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Omar Kawash Jun 2015
I miss my cargo green canvas backpack

Shredded with the mass of three
science textbooks: biology,
classical history, chemistry.

Not like backpack was meant for
several colossal three hundred page
hardcover books.

When it was empty,
it was light,
barely anything, tugging
on my shoulders;
but I insisted the friend come with me.

But I used backpack
for study,
drudgery,
play.
The linen wore
with every use.

It was my safety blanket,
under loose cloth
that contained
sacarine
orange glucose
tablets that I hoped
to never need

Inside the main large pocket,
there was a secret
zipper, within held
a pack of cigarettes,
an excuse,
to pardon myself into a realm of aloneness-
with little questions asked

There were strings that adjusted
its position on my back that
I would pull down,
using tension to fling myself
terminal to terminal

More than fifteen times, I lost
count, of my partner traversing
across oceans, gently cradling my laptop and phone-
my trusted links
with the outside world

Nervousness alleviated by the tassels
in my mouth, I bite and chew
on the cloth, but it holds steadfast
as I ponder how to approach
what's next,
the bittersweet coffee they fell into
rehydrates with my salivating mouth,
hungry for adventure
but a stomach empty
knots itself
anxious
for what's to come

My backpack weighs
on my shoulders, empty or full,
but it's trained my body
to carry the load thoughts in my
head bring upon me

But it yielded to what was to come,
the seams at the bottom gave out.
Backpack let me know: I needed to
learn to carry on
without reliance.
An old poem I wrote dedicated to something that used to be inseperable from me. In other news, I have a new backpack that resembles this old one, but is a bit hardier because for those who know me, they would ask if this current one ripped and no, not yet. (; This is an ode to the first one I had that I was known for and had for an innumerable amount of years.
Hrithik Hiran May 2020
Kabhi chale ** un raahon pe
Jinse jude ** qisse kaafi tumhaare
Jin raahon pe hasi mazaak ki thi doston ke sang
Unnhi raahon mein tumne bhare the woh yaadon ke rang

Kabhi socha na tha ki
Akele bhi chalna padega kabhi
Goonjti hai woh awaaz tumhaari
Jab bhi chalta hu un raahon parr
Peeche mudke dekh bhi leta hu kabhi
Ke mehez dikh jaaye parchayi tumhari
Parr dikhte toh woh adhoore waadein he hein
Bebas karr rakhe hein mujhe jinhone

Woh baarish..woh dhoop
Sabka kiya tha saamna
Jab haath tha tumne mera thaama
Kya Yaad hai woh fool
Jo tod laayi thi tum uss ped se
Mere yaadon ke Gulshan mein
Khila hai woh fool kabse
Hasrat toh dekhiye
Woh ped bhi na sambhal paaya
Mujhe akela dekhkar
Woh bhi murjhaaya

Yahin chalte waqt kaha tha na
Ki chodogi nahi yeh haath kabhi
Chaahe fariyad ** jaaye humse harr koi
Tumhaare usi saath ki khoj mein hu
Jise laga liya tha apne rooh se kabhi
Sahi kaha tha uss shaks ne ki
Manzil nahi raahon mein junoon pao
Kyunki manzil toh pahuche he nahi the ke
Bewafa karr gayi mujhe uss raah pe akele
Kabhi Chalke dekhna
Inhi raahon pe akele
Yaad karna woh beetein hue qisse
Aur ** sake toh mudke dekhna
Dikhunga mein usi mod parr
Jaahan chod gayi thi mujhe..karke inkar
Kyunki badal liye tumne apne raahein
Jo kabhi samajh na paayi
meri yeh fitoor nigaahein
Some roads remind you of that special someone... This is about one such road... (Hindi)
Rajat Sharma Jan 2017
Ek arsaa ** gya h aabaadi dkhte dkhte
Ab khushal ped nhi patjhad lubhata h mjhe
Ab to there ishq mai khaak hona h mjhe
Ab to bas barbaad hona h mjhe

Ab suraj ki roshni nhi andhera pyara lgta h mjhe
Ab upar Jana nhi girna pyara lgta h mjhe
Ab to tere ishq mai raakh hona h mjhe
Ab to bas barbaad hona h mjhe

Ab to dil m pyar nhi dard accha lgta h mjhe
Is bejaan shareer mai khoon nhi nasha acha lgta h mjhe
Ab to tere ishq mai taaj hona h mjhe
Ab to bas barbaad hona h mjhe

Teri ek ek yaad apne ashko se bahani h mjhe
Teri ek ek hasi apne gum se chupani h mjhe
Ab to tere ishq mai zinda laash hona h mjhe
Ab to bas barbaad hona h mjhe

Ishq ki maala m vishwas k motiyon ko todna h mjhe
Duniya k jhoote riti riwazo ko todna h mjhe
Ab to tere ishq mai kisi shayar k labo ki awaz hona h mjhe
Ab to bas barbaad hona h mjhe
This poem is written by me in context when a lover has left everything for her beloved one,Now he don't want anything.

Hope you all will like this.
Crandall Branch Feb 2018
words all have their roots
ped = foot
saurus = dinosaur
photo = light

just like my love for you has roots
or like a tree has roots

and all these things are infinite

the power of language
the power of nature
and
the power of love
please leave a like or comment! It would mean so so so much :) :) :)
mildew Jan 2019
it has been over two years and i am proud of my growth. my main focus this year is to finish my grieving so that i may continue my life in an efficient manner.
the process of grieving is commonly known as, but not limited to:

denial
anger
bargaining
depression
acceptance

my denial proces:
many times the easiest way to get over trauma is to repress it. i was 15 when i was ra ped. legal age of consent is 16. he was 18. i was naive, and could not imagine the man i loved doing that to me. i believed that it was an accident and neither of us knew what was right or wrong. I had assumed that because i had previously given him my body, he was able to ignore my pleads to stop this time. i blamed myself more than i blamed him, and he blamed me. i had been so infatuated with him that i had pushed away the people who cared most about me. when i told them about being ***** our bond was already so far gone that they could not feel anything more than pitty. i was terrified of losing him, so i convinced us both it was an accident. ra pe is no accident.

through denial became anger:
i became genuinely angry for the first time in my life. i was angry at him for being somebody that i had trusted and loved. angry that i had let this happen to myself. angry that i had no strength nor respect to stand up for myself. if i had told him to stop one more time he would have. i understand now that i should not have had to say no more than once. i was angry because i let myself down, but I’m more angry that i could not blame him. being angry was the easiest part of grieving. it is okay to he angry.

bargaining is a toxic healing method:
i became really good at bargaining with myself. after he was gone i had begun to understand my emotions, but i could not control them. my fear of more being taken from me fed my overcompensation. i began to give my body away, so that it could not be taken. it was an unhealthy coping mechanism. my body is not meant to be given nor taken.

depression hit hard:
i began to reflect on all of the points in my life that had lead me to this one. i became close to restarting the grieving process. i spent a long portion of the depression stage in denial. then i was angry that i had backtracked to the beginning. i had more meaningless se x that i now regret more than anything. i saw how good his life had been going and how poorly mine was. it was obvious that i needed help.

acceptance:
this entire passage was my process to acceptance. i reached out to my therapist. i made new friends. i stopped wallowing in self pity and i began to recover. i stopped begging to forget my flaws and began to forgive them.
nivek May 2014
we must be living on opposite sides of the galaxy
I can see you are a bi-ped
what more can a spider say?
TreadingWater Dec 2015
let's go back.  to.  the. start.
Texts-and-Snaps
late-night-talks

can\we\start\over,..?
re­read Clementine
andcrytogether,...

how about a re//do?
Before;...I overusedmyverbs
and you would\n't hear. me. anymore.

