POTS; chronic fatigue syndrome; Median Arcuate Ligament Syndrome; joint hypermobility; Autonomic Dysfunction/dysautonomia/neurological; Autoimmune Disease; the final shot, on July 14, 2016; Information has been received from a lawyer regarding a case in litigation referring to an adolescen female patient (pt). 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, pt had no autoimmune diseases or autonomic issues. In fact, she was an energetic and healthy child who engaged in many activities and sports with a medical history of headaches induced by exercise or allergies. On 22-JUN-2015, the pt was vaccinated with the first dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine(GARDASIL) (strength, dose, lot#, expiration date and route unknown) for prophylaxis. Soon after the vaccination, pt was extremely tired, started losing her hair, had stomachaches, could not focus, and could not keep up with her sports. Pt received her second vaccine about six and a half months later, and things got worse. A few weeks after, pt started having fevers, headaches, neck aches, and continued fatigue, stomachaches, and inability to focus. She began missing school and missed most of her softball season. After the final shot, on 14-JUL-2016 (product use issue), pt's stomach hurt daily to the point where she could not engage in her daily activities. As the months progressed, so did her injuries. She was seen by multiple physicians and specialists and underwent multiple tests for her complaints which now included: extreme fatigue, extreme stomach pain, positive ANA, protein in urine, narrowing of the celiac artery & gastric artery, hair loss, joint pain, and headaches. As a result of her post- quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine(GARDASIL) symptoms, pt was unable to attend school regularly or engage in normal activities that a normal young person would enjoy. Pt was unable to continue her sports or attend school regularly. Her grades and test scores fell because of her inability to concentrate. Pt had missed time with family and lost friends because she was too sick to participate. Based upon her chronic and severe symptoms, pt had been diagnosed with serious and debilitating injuries, including but not limited to, POTS, chronic fatigue syndrome, median arcuate ligament syndrome, and joint hypermobility, autonomic, neurological, heterogenous autoimmune disease, autonomic dysfunction and dysautonomia, other serious injuries 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. The vaccine and its ingredients caused pt's autoimmune disease and other related injuries and had resulted in her suffering from severe, debilitating, disabling and painful chronic injuries. The defects in vaccine were substantial and contributing factors in causing pt's injuries, and, but for company's misconduct and omissions and vaccine's defects, including but not limited to its manufacturing defects, pt would not have sustained the injuries she has sustained to date, and would not have been exposed to the additional prospective risk and dangers associated with the vaccine. As a proximate result of wrongful acts and vaccine's manufacturing defects, pt 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. 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 autoimmune disease and other injuries caused by the vaccine. As a direct and proximate result of her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine(GARDASIL)-induced injuries, pt 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 the events was not recovered. The causality assessment was considered as related by the lawyer.  Upon internal review, autoimmune disease was determined to be medically significant.   The lawyer considered all the events to be disability.