Write something about nothing, call it poetry.
Quiet jet-engine speed turmoil indecision on the topic.
Silent bodies, screaming minds, communication desired and avoided
Chance glances, glimpses. Hoofing it.
Write poetry about nothing, call it something, but only in whispers to yourself, pretend to hope to be heard, have interest feigned or genuine directed your way.
        Confusion. Mingled strings of internal conversation.
        Misdirected. I can’t think crooked, focalisation se présente sideways. Self-expression in non-poetic terms seems likely. Saw girls, one on Detroit street, summer clothes and quiet face, scampered inside from the yard littered. Saw her again in the street next to a minor catastrophe, passed her by and looked.
        Let’s take a second to breathe, introduce a silence to the mind so that everything that comes can be better heard. So much background noise, minor thoughts mingle into static, almost impossible to interpret the bemused psychobabble. Empty it out, slow down, relax, and maybe you’ll begin to recognize coherent thoughts; organize the jumble of words fighting to be understood all out of order and as yet meaningless. Thoughts keep revolving, recycling; the girl, she reminded you of Melissa. Same style, a girl whose mood is always a grateful summer to your wintry perspective. Refreshing reminder, easy on the eyes. This girl’s likeness and your friend the poet, separated; his utensils. The paintbrushes he flourished about to create were not wooden and sable but liquid and smoke. That small ******* secret voice suggesting unwholesome things, acts unbefitting of brotherly conduct. He is my true brother, my family; an extension of my own soul. I went to treatment, they broke me down, whittled away at my rough hewn surface to make sculpture, a replica of others, manufactured to meet requirements and specifications deemed necessary for target successes. This talk of will, sacrificing my own, force-fed trust and mantras begetting themselves in circular fashion, turning in sync with the earth’s rotation upon its axis in its course of necessary revolution.
        Expended effort and time saved or served, goals impossible until forgotten, let go empty space ellipsis let god. Self-supplanted in unpredictable incomprehensible present, trying to avoid thoughts of crumpled papers in paper bags serving as receptacles for things undesired or abandoned or too truthful, I’m forgetting what it is to hide from myself which makes it possible to disappear. Tune in to the present, your train of thought – a queue – crowding, crowds rushed and frantic me first says everyone impatiently awaiting their turn for attention. Starved but forgotten proper nutrition. Self-criticism equating to self-analysis – spontaneity – uncontrollable, unforeseeable in the present aromatic mixture of mason jars swarmed with colored lights beautiful dim in darkness in which beer was swilled, time spent in unkempt kitchens nervous, standing walking evading settlement peace or rest, this is excitable discomfort, anything to slow down or feel a surrogate thereof. Forgotten words remembered, past rooms beautiful dim in darkness, proper illumination – see everything just right, not too brightly though not too dark. Living in this room for now, seeing as though immersed, submerged in memory of smiling faces easy laughter, cold-eyes Vera and well-at-ease. There is a wealth of self-acceptance. These people, their faces shine contentment, comfort, and mine is manufactured. I’ve become a factory where everything is sought after and nothing is attained because my goals are intangible, comprehensible but beyond aid, sorry, it’s just the way you are, maybe you’ll know one day, but we can’t help. We don’t waste our time with questions of absurdity, we live in this present moment, and that’s how we do it – no plans until plans come. No thoughts until thoughts come. Easy transitions in conversations, we don’t think of how to be ourselves, we just do it because we slow down, we know we are breathing, and it is not in our nature to forget it. It is not in our nature to live in our heads, to flail in a swell of questions less dense than water, we attend. We simply are.
        This is contentment. This is their seamless skin where mine corresponds to scars and rabid suspicious scratches dug deep. They were content with their surfaces; I was convinced of malice subcutaneous hence the scars and blood breathing open air. It is this suspicion that draws a line, places me on one side, them on another; it is this curiosity intrinsic and ironically unquestioned that digs the trenches in shape of graves. This fatal imaginary need for understanding where there is nothing to be understood. Questions are my poison, self-manufacturing, self-sufficient destruction, coming hot off the assembly line in my skull. Questions incubating further questions error: implement infinite loop, killall. Find the bug, recompile, run. Sit still, learn from the wind and atmosphere you’ve learned to sense which makes you an outsider only because you wanted this somehow. Uncertainty, confused reflection, arbitrary comments; coincidences, conspiracy, breakpoint. Programs running in smooth operation.
        Radiohead blaring, self-conscious self-care, these people enjoy themselves with unconscious grace, they let themselves be and immediately I tear my mind in two to understand what they understand without understanding. It is the nature of love and music that displays the closest correlation. These people are my idealized notion of grace, rendered more so by speed of processing, depth of analysis so that they appear not only graceful creatures, but with grace amplified as if observing them in slow-motion. So much contingent on understanding, contingency notwithstanding if I was comfortable with ignorance, if questions did not occur. These people are appropriate; balanced, no need for brutal introspection, no need to stir up sand composing the sea bed. These people, they understand certain things I cannot as of yet. They understand, they know without knowing that things are the way they are because things are the way they are and that’s ok, we’re ok, and everything is and will always be ok as long as we know well enough to leave well enough alone. We are each other, serving compliments to sainthood.
        ...let go, and be one with us, for love is in our hearts.