I could turn-down-the-noise
...to a suit/ab/le level
for us to continue
...ex》ploring each》 other

I want {you} to be back
whenall_ I couldhopefor
...was. your. lipPsSsss
awake\every\night
...with °thou°ghts° of. your. kiss.

Before my s/t/u/p/i/d
₩,...romanTIC...°°mind
Caved>> every//thing//in

But,..then;.... a
_gain,...

maybewewereneverreally
meant;... to be
...JUst,... friends
Rita G Jul 2013
Fair-weather front seat
Lookin' at the moonbeams
Solid, sympathizing
The sun on the horizon
Sippin' foreign coffee
Listening to redwood heartbeats
Smoking cigarettes in a black dress
At 430 am, nonetheless.

430 am ocean breeze
Quiet enough to hear a stop sign sneeze
Counting all the bird calls
Staring at the fog walls
Making entities out of mist and light
And thinking about where to crash tonight
Or where to drink-

How arousing is pink?
Pink, plush lips on a long skinny straw
It's amazing how I get anything done at all,
Always thinking about ***,
Always thinking about ****.
He asked for a smile,
I said, "Whatever you need."

Got some stories I don't care to tell
Got a family I don't know so well
So, which do you trust?
Your love or your lust?
Have no resistance at all
And get kicked around like a rag doll.

My eyes get withdrawals
When I ain't near the stars
My ears and nose start to bleed
When I ain't near the sea
Bi-ped amphibean
Transplant Caribbean
Sittin' here wrongin' wishin
I was belongin'
orfeanegra.wordpress.com

@RawRaSpeak
Rasha Omer Jul 2014
It has been 20 something years.
And on a single day within layers of hours.
I've felt a shrug for the first time.
Like pins on the pillow you have
left behind when all the dust have settled.

The ball has dropped. A million times.
And then some.
And on a ***** slippery and distinctly
overwhelmed.

I've felt a beat within my rib-cage
slightly loud that it has shaken me
in sleep.

The dust you have left to shrivel
still dances around my plethora
of emotions, unsettled.

And, I'm standing here, surrounded by
what could have been
but should have never been.

Saved by frantic clicks
on a keypad. Typing into the existential
delusions of your listless memories.

I have stood here, unshaken, by the mistakes
we have accumulated down the polarizing roads.
And the dainty trickling down the drain.

I am standing and withstanding
a shootout of the most frivolous nature.

Like the pins striking this pillow
in a poetic wave of dissonance.
Ken Pepiton Oct 2018
---october, same year, after the bomb,

How should we train the surplus of boys?
We can't use them to sweep chimneys any more.
Nor work in Nike's winged victory factory,
child labor's not a means to an end
any more.
A seller must sell such as toys in Thailand today.

There are too many to waste efficiently in war.
A global conundrum beating time in our global brain.

A conundrum beating cadence for the dancers on parade.
Proud dancers with a vision...

Utopian distanty visiony,
since nought left ought as our only
understood shelter,
from the storm. Cower under ought, my child,
every thing is under control.

You are welcome in our safe place,
was once the reply to thanks, in essence, that was meant.

Now, it's no problem, serves and means nothing, in return.

Why should any boy grow into man? Let them play.
Entertainment's all that needed,
that'n' bread, with sugar,
that'll fixit, do the trick, keep the boy in hero role, virtually
forever, never growing
wiser.

Virtual virtue. Tech them that.
Virtually anyone can see the connection,
virtue, virtually means

What? Exactly. The act is outed.
Virtue went forth from Jesus, there's the bomb.

What does virtue being drawn through thy very e-sense
feel like?
Would we know, you or I, the feeling of virtue going out,
escaping?

A shocking short circuit? or a buzzer triggered by alarming
outflow of essential immaterial
stuff. Unnamed, unspeakable stuff?

Immaterial. The judge declares. The clar-if-ication
means look
elsewhere.

Virtue is too dangerous for little boys at play.
'Tis a cept, signified, perhaps
that
is what a sceptre does, officially it de-sig-nates who got it,
when virtue first
appeared needing shelter in the storm.
lightning lightening,
immaterial. Nonsense, can you sense immaterial matter.
You can't touch it. The judges believe.
Nor can mortals
even imagine immaterial matters reserved for Kings and king builders.

So why seek whys, when nothing matters more than...
why? what? who? when? where?
altogether on the six o'clock news.
All-in-one, all the knowing needed. Be joyfully entertained.
Sing along, meaningless songs,
doo-dah day.
Hallelujah (wait, did you say that? Out loud, ever? In a song?

What if... never mind.. could be a trap. Don't think it means anything. An old fashion past, that's all, now.
No magi utterance that changes
matters, in real time.
Not words and ideas, but
Clocks rule this domain, it's minions are the yoke bearers pulling
loads declared worthy of laboring incessantly happy.
The yoke is on you. (Take mine, it's light.) Carry on.

Take Sisyphus, for ensample. He's as happy as a clam, they say.
Those who live near the see declare the wee bivalves happy as pi.
We don't know why.
That's all.
At this particular point in time, as the ped-ants say.
Let patience perfect that which concerns you.
Let simple morph to sublime.

See, Jesus winked.
Epic poems are a burden to the reader, this is part of something much longer This poem's been keeping time with the one life I had to live, this time, guiding me to what I am, not what I have become. Tell me if i said it right.
softcomponent Dec 2013
curse the cigarette per
ched between the inde
x and the middle on th
e left and curse it's phy
sical continuity from w
rist to arm to elbow to s
houlder to ribs to torso t
o leftleg to  leftfoot cram
ped in campus awkward
slytherin shoelace concre
te sidewalk enter McDon
ald's and see u are trappe
d --- yer surrounded and p
oundin yer head on a wris
twatch of visceral grease an
d invincible greed and invis
ible seeds of 'why cryin' ol' c
hild why cryin'?'
Nat Lipstadt Jun 2013
How To Dress For My Funeral



black or white, hot n'pink,
lavender always a fav,
at a fun funeral rave,
lacy or plain, your choice,
tho clean would be nice,
won't matter to me very much,
the color of your underwear.
but do not fail to recall, the dead,
their vision keen, can see all!

funeral gravity rules to be strictly observed,
snickering and giggling to commence in the
back row, when holy pomposity gets uttered,
let it wend its way forward from the aft,
until y'all better be
laughing your ***** off

anyone who chooses to speak,
must commence with words,
"Did ya hear the one about"
or be haunted by my spectral shadow
tickling both feet at midnight, or,
worse yet, reciting this awful poem
in their head, like Henry the Eighth,
I am, I am

perhaps a hora dance might be nice,
a mamba line, butts,  holy rolling n'shaking,
past rows of rock n' rolling tombstones, guitar-playing
some Metallica,
while the rabbi intones somberly,
Let's get this party started, gad ******!

if my untimely hour should arrive in July,
I humbly request that flip flops be the ped-modality,
if January should be my season
of absence treasoned, use some reason,
please stay home, and let the paid professionals
suffer in fine phony, professional, seasonal frigidity

at the post partum party, should that occur,
I humbly repast request, barbecue be the cuisine,
in the hopes you all recall to place
a generous helping, repeat, generous helping,
inside my sauce- proof pine wood casket,
with extra napkins for the long trip ahead

now these are all post hypnotic, post breathing,
helpful suggestions, not requirements,
but honor or disparage, cry or vent,
curse or bless my perma-absence,
don't matter to me, as long as somebody
reads this manifesto at the festivities, first and last.
tmartin Sep 2019
we have been assassins for a while
|
we just didn’t have targets...
pillows and records
“Memories of an old friend”
abs Jun 2016
pillow fights
late nights
sailor jerry
cigarettes
tattoos

I don't know if this is going anywhere, but having it in this moment seems right.
palladia Feb 2014
A tyrant                king, a
Vandal’s               scream        
Of moor               & rock        
And fair                 I sing;                  
  Life’s                    to its                              
   Test,                  guer-            
     don of        unrest,            
      &strife; believed!  

