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TC Mar 2013
Calcified age lines,
driftwood was once a shiny ship:
hallowed bow, curved spine, dead.

Jaundiced and gaunt didn’t appear
until after the fact,
break a bottle on its back
because I'm facedown,
dead drunk, waves of saliva breaking
desperately against the asphalt.
Tree branches grappling together in the wind
are handsome
like a handshake
in a bad poem
but they're just trees, just wood.
I am slowburning like an all natural cigarette.

Jaunt through the woods. Drinking spot.
Acrid friends.
Warm bonfire, I want it to be more like a movie.  
Davy Jones my sorrows. Sitting on a log.
Rock bottom and I’m sitting on a log.
Weird girl comes over, she’s artsy and dyslexic.
I hate that word. Artsy. *******.
She asks if I’m okay and I say yeah.

At home,
exhume pillowcase from *****,
futon forget-me-nots
some thick haired little boy
had curled up to die inside;

Post embrace.
Crashed; a solemnly sinking ship captain
with skin peeling like lottery tickets
too leather-faced to shout anything but
TEN THOUSAND THUNDERING TYPHOONS
as he goes down
with his cracked nymphal exoskeleton
wipes the fire off his brow
he is burning like an all natural cigarette
but phoenixes are not legends
they are metaphors,
and that is enough difference for me.

The sea is salty and stinging
and they say
a smooth one
never made a skillful sailor
but you cannot build a ship
out of driftwood,
just watch one deteriorate into it.

Maybe that’s the point.

For three years,
I found myself in an oozing freefall
base jumping as I carved through the air
like an anchor
parachute made of somber bottle twist
carved cork and microscope slide,
salt stained shoes,
brackish eyes
distort flashes of organic sunlight
thick necked forays into begging for fare
at deserted train stations
lashed out at friends with bullwhip arms
I couldn’t reach my own back
freefalling, base camp
welling up to greet me
from the depths of a tar pit
but the thing about rock bottoms is:
if they don’t destroy you
they give you something solid to stand on.

And if you leap back up, spread eagle
Like a petrified starfish, swim through that tar pit
that is ocean, the warm hovel of under the covers,
Bonfire, whiskey in the back of an old sailors throat,
All natural cigarette,
You can be born again. I promise.

Depression is not sadness, it is the absence of hope
And it is numb. Reduces us to ashes and drowns us all at once.
But it waxes and it wanes, burns itself out if you let it.

And from that flame, scattered splinters in the ocean,
The shedding of my cracked, nymphal exoskeleton,
I understood the impermanence and necessity of flailing tendrils
White hot curling up a mainmast like a handshake
Wet flesh in the womb of moment between sleep and wake,
Breath slipping away like low tide
Gasping for air until it’s easier to ****
Oxygen out of the saltwater in your lungs
Pain killed a boy and made a man

Watch a phoenix **** a baptism
Violently conjure steam into existence
Just for it to disappear, watch them smile.
You’ll understand.
Christian Reid Oct 2014
I have fallen asleep in your dark waters
And lifted the heavy meniscus thereof
I have been cut off from identity
And returned with your love

My eyes have rolled like floating maraschinos
Aimlessly drawn to the vacant potential
Out of the pool of scattered images
The puppet master culled

Stories written by grey neurological
Fibers assembled appearance of array
Fastening to muscular reflexes
That danced to the display
Norbert Tasev Mar 2020
I don't care about fashion anymore because of the odors! Deprive yourself of a new susceptibility to zamtok, who only cares for the telltale signs of externalities! Balancing your interests can also quickly lead to defects in taste! What does the exibitionist trend mean ?! Perhaps we don't even notice others simply because of their dressing habits, so that we can blend in with the sophisticated, elegant elite?

The culprits and the victims are thus put together, in a complicity, into dead-end stalemates, because they fear what the public opinion would say if many of them were to detect the protein in their teeth! - And once a health-minded, superficial-looking superficial, it is very upsetting; it might be a problem to try to see that exceptional One among many like that! The difference in the glass tiles of curved mirrors also looks different!

In the penultimate moments, are the Good Friends of Loyalty recognizable ?! Thugs and Timothy Tikitaki ?! - In all respects, the silent refusal of refuge is hiding silently; cocky misunderstanding shakes their heads and can keep them in cage captivity! The Imperial Ranking of Impossible Daydreams That Everybody Says Somebody or Something! Even now, some conscious mistrust is infecting!

All the cheap sensationalist celebrity pics have become more interesting; the message of sinking airships, instead of sitting at peaceful home conversations with sticky masses of secrets!
Seth Davis Apr 2010
The room shrinks.
She missed again, the vein dodging the needle.
The body reacts

                                                       confused

And ineffective. Cold yet sweaty, those ears sink under water.
My bags unpacked, my threads untied, yet

                                                                                           I am gone.

Nothing remains, and the nothing is tranquil.

A second? An hour?
The cacophony begins, muted
The ears throb and resurface.
Voices touch, hands speak. I taste their worry.
And finally

                                                                                            I am back.

I wash in the relief of my return. I’m not ready.
I'm on a medication that requires my blood to be monitored no less than once a month. Since starting this process some five years ago, I have had a few vasovagal episodes like this one.
Bobcat Dec 2018
Clock out, start my car and check my phone.
I look down, see a text "Hey, you doing okay bro?"
Confused and realizing I missed about 12 calls.
Didn't know what was going on, nothing was clear,
Incoming call from 'enter name here'.
I answered "Hey what's up?" and then I heard the tears.
"What's going on? What did I miss? Are you alright?"
'You didn't hear? She was driving and passed away last night.'
I dropped my phone on the floorboard and head hit the wheel.
Thinking to myself-****, this **** can't be real-
This 10 minute drive home felt like forever.
I turned on our song before I stopped to get liquor.
I didn't know what to do and I didn't have much to say,
So I just decided to drink my night away.
I remember calling my mom, it must have been 4am.
She started to cry and asked me, what happened?
I just kept apologizing for not being able to cry.
I tried and I tried but my tear ducts were dry.
I just had an overwhelming feeling of hollowness inside.
I know they say there is 5 stages of grieving,
But I just couldn't accept that forever you're leaving.
You had plans, goals and so many ambitions.
It all changed when you were taken by the ambulance.
Flashing lights and sirens never sounded more silent.
Ear piercing screams heard miles from the accident.
I remember when we wanted to move and start a life.
On our drive home you looked at me and said "Idaho feels right;
We can both work and I heard they have really good schools
Now can we stop somewhere so I can get some food?"
You were so funny and always could make me smile.
Sure, we fought and argued but that only lasted a little while.
Though we hadn't talked in just about a year,
I was still living my most awful of fears.
No matter what happened or time spent apart,
We'd always find our way back to each others heart.
So, though each year gets just a little bit harder,
I know that someday soon we'll get to see eachother.
Denise Feb 2012
the feeling before is the worst
when I know I'm going but I can't stop
it's blurred vision fuzziness
and then bees on fire
dark and wooshing

