miscarriages; headaches/dizziness/nausea/temperature intolerance/drained/fatigue/brain fog/rash/anxiety/depression/mast cell activation syndrome; adrenal disfunction; back pain; non-cancerous breast tumors; reduced bone density; premature ovarian failure / anti-ovarian antibodies; anaphylaxis; paralysis through the night with the inhability to shout for help / sleep paralysis; convulsions / non-epileptic seizures; fatigue/insomnia/weak/episodic cognitive impairment/cognitive slowing/have no memory/autoimmune inflammatory syndrome; gastrointestinal discomfort/trembling, shaking, chest pressure, palpitations, headaches/tunnel vision/insomnia/shortness of breath/chest pain/fainting spells/anger, irritability/extreme dysautonomia symptoms; body aches; headaches/dizziness/nausea/tremorduring sleep/bursts of shakiness/fatigue/drained/pale/brain fog/excessive sweating/fainting/spasms/trying to concentrate in class/postural orthostatic tachycardia syndrome; Information has been received from a lawyer regarding a case in litigation concerning a currently adult female patient (pt). No information has been received regarding the pt's past medical history, concurrent conditions, or concomitant medication. On 21-NOV-2013 (when she was 13 years old), the pt was inoculated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) at a physician's office, as prophylaxis. On an unspecified date in 2013 (reported as "soon after she received her first quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injection") (exact dose, route of administration, lot number and expiration date were not provided), the pt developed headaches, body aches (pain), dizziness, and nausea. She experienced tremors during sleep and her parents noticed periodic bursts of shakiness. Over the subsequent weeks, she developed new symptoms of gastrointestinal discomfort, temperature intolerance, and fatigue. On 23-JAN-2014, she returned to the pediatrician's office for her second dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (exact dose, route of administration, lot number and expiration date were not provided). On an unspecified day in 2014, after that second dose (reported as shot), that she began to experience extreme symptoms of dysautonomia, such as trembling, shaking, chest pressure, palpitations, and headaches. She experienced tunnel vision while trying to concentrate in class, and at night she experienced episodes of convulsions (seizure). Her parents noticed that she looked weak (asthenia), drained, and pale. The pt was taken back to the pediatrician on 28-FEB-2014, after complaining about paralysis through the night with the inability to shout out for help (sleep paralysis). As the months progressed, so did her injuries. She was seen by multiple physicians and specialists for her complaints which now included: brain fog, insomnia, rashes, shortness of breath, chest pain, back pain, episodic cognitive impairment, excessive sweating, insomnia, intensified dizziness, orthostatic dizziness including visual obscurations, tunnel vision, black out of vision, fainting spells, cognitive slowing and moments where she would lose time and have no memory of what occurred, episodes of shaking, and sleep paralysis. She also experienced a decline in her mental health, with outbursts of anger, irritability, anxiety and depression. By May 2015, she was unable to attend school and entered a hospital homebound school program through the county school district. Based upon her chronic and severe post- quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms and adverse events as outlined above and the tests performed by her medical providers (no results were provided), the pt has been diagnosed with various medical conditions, including but not limited to, postural orthostatic tachycardia syndrome (POTS); premature ovarian failure and anti-ovarian antibodies (premature menopause), miscarriages (abortion spontaneous), non-cancerous breast tumors (benign breast neoplasm), autoimmune inflammatory syndrome ("ASIA") (autoinflammatory disease), non-epileptic seizures, spasms, dysautonomia, anaphylaxis (anaphylactic reaction), reduced bone density (bone density decreased), mast cell activation syndrome (MCAS), and adrenal disfunction (adrenal disorder). As a proximate result, she suffered and continued to suffer severe and permanent physical injuries and associated symptomology and has suffered severe and permanent emotional injuries, including pain and suffering. She also had a substantial fear of suffering additional and ongoing harms, including but not limited to now being at an increased risk of cancer and future symptoms and harms associated with her autoimmune disease and other injuries caused by quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). As a direct and proximate result of her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) - induced injuries, she suffered and continued to suffer economic losses, including considerable financial expenses for medical care and treatment, and diminished income capacity, and she will continue to incur these losses and expenses in the future. The outcome of all the events was considered as not resolved. The reporter considered all the events to be related quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). The above-mentioned events were considered by the reporter as disabling events; however, no specific details were provided.  Upon internal review, the events seizure, mast cell activation syndrome, anaphylactic reaction, and abortion spontaneous were determined to be medically significant.