dysautonomia,; nightmares; joint pain; anxiety; emotional suffering; Postural orthostatic tachycardia syndrome/racing heart rate/autonomic, neurological, heterogenous autoimmune disease/brain fog/persistent nausea/heavy fatigue/shortness of breath; Information has been received from a lawyer regarding a case in litigation and referred to a 13-year-old female patient (pt) of unknown age. Prior to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccination, she had no autoimmune diseases, and no autonomic issues. Although, she had borderline hypo-thyroidism but was healthy and doing well. She was active during her middle school years prior to receiving her vaccination. She was accepted onto a cheer team in which she was very active and social. Information on the pt's concomitant therapies was not reported. On 20-AUG-2018, three weeks after the star of her eight-grade year, the pt's health care provider (HCP) recommended that pt receive quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) vaccine. On the same date, (at age of 13), and under her parent's consent, the pt was vaccinated with the first dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) as safe and effective vaccine for preventing cervical cancer (prophylaxis) (lot #, expiration date, dose, route of administration and anatomical location were not reported). In the weeks following her vaccination, the pt began to feel heavy fatigue set in. Also, she began to suffer from persistent nausea that would not resolve. Therefore, she began to miss school due to her symptoms and visited numerous doctors. As the months progressed, so did the pt's injuries. She was seen by multiple physicians and specialist for her complaints. She was referred to an infectious disease specialist where she was ultimately diagnosed with an autoimmune disease called postural tachycardia syndrome (POTS). She continued to suffer from POTS, brain fog, heavy fatigue, anxiety, racing heart rate, shortness of breath, nightmares, join paint and emotional suffering. As a result of her post- quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) symptoms, she was unable to engage in normal activities that a normal young person would enjoy. She had to be withdrawn from school to be homeschooled due to her condition and continued to be homeschooled at the present time. As a result, she was no longer able to engage in social activities normal teenagers would enjoy in a school setting. She also lived in fear that she may die and had a tremendous amount of anxiety. She had been diagnosed with various medical conditions including but not limited to POTS. Pt's contends that her quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) caused her to develop serious and debilitating injuries, including but not limited to autonomic, neurological, heterogenous autoimmune disease, POTS, and dysautonomia, as well as a constellation of adverse symptoms, complications, injuries, and other adverse events, many of which were 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. As a proximate result of vaccination, pt had suffered and continued to suffer severe and permanent physical injuries including 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 quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). At the reporting time, the outcome of the events was considered as not recovered. The reporter considered all the events related to quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL). All the events were considered as disabling events.