and I'm out
for 3 minutes or 10
I can never be sure
it's like being in a pool with your eyes closed
but not wet
and I dream

the dreams are the strangest of my life
they are dreams without thought
dreams without shape
color is felt
liquid is breathed
thoughts are as solid as non-Newtonian fluids

when I wake up
I'm still in the dream
still in the dark colors and thrashing out of it
then it's cold tiredness
even if the room is as hot as my face
from the embarrassment of having people look at me
even when people are just my mom staring at me while we sit by the side of the road
best case scenario is when I'm at home in bed
it's so much worse when people are around
hitting concrete and have to be taken away on a stretcher
through a school full of kids who will be talking about that girl who fainted
when I came back every one stared and asked how I was
I didn't know how to act and I did't know what to say
but it faded like my consciousness did
until it happened again
LDuler Mar 2013
There's a pounding in my head
Too sick to be alive, too astir to be dead
Everything is hazy, shifting into distant lands
A nervous shaking in my hands
Am I hot or cold?
I feel so vulnerable and young, yet so sickly and old
There's a ringing in my ears
And I can't stop my tears
As fuzzy thoughts, bated breath
Feel like impending death
My brain is melting, I'm losing my wits
The spinning never quits
Everything is muddled, whispered despair
I'm done, finished, this is too much to bear
Maybe I should just...drift away...
Maybe I should let my head gently sway....
The shaking stops
The darkness drops
I don't fight it, I don't try to flee
The liquid waves of malaise carry me
To somewhere deep within the abyss of my brain
And everything disappears, the confusion and pain
But it's transient, it doesn't last
Consciousness comes back with a blast
The waves wash me back ashore,
But I still feel wobbly to the core
My ebbing spirit  did revive,
Though I'm too weak to feel alive
Mortal Syncope by Geneviève Pardoe Macchiarella is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Barton D Smock Jul 2012
the details of the effort have left me now that I am weak and moral.
even that I call it an effort seems to me common.

I don’t want to hurt you.

the three boys I will start with were born yesterday and shirtless.
one of them had a sister the other two were in love with.
she wanted to see a pitch black squirrel.

what darkness in her mouthed such a request must’ve been her mouth.
the two boys had never kissed a thing and her promise to kiss on sight of said squirrel
must’ve stirred
vague & crow
into one bed.

the squirrel itself might’ve been on its way to being asleep but instead it died
struggle
and / or
fumes.

sister laid her eyes on it.  one resting, and then the other.
Meenu Syriac Mar 2015
What is that swirling darkness,
That velvety shroud of comfort?
Falling slowly into an abyss,
Devoid of all reality.
Let me lie here,
Let me slumber,
Maybe dissolve into this blackness.

This silence is music,
A lust, I cannot comprehend.
Let me rest,
No, let me wander.
A dreamland to discover,
A temple for my insanity.

Voices peak,
Noises from afar,
As a daunting fear settles in.
A bounding pulse, a throbbing ache,
As shadows begin to creep.
Please, let me dream,
Just let me be.
Here,
In this void,
In this realm,
There's no one who'll want to forget me.
©Meenu Syriac

Being a medical student, this was my poetic interpretation of a medical condition, as a result of my own experience with the same. More perspectives to medicine. Well, why not poetry!
primordialgirl Jul 2022
Rivers of velvet sadness
Stream through my veins at night
The heaviness of the flesh
and of my mind crippling blind
I'm crippling blind
My eyes wide open
Gradually turning black

The feeling before syncope.
ChawzzyScript Jan 2013
Can the skin of my lips touch again the soft suppleness of yours?
I like the euphoria that races down my spine and spreads through me like fever;
Weak and lightheaded, I am painfully vulnerable to its effect.
Giddy like a child to know you feel it too as we linger pressed together.

Can we meld again our faces and make our tongues dance?
I crave the taste of the mint that still haunts your house;
With eyes closed, I greet the endorphins with playful giggles.
Your hands clasped in mine, we brace for the onslaught of our zeal.

Can we again have our souls collide within the envelope of our breaths?
I long for the dizzy heights aloft of my infinite love of you;
Your arms around my neck forcing my head to meet yours with haste.
My hands cradling your backside, drawing our bodies yet closer together.

Can we repeat again the wordless speech, the slow mind coition?
I fancy my heart a metronome escalating a beat in syncope with your own.
A little nibble, a teasing bite, a nosh if you will, as if your silk lined set were food stuffs with gravy.
I suckle the lower lip as if it were an areolar protuberance feeding my infantile psyche.

Can I again passionately conjoin your mouth with mine, and hold you there in my thoughts?
Can I dare evoke the feelings I so wholeheartedly embrace, and return them to you with fervor?
Can we share each other in spontaneity as a hello or goodbye, again my love forever?

Please...!

Can I kiss you again?

-----ChawzzyScript
annh Jun 2019
Honey-flowing rivulets of jazz-beaten syncope,
Trumpets blowing smoke across the room,
‘Curveball’ Sammy hustles bass behind the bar,
Snares his songbird in a played back loop.

Harlem shufflers work the floor, breaking safe,
Clave rhythm scufflers with a New York twist,
Black keys write with borrowed brass on iv’ry walls,
Pick the lock on a swelt’ring southern riff.
‘If you have to ask what jazz is, you’ll never know.’
- Louis Armstrong
neth jones Jun 2020
ground swell
and furniture at odds
storage collage
the breathing flutter
shutter-ring
lists

head blood flush
rush until taunt
and breathing...
                     an ail

air
off of still
warmth
pudding the chamber
tow my breathing
as ought

a gentle petitioning
takes effect

my senses are hooked back up
and i observe i am sat awkward
; floor and wall
untightening into feeling
Read like The Shipping Forecast if you like
Oli Mortham Sep 2014
For the first time,
Stricken by thirst
…And blind…
A young girl emerged from a dark captivity
And stumbled headlong into the jaws of a rich and rapturous city
CONSUMED by light.
A light as opulent as the gold which it acted to illuminate:
A policy of the “Great” warden, Ciro...
Whose callous mandate stated that no trees should be allowed to grow
Within the walls of the region.
With all the forests torn, it freed him
To covet his plundered wealth without stealth's covering eyelid,
So that every jewel and sculpted idol
Glittered with the unrelenting reflected fire of the Sun,
Like ornamental flames bedizening some roofless civic solarium.
Blades of heat rumbled in the sand,
And invaded the young girl's consciousness with suffocating hands...
...And, as she slowly ebbed into a syncope,
A faded groan edged in single beats about her:
It was the laboured breath
Of a lonely spinster,
Aged, yet walking wearily
Towards the waterside
To drink, and rinse her clothes -
Her only cooling comforts
In these days which closed
Her journey between life and death.
…A moment passed in a silent rest,
Until…
Familiar darkness wound around the young girl's waking eyes,
But what she felt was different:
In brief abatement, the heat lay held aside,
And, in its place, an umbra coolly shrouded her predicament.
Its caster, standing arms akimbo, was a curious young boy,
And to him no greater joy came than from the task of answers sought;
‘Always asking,’ once taught his father
‘Is both the fuel and mastery of thought.’
So, with this in mind, he asked her:
‘Why are you lying furled and frightened across the ground?’
On hearing this sound,
She lightly unclasped
The fabric of her uncertain whisper:
‘I’m afraid I may have lost my way…’
And, through the blackness of her personal void, it fell…
To twist,
And whirl,
And fade…
‘Well…look around.’
The boy insisted,
Catching that ambivalent cascade in motion;
The opposing palm of his reply
Held outstretched and shimmering against the shadow-flow.
  He calmly posed the notion
That, so her way could again be found,
She should picture a searching arm
Linking the wayward loop of her location
To those famous, sparkling landmarks
That mapped each inch inside those gates
With which that desert metropolis was bound.
The girl reached out, with spoken fingers…
The worded tips cracked and broken by doubt…
And twelve years of dreaded bleakness
Spent chained down under the clenched fists
Which were bolted on
To stand gravely upon
The wrists of her lingering incarcerators:
‘Thank you,
For being kind…
And for the guide with which you try to help me…
But…I fear…I cannot use it…
For…in truth…
I cannot see.’
Part 1 of 3
Tim Mansour Oct 2020
You cut a dashing figure
between em and en and
oh, by the way