The other day, as my tears weren't drying,
I wrote   'stop hating yourself'
in hope, on my left arm.

I carried it round with me the next day,
hidden under clothing and smiles
praying the words would sink in.

That black ink would slide under
Subcutaneous layers; deep within marrow
Sparkling kindle within.

A week later there was no trace to be found
of those words or that false hope.

Those permanent marker promises
which I can't say I broke,
because I never made them in the first place.

My words are cutting themselves again;
razoring their loosely-sutured syllables,
deep as white-eyed bone.

The suave dipththongs butchered
to the cadence of bloodletting
in hemorrhagic oppositions.

Stapled-closed sentences, smeared with Iodine,
and subcutaneous sentence diagramming
for the retractable scalpel
swiveling along the edge,
of the well serrated cliche.

Once I pressed my wordy flesh
against the wrong side
of a paring knife, while paying no attention
and suddenly,
and without warning
it gave, like an over ripe peach
to the cleaver-
and after that, I was hooked.

A subcutaneous doubt musters and you itch
The shore line depression is here without hitch
A sea of harps instigating an emotive atrophy
You discharge and you dive with certain alacrity

There is a boat afloat out in the briny of spite
Oar-less and holey amid the bark and the fight
You plunge and you quaff as you leave quiet behind
A clamber and a climb and inside you will find

Ruckus and roar as you rock with each crash
Thunder and hail as the waves tempestuously lash
Gladden with the grim elation preserves you
Mirthful and drugged whilst the wet pours through

To the most aphotic of waters that drags you deep
The boat now just wood unto rocks in a heap
Too eager to leap and now too weak to swim
A stoical sink under madness to dim

The seashore despair was a lie to itself
The still and the shielded brimming with wealth
Never attempt to weather a storm
Of a storm as endless as that of that storm

A wish that you stayed a want that you listened
You’d still be where her green eyes glistened
Where love and the good is now once tendered
Most is best left as how it’s remembered.

you chew on coffee beans to cleanse your mouth of this
one long silence
it is open like a wound
it festers

when your breath condenses in the cold air you feel its presence
with icy hands it holds yours
it is patient
it is strict

chewing gum is not sufficient; it is sweet, it makes you wonder
about sugar crystals
they grow like bones
they are brittle

but the taste of blood, of coffee, of chocolate with no milk is good
you can remember without remorse
you can sit and think about dreams
without letting them in

and all your pain can stay subcutaneous
as long as you don’t speak

balance is beholden to little,
just as the stars do not compel.

i roused with asphyxiation,
down suffocation, fever.

reverie so irreverent,
(removal proves impossible).

subcutaneous deposits of venom
perspiration is the poultice.