           Milked out                
  like utter red; lipids        
   ****** hard                  
           at birth: semi-          
                     born: made
three         legion’s ****,    
careful;       cuz fate’s,  
      Allectus, mean.      

      Made in            sheaths        
     An aural           memor-      
     y lock, a-          nswer ur
    calling;              tricky to  
      be bad             &get; a-  
         way w/it!     Caraus-      
           ius’s on     guard          
             duty; he’s in.              

              Fog in chan-              
    nel; no               lights:        
    Bware!            Usurp-        
   ing cou-             ntry,        
   mauling& killing men      
   To ob-        tain                
   Power;            @any        
   risk in                   Britain.

       gold insignias!          
     shine           ur lite!      
    greed              can’t      
    pay—poenas dat!      
   Ascle-                              
    piod-                              
    otus                                
   hears:                            

    He, Allectus does a-      
    way w/.                            
   Besei-                                
   ge in London—rime      
   the trea-                            
   sure al-                              
   located;                            
   Vain he found, good.    

       Crack souls’ ice;
   To ruin              comes
   conceit,           comes
   that rip-       ped part.
   Ah, to p’wer& knifes
   Like wo-      rds...
   P’wer               slashes
    Carves,                &impales;.
usurper: a visual poem
(the poem spells the word "usurper")

i often like bragging about the fact that i've taken six years of Latin, so i have Roman History pretty much under my belt. this was written about last year when i was translating/learning Caesar for the AP Latin exam i took that spring. alongside the AP requisites, our class took a historical journey into the various parts of Roman life and warfare. because Caesar was our focus, places where he'd been were golden. the Roman occupation of Britain always fascinated me; i did some extra research and came across the story of Allectus, Carausius, and Asclepiodotus. Allectus was an usurping emperor of Roman Britain in the mid 290s AD. Allectus first was the treasurer to Carausius, an officer in the navy who took control of Britain and northern Gaul, modern-day France. Allectus was power-hungry assassinated Carausius, but his schemes did not go unnoticed for too long. Constantinus I, emperor of Rome, endeavored relentlessly to seize him but to no avail, however praetorian prefect Asclepiodotus entered into the fight and one night, when it was foggy in the English Channel, Asclepiodotus managed to burn Allectus' fleet on Vectis (modern-day Isle of Wight). He was killed in the battle and Asclepiodotus became the next king of Britain.

Carausius was greedy for power and established himself as Britain's king, but Allectus overthrew him, additionally greedy for power. Asclepiodotus steps in and disposes of Allectus, becoming king for 10 years until he too is overthrown. so it's all very ironic and one of my favourite stories of Roman history, and i turned it into a poem...a visual one, mind you!
maria Jul 2023
I yelled at him until my lungs lost their air and my throat felt raw.
Yes, he had wronged me, but somewhere deep inside, I knew I was screaming at the one hundred men standing in line behind him.
He became the face and the voice of all the men I hate,
the men who have shut me up,
cut me off,
pushed me down,
run me over.
He has begun to remind me of the angry man in my house,
the man who r*ped me,
wronged me,
used me,
left me.
When I say that I hate him to his face, in some ways, I do. Yet, somewhere deep inside, I know I have been harboring and fueling a hatred that was left to fester by someone long before him.
CE Green Jan 2014
Old beaten path, bent backward on its axis acting like a scientific textbook projection map.
Becoming something impossible to traverse even for expert woodsmen or a genius of a certain variety that is imbued with Zoom Zoom PED's, just enough red wine, or some self appointed enlightenment that "never failed me before"
Ignoring all traces of anxiety, disregarding inhibition, conquering every whim and mental roadblock desperately vying for success and representation as SOMEone instead of everyone else who writes in blue ink and drinks their coffee black and hides in plain sight and doesnt care what other people think and watches primetime reality television programs and believes in Jesus Christ and chews with their mouths closed and keeps their finges clean.

The Path
remains forever unbeaten
how far we get along it is our legacy that no one ever gave a **** about until we wrote about it.
ed
med
head
shed
ped
jed
led
dead
bed
ted
qed
yedi
ved
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ied
pl­ed
said
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wed
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snnjsndderped
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!#@REDFGV#J­KUIL&(&^Y%TEWRFGFDHFJHKGUL)^+_)OZXC>ed
IHAVEAPhD-ed
wazup-ed
imsmartererthanu-ed
ifurreadingthisur­weird-ed
The Good Pussy Jun 2015
.
                             Whipped
                         Whipped Whi
                        Whipped  Whip
                       Whipped  Whipp
                          WhippedWhip
                          ped  Whipped
                          Whipped  Wh
                          ipped Whippe
                          d Whipped  W
                          hipped Whipp
                          ed Whipped W
                          hipper Whipp
             Whipped               Whipped
        Whipped Whipped Whipped Whip
     Whipped Whipped   Whipped Whipp
             Whipped                   Whipped
Zarathustra told me "be calm"
And gently folded closed my eyes
“There’s no depth to escape from
There’s no eternal prize.
Your wire was our bridge, dear son
Above the raging current of man”
No, wise one, say it isn't so
Will I balance again
Above the glistening, crystal waters?
Please tell me that it doesn’t end!
“Be calm, dear son, you’ve neither
Lost nor won
Your trials will soon be over”
Why do you carry me into the night?
Why am I in the trees?
It’s cold here, friend!
Don’t leave me here afraid, dark and lonely
“Relax, and breathe,” he said to me
“It’s begun to end" and raised me upward slowly
I’m propped atop an arbor burial
Like a dead-egg’s nest ready to die
Before I realize to my horror
As the bi-ped's shadow awkwardly trots off
He was a stranger and my friend,
Regardless, Zarathustra's just another guy!
"On mine honour, my friend," answered Zarathustra, "there is nothing of all that whereof thou speakest: there is no devil and no hell. Thy soul will be dead even sooner than thy body: fear, therefore, nothing any more!"

The man looked up distrustfully. "If thou speakest the truth," said he, "I lose nothing when I lose my life. I am not much more than an animal which hath been taught to dance by blows and scanty fare."

"Not at all," said Zarathustra, "thou hast made danger thy calling; therein there is nothing contemptible. Now thou perishest by thy calling: therefore will I bury thee with mine own hands."

~Nietzsche
Grace Haak Dec 2019

silver
tinsel wrap
ped around the
christmas tree in the
living room and glass bau
bles hanging from the branch
es with white lights woven in be
tween such a soothing sight to see as
i start my early morning with some pepp
ermint coffee and i just love these december
days
with
the
tree
i just wanted to try a concrete poem
Tommy Johnson Jun 2014
The Packrat has morphed into a hoarder
I tried to removed the monkey in a suite off his back and put it in he barrel with the rest of them even though it wasn't my business, although I was its uncle

Get in

A quaint little bungalow
Where sweltering heat is a constant
"There's coffee on the back burner, ya want some?"

