Sugar strikes us down
You see everyone will have so many spoonfuls of sugar in
Certain foods and drinks
Like Coke and donuts and tomato and BBQ sauce
And Mountain Dew is definately not dew of the mountains it has caffeine and sugar in it
And the brain says have sugar cause it gives us energy well it is just fake energy
I used to drink a big bottle of Coke doing a poetry concert on YouTube and despite I might have felt happy if was just fake happy
I like the colours of pizza and Coke and hamburgers and loliies and other soft drinks but the colours mean nothing
I developed obesity
Because the sugar in my diet was too much
I ate a big rolly poly cake
And every Easter I like the big chocolate bunny
In 2013 I was running to burn all the sugar but I ate more sugar to build up my weight when or if I stopped running
I didn't really feel good great
At the poetry Slam sure I read my poem and was cheered off the stage but I felt very itchy and tired and yes everyone liked me and they thought I was cool but I had cracked feet and tinnea on my feet and now I have exthma on my legs I was very unhealthy
My brain was telling me I need sugar it gives me energy and Coke adds life to your day
Well that is a bunch of crap
Especially when aborigines eat healthy food can give on to sucrose and fructose but then again I did and I got obesity
I have just made a choice to start working with a personal trainer who told me to watch a show called that sugar film teaching me that sugar can really dominate your life in foods you will never think had it but junk food is bad
I could relate to one boy who wanted to get dentures after having very unhealthy teeth
But the pain of the dentist drill
Forced him to rethink his decision still wanting to have soft drink
Even the party drink in alcohol would be bad for you because they can have sugar as well and you can party with water which might be better and you can also have a berry which makes things sweeter like a lemon and a chilli and apple cider vinegar
But sugar is in that berry
You can bet your ****** oath
You see sugar is the big bad wolf of the diet world

Hades escaping the first leaves of virginity
The realm of Io scattering molten silica
In degrees
Water drops from God’s shoulder burst and buried
Her eyes at my scar;  she stops the bleeding
Sucrose sun whetting the crest of a bee
The dutiful molecules of my shirt sleeves
Zaccheus in a sycamore tree
Her words on a southerly trajectory
Crawfish in my grandmother’s stream
The Battle of Moon Sound beaching infantry
A northern gannet nesting her babies
The decibels of smoldering wood beams
Flesh constructing hairs in the breeze
Molecules muddy as I try to breathe
Ghosts approaching the Andromeda galaxy
Stars floating to the top of the stream
I      N      F      I      N      I      T      Y

when you are young
your taste buds are
naïve and
the sweetest thing of all is
destruction.

as you age your tongue
grows wiser but
no matter how sour
revenge tastes now
it has saturated the roof of your mouth
and it stings your gums like
vinegar.

When we decided on ice cream
I suggested caramel
sticky sweet
dripping down the sides
I wanted to lick it up and
feel the sucrose explode on my tastebuds
a minefield of pleasure.

When we decided on ice cream
you promised whipped topping
and hot fudge
rich luscious chocolate
oozing toward the edges
swirls of dark intensity
intermixed with bouts of airy lightness
a most delightful contradiction.

With all the imagery that’s found in words
and pictures bound to play out in my head
It’s fair to say this sundae tempted me at waking hours
(and maybe even crept into my dreams)

… it’s quite a shame that in the end you settled for vanilla.

Singing honey    sucrose stream
Tidy shelving snug underneath
Nestled neatly inter-wing
Feather down cream

Mothers stroking cradle   rocks
A thousand balls of foam spill
Softly avalanche and bury
Pure angels in snow    hands

Petal sky smeared casual
Walks warmly sweetly
Silken fur raises brow
    At       the coming

Lily padded velvet pawed
Strong slender limbs graceful dancing
The Supple strength
Holds a breath for dawn

Long stalks arch backs
Purring release modesty
Pure unction weeps    complete
Smooth shell face washed in milk

A banner sail widened arms
Outstretched for breeze’s kiss
A wishing penny glides
Through water falling   leaf

Mallow clouds woolen sheep
Dandelion umbrellas    borne away
Slowly sinking Sun dyes autumn
Watercolour cascades melt

Thinly  delicately   imagined
Fragile world Mary’s peace
Doll dependent doting
Soul canopied sanctuary

Silence **speaks

I zip up my astronaut suit,
plop the cubed veil onto my head.

In my hat, I am the observer
Living behind the netted television.

Dressed for pain avoidance.  No tears.
(Perhaps I should wear this out on dates)

A tall metal teapot with its accordion attachment rests,
on guard, in my yellow stained gloves.

Together, we enter the boxed colony
The teapot’s steam spurts clusters of buzzers into the air—

I grab coarse honeycombs, drain the
visions of nectar.

When the day is over, I gather the jars,
amber sucrose, the ***-colored concoctions, to head inside.