Your abbreviated smile
has me wondering what
it stands for

as I place my finger on
your ellipsis … you lead me on,
there is no doubt
I feel left out

But as we track and kern
our forms, ascending,
make ligatures to avoid
an overlap of strokes

a diphthong doth emerge
o’er our line o’ type
and what was once

paragraphed into separateness,
our thoughts juxtaposed

begins to merge
(bind in parentheses)
you’n’me make syncope

and, once the story forms,
the digraphs make shapes
with our mouths.
A poem set in the font of love.
j carroll Feb 2013
rickety rackety hickory sticks 10
bundled for the burning 6
finicky syncope, verse that predicts 10
a pleasure twice returning. 7


clickety clackety silver-wrought tongues 10

kittens and cats in cahoots 7
Geno Cattouse Jun 2013
The first thing went through my mind when I
saw a  beautiful woman was.

1. what does she taste like. Her skin. her mouth. that spot right behind her ear. just inside her ear.
The soft curve of her neck. Her shoulders.  The  junction where ******* meet her arm. That long expanse of her soft belly. Her sweet lips as they parted to allow access. ****,salty, sweet all combined. I could see myself eating all courses slowly savoring.

2. What does she smell like. Not her shampoo or lotion or perfume or body oils. I mean her pheromones.

that deep unique essence of her.That smell at the base of her neck. under her chin her armpits,the hollows of her elbows. her belly button,her beautiful mound, that simmering potion be it ever so slight or close to overstated as I gradually slid down to Taste. To nibble at her taint and stab gently with my tongue. Her ***. That never- never land of sensual convergence.

3. What does she sound like in various modes. Her voice lilting, high pitched, throaty, nasal. he cadence of her speech. her laugh nervous, content, sing-song. early upon waking.so many undulations and coloration's.

4. What does she think like. concise open, flowing restricted, guarded,untrusting, fair, fearful,provocative, sensual, ******,cold, shallow, deep,intelligent, smart,vengeful,hurt,
carefree,calculating,ditsy,unsettled, divided, loving,caring,nurturing.

5. Is she **** or *** or a combo of both.  And what other erogenous hot spots. Which one gets her out of her head and free falling in unabashed ecstasy. Which hollow or crevasse or soft expanse is a fuse. Another ingredient to her potion. how many stimuli could I apply and keep in her sensual Calliope until a thrashing conclusion or a cessation of movement, breathing or sound that will bring her release tumbling down in near syncope.  

6. If she had on no lipstick I would imagine her *******/aereolas/*******. brown, wide, smooth , bumpy, pink,caramel thick long endless.

7. what comes through her eyes. my god her eyes. That is another universe worth of endless research and
books.

Now I don't do the subconscious speed of light hound dog amalgam.

Now I just see the woman and see the woman again.

All is still applicable but is casual thing. third nature even.
God. Thank you for your gifts.
Amen.
Olivia Kent Oct 2013
In syncope she quivers.
Shaken up.
Lost all her fizz.
She's known all along.
All that glitters is not gold.
The silversmith came.
Forged a blade of silver.
For her to slip into her purse.
The blade in shape of crescent moon.

Ripped her heart to shreds too soon.
Wanted to keep it close at hand.
To breach no promises.
Not to demand.
Princess pushy.
Has regrets.
Would have a whole lot less.

If he should answer messages sent.
Then requests would be received.
Wouldn't be pushy.
No pushiness would e'er be shown.
There'd be no need at all.
Ignorance is bliss they say.
If only she had known.
She wouldn't have to moan!
By ladylivvi1

© 2013 ladylivvi1 (All rights reserved)
Edna Sweetlove Jan 2015
So sad the cemetary stood,
Rows of identical crosses
Commemorating wasted lives
And pointless sacrifice for glory.
One rainlashed day I was there with a fat little **** I knew
To inspect her great-grandfather's grave;
A hero who had repeatedly groped his own daughter
Shortly before meeting death in Paschendael's slaughter.

My friend elegantly squatted, hovering o'er the grave
And performed a perfect Valsalva manoeuvre,
Depositing a well-aimed sausage thereupon.
"That's for you, you grandmotherfucker"
She gaily murmured sotto voce.
But tragedy struck: a defecation syncope
Caused her collapse, skull smashed on the gravestone;
"I'm in the ****," was her final tragic moan.
Terry Collett Mar 2013
Sophie Syncope
suffocated

her sixth child,
placed the pink pillow

over the small head,
held it there, against

the struggling for breath,
until still, until dead.

Sophie waited, listened,
held her breath,

watched for movement.
None came; she removed

the pillow, stood holding
it by her side. The sixth

child lay closed eyed,
opened mouthed, small

hands in tight fists.
Sophie dropped pillow,

put child’s hands crossed
one over the other. Dead child,

crucified mother. Pushed
mouth closed, moved head

upright, steadied. She placed
her palms on the child’s cheeks,

felt smooth skin, knew
the stilled cancer within.

Cut short
the suffering,

snuffed out
the cancer’s route,

released her child’s spirit
to boot.
Irina BBota Dec 2018
Stay!
And fly with me into the world of mystery,
into a proud, poetic and passionate dance,
feel the freedom in the tango's victory,
dancing sincerely, your body melts in this trance.

Whisper to me in syncope, in a sweet tone,
in spasmodic, elegant moves in this romance,
while the eyes sparkle like a diamond, for they own
the passion in this extravagant, vivacious dance.

Touch me in this poem full of rhythm and sensuality,
stay with me under the spell of the imaginary space,
losing ourselves in the exchange of signals, we have the key
to change the steps  and move with irresistible grace.

Paint the unknown again on my naked shoulder
with your lips craving after my sweet kiss, it seems,
cover me with your entire palm, bring me closer,
make me a bedding in the land of foolish dreams.

