rheumatoid arthritis/Tested positive for cyclic citrullinated peptide (CCP) antibodies (a test used to diagnose rheumatoid arthritis)/pain in her joints; muscle spasms; palpitations; shortness of breath; increased digestive issues; endometriosis/abnormal menstrual pain; infertility/uncertain whether she would ever be able to have children of her own; ovarian cysts; neurological injuries; autoimmune injury/disorder; rashes; chest pain; chronic fatigue; myalgia; Information has been received from a lawyer, regarding a case in litigation and concerning a female patient (pt) of an unknown age. No other information concerning the pt's medical history, concurrent conditions or concomitant medications was provided.  On an unspecified date, at the age of 19 years old, the pt received her first dose of quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL) (dose, route of administration, anatomical location, lot # and expiration date were not reported) for preventing cervical cancer. On an unspecified date, the pt received her second dose of quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL) (dose, route of administration, anatomical location, lot # and expiration date were not reported). The pt was a healthy and physically active young woman prior to receiving quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL). After receiving quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL), the pt began experiencing pain in her joints, muscle spasms, rashes, and chronic fatigue. She also began experiencing chest pain and palpitations, shortness of breath, increased digestive issues, and abnormal menstrual pain. She was seen by multiple physicians and specialists for her complaints. On an unspecified date in February 2021, was the first time the pt discovered that her injuries could have been caused by quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL). As a result of her post-quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt had been unable to engage in activities that a young person her age would normally enjoy. She has suffered chronic fatigue, pain, and infertility. Her college performance suffered because of her symptoms, and she was uncertain whether she would ever be able to have children of her own. On unknown dates, based upon her chronic and severe post-quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt was diagnosed with various medical conditions, including but not limited to, myalgia, endometriosis, rheumatoid arthritis, chronic fatigue, ovarian cysts, and infertility. The pt was tested positive for cyclic citrullinated peptide (CCP) antibodies (a test used to diagnose rheumatoid arthritis). The pt sustained serious autoimmune and fertility injuries as a result of her quadrivalent human papillomavirus (hpv) (types 6,11,16,18) recomb. vaccine (gardasil) injections. The pt contended that her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injection(s) caused her to develop serious and debilitating autoimmune and neurological injuries, including but not limited to chest pain and palpitations, shortness of breath, chronic fatigue, rheumatoid arthritis, myalgia, digestive issues, abnormal menstrual pain, endometriosis, ovarian cysts, and infertility, 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 his quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL)-induced autoimmune disorder. The pt had suffered and at the time of report and continued to suffer severe and permanent physical injuries, and associated symptomatology and had 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 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 suffered and at the time of report 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 rheumatoid arthritis, nervous system disorder, autoimmune disorder, ovarian cyst, myalgia, infertility, endometriosis, dyspepsia, dyspnoea, palpitations, chest pain, fatigue, rash and muscle spasms was considered to be not recovered. The lawyer considered the events of rheumatoid arthritis, nervous system disorder, autoimmune disorder, ovarian cyst, myalgia, infertility, endometriosis, dyspepsia, dyspnoea, palpitations, chest pain, fatigue, rash and muscle spasms to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).  Upon internal review, the event of rheumatoid arthritis and autoimmune disorder was determined to be medically significant. The events of rheumatoid arthritis, nervous system disorder, autoimmune disorder, ovarian cyst, myalgia, infertility, endometriosis, dyspepsia, dyspnoea, palpitations, chest pain, fatigue, rash and muscle spasms were considered to be disabling.