adverse autoimmune reaction to HPV vaccine materials; HPV vaccine-induced illness; This literature marketed report has been received from the authors of a published literature article and refers to a 21-year-old female patient.  The patient's concurrent conditions and concomitant therapies were not reported. She had received a variety of other vaccinations without untoward effects, including tetanus, diphtheria, pertussis, influenza, hepatitis A and B, measles, mumps, rubella, and polio.  On an unknown date in October 2012, the patient was vaccinated with 1st dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) intramuscular injection, administered for prophylaxis (exact dose,  lot #, expiry date, and route of administration were not provided). Seven days after the first quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) immunization she began to experience generalized fatigue, difficulty in concentration, problems with name recall and word recall, memory lapses, and impaired ability to perform calculations or assimilate newreading assignments, all of which persisted unabated.  Eleven weeks later, in January of 2013, she received the second of three quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) immunizations. Within a few days her original complaints became augmented, and within another two weeks she began to complain of chronic headaches, widespread generalized pain in multiple joints and muscles, protracted AM stiffness, alternating constipation and loose stools, near fainting episodes when standing up, intermittent palpitations, non-restorative sleep, anxiety, and tingling and numbness in her extremities. Over the next three months she was evaluated by a psychiatrist, rheumatologist, infectious disease specialist, gastroenterologist, neurologist, and cardiologist, but multiple physical examinations, exhaustive diagnostic and invasive investigations, and laboratory tests failed to reveal a reliable explanation for her symptoms. A variety of medications from each specialist afforded no improvement in her condition.   In May of 2013 she received the third and final quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) immunization. Her morbid multisystem illness persisted unabated, and soon thereafter she complained of intermittent eyelid twitching, dry eyes, food intolerances, and odor and smell hypersensitivity. This latter phenomenon was characterized by nausea, dizziness, and headaches on exposure to perfumes, room fresheners, hairsprays, cleansers, deodorants, exhaust fumes, and furniture polish. Repetitive evaluations and prescriptions by the same practitioners did not favorably alter her clinical course. The patient then began to utilize a variety of alternative medicine disciplines and modalities, including dietary inclusions and exclusions, colon hydrotherapy, acupuncture, physical therapy, infusions of vitamins and amino acids, and Reiki therapy. Over the next four years she noted gradual improvement, but by no means resolution, of her multisystem illness.  The reporter considered adverse autoimmune reaction to HPV vaccine and HPV vaccine-induced illness to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).   Upon internal review, the event adverse autoimmune reaction to HPV vaccine materials was determined to be medically significant.  A copy of the published article is attached as further documentation of the patient's experience.