It was a blessing in disguise
A bona fide  slice of paradise

We read up on the complex of Oedipus Rex and the debate of moral fiber when talking about Ped Xing

We hopped on to a plane going to Pismo Beach and joined the mile high club then enjoyed clams on the half shell  

We listen to a dollar fifty nickelodeon
And talked about how music is dead because everyone is just na na naing and yeah yeah yeahing their way to the top of the pop charts  

Over a *** pie
I confessed my love
His rebuttal seemed abysmal to my sleeve dwelling heart

He said this was an unnatural habitat for him
And if we were to be together it would raise eyebrows
Tarnish his illustrious reputation

It was an unanswered prayer
After all the whatnots and whathaveyous
He got sick and died of AIDS about a year and a half later
He never came out

Dodged a bullet there on that one
Thomas Jun 2016
I'm sitting here taking a ****,
Looky right at a roll of ****,
Well at least that's what it wipes off,
I am bored as a car on Sunday that got hit in slow motion,
By a mo-ped,
Good god I am bored as ****,
THIS ISN'T EVEN A ******* POEM!
It's not a poem at least I express that with truth
Paul Hardwick Aug 2014
Now               M  O      V          E
Could not stand still
U M
J            PED
up
THEN
M  O      V          E
was OVER                               there.
OW! look that the  X  factor         P@ul.
Arlene Corwin Sep 2020
The Funniest Word: Sesquipedalian: Long-Winded

I just learned the strangest word:
An adjective ne’er seen or heard.
Sesquipedalian.
Sesqui-pedal-ian:
Are we the aliens depicted?
Is it us the word has painted?
Latin for a foot plus half**
Which makes me laugh.
“Polysyllabic or long-winded”.
If there ever was a winding
Longish ended word, it is sesquipedalian.
You have to laugh
At something that’s a ‘foot plus half’
That uses fourteen signs to say it.
‘Sesquipedalian names, or prose’
God only knows how long is wrong,
And even, what is wrong with ‘long’!
Eighteen inches, fourteen letters.
Something in the letters fetters.

Words are born from situations:
Every nuance. each emotion.
How they come about’s the question.
Are we so observant, we,
Disposed to live linguistically?
I’ve no idea,
But it sure is
****** funny.
18 inches or 45.72 centimeters.
The Funniest Word: Sesquipedalian 9.27.2020 A Sense Of The Ridiculous II; Circling Round Experience; Arlene Nover Corwin

