wild o’er the stage—we’ve time for tears at home;
Let Archer plant the horns on Sullen’s brows,
And Estifania gull her “Copper” spouse;
The moral’s scant—but that may be excused,
Men go not to be lectured, but amused.
He whom our plays dispose to Good or Ill
Must wear a head in want of Willis’ skill;
Aye, but Macheath’s examp
Th’ast dar’d too far ; but, fury, now forbear
To give the least disturbance to her hair:
But less presume to play a plait upon
Her skin’s most smooth and clear expansion.
’Tis like a lawny firmament as yet,
Quite dispossess’d of either fray or fret.
Come thou not near that film so finely spread,
Where no one piece is yet unlevelled.
This if thou dost, woe to thee, fury, woe,
I’ll send such frost, such hail, such sleet, and snow,
Such fears, quakes, palsies, and such heats as shall
Dead thee to th’ most, if not destroy thee all.
And thou a thousand thousand times shalt be
More shak’d thyself than she is scorched by thee.
If you ask him he will talk for hours--
how at fourteen he hammered signs, fingers
raw with cold, and later painted bowers
in ladies' boudoirs; how he played checkers
for two weeks in jail, and lived on dark bread;
how he fled the border to a country
which disappeared wars ago; unfriended
crossed a continent while this century
began. He seldom speaks of painting now.
Young men have time and theories; old men work.
He has painted countless portraits. Sallow
nameless faces, made glistening in oil, smirk
above anonymous mantelpieces.
The turpentine has a familiar smell,
but his hand trembles with odd, new palsies.
Perched on the maulstick, it nears the easel.

He has come to like his resignation.
In his sketch books, ink-dark cossacks hear
the snorts of horses in the crunch of snow.
His pen alone recalls that years ago,
one horseman set his teeth and aimed his spear
which, poised, seemed pointed straight to pierce the sun.
brooke Mar 2016
maybe i got caught up in that rustic
devil-may-care way that you leaned
on any counter, how the hot oil from
your grandmother's pans shot up and
flecked across the posterior of your
hand and you didn't even flinch, just
sort of sighed through your teeth
and how I spent the few seconds after
that wishing I could press myself against
your back because you are so solid.
But I digress, because I've learned that
idolizing people is a mess of self-inflicted
palsies

Nevertheless, my affinity for compounding
problems manifests in my lack of willpower,
in your forearms that are like thick bristlecone pine
branches, dry and scarred with your
obstinance--

and when you would go to wash your
hands, you'd roll your sleeves in
this rough, intensely **** manner
with your hip pushed up against
the lip of my sink, working the
dirt out of your knuckles.
So as you kneaded your fingers
back and forth; your Venke's
pulsing, I found myself to
be too hungry for you,
for this

I've never been around so much
man,  so much cord and bark
i've never touched a person and
not felt like I was going to slip
through them like some spectral
being, like their spine would
give way before they bend in
two around my palm, barely
grounded by their own
body weight.
The difference is (was?) that
you feel so full, so stalwart
and



(I got to thinking; maybe I wasn't ready.
Because for all your worth, all your
redeemable qualities, I'd cashed in on
the way you made me feel when
I hadn't for so long and that's not
the way I want to,
Not the way I
Want to
Not the
Way )
and we are

(c) Brooke Otto 2016

i wanted to leave this in my drafts but here it is.

written to Death Row by Jimi Charles Moody, definitely sets the mood if you're interested.
Ron Sanders Feb 2020
Was it bleak or bright, I cannot say, so mesmerized was I,
when I saw you cross your balcony to take the morning air.
Brilliant were the beams and bands that danced about your hair:
an angel in her nimbus, uniting earth and sky.
And I saw you there—saw your red eyes catch the day,
saw you look in my direction, saw your red eyes look away.
A man am I, a dog with human glands.
I snuck behind a moving van and wiped my sweaty hands.
A love unreal confused me, abused me,
tucked my tail and called me stray. Bite the hand
or beg for more? True to form, I slunk away.
And though indeed it strained me, and pained me to adjourn,
I blew a kiss and swore that on the morrow I’d return.
My heart, he soars on silken wings.

That new day came. Ah, so unjust! And so complete my pain—
I saw you with another man, your higher halves entwined…perhaps,
though shards of years were ground to dust, my blood prints marked me plain:
a mongrel doomed to stoops and stones, a cur condemned to scraps.
I saw you—saw you slit me like a knife,
eviscerate my very soul and leave my pride to rot.
You…you kissed this man! You graced his life
with lips Love meant for me. You left me nought.
So rapt, this man! Oh, why, sweet thing, were you so wrapped in he?
A fractured dream, a crippled heart—Ha! What are they to me.
My brain, he lurches light-to-shadow.

The day was black, and cold as sin. Intent, hell-bent,
I sought your hearth again…and saw you with a dozen men!
I blew it there, I lost it then. I split but scampered back in ten.
Then kneeling ’neath your window, and bleeding onto chalk,
I visualized a pentagram, and drew it on the walk.
O wretched me! The ills I loosed were sudden and extreme.
I seemed to reel through realms surreal, engulfed in flames and steam.
But in that rune I saw you—your burning hair, your melting face—
betrothed to a misshapen brute, and crushed in his embrace.
I saw you fry, my tainted pie, my angel-not-to-be.
No matter, dear, our course is clear. No other fool,
you fickle jewel, will share your fate with me.
My fist, he palsies as he clenches.

Dismayed by dreams of infants’ screams, I part my lids to find
I’ve merely lost my will-to-be, I’ve yet to lose my mind.
The frauds and freaks run howling, the living **** the dead—
I’d give my all to make my peace; alas, I’ve made my bed.
With toes aflame I wander lame down ways that pitch and wind;
the lashers all assume I’m lost, the hiders think I’m blind.
But I saw you—the Master’s squeeze—a wizened, crippled crone:
a wagging head and yoke of lead, an anvil on your rear.
Your shins were munched, your back was hunched, your skin was puckered rind.
A scorched queen with a smoking crown, your swelling belly led you down
a path of spewing stone, where fouled and flanked by giant flies,
I saw you pass through veils of gas, your piglets close behind.
Your clogs were frogs, your wedding ring a thing of chiseled bone.
Your skirt was thatch, with hose to match the squalor of your thighs.
I saw you walk his wombats, dear, but I was in your eyes.
My leg, he chases me in circles.


Thanks for reading I Saw You. NOW PLEASE CLICK ON THE LINK BELOW TO READ HERO, A SPRAWLING, GROUNDBREAKING FANTASY FOR GROWNUPS IN TWO PARTS, ALL ABOUT THE FIRST HUMAN TO CIRCUMNAVIGATE THE PLANET. (BUT YOU MUST CLICK ON THE PROVIDED LINK AT THE CONCLUSION OF PART ONE TO ACCESS PART TWO! THAT’S WHERE THIS TALE’S AMAZING RESOLUTION LIES. But please...intelligent, readers only!)
NOW HERE’S THAT LINK:

https://allpoetry.com/poem/14922744-Hero---Part-One-by-Ron-Sanders


Copyright 2020 by Ron Sanders.

contact:
ronsandersartofprose@yahoo.com
Drop that skateboard! Put down that cell phone! Click on the provided link to read actual literature.
Jedidiah Jensen May 2016
I
Swallowing* the almond breeze
Choking heartsick memories
Fading like a dry threadbare
Necrotic, vain, unaware

Shushing the cindery pleas
Covering sanguine palsies
Falling in a scenic snare
Tired, unspeaking, disrepair
Randomly chosen word poem
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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