postural orthostatic tachycardia syndrome; autonomic, neurological, heterogenous autoimmune disease; chronic migraines; pityriasis rosea; vertigo; inability to walk; declined receiving the second dosage of Gardasil due to experiencing adverse reactions to the first shot; This spontaneous report has been received from a lawyer, regarding a case in litigation and refers to an adult female patient of unknown age. Her concurrent conditions, medical history and concomitant medications were not reported. On 06-NOV-2017, during a routine visit with her gynecologist, the patient's doctor, recommended that the patient receive the quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccine. On the same date, at the age of 19 years old, the patient received her first shot of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (dose, route of administration, anatomical location, lot # and expiry date were not provided) for prophylaxis. On an unknown date, reported as soon after receiving her first dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), she developed symptoms of heart palpitations, faintness, chest pains, severe rash, chronic migraines, and vertigo. The patient, her parents, and her employer noticed a significant decline in her ability to work, study, and exercise. Quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) and its ingredients caused the patient's autoimmune disease and other related injuries and resulted in her suffering from severe, debilitating, disabling and painful chronic injuries. On 15-JAN-2019, she returned to her doctor's office and declined receiving the second dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) due to experiencing adverse reactions to the first shot. As the months progressed, so did her injuries. She was seen by multiple physicians and specialists for her complaints which at that time included: skin rash, tachycardia, fatigue, feeling faint, anxiety, chronic migraines, light and sound sensitivity, digestive issues, shortness of breath, heart palpitations, chest pains, vertigo, inability to walk, and inability to drive. She went to the hospital on 14-MAR-2019 and 14-JUL-2019, for heart palpitations and near syncope. She continued to suffer from heart palpitations and extreme heart rate fluctuations and had to take the 2019 fall semester off to rest and try to improve her health. As a result of her post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, she was unable to engage in normal activities that a young adult would enjoy. She had trouble keeping up with classes and her grades dropped. She was not able to work as she was used to and had to call out often. The patient was not able to drive herself as she once could and had to stop participating in many activities that she once enjoyed. 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, on unknown dates, she was diagnosed with various medical conditions, including but not limited to, postural orthostatic tachycardia syndrome (POTS), chronic migraines, tachycardia, vertigo, and pityriasis rosea. She contended that her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injection caused her to develop serious and debilitating injuries, including but not limited to autonomic, neurological, heterogenous autoimmune disease, POTS, chronic migraines, tachycardia, vertigo, and pityriasis rosea, as well as a constellation of adverse symptoms, complications, injuries, and other adverse events, many of which were alleged herein and all of which were caused by quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) or otherwise linked to her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL)-induced autoimmune disorder. She suffered and continued to suffer severe and permanent physical injuries, and associated symptomology, and 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 would continue to incur these losses and expenses in the future. The outcome of the events was considered to be not recovered. The reporter determined those events to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).  Upon internal review, the event of autonomic, neurological, heterogenous autoimmune disease was considered to be medically significant. The events were considered to be disabling.