In the kitchen, the timer aches to sing as the clouds
From the pumpkin loaves clog the room.

I hold my honey and I store my bread.

KNOW your fate
Don’t just ******* talk about it or think about it
Let the sucrose of the idea of that fate percolate your mind, know it and all of its idiosyncrasies, and then accept it and follow it
Hound it down and hunt it until you shoot it in the back of its **** head with a Tommy gun
Then grab that ******* by its hind lags, drag it down that dusty road and throw its *** into the arena
Hurtle it over all those wooden barricades and watch it convulse as his back strikes the dirt ground
Then stand over him with your spear
(you don’t know where the hell this spear came from, it spontaneously materialized in your hand, but its ******* fitting so you go with it)
and bellow “Holy, Holy everything!!! Victory is in my back pocket and all the dues in my wallet.”
The crowd in the ancient stadium cheers
You swing your red cape behind your shoulders
(this red cape is also a recent “randomly materialized” sartorial addition)
and grab a magnolia and bite down on it its succulent stem
Oh my, do you taste that?
How does it first settle on your tongue?
Does it fizzle like pop rocks?
Does it glide like milk?
Toe scrunching sweetness
How does it taste when it inundates your throat?
When it spreads in your chest and settles at the bottom of YOU?
Your fate
The stem
The spit
Your head

There is no misery
Quite like black coffee
Raised on the sugared ****
Of North America
A lack of sucrose
Indicates a failure of your lifestyle

Never mind the diabetes
And wasting diseases
That come later

We are new, now, blank
A flat white lying prone
Waiting on the fat black footprint
Or haphazard dog defecation
To sully our facade
We'll pretend we earned it

Just as long as you pass that sugar.

I trache myself to scream out blood,
To make sure you felt what i said and understood,
Cut open my throat so you can see my voice,
Through cords that shake your core,
Wanting vibration avoidance.

Desiccated hands try to grab your hair and break it,
Like brittle crystals of sucrose.
Each molecule overcame with freezing
From the spatial distance in each look

No matter how hard i try and comfort your heart
Malady wins.
It corrodes your engine and your metabolism begins to fade.

You're frozen in dying
For the rest of time
And I can do nothing to change it.
Its the roots in your heart that i just cant **** out
Heart worms in a dying dog.
Heaving each breath
This is the end of fondness
This is suicide of emotion
Killing echoes of every beautiful girl you gave a **** about.


My voice cant get through the air to you

My blood cant paint on your face

My hands fall apart before they caress and love just withers away like a dead, once verdant chrysanthemum.

you seen, once they found it, they "dittoed" it out, in english the " sign is not used accordingly to it's original and intended purpose,
e.g.     i said this would never work
           "   "       "        "      always   "                            
the structure of narration is different, the Irish are like the Polish, they write dialogues like this: and encounter with Jim and Paul
- so i says that pint of bitter is grapefruit grease.
- Jim, can't be right! it's sucrose!
- ah ******* Paul, it's grapefruit grease!
in the English speaking world the balance between ' and " signs is strange, i can't explain it at the moment, it's almost like the sign ' represent first person narration, while the sign " represents an internalised narration, even though English language books treat " not as an imaginary conversation, but an actual one, a simultaneous thinking and speaking realisation that's quiet impossible... a bit like breathing and swallowing at the same time - the pharynx suggestion.

i found it in philosophy books,
like Adam, **** naked in the garden of Eden
unaware of his genitalia pronounced
in the open like a dog's ******* bouncing
around while moving (****'s sensitive,
got to fasten it with some bay leaves,
Eve! strap those **** up, we're gonna be running
from sabertooths!)...
the practice of introversion, introspection,
inward Buddhist whatever...
people actually fear it... you know why
they fear it? they're scared of finding
the ego... honest to god, they're protected
by the banality of thinking, well...
"thinking" protects them, daily routines
and the thoughts ascribed to the routines,
it protects them from looking in and
finding the "holy grail"... you know why
they're scared of introversion, of this looking
in, apart from reminiscence, you know why?
they're scared to find their ego (their sigma
identity unit) to be a non-affirmative,
a thing that's not affirming but is de-affirming,
the daily tasks somehow do not affirm it
when the practice of introspection is imposed
since the routine of the daily does not require
any affirmation of the ego - on principle a *per se unit
that desires less and less disturbances and more coherence;
the once affirmative unit of encoded sound
is no longer (to their surprise) akin to
a sparrow's chirping, or a wood-pigeon's cooing...
it's submissive, a ******* is there in
leather and a gimp mask, hovering over them
with her legs spread open, a vaginal boa,
there ain't no halo... once they find their ego
they realise it's no longer a simple aye
but an even simpler nay... forget all the social
constructs... you don't want to end up
on a television game show, strutting in your
diapers telling everyone your false curriculum vitae
about helping old grannies (an example of
tautology, purposively at close approximate)
across the street or having an interest in sports
when in fact the foggiest... people fear this introverted
introspection, when they find their ego to be
non-affirmative, but submissive, "Islam" riddled
according to their daily routines... but that's
fine by me, it's when they write snippets called
"poetry" that it becomes all too apparent
that the desperation is there, and it's brimming
at a boiling point that consumes them,
and by consuming them, they realise that it's
actually more of a blockage, than an active volcano;
me? my familiar is rage - i have lost my prowess
at the cognitive narrative - all i have is a void
and a piece of paper where narration belongs,
cognitive narration used to be a blessing, indeed
a halo, but it's gone, lost to an archaeology of
some kind (perhaps medical) and never to return,
just sometimes the Hydra pops up again, like this.

