random onset alopecia areata; biliary dyskinesia; irritable bowel syndrome; small intestinal bacterial overgrowth; bile acid malabsorption; temporomandibular joint disorder; postural orthostatic tachycardia syndrome; dysautonomia; Information has been received from a lawyer referring to a 19 years old female patient regarding a case in litigation. The patient was in her usual state of health, and enjoying her life. Information about history condition and concomitant medication was not reported.On 28-AUG-2015, during a routine visit to discuss birth control, the patient was vaccinated with the first dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, dose, route, lot # and expiration date were not reported) for preventing cervical cancer, in light of the physician's recommendations, as well as relentless marketing and advertising messages. Within a month of receiving the first dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), the patient developed symptoms of fatigue, headaches, joint pains, dizziness, and brain fog. On 27-OCT-2015(also reported as 27-OCT-2915, inconsistent information), the patient returned to the physician's office to receive her second dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, dose, route, lot # and expiration date were not reported). Immediately following the shot, the patient became suddenly dizzy and felt intense pain in her arm where the vaccine had been administered. The patient was instructed to sit in a chair for a few minutes until she felt well enough to walk out of the office. The pain in her arm and the dizziness continued for many days. The patient also continued to experience severe joint pains, which eventually worked their way into her jaw. The left side of her jaw would ache until she could not eat or speak. The patient saw her dentist and was diagnosed with temporomandibular joint disorder (TMJ). In October 2015, the patient quit her job due to fatigue, dizziness, and generalized pain. The physical fatigue and mental brain fog she experienced made doing even the simplest tasks nearly impossible. By February 2016, the patient was experiencing increasingly severe stomach pains and nausea. She also suddenly developed anxiety, depression, and panic attacks. She had to miss school or leave early from her classes because she was in so much pain that she couldn't focus or would have a panic attack in the middle of class. The patient stopped being able to drive to school and she had to rely on her father for a ride. On 14-MAR-2016, the patient returned to her physician's office, for her third and final dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, dose, route, lot # and expiration date were not reported). On 27-MAR-2016, the patient woke up with a patch of hair missing from the top of her head. She had a bald spot the size of a quarter right above her forehead, and the spot continued to grow over the days until it was about 2 inches in diameter. The patient was diagnosed with random onset alopecia areata. In May 2016, the patient was very ill with stomach pains and nausea. She was suddenly unable to eat or drink anything despite being hungry and wanting to eat. She could not swallow anything. She went from doctor to doctor trying to find answers for around two weeks until she finally had a hepatobiliary iminodiacetic acid (HIDA) scan. It was found that her gall bladder was deemed "non-functioning" at zero percent. On 13-JUN-2016, an emergency surgery was performed to remove the gall bladder. After the surgery, the patient was able to eat again, but her abdominal pain persisted and in fact worsened. As the months progressed, so did the patient's injuries. She was seen by multiple physicians and specialists for her complaints which now included: dizziness, brain fog, joint pains, swallowing issues, breathing difficulties, fatigue, hair loss, severe stomach issues, vitamin/mineral deficiencies, muscle weakness, severe weight loss, insomnia, tachycardia, insomnia, anxiety, depression, panic attacks, and obsessive-compulsive disorder (OCD) behaviors. As a result of her post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the patient was unable to engage in normal activities that a young adult would enjoy. She could no longer be physically active, nor participate in the activities that she used to. The patient has taken time off from college and has put her dreams of working in the film industry on hold to focus on her health. 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, the patient had been diagnosed with various medical conditions, including but not limited to, postural orthostatic tachycardia syndrome (POTS), dysautonomia, alopecia areata, biliary dyskinesia, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), bile acid malabsorption (BAM), and TMJ. The patient had suffered and continued to suffer severe and permanent physical injuries and associated symptomology and had suffered severe and permanent emotional injuries, including pain and suffering. The patient 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, the patient had suffered and continued to suffer economic losses, including considerable financial expenses for medical care and treatment, and diminished income capacity, and she (also reported as he, inconsistent information) would continue to incur these losses and expenses in the future. The outcome of all events was not recovered. The causality assessment was considered to be related by the lawyer.  These events of POTS, dysautonomia, alopecia areata, biliary dyskinesia, IBS, SIBO, BAM, and temporomandibular TMJ were considered as disability by the lawyer. The event of biliary dyskinesia was determined to be medically significant because the surgery of remove the gall bladder was on supplemental surgical and medical procedures always serious terms list.