Feel my pure madness in this rhythmical speech,
resonating, vibrating together, for one last dance,
don't look down, but breathe my air and you'll reach
the top of the Eiffel-tower in magnificent France.
Sparrow Junk Sep 2017
Coming back
Coming back without a grandstand
Coming back from the hinterland
Coming back as an old hand

I had cast myself aside
to focus on new graces
Instead placing myself
in permanent stasis

I had all these grand plans
and each one fell through
So now I stumble on back
down a crumbling avenue

Never knew which dream to follow
Never knew which pill to swallow
Now my words they ring so hollow
Now my passions no longer wallow

Coming back
Coming back to a humble home
Coming back to a field to roam
Coming back to find one's own

The sofa begins to mold
itself around my spine
As I lay and acting out
like it was all of mine

Not wanting to address
my failures or success
Claiming that it was all
just part of the process

Never knew what I should do
Never knew how to carry through
Now it happens out the blue
Now I need a new point of view

Coming back
Coming back to build myself
Coming back to repair my health
Coming back with the cards I dealt

Never knew I had it in me
Never knew if I could be happy
Now I skip the hyperbole
Now I give up emotional syncope

Coming back
Coming back to sing my song
Coming back from what was wrong
Coming back to live lifelong
I had taken a few weeks off due to a holiday, moving house and starting a new job, so of course imagined a story of someone coming home from failing their dream.
Linkuya Jan 2018
I stood upon the grey steps of Atrifore,
Bitter water greeting my feet with cold mists,
I stood with the ghosts of dignity and valour,
My broken body wishing to return to my tryst.

Stone steps cast their hex on my weary soles,
My cobalt eyes burned as my mind twisted,
My martyrized soul still struggling to regain control,
Ice winds serving as salt in wounds self-inflicted.

Feet submerged I stepped into the sea,
Silent howls tore through the ashen sky,
Mind numbing under this chilling syncope,
My flesh sank under the waves to die.
The bay of Patmos brightened in the scaphoid Trinitarians of the Colosso de Apsila, the combustion of the alma matter constituted Solomonic vademecum until the rebirth of those who preserve their sclera that accompanies their cruel torments in muscles of passion, for those who prostrate and recline on the pain that the soul itself asks to alleviate morbidities in the hay that grows when nothing rises before the tragedy of the pious fragments that divide the heart of a Sufi. Everything pretends that it is religious epilepsy bubbling vapor of faith through the mouths of the gods when illegible gestures of stars shine through from others that are greater in light and form when chaos was first, and the darkness became entangled in chaotic truthfulness of what converts the sacramental guarded by the angel Iblis. Judas Iscariot was a hybrid to dissent from Asmodeus, taking him from those fates of the firmament that had six apices, thus enrapturing him of the Siblis who had gone into exile in the caravans of Morocco, then falling from the despotic saying that shook the heads of the Achaemenids indicating anticipated conversions of unbelievers, when seeing that the six vertices of the first star of subjugation were declared, coming behind the second-star splint that was made up of other hexagons taking out ruinous cults that lay in the infertility of skepticism, not tolerating interpositions in any other way. Everything indicated that the light of the Shamesh of the Ruach Hakodesh in the roadstead of Patmos could already be asserted so that all the fires of the fertility of the Holy Spirit waving a loud voice that raises the worlds in the ablutions of the effluvium, with the emissions of Delphi, and with the lightning bolts of Zeus that would be encased in the scapulae of the Colosso de Apsila, silencing the delirium that only spoke out loud in those who did not know more than to hear in another sense, that avoids subsistence and where it grants more sap.

The Siblis says: “with my hands, I take what remains of life, and what will remain I will put under my comforts where everything will speak with withered corners of the lullaby, and of what the asylum of what it despises. Thus, everything that comes before the fourths happens to the fifths, and I subtract them from my hell, Iblis. The deities are withdrawn and the almighty is constrained further from the clouds that shelter the consciousness of the burning, and from the rays that exceed a thousand volts and more lights with large megawatts over the wings of the body that will experience growth, when it is a dream may he remain alive on the one who is at odds and is knocked down by his gesture of triumph that never annihilates, he only hangs on the body that is defeated "
The high tide was decomposing in degraded red blood cells, strangling bodies that were banned from their automaton skeletons, and from what was sacrosanct of Allah, which was also of the Mashiach, making a refuge that would make bones rest for more than thousands of years that did not rest. In the forging of a bronze frame, leaving every paradigm to the patronage of the amulet for anyone who suffers merciful debasement of the talus, beginning to flare up in the fords of capsular phototropism, leaving on them springs that cause and fill hearts that do not pulse, but if after an acquiescent nucleus of the rarest corporal alive or not! Praising what he writes by himself when for thousands of years everything has separated us instead of joining the immense room called Megaron Áullos Kósmos, eminent, free of all symptoms where impudent politai paraded through the flattened flowers that mix monstrosity of their cheers and the strings that surround him elliptical from the perihelion far and reviled and dangerous preventive. What exceeds the stature symbolizes the wrought iron that in a series of thousands becomes siege weapons instead of farming, and what the high sword invests leaves its merit when it discovers the weapon of punishment, cut off in deaths that are crossed when revived. from the same edge of the converted spirit of the one who wields it. The pairs of symbolisms protect almost depopulated those who have dwellings in paradise, with bent consciences that ****** Xiphos of conversion into staves of a mortuary color, which mutilates the mezzanines that are typical of a black cane exiting the human figure. The ruins produce architectural syncope that concerns the ineptitude of the castrated humanity of the Berith Milah, as a baptism of ancestry and circumcision slicing courses of arteries that fragment hemispheres of reason to found adherence to who really lives in you ..., if Hanael or another who has always been livid in you without becoming fatigued at the disposition of calling you a degraded son, materializing spiritually and becoming symptomatic of prevalent shocks by having them exulted by ancestral kindnesses.

The resentment caused planetary rumblings and extreme unfolding that sprouted from the exact diameter of its joints, leaving the grasses connected to neurosciences that slaughtered at dawn, and collected the expiation of what it is not capable of resisting in its faded sacrosanct body when all they were going through the drain of Judas Iscariot. Reflecting majolica and boches encrypted in themselves, withdrawing from the incense, from Hellenics who have never stopped beheading spheres that doze in the oasis where the water seeps through meadows that fill creek beds, apriorism of infusions that are injected where the meadow do not flee! Patmia was the silence of the tabernacle superior to the sizes that annul all composure in the cusp and in the spaciousness, and if it were to be seen like this, syllables would be limited that they uttered their only cheers that agonized at the side of their enemy, gracing them with the pain celebrated in courtship linguistics in its parallel.

