bruising on her face; bone pain; shaking; ringing in ears; mouth sores on gums, lips and tongue; mouth sores on gums, lips and tongue; mouth sores on gums, lips and tongue; lymph node swelling and pain; rapid pulse; restlessness; spasms and twitching; spasms and twitching; small fiber neuropathy (feeling of being off balance, lightheadedness, dizziness, autonomic, neurological injuries, tingling, numbness, stinging, burning,difficultywalking,  bending, and standing for prolonged periods of time); trigeminal neuralgia (facial numbness); medial epicondylitis; lumbar and cervical stenosis (feet began to hurt, heaviness in legs, neck and back pain and stiffness, difficultywalking,  bending, and standing for prolonged periods of time); tendonitis (stiffness/pain and itching in legs and feet); severe brain fog, confusion, focus and concentratiion; Autoimmune injuries; insomnia; mixed connective tissue disease (fever, tired, achy, energy level decreased, muscle aches, joint pain, cold hands, feet and legs,; lumbar and cervical stenosis (neck and back pain and stiffness); lymph node swelling and pain; headache; Seconf dose of Gardasil administered on 14-AUG-2018, third on 06-NOV-2018; patient was 44 years old when she received her first dosage of Gardasil; nausea; After the first dosage of Gardasil on April 20, 2018, pt's arm became extremely red and sore; eczema (burning scalp, red blotches appeared on her face, and welts, bump on her earlobe, blisters, swelling, reddness on face, skin rashes on legs, feet, hands, arms and back); After the first dosage of Gardasil on April 20, 2018, pt's arm became extremely red and sore; boils on her scalp and ear; cysts on her scalp; memory loss/have trouble remembering simple details throughout the day; Information has been received from a lawyer, regarding a case in litigation and concerning a 44-year-old female patient (pt). There was no information about the pt's concurrent conditions, concomitant therapies or medical history provided.   On 20-APR-2018, at the age of 44 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 the HPV virus. After the first dosage of quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL) on 20-APR-2018 (considered as on unspecified date in 2018), the pt's arm became extremely red and sore. She ran a fever and experienced nausea and burning scalp that evening and became tired and achy. Red blotches appeared on her face, and welts and boils on her scalp and ear showed up the following day. As the weeks progressed, pt began to feel tired and achy, and her feet began to hurt. On 14-AUG-2018, 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). Again, on an unknown date in 2018, large red blotchy patches showed up on her face, a bump developed on her earlobe, which had to belanced, her foot pain worsened, and her energy level decreased even more. On 06-NOV-2018, she received the third dosage of quadrivalent human papillomavirus (HPV) (types 6,11,16,18) recomb. vaccine (GARDASIL). Within a month of this dose (on an unknown date in 2018), pt experienced extreme fatigue, muscle aches and joint pains. She had more boils, lesions, and cysts on her scalp, and she began to have trouble remembering simple details throughout the day. As the months progressed, so did the pt's symptoms. She was seen by multiple physicians and specialists for her complaints which now included: multiple lesions, welts, blisters, swelling, bruising and redness on her face; skin rashes on legs, feet, hands, arms and back; returning boils on scalp and earlobes; headaches; dizziness; nausea; lightheadedness; severe fatigue and weakness; bone and joint pain; facial numbness; tingling, numbness, stinging, burning, shaking, weakness, stiffness/pain and itching in legs and feet; heaviness in legs and feeling of being off balance; ringing in ears; cold hands, feet and legs; mouth sores on gums, lips and tongue; insomnia; neck and back pain and stiffness; lymph node swelling and pain; rapid pulse; memory loss; severe brain fog; confusion; focus and concentration issues; restlessness; stabbing pains in legs and feet; elbow and knee pain; spasms and twitching; and difficulty walking, bending, and standing for prolonged periods of time. As a result of her post- post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt has been unable to engage in activities that she normally enjoyed. Before quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), the pt was active and in good shape, with plans to pursue an advanced degree. She taught multiple fitness classes each week and enjoyed being physically active. At the time of the report, the pt only had the stamina to teach fitness classes to senior citizens while seated, and she has been unable to continue her education. Based upon her chronic and severe post- post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt has been diagnosed with various medical conditions, including but not limited to, small fiber neuropathy, mixed connective tissue disease, trigeminal neuralgia, medial epicondylitis, lumbar and cervical stenosis, eczema, and tendonitis. The pt contended that her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injections caused her to develop serious and debilitating autoimmune and neurological injuries, including but not limited to small fiber neuropathy, mixed connective tissue disease, trigeminal neuralgia, medial epicondylitis, lumbar and cervical stenosis, eczema, tendonitis, fatigue, 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 post-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 result of being vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), the pt has suffered and continued to suffer severe and permanent physical injuries, and associated symptomology and has suffered severe and permanent emotional injuries, including pain and suffering. The 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 injuries caused by 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 continued to suffer economic losses, including considerable financial expenses for medical care and treatment, and diminished income capacity, and she will continue to incur these losses and expenses in the future.  The outcome of the events was considered to be not recovered. The reporter considered the events to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).  The events were considered to be disabling.  Upon internal review, the events mixed connective tissue disorder, autoimmune injuries and cervical spinal stenosis were determined to be medically significant.