(but the brain was never meant
to drown in the skull)

purveyors of manufactured

kitsch

reminiscent of

plaster wall pool hall pastime bulls

eye

plastered

America’s

got stars

stripes

corncob pipes in

straight

lines and circles within circles
within

I’s

Jasper laid himself down on the plains of canvas in

perpetual concentrics

perpetuating eccentric eclectic economics of

subcutaneous pricetag politics.

bull’s

eyes on the prize of a new American dream

a dream deferred and defined

in straight and curved

lines.

Slogging through endless Whitman prose and I have to make little marks
on the pages every 8 to 14 lines as my mind will not quit the wandering roam.
Blanket paragraphs blend into infinite droll, never ending whine-fest of bull
jazz…jazz singers fill the empty spaces between
the lines of drivel.

The dog barks on the veranda looking old and sad in the wind,
The water trickles through a series of rusted and holey pipes… peeling
asbestos laden lead paint tricks the mouths of children… a sick cat heaves near the Chesterfield.

Finding myself no longer interested in freelance fodder, I real from one daydream to the next
without enough pause to subconsciously journal… a subcutaneous oak shard
gives a slight reddish bump to my well defined forearm,
slight pressure sends nearly transparent ****
screaming from its melanin tomb.
The sliver remains diligent.

The sliver holds its ground,
The sliver has a new home,
The sliver wants to die here,
and never again travel the long lonesome forest road,
The sliver shines silver in the sunlight,
I shiver at the sight.

Is it elegance or ignorance? Subcutaneous subterfuge. Blanketed and varying slightly, insolvent and limited. Bourne amidst a social caste of wealth or not for you.

The reigning victors make the rules. Life is a habit, not a reflex. To learn I must clear my mind of unnecessary clutter and make order within the hoard.

A mass pushing into me like a great lorry
The leather jacket, the smell of the dead
The skin so shiny like a glass filled with milk,
White and whole and fattening, filling you up

But not full yet, one final blow to come
And the covering of the legs like netting,
Rips apart, an opening to another world,
Begging me, asking for it, shaking with knowing

Had you not picked the fruit from that tree,
Tasting its seeking, desperate sweetness
Perhaps i would not feel your weight as I did
And you would fall down like an infantile bundle of feathers

The epidermis, the subcutaneous layer, the blood
Moving quickly then slowly then quickly
Are you still there? I shouldn’t care
A button falls from your breast, a trickle down your cheek

The eyes, the eyes! They follow me, the train,
Moves slower as it pulls into the station
And makes one final sound, a signal,
I’d rip their eyes out and let them bounce onto the tracks like marbles

So many stains of blood and war and toil
Lie across the carriages and out onto the moors,
I wouldn’t worry,
I’ll make it clean with disinfectant and run smooth again with oil

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
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There's something swimming down there.
Unseen, subcutaneous under layer and layer.
Malice in that silence,
venom in that stare.
laying in wait, to strike, break,split tear.

Peace as a siloullusion of the swelling act.
Waiting on reality's organic nascent,
unresolved affair.

Whatever it is that swims waiting for a chance,
in your terror askance.
Will soon break on out, too real for fiction:
to swallow you whole in it's gruesome glory.

blue at times on the cusp of something deep and profound
or careless on  the brink of a laugh at me
or subcutaneous itching all over for something new
now I am in between caught right there where I doubt
the next meaning and **** itch
is quite annoying
as are the little thoughts sprung forth from inside to
fleetingly go away as fast

mere life is
plenitudes
disarray there is
subcutaneous actions little lies
subversive factions actively pursuing
evil deeds wrong hating
stabbing
the well felt
normal, actually
living beings,
I just don't turn
my back.

