migraines; postural orthostatic tachycardia syndrome; orthostatic intolerance; fibromyalgia; autonomic dysfunction; chronic fatigue syndrome; ovarian cysts; narcolepsy; pilonidal cysts; Information has been received from a lawyer and a 13-year-old female patient regarding a case in litigation. Information about concurrent condition, medical history and concomitant medication was not reported.   Prior to receiving quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injections, the patient was in her usual state of health, was physically very active, and had been involved in competitive cheerleading for many years.  On 20-JUL-2012, the patient was vaccinated with the first dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (strength, dose, route, lot number and expiration date were not provided) for preventing cervical cancer. On 11-OCT-2012, the patient was vaccinated with the second dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). On 23-JAN-2013, the patient was vaccinated the third dose.   On unknown dates in 2013 ( reported as a few days after the patient received her third quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injection), she developed headaches, loss of appetite, increased trouble sleeping, tingling and numbness, extreme fatigue, and irritability. By February 2013, the patient academic performance had dropped, and she had symptoms of increased isolation. She returned to her pediatrician's office on 08-MAR-2013, with symptoms of abdominal pain, nausea and vomiting, although there was no sign of infection. As the months progressed, so did the patient injuries. She was seen by multiple physicians and specialists for her complaints which included skin abscesses, painful cysts, excessive sweating, chronic daily headaches and migraines, dizziness, sleep disruption, insomnia, daytime hypersomnolence, cognitive slowing, brain fog, fast heart rate, heart palpitations, episodes of shaking, nausea, hypnagogic hallucinations, ovarian cysts, chronic pain, chronic fatigue, seizure-like episodes, irritability, anxiety, and panic attacks. 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 teenager would typically enjoy. She had to stop cheerleading in 2013 due to her severe symptoms. The patient continued to have trouble keeping up with classes in school. She was at risk of failing almost all of her subjects despite being enrolled in an individualized education program (IEP) in 2014 and also receiving private tutoring. The patient was unable to complete a specialized trade program after completing high school due to the physical and cognitive impairments caused by her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL)-induced injuries, and thus has put her career dreams on hold. 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"), orthostatic intolerance ("OI"), fibromyalgia, autonomic dysfunction, migraines, and chronic fatigue syndrome ("CFS"), ovarian cysts, narcolepsy, and pilonidal cysts. The patient 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, OI, fibromyalgia, CFS, as well as a constellation of adverse symptoms, complications, injuries, and other adverse events, many of which are 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 our company's wrongful acts and quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL)'s manufacturing defects, 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 would continue to incur these losses and expenses in the future. The outcome of all events was not recovered. The lawyer considered all events were related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).   The lawyer considered all events to be disability.  Upon internal review, the event of narcolepsy was determined to be medically significant.