Names of affection and endearment tenderize couples with their prophecy of a life so sweet  oozes crystals of sucrose. I hope you've all brought the quintessential insulin for this ****** malady.
Baby girl, sweetheart. Who can say that to you, honeydew? He lies next to you and into your ears at night, whispers spoken in the silence of thoughts in the gradient dark.
I was given a name. It's on a certificate. I can show you. "Babe, it's okay."
"Why didn't you answer me?"
"... Huh? What? Sorry, Mom, I haven't really heard that name lately."
I had to write every day. 12 years. More. Circumventing the pale blue dashes of thin elementary parchment.
My goal at the end of first grade was to "not have loops in my d's."
And how can that be, Dear?
Avoidance is the opposite of absence, in which the avoidness is attentive and absence not able to produce a **** to give, the tattered red rag persisting to grow fonder.
An 'S is the downfall of all. mine. Yours.
"I'm so glad your mine <3"
Why am I indentured to you, only when I walk through the kitchen, can't standing to be barefoot because then only one last peg of the possessed woman chain is needed.
Not that there aren't more levels. Danti mentors. Heat lightning, electrocution- are you feeling the chemistry?
I was given skin.
Porcelain. A marble counter top. Albino creatures suffer for their melanlin-less beauty.
Is pain.
Why are purple flowers blossoming on my body that was once a temple in a garden?
My body is Detroit. Spray paint in the form of a Kaleidescapic, mountainous macabre- knuckle
avalanche going down the 90 degree angle that just isn't right but I can't call it obtuse.
I have gang signs littered across the human vessel, spotty and an embarrased brown covered by a collar, and green, yellow and maroon covered by sunglasses.
Love is not possession in the way abuse is not love.
Both own you. Sailing, he's steering. my cruise is on the Slave Trade Triangle route.
You never asked me to get your name tattooed on the past 18 years of dermis cut, shaved, kissed, caressed, burnt and brown.
That didn't stop you from placing yourself all over me, every blooming tulip as a penny for my thoughts stored on your test's word bank.
"Good" is only "not good enough"
mint condition only makes me green.

2/19/2015

The hurt is not enough.
the Frost crawling on the window keeps me grounded
on this sickly saccharine reality,

i'd once described a bedroom in July as an example of
the sucrose candidity of the human condition,
sticking bobby pins in my hair i'd realise in January

that the Chelsea Hotel #2 scenes were as well,
sticking to a sort of geniune artistic integrity
come to bed, hey hello to my friend afterwards

and how was it's? with little no big toothy grins
but then I would remember
sitting under elm trees at Fitzrandolph drinking a cold

coffee, because it was hot then! and it was sunny then!
and the weather conjured sweet artificial caramel flavorings-
sitting under the tree and thinking about how good life is or

was. And when I realize that the forest is as dead as it ever was
and I look at pictures of trees with leaves fully on, maybe in the
forests of Alabama or Georgia,

I realize that I haven't seen a life in a long time- but
when i burn my hand with the lighter the butane glaze on my skin
i don't really mind it that much because i think of it and quite frankly

I like to say i'm as pure as I always was but,
what burns me now: Desire desire desire
and back then the museum was talking about Roethke

and it was all I needed I didn't mind the
idle cab drivers that would call me Angel by the gates.
and my Mennonite father said I need to

repent.  I don't even want to go to
church but that is all I end up doing nowadays anyways.
Thinking about the sun, and falling over a piece of ice and seeing the

red scarlet (connotation vs denotation?) on the
white of the ice i cannot help but think that once again *the
hurt is not enough.

we used to leave the extra Statistic lesson after 3.30pm, used to jump across the wall over the playground, catch the train home... we used to break fast with dates when Ramadan came along... then the hens came along... that sort of brotherly ******* doesn't really concern me these days... i'd gladly **** your mother these days... like you ***** my mother telling me whatever that ***** said you ought to believe... do i believe in God? do i have to? do i have to believe you said those words rather than a maggot? personally i think a maggot said them... on an existential inspection, you're just someone that goes into a charity shop and buys everything for under a quid - you're just a ******* gypsy to me; but believe me, i really want to be a gypsy, mortgage free, living like river-rat... i'm comparing your intelligence to a donkey when is shouldn't be insulting a donkey... i'd love the circus, the gypsy uncertainty... i can't believe your mother actually liked me... and that you have to lie about me as "non-engaging" schizoid... when i meet your mother in heaven i'll not fail to mention that detail.