sesquipedalian | ˌsɛskwɪpɪˈdeɪlɪən |
adjective formal
(of a word) polysyllabic; long: sesquipedalian surnames.
• characterized by long words; long-winded: the sesquipedalian prose of scientific journals.
ORIGIN
mid 17th century: from Latin sesquipedalis ‘a foot and a half long’, from sesqui- (see sesqui-) + pes, ped- ‘foot’.
HIGHLIGHTS OF PRESCRIBING INFORMATION
These highlights do not include all the information needed to us e
M-M-R II safely and effectively. See full prescribing information
for M-M-R II.
M-M-R® II (Measles, Mumps, and Rubella Virus Vaccine Live)
Suspension for subcutaneous injection
Initial U.S. Approv al: 1978
-------------------------------INDICATIONS AND USAGE-------------------------------
M-M-R II is a vaccine indicated for active immunization for the
prevention of measles, mumps, and rubella in individuals 12 months of
age and older. (1)
-------------------------- DOSAGE AND ADMINISTRATION--------------------------
Administer a 0.5-mL dose of M-M-R II subcutaneously. (2.1)
• The first dose is administered at 12 to 15 months of age. (2.1)
• The second dose is administered at 4 to 6 years of age. (2.1)
------------------------DOSAGE FORMS AND STRENGTHS -----------------------
Suspension for injection (0.5-mL dose) supplied as a lyophilized
vaccine to be reconstituted using accompanying sterile diluent. (3)
---------------------------------- CONTRAINDICATIONS ----------------------------------
• Hypersensitivity to any componentof the vaccine. (4.1)
• Immunosuppression. (4.2)
• Moderate or severe febrile illness. (4.3)
• Active untreated tuberculosis. (4.4)
• Pregnancy. (4.5, 8.1)
-------------------------- WARNINGS AND PRECAUTIONS --------------------------
• Use caution when administering M-M-R II to individuals with a
history of febrile seizures. (5.1)
• Use caution when administering M-M-R II to individuals with
anaphylaxis or immediate hypersensitivity following egg ingestion.
(5.2)
• Use caution when administering M-M-R II to individuals with a
history of thrombocytopenia. (5.3)
• Immune Globulins (IG) and other blood products should not be
given concurrently with M-M-R II. (5.4, 7.2)
----------------------------------ADVERSE REACTIONS----------------------------------
See full prescribing information for adverse reactions occurring duri ng
clinical trialsor the post-marketing period. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Merck
Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., at 1-8 7 7 -
888-4231 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.
-----------------------------------DRUG INTERACTIONS----------------------------------
• Administration of immune globulins and other blood products
concurrently with M-M-R II vaccine may interfere with the
expected immune response. (7.2)
• M-M-R II vaccination may result in a temporary depression of
purified protein derivative (PPD) tuberculin skin sensitivity. (7.3)
-------------------------- USE IN SPECIFIC POPULATIONS--------------------------
• Pregnancy: Do not administer M-M-R II to females who are
pregnant. Pregnancy should be avoided for 1 month following
vaccination with M-M-R II. (4.5, 8.1, 17)
See 17 for PATIENT COUNSELING INFORMATION and FDA
approv ed patient labeling.
Rev ised: 06/2020
FULL PRESCRIBING INFORMATION: CONTENTS
1 INDICATIONS AND USAGE
2 DOSAGE AND ADMINISTRATION
2.1 Dose and Schedule
2.2 Preparation andAdministration
3 DOSAGE FORMS AND STRENGTHS
4 CONTRAINDICATIONS
4.1 Hypersensitivity
4.2 Immunosuppression
4.3 Moderate or Severe Febrile Illness
4.4 Active Untreated Tuberculosis
4.5 Pregnancy
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
5.2 Hypersensitivity to Eggs
5.3 Thrombocytopenia
5.4 Immune Globulins and Transfusions
6 ADVERSE REACTIONS
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
7.2 Immune Globulinsand Transfusions
7.3 Tuberculin Skin Testing
7.4 Use with Other Live Viral Vaccines
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
8.2 Lactation
8.4 Pediatric Use
8.5 Geriatric Use
11 DESCRIPTION
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
12.6 Persistence of Antibody Responses After Vaccination
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
14 CLINICAL STUDIES
14.1 Clinical Efficacy
14.2 Immunogenicity
15 REFERENCES
16 HOW SUPPLIED/STORAGE AND HANDLING
17 PATIENT COUNSELING INFORMATION
Sections or subsections omitted from the full prescribing info rma tion
are not listed.
2
FULL PRESCRIBING INFORMATION
1 INDICATIONS AND USAGE
M-M-R® II is a vaccine indicated for active immunization for the prevention of measles, mumps, and
rubella in individuals 12 months of age and older.
2 DOSAGE AND ADMINISTRATION
For subcutaneous use only.
2.1 Dose and Schedule
Each 0.5 mL dose is administered subcutaneously.
The first dose is administered at 12 to 15 months of age. A second dose is administered at 4 to 6
years of age.
The second dose may be administered prior to 4 years of age, provided that there is a minimum
interval of one month between the doses of measles, mumps and rubella virus vaccine, live {1-2}.
Children who received an initial dose of measles, mumps and rubella vaccine prior to their first
birthday should receive additional doses of vaccine at 12-15 months of age and at 4-6 years of age to
complete the vaccination series [see Clinical Studies (14.2)].
For post-exposure prophylaxis for measles, administer a dose of M-M-R II vaccine within 72 hours
after exposure.
2.2 Preparation and Administration
Use a sterile syringe free of preservatives, antiseptics, and detergents for each injection and/or
reconstitution of the vaccine because these substances may inactivate the live virus vaccine. To
reconstitute, use only the diluent supplied with the vaccine since it is free of preservatives or other
antiviral substances which might inactivate the vaccine.
Withdraw the entire volume of the supplied diluent from its vial and inject into lyophilized vaccine vial.
Agitate to dissolve completely. Discard if the lyophilized vaccine cannot be dissolved.
Withdraw the entire volume of the reconstituted vaccine and inject subcutaneously into the outer
aspect of the upper arm (deltoid region) or into the higher anterolateral area of the thigh.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to
administration, whenever solution and container permit. Visually inspect the vaccine before and after
reconstitution prior to administration. Before reconstitution, the lyophilized vaccine is a light yellow
compact crystalline plug, when reconstituted, is a clear yellow liquid. Discard if particulate matter or
discoloration are observed in the reconstituted vaccine.
To minimize loss of potency, administer M-M-R II as soon as possible after reconstitution. If not used
immediately, the reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from
light, for up to 8 hours. Discard reconstituted vaccine if it is not used within 8 hours.
3 DOSAGE FORMS AND STRENGTHS
M-M-R II vaccine is a suspension for injection supplied as a single dose vial of lyophilized vaccine to
be reconstituted using the accompanying sterile diluent [see Dosage and Administration (2.2) and How
Supplied/Storage and Handling (16)]. A single dose after reconstitution is 0.5 mL.
4 CONTRAINDICATIONS
4.1 Hypersensitivity
Do not administer M-M-R II vaccine to individuals with a history of hypersensitivity to any component
of the vaccine (including gelatin) {3} or who have experienced a hypersensitivity reaction following
administration of a previous dose of M-M-R II vaccine or any other measles, mumps and rubellacontaining vaccine. Do not administer M-M-R II vaccine to individuals with a history of anaphylaxis to
neomycin [see Description (11)].
4.2 Immunosuppression
Do not administer M-M-R II vaccine to individuals who are immunodeficient or immunosuppressed due
to disease or medical therapy. Measles inclusion body encephalitis {4} (MIBE), pneumonitis {5} and death
as a direct consequence of disseminated measles vaccine virus infection have been reported in
3
immunocompromised individuals inadvertently vaccinated with measles-containing vaccine. In this
population, disseminated mumps and rubella vaccine virus infection have also been reported.
Do not administer M-M-R II to individuals with a family history of congenital or hereditary
immunodeficiency, until the immune competence of the potential vaccine recipient is demonstrated.
4.3 Moderate or Severe Febrile Illness
Do not administer M-M-R II vaccine to individuals with an active febrile illness with fever >101.3F
(>38.5C).
4.4 Active Untreated Tuberculosis
Do not administer M-M-R II vaccine to individuals with active untreated tuberculosis (TB).
4.5 Pregnancy
Do not administer M-M-R II to individuals who are pregnant or who are planning on becoming
pregnant within the next month [see Use in Specific Populations (8.1) and Patient Counseling Information
(17)].
5 WARNINGS AND PRECAUTIONS
5.1 Febrile Seizure
There is a risk of fever and associated febrile seizure in the first 2 weeks following immunization with
M-M-R II vaccine. For children who have experienced a previous febrile seizure (from any cause) and
those with a family history of febrile seizures there is a small increase in risk of febrile seizure following
receipt of M-M-R II vaccine [see Adverse Reactions (6)].
5.2 Hypersensitivity to Eggs
Individuals with a history of anaphylactic, anaphylactoid, or other immediate reactions (e.g., hives,
swelling of the mouth and throat, difficulty breathing, hypotension, or shock) subsequent to egg ingestion
may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving M-M-R II vaccine
.The potential risks and known benefits should be evaluated before considering vaccination in these
individuals.
5.3 Thrombocytopenia
Transient thrombocytopenia has been reported within 4-6 weeks following vaccination with measles,
mumps and rubella vaccine. Carefully evaluate the potential risk and benefit of vaccination in children
with thrombocytopenia or in those who experienced thrombocytopenia after vaccination with a previous
dose of measles, mumps, and rubella vaccine {6-8} [see Adverse Reactions (6)].
5.4 Immune Globulins and Transfusions