Judas thinks: “In the next dawn everything seemed as if the world had just begun to be reborn, the whole world appears as the greatest satisfaction in the world. Some wondered what had happened or what it was that transformed everything when they observed from afar when an image came that pretended to be further away from the whole world, encompassing the realms of abstraction. They are the hearts that beat far away and they think that the strong reason is supported by the stratum by orpheons of angels, where the Master does not bother to teach us that great dreams are always accompanied by great beats "
Battle of Patmia  Part IV
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to us e
M-M-R II safely and effectively. See full prescribing information
for M-M-R II.
M-M-R® II (Measles, Mumps, and Rubella Virus Vaccine Live)
Suspension for subcutaneous injection
Initial U.S. Approv al: 1978
-------------------------------INDICATIONS AND USAGE-------------------------------
M-M-R II is a vaccine indicated for active immunization for the
prevention of measles, mumps, and rubella in individuals 12 months of
age and older. (1)
-------------------------- DOSAGE AND ADMINISTRATION--------------------------
Administer a 0.5-mL dose of M-M-R II subcutaneously. (2.1)
• The first dose is administered at 12 to 15 months of age. (2.1)
• The second dose is administered at 4 to 6 years of age. (2.1)
------------------------DOSAGE FORMS AND STRENGTHS -----------------------
Suspension for injection (0.5-mL dose) supplied as a lyophilized
vaccine to be reconstituted using accompanying sterile diluent. (3)
---------------------------------- CONTRAINDICATIONS ----------------------------------
• Hypersensitivity to any componentof the vaccine. (4.1)
• Immunosuppression. (4.2)
• Moderate or severe febrile illness. (4.3)
• Active untreated tuberculosis. (4.4)
• Pregnancy. (4.5, 8.1)
-------------------------- WARNINGS AND PRECAUTIONS --------------------------
• Use caution when administering M-M-R II to individuals with a
history of febrile seizures. (5.1)
• Use caution when administering M-M-R II to individuals with
anaphylaxis or immediate hypersensitivity following egg ingestion.
(5.2)
• Use caution when administering M-M-R II to individuals with a
history of thrombocytopenia. (5.3)
• Immune Globulins (IG) and other blood products should not be
given concurrently with M-M-R II. (5.4, 7.2)
----------------------------------ADVERSE REACTIONS----------------------------------
See full prescribing information for adverse reactions occurring duri ng
clinical trialsor the post-marketing period. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Merck
Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., at 1-8 7 7 -
888-4231 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.
-----------------------------------DRUG INTERACTIONS----------------------------------
• Administration of immune globulins and other blood products
concurrently with M-M-R II vaccine may interfere with the
expected immune response. (7.2)
• M-M-R II vaccination may result in a temporary depression of
purified protein derivative (PPD) tuberculin skin sensitivity. (7.3)
-------------------------- USE IN SPECIFIC POPULATIONS--------------------------
• Pregnancy: Do not administer M-M-R II to females who are
pregnant. Pregnancy should be avoided for 1 month following
vaccination with M-M-R II. (4.5, 8.1, 17)
See 17 for PATIENT COUNSELING INFORMATION and FDA
approv ed patient labeling.
Rev ised: 06/2020
FULL PRESCRIBING INFORMATION: CONTENTS
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Dose and Schedule
2.2 Preparation andAdministration
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
4.1 Hypersensitivity
4.2 Immunosuppression
4.3 Moderate or Severe Febrile Illness
4.4 Active Untreated Tuberculosis
4.5 Pregnancy
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
5.2 Hypersensitivity to Eggs
5.3 Thrombocytopenia
5.4 Immune Globulins and Transfusions
6 ADVERSE REACTIONS
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
7.2 Immune Globulinsand Transfusions
7.3 Tuberculin Skin Testing
7.4 Use with Other Live Viral Vaccines
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.6 Persistence of Antibody Responses After Vaccination
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
14.1 Clinical Efficacy
14.2 Immunogenicity
15 REFERENCES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
Sections or subsections omitted from the full prescribing info rma tion
are not listed.
2
FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE
M-M-R® II is a vaccine indicated for active immunization for the prevention of measles, mumps, and
rubella in individuals 12 months of age and older.
2 DOSAGE AND ADMINISTRATION
For subcutaneous use only.
2.1 Dose and Schedule
Each 0.5 mL dose is administered subcutaneously.
The first dose is administered at 12 to 15 months of age. A second dose is administered at 4 to 6
years of age.
The second dose may be administered prior to 4 years of age, provided that there is a minimum
interval of one month between the doses of measles, mumps and rubella virus vaccine, live {1-2}.
Children who received an initial dose of measles, mumps and rubella vaccine prior to their first
birthday should receive additional doses of vaccine at 12-15 months of age and at 4-6 years of age to
complete the vaccination series [see Clinical Studies (14.2)].
For post-exposure prophylaxis for measles, administer a dose of M-M-R II vaccine within 72 hours
after exposure.
2.2 Preparation and Administration
Use a sterile syringe free of preservatives, antiseptics, and detergents for each injection and/or
reconstitution of the vaccine because these substances may inactivate the live virus vaccine. To
reconstitute, use only the diluent supplied with the vaccine since it is free of preservatives or other
antiviral substances which might inactivate the vaccine.
Withdraw the entire volume of the supplied diluent from its vial and inject into lyophilized vaccine vial.
Agitate to dissolve completely. Discard if the lyophilized vaccine cannot be dissolved.
Withdraw the entire volume of the reconstituted vaccine and inject subcutaneously into the outer
aspect of the upper arm (deltoid region) or into the higher anterolateral area of the thigh.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to
administration, whenever solution and container permit. Visually inspect the vaccine before and after
reconstitution prior to administration. Before reconstitution, the lyophilized vaccine is a light yellow
compact crystalline plug, when reconstituted, is a clear yellow liquid. Discard if particulate matter or
discoloration are observed in the reconstituted vaccine.
To minimize loss of potency, administer M-M-R II as soon as possible after reconstitution. If not used
immediately, the reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from
light, for up to 8 hours. Discard reconstituted vaccine if it is not used within 8 hours.
3 DOSAGE FORMS AND STRENGTHS
M-M-R II vaccine is a suspension for injection supplied as a single dose vial of lyophilized vaccine to
be reconstituted using the accompanying sterile diluent [see Dosage and Administration (2.2) and How
Supplied/Storage and Handling (16)]. A single dose after reconstitution is 0.5 mL.
4 CONTRAINDICATIONS
4.1 Hypersensitivity
Do not administer M-M-R II vaccine to individuals with a history of hypersensitivity to any component
