Chronic fatigue syndrome/intense exhaustion, cognitive impairment,  brain fog, muscle weakness; Neurological problems; Food sensitivities; Loss of appetite; slowed metabolism; Autonomic injuries/autonomic dysfunction; Chest Pain; Autoimmune disease; Information has been received from a lawyer regarding a case in litigation and referred to a currently adult male patient (pt) of unknown age. Information on the pt's concurrent conditions, medical history or concomitant therapy was not reported. It was reported that he was involved in sports and enjoyed physical activities, had no autoimmune disease and no autonomic issues. On an unknown date, the pt's pediatrician recommended that pt receive quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccine. Under the consent of pt's parents, the pt was vaccinated with a total of three separate doses of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) as prophylaxis (dose, route of administration, anatomical location, lot number, and expiration dates were not reported). He was 17 years old when he received the first dose. After his third dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), he developed muscle weakness and neurological problems. He also developed chronic fatigue, including intense exhaustion, the inability to work, and the inability to attend class. He was seen by multiple physicians and specialists for his complaints which included: intense exhaustion, chest pain, cognitive impairment, brain fog, food sensitivities, slowed metabolism, loss of appetite, and muscle weakness. As a result of his post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, he was unable to engage in normal activities that a normal young person would enjoy. Pt had to quit playing sports and exercising, and he was not able to continue college after his first two years due to cognitive impairment and brain fog. Based upon his chronic and severe post- quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, pt was diagnosed with various medical conditions, including but not limited to, chronic fatigue syndrome (CFS). The first time the pt discovered or suspected that his injuries were linked to or caused by his quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccination was in or about May 2021. Therefore, it was claimed, that the pt sustained autonomic injuries, autoimmune disease and other related neurological injuries as a result of his quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injections. As a proximate result of vaccination, pt had suffered and continued to suffer severe and permanent physical injuries and associated symptomatology and had suffered severe and permanent emotional injuries, including pain and suffering. 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 as a result of her exposure to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). At the reporting time, he had not recovered from the events. 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.