Immune Globulins (IG) and other blood products should not be given concurrently with M-M-R II [see
Drug Interactions (7.2)]. These products may contain antibodies that interfere with vaccine virus
replication and decrease the expected immune response.
The ACIP has specific recommendations for intervals between administration of antibody containing
products and live virus vaccines.
6 ADVERSE REACTIONS
The following adverse reactions include those identified during clinical trials or reported during postapproval use of M-M-R II vaccine or its individual components.
Body as a Whole
Panniculitis; atypical measles; fever; syncope; headache; dizziness; malaise; irritability.
Cardiovascular System
Vasculitis.
Digestive System
Pancreatitis; diarrhea; vomiting; parotitis; nausea.
Hematologic and Lymphatic Systems
Thrombocytopenia; purpura; regional lymphadenopathy; leukocytosis.
Immune System
Anaphylaxis, anaphylactoid reactions, angioedema (including peripheral or ****** edema) and
bronchial spasm.
Musculoskeletal System
Arthritis; arthralgia; myalgia.
4
Nervous System
Encephalitis; encephalopathy; measles inclusion body encephalitis (MIBE) subacute sclerosing
panencephalitis (SSPE); Guillain-Barré Syndrome (GBS); acute disseminated encephalomyelitis (ADEM);
transverse myelitis; febrile convulsions; afebrile convulsions or seizures; ataxia; polyneuritis;
polyneuropathy; ocular palsies; paresthesia.
Respiratory System
Pneumonia; pneumonitis; sore throat; cough; rhinitis.
Skin
Stevens-Johnson syndrome; acute hemorrhagic edema of infancy; Henoch-Schönlein purpura;
erythema multiforme; urticaria; rash; measles-like rash; pruritus; injection site reactions (pain, erythema,
swelling and vesiculation).
Special Senses — Ear
Nerve deafness; otitis media.
Special Senses — Eye
Retinitis; optic neuritis; papillitis; conjunctivitis.
Urogenital System
Epididymitis; orchitis.
7 DRUG INTERACTIONS
7.1 Corticosteroids and Immunosuppressive Drugs
M-M-R II vaccine should not be administered to individuals receiving immunosuppressive therapy,
including high dose corticosteroids. Vaccination with M-M-R II vaccine can result in disseminated disease
due to measles vaccine in individuals on immunosuppressive drugs [see Contraindications (4.2)].
7.2 Immune Globulinsand Transfusions
Administration of immune globulins and other blood products concurrently with M-M-R II vaccine may
interfere with the expected immune response {9-11} [see Warnings and Precautions (5.4)]. The ACIP has
specific recommendations for intervals between administration of antibody containing products and live
virus vaccines.
7.3 Tuberculin Skin Testing
It has been reported that live attenuated measles, mumps and rubella virus vaccines given individually
may result in a temporary depression of tuberculin skin sensitivity. Therefore, if a tuberculin skin test with
tuberculin purified protein derivative (PPD) is to be done, it should be administered before, simultaneously
with, or at least 4 to 6 weeks after vaccination with M-M-R II vaccine.
7.4 Use with Other Live Viral Vaccines
M-M-R II vaccine can be administered concurrently with other live viral vaccines. If not given
concurrently, M-M-R II vaccine should be given one month before or one month after administration of
other live viral vaccines to avoid potential for immune interference.
8 USE IN SPECIFIC POPULATIONS
8.1 Pregnancy
Risk Summary
M-M-R II vaccine is contraindicated for use in pregnant women because infection during pregnancy
with the wild-type viruses has been associated with maternal and fetal adverse outcomes.
Increased rates of spontaneous abortion, stillbirth, premature delivery and congenital defects have
been observed following infection with wild-type measles during pregnancy. {12,13} Wild-type mumps
infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.
Infection with wild-type rubella during pregnancy can lead to miscarriage or stillbirth. If rubella infection
occurs during the first trimester of pregnancy, it can result in severe congenital defects, Congenital
Rubella Syndrome (CRS). Congenital rubella syndrome in the infant includes but is not limited to eye
manifestations (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and
intellectual disabilities. M-M-R II vaccine contains live attenuated measles, mumps and rubella viruses. It
is not known whether M-M-R II vaccine can cause fetal harm when administered to pregnant woman.
There are no adequate and well-controlled studies of M-M-R II vaccine administration to pregnant
women.
5
All pregnancies have a risk of birth defect, loss or other adverse outcomes. In the US general
population, the estimated background risk of major birth defects and miscarriage in clinically recognized
pregnancies is 2% to 4% and 15% to 20%, respectively.
Available data suggest the rates of major birth defects and miscarriage in women who received
M-M-R II vaccine within 30 days prior to pregnancy or during pregnancy are consistent with estimated
background rates (see Data).
Data
Human Data
A cumulative assessment of post-marketing reports for M-M-R II vaccine from licensure 01 April 1978
through 31 December 2018, identified 796 reports of inadvertent administration of M-M-R II vaccine
occurring 30 days before or at any time during pregnancy with known pregnancy outcomes. Of the
prospectively followed pregnancies for whom the timing of M-M-R II vaccination was known, 425 women
received M-M-R II vaccine during the 30 days prior to conception through the second trimester. The
outcomes for these 425 prospectively followed pregnancies included 16 infants with major birth defects, 4
cases of fetal death and 50 cases of miscarriage. No abnormalities compatible with congenital rubella
syndrome have been identified in patients who received M-M-R II vaccine. Rubella vaccine viruses can
cross the placenta, leading to asymptomatic infection of the fetus. Mumps vaccine virus has also been
shown to infect the placenta {14}, but there is no evidence that it causes congenital malformations or
disease in the fetus or infant .
The CDC established the Vaccine in Pregnancy registry (1971-1989) of women who had received
rubella vaccines within 3 months before or after conception. Data on 1221 inadvertently vaccinated
pregnant women demonstrated no evidence of an increase in fetal abnormalities or cases of Congenital
Rubella Syndrome (CRS) in the enrolled women {15}.
8.2 Lactation
Risk Summary
It is not known whether measles or mumps vaccine virus is secreted in human milk. Studies have
shown that lactatingpostpartum women vaccinated with live attenuated rubella vaccine may secrete the
virus in breast milk and transmit it to breast-fed infants.{16,17} In the breast-fed infants with serological
evidence of rubella virus vaccine strain antibodies, none exhibited severe disease; however, one
exhibited mild clinical illness typical of acquired rubella.{18,19}
The developmental and health benefits of breastfeeding should be considered along with the mother’s
clinical need for M-M-R II, and any potential adverse effects on the breastfed child from M-M-R II or from
the underlying maternal condition. For preventive vaccines, the underlying maternal condition is
susceptibility to disease prevented by the vaccine.
8.4 Pediatric Use
M-M-R II vaccine is not approved for individuals less than 12 months of age. Safety and effectiveness
of measles vaccine in infants below the age of 6 months have not been established [see Clinical Studies
(14)]. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have
not been established.
8.5 Geriatric Use
Clinical studies of M-M-R II did not include sufficient numbers of seronegative subjects aged 65 and
over to determine whether they respond differently from younger subjects.
11 Description
M-M-R II vaccine is a sterile lyophilized preparation of (1) Measles Virus Vaccine Live, an attenuated
line of measles virus, derived from Enders' attenuated Edmonston strain and propagated in chick embryo
cell culture; (2) Mumps Virus Vaccine Live, the Jeryl Lynn™ (B level) strain of mumps virus propagated in
chick embryo cell culture; and (3) Rubella Virus Vaccine Live, the Wistar RA 27/3 strain of live attenuated
rubella virus propagated in WI-38 human diploid lung fibroblasts. {20,21} The cells, virus pools,
recombinant human serum albumin and fetal bovine serum used in manufacturing are tested and
determined to be free of adventitious agents.
After reconstitution, each 0.5 mL dose contains not less than 3.0 log10 TCID50 (tissue culture infectious
doses) of measles virus; 4.1 log10 TCID50 of mumps virus; and 3.0 log10 TCID50 of rubella virus.
Each dose is calculated to contain sorbitol (14.5 mg), sucrose(1.9 mg), hydrolyzed gelatin (14.5 mg),
recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin
and other buffer and media ingredients. The product contains no preservative.
6
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action
M-M-R II vaccination induces antibodies to measles, mumps, and rubella associated with protection
which can be measured by neutralization assays, hemagglutination-inhibition (HI) assays, or enzyme
linked immunosorbent assay (ELISA) tests. Results from efficacy studies or effectivenes s studies that
were previously conducted for the component vaccines of M-M-R II were used to define levels of serum
antibodies that correlated with protection against measles, mumps, and rubella [see Clinical Studies (14)].
12.6 Persistence of Antibody Responses After Vaccination
Neutralizing and ELISA antibodies to measles, mumps, and rubella viruses are still detectable in 95-
100%, 74-91%, and 90-100% of individuals respectively, 11 to 13 years after primary vaccination. {22-28}
13 NONCLINICAL TOXICOLOGY
13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility
M-M-R II vaccine has not been evaluated for carcinogenic or mutagenic potential or impairment of
fertility.
14 CLINICAL STUDIES
14.1 Clinical Efficacy
Efficacy of measles, mumps, and rubella vaccines was established in a series of double-blind
controlled trials. {29-34} These studies also established that seroconversion in response to vaccination