i grew up in an evangelical home in the burbs. i now like to think of this brand of belief in christian doctrine as the sorta "star but humble upstart" ---- a shy new jesus on the block. not very showy with ritual. not too brimstone-y with rules. but nevertheless it is terribly aggressive and convincing in its apparent passivity, summoning up a tactical confusion in the believer that petrified the will before it had a chance to bloom and raked in the imagination before it could body forth an inner-whorl.

the evangelical brand leads with a hidden, veiled threat of eternal damnation best served cold with kind eyes. these eyes, they grow mouths inside them to speak to you the truth as they see it. it assumes your consent already. it rips initiative from the realm of possibility. it rents you a god, a "real living god" amid a scarcity of eternal life. you are sold. you must be. it trains a deep, serene dispassion that enslaves any shred of emotionality. it grips ****** life-affirmation with thousands and thousands of self-induced mental strokes against the backside, moving into position various leather tentacles tipped with acute tapered bones that seek out, lick, dig and pull up a guilt that beats subcutaneous, stuck to the very core center of the hard white tissue holding up humanity itself. you are fallen now because of before, or so it goes. it is the worst kind of violence. it steals who you are and gives you back a cheap copy that tells or suggests you hate, with a vengeful love of course, these original pieces of you that keep cropping up, keep emerging through nice smooth paved suburban sidewalks, still wanting, still desiring -- new words worming through old written ones.

it starts with a lack, and it wants to color you in. "you are not good enough" it sez. "you need something" it warmly alleges. "don't resist, let him in" it condescends with a grin reaching for the ear. it is a vamp asking for permission to eat your heart out with fork and knife, only to replace it with himself - all as you watch the procedure. it loves you to death.

tell it *******, kindly. then shut the door.

i stare at my half-clothed body in the mirror,
comparing to your red-filtered half-skinned silhouette
in the photograph you sent me ever so faultlessly:
brutalist and surreal, in sharp monochrome definition,
with an expression as cold and unfeeling as concrete...

all bright eyes, wry grins,
and a corrugated abdomen:
yet your arms conceal
your chest and navel,
betraying a baser shame

you need not hide from me,
my laurel-crowned achilles:
in these eyes, you will
forever be god incarnate

emulation comes natural
(i could only ever behold
beauty by plagiarizing it):
so i shave.

not just my face...no, i take the razor
and drag it into the heath of my underarms,
across my chest, the insides of my thighs,
tracing my collarbone and (waist | waste)

i shave till my skin is raw, blotchy red;
till hair no longer bristles against
the strokes of my jaundiced fingers

i want to tear off patroclus
like the ill-fitting bandage he is:
his shame is my own, seborrheic and crawling
(learn to treat the source, not the symptoms;
cull those parasites from their deep-set roots)

god, would you grant me your favor...
if i was youthful as ganymede?
call upon me in your times of need...
if i was faithful as hephaestion?
give me all i have ever longed for...
if i was as narcissus, that conceited beauty,
who was no more egotistical than he was honest?

i clutch the rolls of subcutaneous fat in the shower,
cranking the faucet in hopes of
rendering it out with the heat
like some ****** up confit;
such is the price of my babylon

bloated, the cystic acne on my back
bleeding into my bedsheets,
i realize it is moments like these,
when my woolen throat abrades at my voice
and i want to retch with each inhale;
when torpid tide pools of saliva
lap against my cheeks
and nausea consumes me:

i am at the mercy of my body and its afflictions—
i can only take these sensations, seen and unseen,
silently as they come, moment by moment,
patiently enduring this migraine of the heart.

the only thing that gives me joy
is seeing the water roll down
my body in beautiful thin sheets,
unobstructed by thick forests of hair

a diagnosis would only warrant my weakness,
justify the existence of the black villous mass
beyond mortal comprehension within me—
within us, wretched god—

i resignedly accept that your messages
will find their way to me only in the dark hours;
i know this even as i text you on the bus ride home,
because you never had time for me but i find myself
constantly making time for you,
begging for someone to care the way i do...

oh but there are still debts to be exacted,
reparations to be paid, my bright-eyed misgiver
(and you won't want to be around
when i collect on them)

when you gaze upon my withered husk
on the hospital bed,
permit me my resplendent self-destruction
silence those morphine alarms
trace the morse code scars on my arms
read and heed their silent plea:
do not resuscitate.