of the vaccine (including gelatin) {3} or who have experienced a hypersensitivity reaction following
administration of a previous dose of M-M-R II vaccine or any other measles, mumps and rubellacontaining vaccine. Do not administer M-M-R II vaccine to individuals with a history of anaphylaxis to
neomycin [see Description (11)].
4.2 Immunosuppression
Do not administer M-M-R II vaccine to individuals who are immunodeficient or immunosuppressed due
to disease or medical therapy. Measles inclusion body encephalitis {4} (MIBE), pneumonitis {5} and death
as a direct consequence of disseminated measles vaccine virus infection have been reported in
3
immunocompromised individuals inadvertently vaccinated with measles-containing vaccine. In this
population, disseminated mumps and rubella vaccine virus infection have also been reported.
Do not administer M-M-R II to individuals with a family history of congenital or hereditary
immunodeficiency, until the immune competence of the potential vaccine recipient is demonstrated.
4.3 Moderate or Severe Febrile Illness
Do not administer M-M-R II vaccine to individuals with an active febrile illness with fever >101.3F
(>38.5C).
4.4 Active Untreated Tuberculosis
Do not administer M-M-R II vaccine to individuals with active untreated tuberculosis (TB).
4.5 Pregnancy
Do not administer M-M-R II to individuals who are pregnant or who are planning on becoming
pregnant within the next month [see Use in Specific Populations (8.1) and Patient Counseling Information
(17)].
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
There is a risk of fever and associated febrile seizure in the first 2 weeks following immunization with
M-M-R II vaccine. For children who have experienced a previous febrile seizure (from any cause) and
those with a family history of febrile seizures there is a small increase in risk of febrile seizure following
receipt of M-M-R II vaccine [see Adverse Reactions (6)].
5.2 Hypersensitivity to Eggs
Individuals with a history of anaphylactic, anaphylactoid, or other immediate reactions (e.g., hives,
swelling of the mouth and throat, difficulty breathing, hypotension, or shock) subsequent to egg ingestion
may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving M-M-R II vaccine
.The potential risks and known benefits should be evaluated before considering vaccination in these
individuals.
5.3 Thrombocytopenia
Transient thrombocytopenia has been reported within 4-6 weeks following vaccination with measles,
mumps and rubella vaccine. Carefully evaluate the potential risk and benefit of vaccination in children
with thrombocytopenia or in those who experienced thrombocytopenia after vaccination with a previous
dose of measles, mumps, and rubella vaccine {6-8} [see Adverse Reactions (6)].
5.4 Immune Globulins and Transfusions
Immune Globulins (IG) and other blood products should not be given concurrently with M-M-R II [see
Drug Interactions (7.2)]. These products may contain antibodies that interfere with vaccine virus
replication and decrease the expected immune response.
The ACIP has specific recommendations for intervals between administration of antibody containing
products and live virus vaccines.
6 ADVERSE REACTIONS
The following adverse reactions include those identified during clinical trials or reported during postapproval use of M-M-R II vaccine or its individual components.
Body as a Whole
Panniculitis; atypical measles; fever; syncope; headache; dizziness; malaise; irritability.
Cardiovascular System
Vasculitis.
Digestive System
Pancreatitis; diarrhea; vomiting; parotitis; nausea.
Hematologic and Lymphatic Systems
Thrombocytopenia; purpura; regional lymphadenopathy; leukocytosis.
Immune System
Anaphylaxis, anaphylactoid reactions, angioedema (including peripheral or ****** edema) and
bronchial spasm.
Musculoskeletal System
Arthritis; arthralgia; myalgia.
4
Nervous System
Encephalitis; encephalopathy; measles inclusion body encephalitis (MIBE) subacute sclerosing
panencephalitis (SSPE); Guillain-Barré Syndrome (GBS); acute disseminated encephalomyelitis (ADEM);
transverse myelitis; febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis;
polyneuropathy; ocular palsies; paresthesia.
Respiratory System
Pneumonia; pneumonitis; sore throat; cough; rhinitis.
Skin
Stevens-Johnson syndrome; acute hemorrhagic edema of infancy; Henoch-Schönlein purpura;
erythema multiforme; urticaria; rash; measles-like rash; pruritus; injection site reactions (pain, erythema,
swelling and vesiculation).
Special Senses — Ear
Nerve deafness; otitis media.
Special Senses — Eye
Retinitis; optic neuritis; papillitis; conjunctivitis.
Urogenital System
Epididymitis; orchitis.
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
M-M-R II vaccine should not be administered to individuals receiving immunosuppressive therapy,
including high dose corticosteroids. Vaccination with M-M-R II vaccine can result in disseminated disease
due to measles vaccine in individuals on immunosuppressive drugs [see Contraindications (4.2)].
7.2 Immune Globulinsand Transfusions
Administration of immune globulins and other blood products concurrently with M-M-R II vaccine may
interfere with the expected immune response {9-11} [see Warnings and Precautions (5.4)]. The ACIP has
specific recommendations for intervals between administration of antibody containing products and live
virus vaccines.
7.3 Tuberculin Skin Testing
It has been reported that live attenuated measles, mumps and rubella virus vaccines given individually
may result in a temporary depression of tuberculin skin sensitivity. Therefore, if a tuberculin skin test with
tuberculin purified protein derivative (PPD) is to be done, it should be administered before, simultaneously
with, or at least 4 to 6 weeks after vaccination with M-M-R II vaccine.
7.4 Use with Other Live Viral Vaccines
M-M-R II vaccine can be administered concurrently with other live viral vaccines. If not given
concurrently, M-M-R II vaccine should be given one month before or one month after administration of
other live viral vaccines to avoid potential for immune interference.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Risk Summary
M-M-R II vaccine is contraindicated for use in pregnant women because infection during pregnancy
with the wild-type viruses has been associated with maternal and fetal adverse outcomes.
Increased rates of spontaneous abortion, stillbirth, premature delivery and congenital defects have
been observed following infection with wild-type measles during pregnancy. {12,13} Wild-type mumps
infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.
Infection with wild-type rubella during pregnancy can lead to miscarriage or stillbirth. If rubella infection
occurs during the first trimester of pregnancy, it can result in severe congenital defects, Congenital
Rubella Syndrome (CRS). Congenital rubella syndrome in the infant includes but is not limited to eye
manifestations (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and
intellectual disabilities. M-M-R II vaccine contains live attenuated measles, mumps and rubella viruses. It
is not known whether M-M-R II vaccine can cause fetal harm when administered to pregnant woman.
There are no adequate and well-controlled studies of M-M-R II vaccine administration to pregnant
women.
5
All pregnancies have a risk of birth defect, loss or other adverse outcomes. In the US general
population, the estimated background risk of major birth defects and miscarriage in clinically recognized
