autoimmune disease, autonomic dysfunction, alopecia areata, chronic fatigue, depression, and anxiety.; Autonomic Dysfunction; autoimmune disease, autonomic dysfunction, alopecia areata, chronic fatigue, depression, and anxiety.; autoimmune disease, autonomic dysfunction, alopecia areata, chronic fatigue, depression, and anxiety.; autoimmune disease, autonomic dysfunction, alopecia areata, chronic fatigue, depression, and anxiety.; autoimmune disease, autonomic dysfunction, alopecia areata, chronic fatigue, depression, and anxiety.; Information has been received from a lawyer regarding a case in litigation and referred to a currently adult female patient (pt) of unknown age. Information on the pt's concurrent conditions, medical history or concomitant therapy was not reported. It was reported she had a great circle of friends; she was hardworking, and full of life. The pt belonged to the girl group and took part in extracurricular activities. On an unknown date, the pt's was vaccinated with the 1st dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccine. On 31-AUG-2018, the pt was vaccinated with the 2nd dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, dose, route, lot # and expiration date were not provided). It was reported that the pt's mother had indicated that she did not wish for her daughter to be vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), however, the pt's older sister accompanied her and medical providers administered the vaccine, notwithstanding the previous, express rejection of the vaccination by pt's mother. After his 2nd dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), she was seen by multiple physicians and specialists for various complaints and symptoms including but not limited to dizziness, nausea, brain fog, joint pain, muscle pain, weakness, severe fatigue, migraines, eczema, sensitivity to light and sound, rapid heartbeat with palpitations, syncope, anxiety, depression, and panic attacks. On an unspecified date, she began losing patches of hair and was diagnosed with autoimmune alopecia areata. As a result of his post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt had to drop out of college after just one semester, and she cannot work a normal job due to severe fatigue, pain, anxiety and depression. She spends most of her days in bed, and she is unable to complete everyday tasks or live a normal life. Based upon his chronic and severe post- quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms and adverse events as outlined above, and the test performed by her medical providers, she was diagnosed with various medical conditions, including but not limited to, autoimmune disease, autonomic dysfunction, alopecia areata, chronic fatigue, depression, and anxiety. At the time of reporting, the outcome of the reported events was unknown. The reporter considered all events to be disabling and related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).  Upon internal review, the event autoimmune disorder was determined to be medically significant.