Subcutaneous,
in and under the bubbling skin
a pin *****
I feel sick
I look thin,
a nerve trapped
body sapped of energy
in pain under the Christmas tree
sleeping only fitfully,
December's really not for me
give me June,July and
let me live
or let me die
in peace.

Dreams that make your body pop, force the show to stop, let your jaw drop and breathe them in,

my dreams are kept in a biscuit tin
and hidden in the wardrobe.

File that under miscellaneous or under the skin, subcutaneous, any information unsought, bought, is probably extraneous and that's enough of us,

It's bedtime in the suburbs, the adverts have taken the lead, the dog's flopped into his basket after having a ****** good feed,

About now I'll jump ship, skip the light fantastic,
I could dream of her knicker elastic, but they don't make that anymore
(actually they might do but what would I know?)

Friday is on the horizon
but it'll never come for those who believe that
the earth is flat.
or maybe it'll just fall into them.

The Beit Hamikdash temple raised crowds after receiving crucibles that descended from the confines of the Duoverse, bringing praises that sustained high temperatures that the major star returned with immeasurable distances in its annals of light, gutting itself in the ravages that converged thousands of illicit that were not able to bear light in wicked after completing them. The sedition was vitiated towards those with the sight that was thrown from the temple, shining in the Vexillum motto that brought all the legions from the garden with all the Falangists, invoking comfort to the last soldier who had no balms to warn them in billions of years light, for all who exhorted the name of the Mashiach. The trans-angelic conception was making vows on Patmos by admitting that the fight had not offended the twelfth men of the Meshuva, appropriating altars that were suitable to support on their feet that have been ..., and that have been aligned umpteenth times from Egypt to Patmos, when canopies heal them from fruitless heartburn, in which oblations resurrect from what serves those who are served, in this way all bronze and iron armor were requisitioned and sheathed in the quagmire of Hades, from which the animals went out to graze on dog days that turned into herbs of Gehenna, witnessing expiations that were curled through meadows, when sheep and rams have been seen that undulate on plantations as if they were devotions that dry the beam in everything, with what is obtained in his true faith of the ministry of error and error conceived as a universe that is subtracted from the clister of the Iblis converted from the lung of the Colosso de Apsila a thousand times, until all s the disobediences of those who slumber with useless geniuses, being neat beings that strip them of the fig tree like winged specimens, rescinating one that will be delimited by the end of it itself when approaching the sink.

They looked with suspicious fear at the sliced thumb of a ministry that sent everyone to lament over uncaused injuries, but the entelechy made a relief of resilience, sending those who have to fight for lost lines in annals of past life, hardened by the Kashmar that bears the exulcers of its dying star. The Aeonium as foliages carry the Biblidacea species of the lullaby of the Vernarth Garden on the Eudicotyledonous axon, where the aquatic ones will bring sub-shrubs with regal pride that resists the albardín of Judas, appetizing in its ****** as an affliction of YH VH of the Mashiach (Yod Hei Vav Hei), constituting Northwest Africa, with succulent etymology when trying to transfigure into diasporas of harassment of the body that make a simple arrangement in basal rosettes that drain nirvana, and that fragrant toast the flowers that are faithful servitudes with androgynous light that all the sacred names of the Moshiach matriarchy profess in what Is and Is not! With a little chalice desoldered from the base, the collector was grasped and adhered, which reaps its sunken follicles, in particular of its luminous atrophy repaired in the scarce flashes where only a Mashiach will put nimble bifurcation photons for others who assiduously do the brush on his macula altar of the cult cluster hybridization process.

