This spontaneous report was received from a 20 year old female patient who was also a pharmacy technician regarding herself on an online article. No current conditions and medical history were reported. No concomitant medications were reported. On unspecified date of December 2006, the patient was vaccinated with dose 1 of GARDASIL. On unknown date in January 2007, one month after the first dose the patient experienced fatigue, dizziness, and chest pains. The patient was transported to the local emergency room for chest pain. But three days later she fainted for the first time in her life. This resulted in another trip to the hospital from her workplace and the patient was admitted to the hospital for the next 5 days. A tilt table test was positive. The symptoms resembled panic attacks: racing heart (increasing from around 80 beats per minute(bpm) to over 160, feeling nauseous and hot). The patient did not actually pass out. An electrophysiology study was done that was negative and the night the tests were done she fainted again. The patient was discharged with a possible diagnosis of Postural Orthostatic Tachycardia Syndrome (POTS). She was put on some medication and advised to increase my salt intake. A month later (February 2007) she received the second dose of GARDASIL and only 5 days after receiving the vaccine she fainted. The very next day the same thing happened again. Up until this point patient had fainted 3 times all in January 2007. The patient was still passing out every two weeks or so. These fainting episodes resulted in concussions, facial bruising, and shoulder injuries on an unknown date in 2007. Once after driving home at night, the patient passed out in the driveway. The next morning she was admitted to the hospital for observation where her cardiologist tried different medications. The patient was discharged after another 5 days. By May 2007, the patient had fainted 9 times and was sent to see a neurologist. While there an electroencephalogram (EEG) was done, as well as an autonomic reflex test both turned out negative in May 2007. By July 2007 the patient had passed out 13 times and was referred to a cardiologist at the hospital and another tilt table test was performed and was also positive. Now the patient had to wear a 24 hour monitor as well as event monitor. The 24 hour monitor showed racing heartbeat and event monitor showed an arrhythmia. A fainting episode could not be recorded because when the patient passed out the leads would get unhooked or the impact of the fall would disconnect the cord or cause the batteries to fall out. As of 30-AUG-2007, the patient fainted 22 times, the last episode resulted in a wrist fracture approximately on August 2007. The very next morning on 31-AUG-2007, the cardiologist decided to implant a pacemaker and this changed the patient's life dramatically. The patient took 6 to 9 pills per day and was able to work 4 hours a day instead of full time. The patient was fatigued all the time and her social life decreased substantially, was not able to go anywhere by herself for fear she would pass out and injure herself. Both the cardiologist and neurologist suggested GARDASIL was to blame for the patient's condition. Before receiving the vaccine the patient was healthy, independent student looking forward to life. But now her social life had become almost non-existent and her future plans had diminished due to her inability to earn a full time wage. On an unknown date the patient became pregnant with her first child. The patient had pre-eclampsia. The doctors believed that the patient had it for some time before she was diagnosed because the POTS masked the symptoms. What would be normal to high for a regular person was her blood pressure and the patient has started with such a low blood pressure reading so normal for her that was much lower than other people. After this pregnancy the symptoms of POTS had diminished and with the second pregnancy (MARRS # 1609USA005960) the symptoms returned with a vengeance. The patient then gave birth to a boy who has many health issues(MARRS# 1609USA005978). The outcome of the adverse events was unknown. The patient was advised not to receive the 3rd GARDASIL vaccination and was told that all of her symptoms could be due to the HPV vaccinations. Causality was not reported for the events. Upon internal review the event pacemaker insertion was determined to be medically significant and the event POTS and pacemaker insertion was determined to be serious due to disability. Additional information is not expected as no contact details were provided.