pregnancies is 2% to 4% and 15% to 20%, respectively.
Available data suggest the rates of major birth defects and miscarriage in women who received
M-M-R II vaccine within 30 days prior to pregnancy or during pregnancy are consistent with estimated
background rates (see Data).
Data
Human Data
A cumulative assessment of post-marketing reports for M-M-R II vaccine from licensure 01 April 1978
through 31 December 2018, identified 796 reports of inadvertent administration of M-M-R II vaccine
occurring 30 days before or at any time during pregnancy with known pregnancy outcomes. Of the
prospectively followed pregnancies for whom the timing of M-M-R II vaccination was known, 425 women
received M-M-R II vaccine during the 30 days prior to conception through the second trimester. The
outcomes for these 425 prospectively followed pregnancies included 16 infants with major birth defects, 4
cases of fetal death and 50 cases of miscarriage. No abnormalities compatible with congenital rubella
syndrome have been identified in patients who received M-M-R II vaccine. Rubella vaccine viruses can
cross the placenta, leading to asymptomatic infection of the fetus. Mumps vaccine virus has also been
shown to infect the placenta {14}, but there is no evidence that it causes congenital malformations or
disease in the fetus or infant .
The CDC established the Vaccine in Pregnancy registry (1971-1989) of women who had received
rubella vaccines within 3 months before or after conception. Data on 1221 inadvertently vaccinated
pregnant women demonstrated no evidence of an increase in fetal abnormalities or cases of Congenital
Rubella Syndrome (CRS) in the enrolled women {15}.
8.2 Lactation
Risk Summary
It is not known whether measles or mumps vaccine virus is secreted in human milk. Studies have
shown that lactatingpostpartum women vaccinated with live attenuated rubella vaccine may secrete the
virus in breast milk and transmit it to breast-fed infants.{16,17} In the breast-fed infants with serological
evidence of rubella virus vaccine strain antibodies, none exhibited severe disease; however, one
exhibited mild clinical illness typical of acquired rubella.{18,19}
The developmental and health benefits of breastfeeding should be considered along with the mother’s
clinical need for M-M-R II, and any potential adverse effects on the breastfed child from M-M-R II or from
the underlying maternal condition. For preventive vaccines, the underlying maternal condition is
susceptibility to disease prevented by the vaccine.
8.4 Pediatric Use
M-M-R II vaccine is not approved for individuals less than 12 months of age. Safety and effectiveness
of measles vaccine in infants below the age of 6 months have not been established [see Clinical Studies
(14)]. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have
not been established.
8.5 Geriatric Use
Clinical studies of M-M-R II did not include sufficient numbers of seronegative subjects aged 65 and
over to determine whether they respond differently from younger subjects.
11 Description
M-M-R II vaccine is a sterile lyophilized preparation of (1) Measles Virus Vaccine Live, an attenuated
line of measles virus, derived from Enders' attenuated Edmonston strain and propagated in chick embryo
cell culture; (2) Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in
chick embryo cell culture; and (3) Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated
rubella virus propagated in WI-38 human diploid lung fibroblasts. {20,21} The cells, virus pools,
recombinant human serum albumin and fetal bovine serum used in manufacturing are tested and
determined to be free of adventitious agents.
After reconstitution, each 0.5 mL dose contains not less than 3.0 log10 TCID50 (tissue culture infectious
doses) of measles virus; 4.1 log10 TCID50 of mumps virus; and 3.0 log10 TCID50 of rubella virus.
Each dose is calculated to contain sorbitol (14.5 mg), sucrose(1.9 mg), hydrolyzed gelatin (14.5 mg),
recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin
and other buffer and media ingredients. The product contains no preservative.
6
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
M-M-R II vaccination induces antibodies to measles, mumps, and rubella associated with protection
which can be measured by neutralization assays, hemagglutination-inhibition (HI) assays, or enzyme
linked immunosorbent assay (ELISA) tests. Results from efficacy studies or effectivenes s studies that
were previously conducted for the component vaccines of M-M-R II were used to define levels of serum
antibodies that correlated with protection against measles, mumps, and rubella [see Clinical Studies (14)].
12.6 Persistence of Antibody Responses After Vaccination
Neutralizing and ELISA antibodies to measles, mumps, and rubella viruses are still detectable in 95-
100%, 74-91%, and 90-100% of individuals respectively, 11 to 13 years after primary vaccination. {22-28}
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
M-M-R II vaccine has not been evaluated for carcinogenic or mutagenic potential or impairment of
fertility.
14 CLINICAL STUDIES
14.1 Clinical Efficacy
Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind
controlled trials. {29-34} These studies also established that seroconversion in response to vaccination
against measles, mumps and rubella paralleled protection. {35-38}
14.2 Immunogenicity
Clinical studies enrolling 284 triple seronegative children, 11 months to 7 years of age, demonstrated
that M-M-R II vaccine is immunogenic. In these studies, a single injection of the vaccine induced measles
HI antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of
susceptible individuals.
A study of 6-month-old and 15-month-old infants born to mothers vaccinated with a measles vaccine in
childhood, demonstrated that, following infant and toddler vaccination with Measles Virus Vaccine, Live
(previously US-licensed, manufactured by Merck), 74% of the 6-month-old infants developed detectable
neutralizing antibody titers while 100% of the 15-month-old infants vaccinated with Measles Virus
Vaccine, Live or M-M-R II vaccine developed neutralizing antibodies {39}. When the 6-month-old infants
of immunized mothers were revaccinated at 15 months with M-M-R II vaccine, they developed antibody
titers similar to those of toddlers who were vaccinated previously at 15-months of age.
15 REFERENCES
1. General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices, MMWR
43(RR-1): 1-38, January 28, 1994.
2. Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, a n d Co n g e nita l Ru b e lla
Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practice s (ACIP), M M WR
47(RR-8): May 22, 1998.
3. Kelso, J.M.; Jones, R.T.; Yunginger, J.W.: Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gel atin , J.
Allergy Clin. Immunol. 91: 867-872, 1993.
4. Bitnum, A.; et al: Measles Inclusion Body Encephalitis Caused by the Vaccine Strain of Measles Virus. Cl i n . In fect. Di s. 2 9 :
855-861, 1999.
5. Angel, J.B.; et al: Vaccine Associated Measles Pneumonitis in an Adult with AIDS. Annals of Internal Medicine, 129: 1 0 4 -1 06 ,
1998.
6. Cecinati V, et al. Vaccine administration and the development of immune thrombocyto pe ni c p urp u ra i n ch i ld re n. Hu m an
Vaccines & Immunotherapeutics 9:5, 2013.
7. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic
Review of the Literature and Guidance for Management. J Ped 156(4): 2010.
