Autoimmune Disease/heterogenous autoimmune disease; Autonomic Dysfunction/autonomic/Dysautonomia; postural orthostatic tachycardia syndrome (POTS); as well as a constellation of adverse symptoms; chronic migraines; chronic pain; arthritis; Information had been received regarding a case in litigation from a lawyer and referred to a 14 years old female patient (pt).  Prior to receiving her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injection, the pt had no autoimmune diseases, and no autonomic issues. In fact, she was an active, healthy, and athletic child with no significant medical history. She was an excellent student who exceled at softball and was expected to play softball on a college scholarship. On 31-JAN-2018, her health care provider recommended that she received the quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccine, which was stated as a safe and effective vaccine for preventing cervical cancer and human papillomavirus (HPV). On the same day, the pt received her first dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (dose, strength, route, lot number and expiration date were unknown) for prophylaxis. On unknown dates (reported as within a few days of receiving the vaccination), the pt developed a rash, shortness of breath, fatigue, and painful, swollen joints so bad she cried herself to sleep most nights. In February 2018 (reported as within 10 days), the pt's joint pain was so bad she could hardly walk. As the months progressed, so did her injuries. She was seen by multiple physicians and specialists for her complaints which now included, in addition to the above: an increased heart rate, brain fog, headaches, nausea, vomiting, constipation, and back pain. As a result of her post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt was unable to attend school regularly or engage in normal activities that a normal young person would enjoy. the pt was unable to continue playing softball. Her family had to move to a one-story residence because the pt could not climb stairs. the pt lost all her friends because she could not walk around and had to rest every couple of hours. Based upon her chronic and severe post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt had been diagnosed with various medical conditions, including but not limited to, postural orthostatic tachycardia syndrome (POTS), autonomic dysfunction, chronic migraines, chronic pain, and arthritis. The pt 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, and dysautonomia, 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. As a proximate result of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), the pt had suffered and continues to suffer severe and permanent physical injuries, including, but not limited to, her autoimmune disease and associated symptomology and had suffered severe and permanent emotional injuries, including pain and suffering. The pt 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 pt had 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 as not recovered. The causality was related.  Upon internal review, the autoimmune disorder was determined to be medically significant.  The reporter considered the events to be disability.