Taxonomy innovated with crass predestinations after the eruption of the Colosso of Apsila, wanting to uncover living cells from the succumbed ones, when Kairós ruled the Sven Tzora flint in those that were to be toned, which was softened by Aeonium flowers as it grew on stones that were a hundredfold in size. Judas's footsteps after putting the leash on his neck generating stained, and away from the Garden of Vernarth, resigning protruding fingers in his right hand with the connecting ruse that made him stick to the knot, closing his deadly phalanxes and flooding the scaphoid with coagulated blood black, who had never been lowered from the inviolable lineage in songs of her death ...! He confessed to the Lord in putting care about it when his mother spoke to him of the vision in El Manyi, by twelfth spirits that led him along his disciplic shoulder of stoning, towards the thick palace where no one lives, only noises would silence the one who speaks worth seeing his apostasy.

Patmia moaned of its lines not sheltered in wayward stars with pale shades, and gentle automatons that freed themselves from their convenient matrix, where no affection has been contemplated in eternal individuals who were torn from the eternal celestial sky of Patmia, now it will be necessary to fill new reformatories of the same eon, behind fetish parapets and intervals of organic matter, giving drink to their cattle and fodder for the lost, among so many who are only servants of those who survive against the followers, until the finite point in which all will have to surrender. To the Ophiucus of the thirteenth ladder of Judas, being ruled by his lateral right discernment with the costly salvation, then the dimensional right hemisphere will be the house that will have to replace him in Aquarius, with evanescent compassionate tragediography, after being cursed in his skillful ascent slipping away by a self-generated destiny. Extensive and limited fiefdoms debased themselves of their greatness after the beauties of the aurum were exhibited, restraining themselves from the invisible third of the transient of breath never guessed. Syntagmas crews facilitated their angelologies by allowing Cereola or Plum to the great darkness that will empty everything from its entrails, with pictures on the first cusp that took the golden diametral segment of the "V", resounding in Nativity prior to incorruptible perspective approaches from a streak that was stowed at forty-five degrees with the affinity of the tangent.

Vernarth's vision approach was subdivided into three hundred and sixty firmaments, giving undaunted competition to his cyclic stealth, also worshiping stealth quantum itself, asserting trans-dimensional quantum millionths for its stirrups, and worshiping immaterial dimensions, of which the Peri Kosmous paternalized. With three hundred and sixty lanterns that will refer to the awareness of the stolon of the Aeonium Virgineum in the garden of Vernarth. The channeling will resemble the generalities of the Apostle Santiago lighting lotions of the Virgineum in his discreet habit, full of Capernaum pollen, uprooting large notches and thick actions with oversized stolons in the expanding universe, along with the annals that were deconfigured into uncontrolled units. Blackish, spatulating and welding the limits of the universe of Patmia, united by expectors that sprouted from the Colosso de Apsila when its pectoral was abrogated. Simultaneously through its mouth, the secretion would make the entire island a sub-species that would ignore the cognition of hatred of internations and dogmas, given the discharges that denoted climatic changes that were creating the intensity that was noted in lack of wisdom, polarizing pubescent stages of geological and theological maturity, in the intricate dichotomy of the Colosso that brought a direct relationship, concealing the upper and lower northeast and the sub-lower world of Vóreios, which was adding minutes to devour, and that will express the purest change of the axial. The expletive of climate change was establishing itself in the Kassotides Omphalo, which is nothing more than another symmetrical purge pectoral of the Colosso de Apsila, enthronement of the previous superior superficial major, leaving the other anterior part of the sternum with the physical enclave, irrigated by arteries of the Bumodos and the Eygues, zoning subcutaneous macro conformations, and analogously making the Valdaine that comes closer from the narrow streams with the Ibex in Chauvet, of Wonthelimar.

Monday!
I wouldn't have it any other way,
well perhaps or
maybe Friday.

I'm calling in a favour from a friend
who voted Labour and I'm asking
for a small piece of the pie.