8. Andrews N, Stowe J, Miller E, Svanstrom H, Johansen K, Bonhoeffer J, et al. A collaborative approach to investigating th e ri sk
of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark. Vaccine. 2012;30:3042‐6.
9. Rubella Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP), MM WR 3 9 (RR-1 5 ): 1 -1 8 ,
November 23, 1990.
7
10. Peter, G.; et al (eds): Report of the Committee on Infectious Diseases, Twenty-fourth Edition, American Academy of Pediatri cs,
344-357, 1997.
11. Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP), MMWR 38(S-9): 5-22,
December 29, 1989.
12. Eberhart-Phillips, J.E.; et al: Measles in pregnancy: a descriptive study of 58 cases. Obstetrics and Gynecology, 82(5): 797-801,
November 1993.
13. Jespersen, C.S.; et al: Measles as a cause of fetal defects: A retrospective study of ten measles epidemics in Greenland. Acta
Paediatr Scand. 66: 367-372, May 1977.
14. Yamauchi T, Wilson C, Geme JW Jr. Transmission of live, attenuated mumps virus to the hu m a n p l ace n ta . N En g l J M e d .
1974;290(13):710‐712.
15. Rubella Vaccination during Pregnancy —United States, 1971-1988. JAMA. 1989;261(23):3374–3383.
16. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. II.
Maternal-neonatal interactions, J. Infect. Dis. 145: 661-666,1982.
17. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. I.
Development and characterization of specific immunologic reactivity in breast milk, J. Infect. Dis. 145: 654-660, 1982.
18. Landes, R.D.; Bass, J.W.; Millunchick, E.W.; Oetgen, W.J.: Neonatal rubella following postpartum maternal i mm un izatio n , J.
Pediatr. 97: 465-467, 1980.
19. Lerman, S.J.: Neonatal rubella following postpartum maternal immunization, J. Pediatr. 98: 668, 1981. (Letter)
20. Plotkin, S.A.; Cornfeld, D.; Ingalls, T.H.: Studiesof immunization with living rubella virus: Trialsin children with a strain culture d
from an aborted fetus, Am. J. Dis. Child. 110: 381-389, 1965.
21. Plotkin, S.A.; Farquhar, J.; Katz, M.; Ingalls, T.H.: A new attenuated rubella virus grown in human fi bro b la sts: Evi d e n ce fo r
reduced nasopharyngeal excretion, Am. J. Epidemiol. 86: 468-477, 1967.
22. Weibel, R.E.; Carlson, A.J.; Villarejos, V.M.; Buynak, E.B.; McLean, A.A.; Hilleman, M.R.: Clinical and Labo ra tory Stu d ie s o f
Combined Live Measles, Mumps, and Rubella Vaccines Using the RA 27/3 Rubella Virus, Proc. So c. Exp . Bi ol. M e d. 1 6 5 :
323-326, 1980.
23. Watson, J.C.; Pearson, J.S.; Erdman, D.D.; et al: An Evaluation of Measles RevaccinationAmong School-Entry Age Ch i ld re n,
31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract #268, 143, 1991.
24. Unpublished data from the files of Merck Research Laboratories.
25. Davidkin, I.; Jokinen, S.; Broman, M. et al.: Persistence of Measles, Mumps, and Rubella Antibodies in a n M M R -Va ccina ted
Cohort: A 20-Year Follow-up, JID 197:950–6, April 2008.
26. LeBaron, W.; Beeler J.; Sullivan, B.; et al.: Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a
Postelimination Environment, Arch Pediatr Adolesc Med. 161:294-301, March 2007.
27. LeBaron, C.; Forghani, B.; Beck, C. et al.: Persistence of Mumps Antibodies after 2 Doses of Measles-Mumps-Rubella Vaccine,
JID 199:552– 60 , February 2009.
28. LeBaron, W.; Forghani, B.; Matter, L. et al.: Persistence of Rubella Antibodies after 2 Doses of Measles-Mumps-Rubella
Vaccine, JID 200:888–99, September 2009.
29. Hilleman, M.R.; Buynak, E.B.; Weibel, R.E.; et al: Development and Evaluation of the Moraten MeaslesVirusVa cci n e , JAM A
206(3): 587-590, 1968.
30. Weibel, R.E.; Stokes, J.; Buynak, E.B.; et al: Live, Attenuated Mumps Virus Vaccine 3. Clinical and Serologic Aspects in a Fiel d
Evaluation,N. Engl. J. Med. 276: 245-251, 1967.
31. Hilleman, M.R.; Weibel, R.E.; Buynak, E.B.; et al:Live, Attenuated Mumps VirusVaccine 4. ProtectiveEfficacy as Measure d i n
a Field Evaluation, N. Engl. J. Med. 276: 252-258, 1967.
32. Cutts, F.T.; Henderson, R.H.; Clements, C.J.; et al: Principles of measles control, Bull WHO 69(1): 1-7, 1991.
33. Weibel, R.E.; Buynak, E.B.; Stokes, J.; et al: Evaluation Of Live Attenuated Mumps Virus Vaccine, Strain Jeryl Lynn, First
International Conference on VaccinesAgainst Viral and Rickettsial Diseases of Man, World Health Organization, No. 147, M a y
1967.
34. Leibhaber, H.; Ingalls, T.H.; LeBouvier, G.L.; et al: Vaccination With RA 27/3 Rubella Vaccine, Am. J. Dis. Child. 123: 133-1 3 6,
February 1972.
35. Rosen, L.: Hemagglutination and Hemagglutination-Inhibition with Measles Virus, Virology 13: 139-141, January 1961.
36. Brown, G.C.; et al: Fluorescent-Antibody Marker for Vaccine-Induced Rubella Antibodies, Infection and Immunity 2(4): 360-363,
1970.
8
37. Buynak, E.B.; et al: Live Attenuated Mumps Virus Vaccine 1. Vaccine Development, Proceedings of the Society for
Experimental Biology and Medicine, 123: 768-775, 1966.
38. Hilleman M.R., Studies of Live Attenuated Measles Virus Vaccine in Man: II. Appraisal of Efficacy. Amer. J. o f Pu b l ic He a lth ,
52(2):44-56, 1962.
39. Johnson, C.E.; et al: Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles
Vaccine Era, Pediatrics, 93(6): 939-943, 1994.
16 HOW SUPPLIED/STORAGE AND HANDLING
No. 4681 ⎯ M-M-R II vaccine is supplied as follows:
(1) a box of 10 single-dose vials of lyophilized vaccine (package A), NDC 0006-4681-00
(2) a box of 10 vials of diluent (package B)
Exposure to light may inactivate the vaccine viruses.
Before reconstitution, refrigerate the lyophilized vaccine at 36°F to 46°F, (2°C to 8°C).
Store accompanying diluent in the refrigerator with the lyophilized vaccine or separately at room
temperature (68° to 77°F, 20° to 25°C). Do not freeze the diluent.
Administer M-M-R II vaccine as soon as possible after reconstitution. If not administered immediately,
reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from light, for up to 8
hours. Discard reconstituted vaccine if it is not used within 8 hours.
For information regarding the product or questions regarding storage conditions, call 1-800-
MERCK-90 (1-800-637-2590).
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Package Insert).
Discuss the following with the patient:
• Provide the required vaccine information to the patient, parent, or guardian.
• Inform the patient, parent, or guardian of the benefits and risks associated with vaccination.
• Question the patient, parent, or guardian about reactions to a previous dose of M-M-R II vaccine
or other measles-, mumps-, or rubella-containing vaccines.
• Question females of reproductive potential regarding the possibility of pregnancy. Inform female
patients to avoid pregnancy for 1 month following vaccination [see Contraindications (4.5) and
Use in Specific Populations (8.1)].
• Inform the patient, parent, or guardian that vaccination with M-M-R II may not offer 100%
protection from measles, mumps, and rubella infection.
• Instruct patients, parents, or guardians to report any adverse reactions to their health-care
provider. The U.S. Department of Health and Human Services has established a Vaccine
Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events
after the administration of any vaccine, including but not limited to the reporting of events required
by the National Childhood Vaccine Injury Act of 1986. For information or a copy of the vaccine
reporting form, call the VAERS toll-free number at 1-800-822-7967, or report online at
https://www.vaers.hhs.gov.
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