it's a funny tale,
how they cite the words          the 21st century
and subsequently ditto them    "     "           "      ,
ever the airs, every the formality,
ever the should have been,
contrasting the ever would haves...
it's hardly a reason to be comparative
with the 17th century,
the 21st century isn't that much
of a surprise... it's not a surprise at all...
it's actually quiet mundane,
the quiet everyday... as said:
via articles definite, and via the charcoal churning:
iron maiden's *strange world
versus duran duran's ordinary world,
as i said: subhuman, cancerous laughs
and still the belittling you:
it was all a worthwhile care for calcium salts,
petroleum jelly and aliphatic acids - some said
sodium acids too...
some mentioned chemists as it was
an aquarium for choir encores to a deafening,
but it wasn't - i too would have learned
the plumber's jacking-off without
groupies... had you minded my intent
to leverage the safety as worth nothing
anything but the Selfie and the jelly-baby sucrose
glue.
i'd like to go back to the 17th century with
the musketeers... i'd be fed less jealous comparisons
with the reigning Louis XIV...
i'd be diverted by an adventure, laying siege to
Lyon, which would mean much more to me
than paying the taxes as a medical doctor....
i'd be agile on the musket, a musketeer,
shooting heads to later write a Don Quixote for
a ballet... but as 21st century's writing proves:
i only wrote because my life was truly banal...
i would't have written otherwise...
had my life the attributes of a Don Juan...
you think i'd have written anything?
only banality prompts you to write...
if you decide to write, and keep banality
as a saintly ordinance best kept unscathed,
well... then you better salt your eyes for an improvement
of the bitterness of shed tears awaiting the
once anthem-blessed glorification a nation likened to Iran
having a pointless streak of competition
sparked alive with a necessity of breathing being excused
so that the competitive acquirement is stocked
and compiled to an encyclopaedic assurance,
preference: A prior to Z.

you know that euphoria
misshapen twisted circumstances
my beloved aquatic relevance
drowning in remnants abandoned utopia

a dreamless state
unfurnished minds defined
those ******* their sickening sake
of whatever hell inclines

I sit in dread
glancing at rain gone sour
with paperweight for a head
death shall toll thy hour

I have lost my eyes
the sucrose in my hearth
an addict drink to realize
this infested dearth

12/15/2015

"You, doctor, go from breakfast
to madness."
Anne Sexton

The engine of my amygdala:
                   so burnt out
I needed coolant, I needed something to prevent my
   immolation
a sort of precautionary measure

***'s flammable
  I'd soon find out
In a crowd of hundred dark and
smoke crawled through my shoulders
    social little parasite
apologize for being an interruption to everyone

   "Wish I could've been there"
Sucrose altruism,
back at the mental hospital id relived
every single second with you

thinking of your anger I read Tennessee William's letters
I loved you

I even loved your hatred.
A girl across the hall screaming
about Jesus and her ****
shouting singing Shenandoah

"But I don't need to be here,"
   I turned to my roommate,
a strong figure I still admire,
"Everyone says that, even with a Thorazine needle halfway down their ***."

They'd had a name for it
Something about kisses, I don't remember

"Yeah, it leaves a huge bruise on
your ***," they laughed in the
tv parlor

there we were
The tristate area's teenage
girls too unstable for the world

a step above "oh, you know how
teenagers are"
A girl with grey eyes

Came in my last night there
"Is it normal to cry on your
first day?"

I wasn't allowed to
even touch her shoulder
and so

with the alcohol and the
Lamotrogine I tried to figure
out where it'd all gone wrong

but it'd been hiding in me
psychotic seed,
a virus carrier a patient zero of my own

tepid insanity!

I've been here before
I've already sang this song
However, I float
still
it drowns

In the absence of love
in the amidst of chaos
in the throes of the heart,
I turn to Amy.
I drown.

He came to my brain
and I felt a kiss that contained pain. Strain.
I've sweat this before.
Am I a truth seeker
or a ******* one?

I could feel the fear
my million thoughts telling me
twisting me
confusing me

Some spark took the wrong track.
I can't trace well what happened then.
Disorder, disorder, disorder everywhere.
Sped up feelings, thoughts uncontrolled...
but not like the quivering fountain of love
more like a car crash.
I can't help but look at
(I am naturally attracted to the dark)

Terror, terror, misled.
He's no sugar - he is sweet sucrose
I can't think about none of them.
I'm in a catch, because of men.
I can feel reality dissolving itself,
not a good thing
Everything loses sense.
How many signals you need for this?
The sky opened, but hell yesterday did.