They can slice it any way
carve it up into today
all I want is one
small portion of the pie.


My belly's started shrinking and
its started me to thinking that the pie
is just the carrot and I'm sick

subcutaneous emotions
underneath the skin there's oceans
but
the fish were fished out many years ago

I wish I knew I know I do
but
it's Monday
why are you

slicing up the pie and eating all the crust?

just one favour from a friend who voted Labour then I'll end
up with a fraction of the cost that it cost me.

Cherry pits and Goodtime while I avoided your frame
Christopherson carrying us quietly... or maybe it was Paul Simon
(I forget)

And I listen to your subcutaneous single-serve salvation
while you're seeing trees for their root structure
watching the AudioArbor curl and weave
with the hue of that little toy xylophone
you two found in some box in the basement
and I feel discovered all over again

I don't know how teaching me a cleat hitch
stumbled into Kant and 21st-century relationship structure
That's a path only you could manage
flanked by a witty remark about the weather or traffic or my day
skimming the depths on nothing more than Zephyr's respiration

And now I know patience was wrong
watching concentrated ambition simply... snuffed
waiting and wisting ebb as you tip-toe to oblivion

Baby I saw your
Moonshine eyes leave my side
Several times.
And when you reached out,
As if to say I'm sorry,
It began again.

You hurt the most -
Even Mysticism underlay
Every wishful brush of the shoulder,
Taste of your scent.
I became your muse.

I went through a thousand
Beautiful scenarios —
Of skin on skin,
Subcutaneous conversations:
Salts mixing,
Hyperplasia of hearts,
The rhythmic chant of breath —
In my dreams.

Nighttime is perilous
pestilential predators lurk
evisceration entropy envelopes everything
wounds are collected like keys to doors leading underground
and I can hear a jingling in my pocket
so I denounce the nighttime
unlocking the door to a home
where one can sleep at night.

But once I go outside in tomorrow’s morning
the sunlight shines into my soul, cooking my sutured skin
along with the keys I’ve collected
burning through my clothes
and into my body
flies can smell subcutaneous sizzling a mile away
they yearn to feast, buzzing all around me
crawling through my insides
multiplying
while vultures fly laps around me from above.

So I throw a nocturnal drape over the tumultuous foothills
and begin imparting my basement keys onto others
an imposing locksmith
a charitable safecracker
Johnny Applekeys
prowling with pouncing predators
masking my petulant bitterness with false wisdom
my edgy perception of maturity tells me to be jaded
hey, that’s just the way it is
I call myself an honest realist
a self ordained keymaster
I wear my key ring proudly
and distribute keys to those around me.

Stuck between persistent motion and paralysis
my key chains start swinging like pendulums
dancing like an opposing militia
like my eyes once I start getting nervous
waiting for the receipts to my exchanges
reflecting how I’m living in the red
and the debt I owe others
I can only pay in keys leading nowhere.

I try to convince them that the doors I unlock lead to riches
but we all know they’re paths to the hell from whence I came
my words are for myself
like the hell I man the ferry for
selling keys to scary doors
used as lifeboats in my shipwreck life
surviving off of other people’s strife.

The keys are overflowing from my makeshift pit
they poke into my veins like needles from the past
suffocating me like a rat in an hourglass, buried in sand
I imagine it’s the beach to the shore I can reach no more
unlike my swamp where I act as lifeguard
to a lagoon no man inhabits
I say “the water is fine, hop on in”
when I don’t even know how to swim
so even the trees think that I’m dim
when I hang my keys on their limbs.

Surviving night means eat or be eaten
yet my decisions effect daytime treatment
when scars put me behind bars
I inquire as to the depth of the dungeon
digging a subterranean home then diving deeper
finding company at the bottom with grim reapers
where the ostrich that flies is ostracized until it’s fossilized
so I sit in my estranged egg
not wanting to ever hatch
but no matter how much I beg
my keys unlock the latch.