significant fatigue, headache, shortness of breath, hypotension, abdominal pain, and near syncope.; visual loss; gastroparesis/noted abdominal pain; migraine; intermittent panic attacks; requent dysautonomia symptoms,; possibly postural orthostatic tachycardia syndrome/heart palpitations/insomnia/Anxiety; nausea; vomiting; endometriosis/severe menstrual cramps/evere dysmenorrhea/pelvic pain; viral infection; bacterial infection; her Gardasil-induced autoimmune disorder.; Information has been received regarding a case in litigation  and refers to a female adult patient (pt) of unknown age. The pt's concurrent conditions, medical history and concomitant medication were not provided.  On 12-DEC-2016, when she was 16 years old, she was vaccinated with a first dose of Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL) (strength, dose, route, anatomical location, lot number and expiration date were not provided) for preventing cervical cancer.  Prior to receiving her Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL) injection, the pt was in her normal state of health, physically active and attended school without difficulty.  Immediately following her first dosage of Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL), the pt experienced significant fatigue, headache, shortness of breath, hypotension, abdominal pain, and near syncope. She fell asleep on the way home from the doctor's office and slept until the next day, which was unusual for her.   On 16-FEB-2017, the pt returned for a follow up appointment and  visit with a physician who noted pt had continued episodes of syncope, as well as migraine with visual loss, vomiting, and intermittent panic attacks. During this visit, the pt received her second dosage of Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL).   On 19-APR-2017, the pt was evaluated by cardiologist who noted frequent episodes of orthostatic lightheadedness, panic attacks, fatigue, abdominal pains, and syncope occurring 1-2x per week. The pt's physician performed orthostatic vital signs, and his assessment included "frequent dysautonomia symptoms, possibly postural orthostatic tachycardia syndrome."    On 12-MAY-2017, the pt was evaluated by gastroenterologist, who noted abdominal pain since a young age, worsening over the past several months with nausea and sometimes vomiting, preventing her from attending school.  Testing was done on unspecified date in July 2017, which showed that pt had mildly delayed gastric emptying consistent with gastroparesis. Additionally, pt had testing done in October 2017, which showed that pt had small intestinal bacterial overgrowth, a condition often seen in patients with gastroparesis.  On 06-NOV-2017, the pt had a follow up appointment with a physician, who noted continued dizziness and 15 episodes of syncope over the past month, difficulty sleeping, decreased appetite, severe menstrual cramps, lethargy, chills, shortness of breath and headache. Pt received her third dosage of Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL) at this visit.  As the months progressed, the pt was seen by multiple physicians and specialists for her complaints which now included: Dizziness, fatigue, lethargy, shakiness, frequent episodes of syncope, heart palpitations, lightheadedness, shortness of breath, headaches, migraines, nausea, vomiting, frequent viral and bacterial infections, abdominal pain, neck pain, back pain, pelvic pain, severe dysmenorrhea, anxiety, panic attacks, and insomnia. As a result of her post-Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL) symptoms, the pt was unable to engage in normal activities that a normal young person would enjoy.  She missed school frequently and has been forced to reduce her social and physical activities. The pt had plans of a career managing exotic animals, but she had to give up that dream, as such a career would be too dangerous given her physical condition. 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, POTS, dysautonomia, gastroparesis, migraines, syncope, pain disorder, and endometriosis.  The outcome of the events was not provided. The reporter considered the events to be related to post-Quadrivalent Human Papillomavirus (Types 6,11,16,18) Recomb. Vaccine (GARDASIL).