Beware of epiphanies
Beware of certain tears
Most of all, beware of yourself
beware your fears
"beware your subconscious
playing you tricks"

Fight fire with fire,
magic with magic

The air is wool
It is the shavings of innocence
It is the blood of atomic love
It is a momentary transience

I am a ticketeer
I own nothing but slips of paper
popcorn between the seats
rotting into kernels of knowledge to sleep with

She was and is the secret sucrose
a mysterious chemical, dreaming of becoming
Something that means more than just syrup
or unappetizing things

The earth was a open casket, nothing to hide
the soils and dreams of a ancient soul that had nothing to abide
She and I, lost amidst the widows
holding onto a dream of new life

Coupling together, we sought the stars
We stared through mirrors at ourselves in rings
Saturn and Mars
They the abodes of future eyes and ours

Not ready to see these things, chosen by god the in-between
Lost in the leaves and the lungs of her tree
I spoke to her, asking her what was
She replied rather callous that there was no love

Let's go on and shear the stars
let's take of their light and share with what's ours
Alight the funeral pyres and bait
God to give us the gifts He had never taken

Darling, I know I'm not the most beautiful thing
but I have gifts to share that don't hold in skin
they are never wrinkled, never tired, never lost of their youth
They are sweet simple liquor that will intoxicate with truth

Enough!


I am a tired Deseret dreaming of a new faith
I seek a maiden in which to build the estate
We can make the paradise of Eden on this plane
We can touch the golden calf and make it obey

Give to me your love and trust
I will give my ****** lust
My eternal heart, my corpse of dust
And push towards the solemn Eden of husks

I wish I had some melancholy memory
Of a romance, long since passed
When a sad song comes on
Talking about the way things used to be
My brain goes blank

The memory of being madly in love
Should evoke something sweet like soda
Every particle, touched and tickled
Just cold enough
A bite, on the lip
Enticing the next sip
Feels like drugs, all the way down
Pulling away, pursed and sticky, you know youll remember
The way that pop popped you way back when
And a thirst for it started
Everything goes better with a cola
A cigarette, sickening and deep, made fresh by that sugar
Whisky, rusty and virile, turned young and naive with that fizz
A good meal, made decadent, with a lick and twist of bubbles

It should, but it doesnt
All I seem to recall
Is feeling as each and every bud on my tongue
Where the seed of your taste was firmly planted
Is scorched
Cindered
Conflagrated
Charred
So the only taste is ash

I remember distinctly the three times I was severely burned
One, I was making cup noodles
Two, I was making food for your trifflin ***
Three, when you made me tell myself that you dont love me anymore

So when a sad love song comes on
Instead of that sparky, stingy, sugary stuff
I get that fructose, sucrose, glucose, rhymes with gross, kinda ****
I learned all too late, that **** like that, is the single worst thing you can put in your body

So whenever I crave to recall
The taste of bittersweet memories
Whispered to me through the turn of a cap
I just think to myself
Soda is ****, water is bliss

the sleeper in the valley is haunting me,
what I should do I haven't.
I'm a junkyard full of false starts.

"I saw the best minds of my generation destroyed by madness, starving hysterical naked,
dragging themselves through the ***** streets at dawn looking for an angry fix,
angelheaded hipsters burning for the ancient heavenly connection to the starry dynamo in the machinery of night,"

:Bought a book of Ginsberg:
:Thought it quite lonely:
:Found out socrates was a *******:

I fell asleep and was dreaming the subconscious dream,
The theorem was proven and I could breathe again.

I awoke to sirens,
nymphs,
and Orpheus standing over me.

I am a small bit of nothing, a Wes Anderson caricature,
a pre-printed, pre-made, pre-packaged archetype.

I bought guitar strings from a lovely woman,
I want everyone to hear me.
Hear me play Pitseleh.

I am quiet now,
I am soft and everyone hears me.
I don't want to say anything,
I want you to look at me and know.
I want you to see my eyes and know I am infinite.

I wake up again and I am sweating,
it was the night terror, the one I have

I was surrounded by intellectuals,
the poets and artists of our generation,
all second rate ******* doing it for the applause and their mommys, same **** that was always done, since ******* Homer, since ******* Shakespeare, since ******* Ruddy Rimbaud.

I keep shaking,

Something is coming after me and I know it.

Maybe it's all the women I looked at wrongly,
one's from the ***** pictures big brother sold me,

Maybe it's all the sucrose and caffeine i've been inserting.

Maybe it's the nothings that i forgot to do, and others did instead.

I am a ******.

I never ****** no one.

******* is stupid.

I am one of the ugliest men alive.

When the saint ended us I saw infinity.

Everything was you, in you, by you, for you, the ******* hours and hours of thought, the stupid lengthy and complicated memories where you were christmas and we were meeting the ocean, all pointless and lost to oblivion and I lost it right then and there in front of you, I sobbed and wanted to **** myself. Then you gave me a *******.