against measles, mumps and rubella paralleled protection. {35-38}
14.2 Immunogenicity
Clinical studies enrolling 284 triple seronegative children, 11 months to 7 years of age, demonstrated
that M-M-R II vaccine is immunogenic. In these studies, a single injection of the vaccine induced measles
HI antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of
susceptible individuals.
A study of 6-month-old and 15-month-old infants born to mothers vaccinated with a measles vaccine in
childhood, demonstrated that, following infant and toddler vaccination with Measles Virus Vaccine, Live
(previously US-licensed, manufactured by Merck), 74% of the 6-month-old infants developed detectable
neutralizing antibody titers while 100% of the 15-month-old infants vaccinated with Measles Virus
Vaccine, Live or M-M-R II vaccine developed neutralizing antibodies {39}. When the 6-month-old infants
of immunized mothers were revaccinated at 15 months with M-M-R II vaccine, they developed antibody
titers similar to those of toddlers who were vaccinated previously at 15-months of age.
15 REFERENCES
1. General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices, MMWR
43(RR-1): 1-38, January 28, 1994.
2. Measles, Mumps, and Rubella — Vaccine Use and Strategies for Elimination of Measles, Rubella, a n d Co n g e nita l Ru b e lla
Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practice s (ACIP), M M WR
47(RR-8): May 22, 1998.
3. Kelso, J.M.; Jones, R.T.; Yunginger, J.W.: Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gel atin , J.
Allergy Clin. Immunol. 91: 867-872, 1993.
4. Bitnum, A.; et al: Measles Inclusion Body Encephalitis Caused by the Vaccine Strain of Measles Virus. Cl i n . In fect. Di s. 2 9 :
855-861, 1999.
5. Angel, J.B.; et al: Vaccine Associated Measles Pneumonitis in an Adult with AIDS. Annals of Internal Medicine, 129: 1 0 4 -1 06 ,
1998.
6. Cecinati V, et al. Vaccine administration and the development of immune thrombocyto pe ni c p urp u ra i n ch i ld re n. Hu m an
Vaccines & Immunotherapeutics 9:5, 2013.
7. Mantadakis E, Farmaki E, Buchanan GR. Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic
Review of the Literature and Guidance for Management. J Ped 156(4): 2010.
8. Andrews N, Stowe J, Miller E, Svanstrom H, Johansen K, Bonhoeffer J, et al. A collaborative approach to investigating th e ri sk
of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark. Vaccine. 2012;30:3042‐6.
9. Rubella Prevention: Recommendation of the Immunization Practices Advisory Committee (ACIP), MM WR 3 9 (RR-1 5 ): 1 -1 8 ,
November 23, 1990.
7
10. Peter, G.; et al (eds): Report of the Committee on Infectious Diseases, Twenty-fourth Edition, American Academy of Pediatri cs,
344-357, 1997.
11. Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP), MMWR 38(S-9): 5-22,
December 29, 1989.
12. Eberhart-Phillips, J.E.; et al: Measles in pregnancy: a descriptive study of 58 cases. Obstetrics and Gynecology, 82(5): 797-801,
November 1993.
13. Jespersen, C.S.; et al: Measles as a cause of fetal defects: A retrospective study of ten measles epidemics in Greenland. Acta
Paediatr Scand. 66: 367-372, May 1977.
14. Yamauchi T, Wilson C, Geme JW Jr. Transmission of live, attenuated mumps virus to the hu m a n p l ace n ta . N En g l J M e d .
1974;290(13):710‐712.
15. Rubella Vaccination during Pregnancy —United States, 1971-1988. JAMA. 1989;261(23):3374–3383.
16. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. II.
Maternal-neonatal interactions, J. Infect. Dis. 145: 661-666,1982.
17. Losonsky, G.A.; Fishaut, J.M.; Strussenber, J.; Ogra, P.L.: Effect of immunization against rubella on lactation products. I.
Development and characterization of specific immunologic reactivity in breast milk, J. Infect. Dis. 145: 654-660, 1982.
18. Landes, R.D.; Bass, J.W.; Millunchick, E.W.; Oetgen, W.J.: Neonatal rubella following postpartum maternal i mm un izatio n , J.
Pediatr. 97: 465-467, 1980.
19. Lerman, S.J.: Neonatal rubella following postpartum maternal immunization, J. Pediatr. 98: 668, 1981. (Letter)
20. Plotkin, S.A.; Cornfeld, D.; Ingalls, T.H.: Studiesof immunization with living rubella virus: Trialsin children with a strain culture d
from an aborted fetus, Am. J. Dis. Child. 110: 381-389, 1965.
21. Plotkin, S.A.; Farquhar, J.; Katz, M.; Ingalls, T.H.: A new attenuated rubella virus grown in human fi bro b la sts: Evi d e n ce fo r
reduced nasopharyngeal excretion, Am. J. Epidemiol. 86: 468-477, 1967.
22. Weibel, R.E.; Carlson, A.J.; Villarejos, V.M.; Buynak, E.B.; McLean, A.A.; Hilleman, M.R.: Clinical and Labo ra tory Stu d ie s o f
Combined Live Measles, Mumps, and Rubella Vaccines Using the RA 27/3 Rubella Virus, Proc. So c. Exp . Bi ol. M e d. 1 6 5 :
323-326, 1980.
23. Watson, J.C.; Pearson, J.S.; Erdman, D.D.; et al: An Evaluation of Measles RevaccinationAmong School-Entry Age Ch i ld re n,
31st Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract #268, 143, 1991.
24. Unpublished data from the files of Merck Research Laboratories.
25. Davidkin, I.; Jokinen, S.; Broman, M. et al.: Persistence of Measles, Mumps, and Rubella Antibodies in a n M M R -Va ccina ted
Cohort: A 20-Year Follow-up, JID 197:950–6, April 2008.
26. LeBaron, W.; Beeler J.; Sullivan, B.; et al.: Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a
Postelimination Environment, Arch Pediatr Adolesc Med. 161:294-301, March 2007.
27. LeBaron, C.; Forghani, B.; Beck, C. et al.: Persistence of Mumps Antibodies after 2 Doses of Measles-Mumps-Rubella Vaccine,
JID 199:552– 60 , February 2009.
28. LeBaron, W.; Forghani, B.; Matter, L. et al.: Persistence of Rubella Antibodies after 2 Doses of Measles-Mumps-Rubella
Vaccine, JID 200:888–99, September 2009.
29. Hilleman, M.R.; Buynak, E.B.; Weibel, R.E.; et al: Development and Evaluation of the Moraten MeaslesVirusVa cci n e , JAM A
206(3): 587-590, 1968.
30. Weibel, R.E.; Stokes, J.; Buynak, E.B.; et al: Live, Attenuated Mumps Virus Vaccine 3. Clinical and Serologic Aspects in a Fiel d
Evaluation,N. Engl. J. Med. 276: 245-251, 1967.
31. Hilleman, M.R.; Weibel, R.E.; Buynak, E.B.; et al:Live, Attenuated Mumps VirusVaccine 4. ProtectiveEfficacy as Measure d i n
a Field Evaluation, N. Engl. J. Med. 276: 252-258, 1967.
32. Cutts, F.T.; Henderson, R.H.; Clements, C.J.; et al: Principles of measles control, Bull WHO 69(1): 1-7, 1991.
33. Weibel, R.E.; Buynak, E.B.; Stokes, J.; et al: Evaluation Of Live Attenuated Mumps Virus Vaccine, Strain Jeryl Lynn, First
International Conference on VaccinesAgainst Viral and Rickettsial Diseases of Man, World Health Organization, No. 147, M a y
1967.
34. Leibhaber, H.; Ingalls, T.H.; LeBouvier, G.L.; et al: Vaccination With RA 27/3 Rubella Vaccine, Am. J. Dis. Child. 123: 133-1 3 6,
February 1972.
35. Rosen, L.: Hemagglutination and Hemagglutination-Inhibition with Measles Virus, Virology 13: 139-141, January 1961.
36. Brown, G.C.; et al: Fluorescent-Antibody Marker for Vaccine-Induced Rubella Antibodies, Infection and Immunity 2(4): 360-363,
1970.
8
37. Buynak, E.B.; et al: Live Attenuated Mumps Virus Vaccine 1. Vaccine Development, Proceedings of the Society for
Experimental Biology and Medicine, 123: 768-775, 1966.
38. Hilleman M.R., Studies of Live Attenuated Measles Virus Vaccine in Man: II. Appraisal of Efficacy. Amer. J. o f Pu b l ic He a lth ,
52(2):44-56, 1962.
39. Johnson, C.E.; et al: Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles
Vaccine Era, Pediatrics, 93(6): 939-943, 1994.
16 HOW SUPPLIED/STORAGE AND HANDLING
No. 4681 ⎯ M-M-R II vaccine is supplied as follows:
(1) a box of 10 single-dose vials of lyophilized vaccine (package A), NDC 0006-4681-00
(2) a box of 10 vials of diluent (package B)
Exposure to light may inactivate the vaccine viruses.
Before reconstitution, refrigerate the lyophilized vaccine at 36°F to 46°F, (2°C to 8°C).
Store accompanying diluent in the refrigerator with the lyophilized vaccine or separately at room
temperature (68° to 77°F, 20° to 25°C). Do not freeze the diluent.
Administer M-M-R II vaccine as soon as possible after reconstitution. If not administered immediately,
reconstituted vaccine may be stored between 36°F to 46°F (2°C to 8°C), protected from light, for up to 8
hours. Discard reconstituted vaccine if it is not used within 8 hours.
For information regarding the product or questions regarding storage conditions, call 1-800-
MERCK-90 (1-800-637-2590).
17 PATIENT COUNSELING INFORMATION
Advise the patient to read the FDA-approved patient labeling (Patient Package Insert).
Discuss the following with the patient:
• Provide the required vaccine information to the patient, parent, or guardian.
• Inform the patient, parent, or guardian of the benefits and risks associated with vaccination.
• Question the patient, parent, or guardian about reactions to a previous dose of M-M-R II vaccine
or other measles-, mumps-, or rubella-containing vaccines.
• Question females of reproductive potential regarding the possibility of pregnancy. Inform female
patients to avoid pregnancy for 1 month following vaccination [see Contraindications (4.5) and
Use in Specific Populations (8.1)].
• Inform the patient, parent, or guardian that vaccination with M-M-R II may not offer 100%
protection from measles, mumps, and rubella infection.
• Instruct patients, parents, or guardians to report any adverse reactions to their health-care
provider. The U.S. Department of Health and Human Services has established a Vaccine
Adverse Event Reporting System (VAERS) to accept all reports of suspected adverse events
after the administration of any vaccine, including but not limited to the reporting of events required
by the National Childhood Vaccine Injury Act of 1986. For information or a copy of the vaccine
reporting form, call the VAERS toll-free number at 1-800-822-7967, or report online at
https://www.vaers.hhs.gov.
For patent information: www.merck.com/product/patent/home.html
Copyright © 1978-2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
All rights reserved.
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Samuel Aug 2011
Squish down below the
                                  filmy line
                    Eyes buckled, buttoned

