hair loss; irregular menstrual cycle; leading to additional injury/injuries; autoimmune disease; POTS/Dysautonomia/seizure like activity/syncope/dizziness/intermittent partial vision loss/headaches/shakiness/fainting/heat intolerance/feet turning purple along with tingling feeling/blurred vision/muffled hearing/; Information has been received from a lawyer regarding a case in litigation and refers to an approximately 15-year-old female patient (pt) (currently as an adult). No other information concerning the pt's medical history, concurrent conditions or concomitant medications was provided. On 11-OCT-2019, at the age of 15-year-old, the pt received her first dosage of quadrivalent human papillomavirus (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 12-DEC-2019, the pt received the second dosage of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (dose, route of administration, anatomical location, lot # and expiration date were not reported). The pt did not receive the third of the series. On approximately 19-DEC-2019 (reported as about a week following her second quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) injection), the pt began to experience symptoms of dizziness, intermittent partial vision loss, minor headaches, and shakiness. With each episode, the family thought it might have been something as simple as needing to drink more water or eat something. As the months progressed, so did the pt's symptoms. She was seen by multiple physicians and specialists for her complaints which now included: hair loss, dizziness, fainting, inability to stand long periods of time, heat intolerance, feet turning purple along with tingling feeling, lightheadedness, fatigue, blurred vision, muffled hearing, migraines, shortness of breath, chest pressure, brain fog, difficulty focusing, irregular menstrual cycle, heat flashes, patches of numbness on skin, body aches, body twitches, and urinary frequency and urgency. On 04-FEB-2020, the pt's mother received a call from the pt's employer stating that she had passed out at work and was not feeling well. The pt was then seen by a doctor to be evaluated. Upon evaluation, it was suggested that she might be suffering from postural orthostatic tachycardia syndrome (POTS) and was referred to a pediatric cardiologist. On 20-FEB-2020, The pt was seen in cardiology where an electrocardiogram (EKG) was performed, and orthostatic vitals were taken. The pt was diagnosed with POTS. On 19-AUG-2020, a tilt table test confirmed her POTS diagnosis. As a result of her post-quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, the pt has been unable to engage in activities that a normal young person her age would enjoy. The pt had played sports since she was seven years old. The team made it to the finals, but the pt was unable to participate in the championship game because she passed out on the bench. She has continued to have daily symptoms and struggles to do everyday tasks. She has had at least nine fainting episodes leading to additional injury. The pt had been working a job she loved, but could no longer do the job. She was also a volunteered, helping serve the community, but could no longer help. Based upon her chronic and severe 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, dysautonomia, POTS, seizure like activity, migraines, and syncope. As a proximate result of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL), the pt has suffered and continues 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 has 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 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 has suffered and continues 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 lawyer considered all the events to be related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL).  All the events were considered to be disabling by the lawyer.   Upon internal review, the event of autoimmune disorder were determined to be medically significant.