A deep pulse of spinning waltzers
burn electric thrills
while pre-teens buzzed on sucrose
and fried dough
scream hot: they want to go faster

back on the promenade
Renee and Don, eyes on a horizon,
warm themselves reminiscing in circles,
minds dancing under glitterball embers

further back, gapped tooth shop fronts
shelter ripped tents, cold on concrete,
meagre piles of trash bagged jetsam,
of those stopped here by memory’s
pernicious tides
and forgot

But what's the point?

Phospholipids, sucrose, phosphates
Biology feels like memorizing vocabulary.

Absquatulate, etymological, effluvium
English wants me to be a human glossary.

Axiom, cartesian, diophantine
Math is repeating the same problems in different ways.

Feudalism, hegemony, cartellino
History is staring at facts about dead people.

Humdrum, repetitiousness, homogeneity
Every second of monotony bores me.

Was it always like this?

My hellos echo inside this black hole,
My heart’s a no call no show, down-in-the-dumps hobo;
Haunted by the ghost of your sucrose coated love.
I’ve licked my fingers down to the bone trying to
Feel it just once on my tongue again.

My brain’s a necrophage, feeding on your face
Until I can’t recognize the taste- the shape,  
You’re just a skull in a grave, and I crave
To decompose alongside you in the bed you made.

My frame has been shoved down the **** drain
And the incessant drip drops sound just like your name.

I’m a repulsive cultist drowning my emotions in solvents,
Trying to deal with the loss of the most revolting poet.

-SLuR

I was wondering when
I would eat my own words
Now I need to count the carbs
In each syllable

Calculate just how much
Life juice to inject
Into my bruised abdomen
After milking the drops
From my tingling finger

I ask of you to see
And watch and listen to me
Because I am not a result
Of sucrose-inclined molars
Or an unlucky inheritance
I am all of my own

So when my jaw grew thin
I praised myself and thought how
I shed some "extra" fat
I thought perhaps
Maybe I had a tape worm
Or a hollow leg
That hid over 2500 calories
In a single day that still didn't feel
Like enough
With 126 oz of water
I was leaking every twenty minutes
I praised myself, but
I didnt feel like myself

I knew before I knew
Had that deep gut feel
Before it was real
It was so undeniably mine
Like a limb I forgot I had

But it was like that limb previously
Slapped me in the face,
Stole my fortune,
Ran off with my fiancé,
Then said I was bound for great things
As it slipped out the back

I was shredded into nothing
But handed something of promise

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
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i can't say it isn't a learning curve, i.e.: how does it feel to pay
of a debt in... four installments? once £200... another time £250... another time at £600 and what's left-over is is? £277... and all of this? done by cash? well... it feels... a bit like giving £130 to a *******... wafer-think comparison... but it's almost on par... i'm just following up on the poems conundrum, autobiographical rigour & hotel reds.

i knew it wouldn't happen, it sounded too good to be true...
i knew she had a young daughter...
and like most prostitutes: she must have conspired
with her coworkers about the idea of... meeting a client...
outside of the hour-mark...
they must have said things like: what were you thinking?!
are you mad?
he propose the idea... no... i did...
                 i said maybe we can meet in a hotel room...
to which he replied... sure, we can go for dinner prior..
i'll bring some brandy...
i did the cost-analysis... she was obvious in a castle made
of clouds... because... isn't it obvious?
    why would i want to have any trouble in my life...
esp. if it's trouble with women?
      last one drew in into a student account overdraft
debt worth about £3000...
          tough times...
      the bank sent me a notice that my bank account
status of a student was about to expire...
  and that i couldn't have a interest-free overdraft
limit of £3000... that prior to going into the bank
and asking for the limit to be extended from £2500
because i had an emergency back "home" and i needed
to fly out for a funeral...

- - interlude - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - i was still close to lightning a cigarette right now...
i only stopped myself because i have some whiskey...
but... when i was painting the garden fence...
i was so ******* i started splashing the paint in rage..
no? mother dearests ask me because her neighbour
asked her to check if Bella the cat has clean water
and the frog's light is off... i hate being interrupted when
i write... i don't mind making concession when
speaking... but when i write and i'm interrupted...
it really is a peace pipe though... tobacco...
it's so much more soothing than outbursts of anger...
i guess marijuana is good for anger that builds
up... but when you need a quick fix... tobacco...
  maybe that's why i have almost have had this terrible
dry cough... my throat is irritated from the lack
of extra phlegm lining my throat... it's not a sore throat...
just sore when i cough... enough whiskey...
i'll be chirpy tomorrow... - - - - end of interlude - - - - - - - -

and i managed to wriggle out of that deficit...
by not exactly working: more suffering from lack of certain
pleasures... alcohol... tobacco...
although i did land that god-send of being paid out
about £3000 in damages for being a car-crash...
call it a fluke? i call it blood good luck...