Snap          
                          ped in half

            to achieve a  
                             tepid calm
                              
                                        is all
Ken Pepiton Aug 2019
words tucked into child minds forming in the mold,
depeche mode, fashion wisdom
blooming in
starstruck lunacy of lost meaning

****** Airline driving Jet Blue
as a sign, you know we

rise and ask redemption
this instant

toiling with tools the psalmist dreamed
and all the first cantors sang
in genuine gentle
spirit of...

genius (n.)
late 14c.,
"tutelary or moral spirit"
who guides and governs
an individual through life,

from Latin genius 
"guardian deity or spirit which watches over each person from birth; spirit, incarnation; wit, talent;"

also
"prophetic skill; the male spirit of a gens,"
originally
"generative power"
(or "inborn nature"),
from PIE *gen(e)-yo-,
from root *gene- "give birth, beget,"
with derivatives referring to procreation and familial and tribal groups.

Sense of
"characteristic disposition"
of a person is from 1580s.

Meaning
"person of natural intelligence or talent"
and that of "exalted natural mental ability"
are first recorded 1640s

and remaining in super position watching
until
we see we be agreed and symbiosis sets in

upto unto upon a time
stumbled into uttering urgent fervent

prayer, simple asking, what remains broken

what quest unmade, unmade imagined asif

this is life's book interpreting your
translation of reason into I'll go rythmic

waves rising from great notions stuck
in the mire at the bottom o' th'ocean

stirred up by trouble peace bringing in times of
see-change

settling in on of by bis more again or less
waiting is all suffer ever meant to mean,

mean men made each furrow seem
too hard to ***, in final
throes of
terminal toil

debitum in praesenti, solvendum in praesenti
debt due now, paid. It is finished.
Good news
darkness consummatum

light

fashioned in the mode of our time
powered for ever by happy Sisyphus's
rock rolled up
rock rolled down
by grace of gravity being the law

reach out

ceive con re de ceive (if you know

what I mean, taken for granted)

praesentium tedium t'do doodle do

touch faith, fingers fail, toe-tippy reach

topple the tinker-toy tower where war once reigned

back ground Johnny Cash praisin' Dylan from the dead

out in the desert, just doin my time--
waitin' by a pile of Hopi
nilhili-pili rocks rolling no more

sitting still in rasta farian blank spaces

between the pieces of we
carried to now as you see. We are in this real,
as real angel messages
made magnificent in worth as
words
worth deeming worship's solventum

songs from the po et tu brutes, breakin' rocks
back down the line,

scarlet thread sewn tendon
anchored to my zen minded ped-dance

kick the liar from his throne,
claim it for my own, my pile of flocci nauci

meaninglessness of weightless worship

turned on, with a merest touch.
No flame,
no night. Words alone reign un fused, un frozen,
new mercies
rising in the sunshine of a rich man
with a satisfied mind,

as time rolls by.

Cohen told us there is a crack in everything,
that's how the life gets in
this bubblin ethosphere we offer

as a sacred secret shown in light of all we share.

Clap clapper in liberty's cracked bell.
Let us lieve well enough alone for the time,

being once rung, listen,

other bells ring still with that pathos we share
logically as mere words.
floccinaucinihilipilification (n.)
"action or habit of estimating as worthless," in popular smarty-pants use from c. 1963; attested 1741 (in a letter by William Shenstone, published 1769), a combination of four Latin words (flocci, nauci, nihili, pili) all signifying "at a small price" or "for nothing," which appeared together in a rule of the well-known Eton Latin Grammar + Latin-derived suffix -fication "making, causing."
Robert C Ellis May 2018
A Skin schism venting heat to the outside
Lacerate, that dusty bucking destination
Just beside
the dream placing
The ream of poetry in my hands,
Slicing as God pulls it, gasping
With laughter as
The crystalline embers
Of the hereafter
                     reach porcelain teeth
From beneath the folds
This world outlasts my old
Eyes
Scratching colors from black and white
                                                           ­     Tides

The bare feet of a child run wild
Near and by
nivek Apr 2014
Mankind has evolved
from Bi-ped
to wheels
JovialPup May 2018
It’s Wednesday.
Some ungodly hour between
4:00 and 6:00. Maybe. I’m not sure.
My mind is soft, unfocused,
sleep-heavy.
Dawn’s greeting is gentle, loving.
A mother’s smile. A susurration, interrupted
by David Wolfe promoting the NutriBullet on an LED screen.
Avocado, kale, blueberries.
Pseudo-science babble stems from wild,
bright eyes, overflowing into bohemian curls. Overgrown and unruly.
Enthusiasm and conviction have
never been more entertaining.
Billy Mays and his dynamic personality pitch.
Stubborn stains shiver before the power of OxiClean.
In a parallel world, I have bought out
every kitchen appliance, every menial utensil
that will revolutionize my quotidian life.
Those ped eggs, the George Foreman grills, Shamwows.
And I am content,
as I sit on my throne of ShamWows,
draped in an oversized Snuggie.
Sometimes I wake up at strange hours and turn on the TV

— The End —