tobacco: two occasions... to calm the nerves...
and to counter what otherwise caffeine does but caffeine
can't do with alcohol...
tobacco + alcohol...
    it's not caffeine + alcohol or for that matter ******* + alcohol...
sure... marijuana + alcohol used to work...
in my youth... if you were smart about it...
few were... tobacco + alcohol all the way...

i never enjoyed the credit system in capitalism...
i was very much always debit: el classico...
   sure... i have a student debt... "debt": the % on that
is so low and i need to be earning over £15,000 a year
to pay it off... but... here's the catch...
the debt gets written off after 30 years... or is it 25?
not for the quality of education they're selling people
right do i feel obliged to pay off this debt...
i've learned more once i left university
than i ever learned when i was inside it...

it's like that current job i'm doing...
sure... i might get paid peanuts compared to others...
but you know what some people
to have the sort of view i had
    at the Tyson Fury match? guess...
   oh man... the 25th of June and the 26th and i've
already pre-booked shifts for the Red Hot Chilly Peppers
performing at the London stadium...

i must have mentioned it... the people with S.I.A. training:
ex-military or ex-cons.... or ex-prison workers...
bouncers at doors... they did idiocy problem with
hierarchy... they love the rough and tumble...
so? they get paid more for a license...
oh man... so many of them have beautiful teeth...
smile that a Mongolian might only be envious of when
it comes to the English-man... it's that pretty...

me? i'm a crowd safety steward... ha ha...
or just someone who talks to people...
                       right... but these S.I.A. guys only get
£5 more hour... and where are they when an event takes place?!
outside...
stewards get paid... say... £10 an hour...
but that doe that entail? i get a free ticket...
i'm oh so tempted to change shifts from London Stadium
on the 12th to Wembley Stadium shift...
mammoth shift... starting at 7am finishing at 11pm...

eh.... but i haven't seen monster trucks in action...
and i'd like to see monster trucks in action...
it's almost as if: i'm going on dates with myself...
and i'm not paying for them: i'm getting ha ah ha *******
paid for them...

- knew it would have been good to be true...
i was already gearing up to disappoint from the myth
of a ******* ******* you in a hotel...
or rather... you know the story... stalemate...
but i'm no pompous Walt Whitman or for that
matter a tender Schwob...
              it is what it is... i won't bother her... until bother
her again... once i get paid at the end of June...
or maybe i should just move onto another woman...
i don't want to break her heart
as she said the unattainable words of reciprocating:
i love you....
    i *******...
        if she would have said: i need you...
i don't think i'd still say i love you...
                     of the things that man loves...
cycling... swimming... walking alone in the fields
or in the forests or among mountains...
i dread the idea that women are merely reciprocating
the hopes and ambitions of the most unimaginative men...

come Monday i was gearing up... "forgot" to buy supplies...
by Tuesday i was going full turkey
from a lack of alcohol stimulation and nicotine stimulation...
i was purging... i had the shivers in the night...
i was pretending to have dreams when it fact i was
just hallucinating with my eyes closed:
this one dream? my dead cat.... Oscar Darshan...
was walking in a host of sheep into my abode... to perfection...

i did have a cold... snotty nose... numbing aches
and pains all over my body from Teusday
night through to Wednesday morning... after ingesting
some cider... smoking that cigarette:
there was no fault with the paint! the fault was in:
my fence... to my left... the wood is of better quality...
precision marking: blindly even... to right?!
low quality timber! ******* ******* seagulls *******
while also taking a ****!

that being said: i have to toil by the sweat of
my brow tomorrow...
i have 1 tonne of rough sand to transfer from
the access road to my garden... no wheelbarrow...
old-school way... whichever way that is...
in buckets... shovel... good exercise...

but for someone who's been missing for the past two days...
not bad... i say no bad...
i started to binge watch some of: the good wife...
because... at least it's not drama set in a hospital
and you expect everyone to be sociopathic *******...
now...
    i'm going to have a second cigarette of today and
wonder why this isn't worth 3,000 words....
oh...but there are additions pointers to be made...

what is the usual knock-out blow of alcohol,
nicotine, 250mg of naproxen
500mg of paracetamolum
+ diphenhydramini hydrochloridu (25mg)...

exactly? what was my "detox list of suggestions"?
phenegran (25mg), 2-4-dichlorobenzyl alcohol,
amylmetacrescol,
paracetamol, promethazine, dextromethorphan,
pseudoepherdrine, pholcodine...
ethanol, sucrose, glucose, propylene glycol...

yeah... what a welcome change...
old habits die hard... mind you: i needed to reiterate
being rejected by a ******* from:
****...i wasn't rejected...
            i just felt like a tonne of bricks
at the donkey... sure... even i have dreams...
i'd love to spend the last years of my life
in some region of Russia or Norway...
              maybe that too will be soul crushing when
my time comes...
i've already had the heart of youth crushed by
not being able to find anyone outside the realm
of merely *******...
          "only child syndrome":
               or... simply... how i adapted to what was
to come... the rarity of a large family.

Oh, heavenly kingdom
Above their burning flesh
Above their screams,
Above the rivers weaned
On sentiment and sucrose laughter
The palace walls stretch to an infinity
The emblazoned ceilings of the ever after

The only scribes are the stars expanding
In their language of no understanding
They watch and we wonder, wet with earth
They are the forest of our birth

We know of Time;  we have met
It inspires our final sin, Regret
Still the stars they stare and never speak
In the heavenly kingdom... just out of reach

The following constitutes a rather
twisted as a pretzel SUBTITLE:

I dash with my jiggling ***** in an attempt to escape...
being overrun by teddy bears and beanie babies
while carrying out heavy duty spring cleaning.

Twas the bright idea of zee missus aye air
and dedicate this poem
(yes tis correct, if you bare
lee remember this mister
did formerly she push lee duck clear
addressed said spouse
"my little buttock blaster” endear
ring - for obvious reasons,
and before she begat two 'ere
rip press ably lovely daughters),

anyway thee wife I fear
to publicize contracted a benign
strain sans incurable glare
ring housecleaning malady;
thus far no unpronounceable hair
raising name affixed
to non contagious condition, nevertheless
accursed malady,
whereby to keep her
from auctioning me on eBay,
I squarely hide in root cellar.

She frenziedly scrubbing stubborn stains
from clothes, dishes,
and gamut of hibernating
Oryctolagus cuniculus domesticus
horde (nee motley crue)
entrapping scampering dust bunnies
that come breathing alive
nsync with beastie boy
city rollers culture clubbing babes
upon first spring day
engrossed in this, that,

or some other sweeping floor foray
(analogously to Velveteen Rabbit)
shedding fifty shades of gray
winter coat when warmer temperatures arrive,
where humongous fur clumps would lay
comprising sudden empty raft
of shelf space minus a may
zing globules, oh...lemme get on track,
whence frenzied fever
"cleaning bug" nee
major virus afflicting wife,  

would necessitate impossible task
strapping former feisty Norwegian farm gal
in straight jacket livingsocial every
would be no game to play
24/7 daily challenge devious skullduggery
Smokey and the Bandits
an imp posse sub bill
outlaw gang, who lived
like Aristo curr Rats along the quay,    
which unpredictable timeframe

boot tiring and cruel task
of her life Yukon say
thine remaining lifetime,
that's my wife oye vey
would frank lee zapping
every last oomph of mine
if able twin door remaining with spouse
meanwhile 'till she obviously
plucks persistent sprouting stranded follicle
tiller broad forehead resembles
a minuscule tarmac way.

Though far fetched, not impossible
for me and Joe Six
Pack to become one and the same
since a concerned counterpart
contributes to the mix
cuz, she waves a scolding gold finger
dying with craven craving for sweet licks
to grace tastebuds longing
to savor and dissolve sucrose
in any one of the natural
or synthesized combinations
in an effort whose memory
of a washboard tummy
doth hunger for youth afflicts

recent embarkation since maintaining a diet
of exercise no more pesky heeding "yo dude"  
(you look like a lady),
the inner fitness maven against
temptation of high caloric junk food
and nightly snack king
on a flexible fitness routine,
this lxiv aged body electric feels good
these myopic eyes and
well-calibrated hands measure less dense hood-

winking *****, that if I feigned being
a "bared naked lady" -
asper this chest lewd
city in reference to "man *****"
that seemed to materialize overnight
now appear to decrease as well
that unwanted "love handle,
this chap more inclined
tubby in a greater mood
to parade around

this non-crowded house shirtless
AND definitely NOT in public,
BUT no weigh Jose
would this generic guy go completely ****
cuz being self-consciousness of my physique
might prompt outsiders
to consider me a *****
and even during closed bedroom door
****** exploits deter me tibia rude
fellow (with average go daddy long legs)

and my dangling dipstick smallish
(concluding biology *******)
a chap worthy tube he more endowed,
though gratitude proffered
to same divine cosmic consciousness
but as the year's pile up appreciation
of functional faculties alter matts' at tee 'tude
accepting physical characteristics
more or less static
*** ping believe mass elf ya wood.

Tiny, almost minuscule. Hollow *****,
The weight of petite feathers, silken sinew,
Sown into tensile strength, beguiling.

Beauty in song. Greater than giants.
Chirping out lovely textiles of golds and silvers;
Strong enough to hold universes in place.

Sweet like sugar. Sweeter than honey, elixir
Of baby's breath.  It ***** in air, exhales
Through an ***** the size of a raindrop,

Pushes out sucrose-laden vibrations
Which pour into my ears, my brain, my heart,
Until we both pulsate in an oscillating Self.