{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:03:11Z","timestamp":1760144591122,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T00:00:00Z","timestamp":1715472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Gardasil 4, a human papilloma virus vaccine, has been shown to protect against various cancers, including cervical cancer. Common side effects include injection site pain, fever, headaches, and muscle aches. In some individuals, the severe side effect of postural orthostatic tachycardia syndrome (POTS) has been reported. POTS is characterized by the abnormal response of lightheadedness, blurry vision, and dizziness while transitioning to an upright posture. POTS predominately affects women, with more than eighty-five (85) percent of POTS patients being female. POTS, on average, takes five years and eleven months to receive diagnosis. Additionally, a strong association between POTS and Ehlers\u2013Danlos Syndrome Type III (EDS) exists. Eighty (80) percent of patients with EDS have POTS. This severe side effect indicates that providers need to be aware of this strong association of HPV vaccinations and POTS. In this report, we will present a case of a young women with a past medical history significant for EDS type III who was diagnosed with POTS after receiving Gardasil 4 vaccination. This case demonstrates the need for physicians to be aware of the association of POTS with EDS type III and HPV vaccination. Physician awareness of the associations, signs, and symptoms of POTS and earlier testing at the first presentation of signs and symptoms will limit the negative impact on patient\u2019s quality of life.<\/jats:p>","DOI":"10.3390\/reports7020036","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:18:17Z","timestamp":1715599097000},"page":"36","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postural Orthostatic Tachycardia Syndrome (POTS) as an Adverse Event to the Human Papilloma Virus (HPV) Vaccine and Its Relationship with Ehlers\u2013Danlos Syndrome (EDS)"],"prefix":"10.3390","volume":"7","author":[{"given":"Nicole","family":"Schipperijn","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Wijesinghe","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisa","family":"Romo","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7456-3074","authenticated-orcid":false,"given":"Benjamin","family":"Brooks","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,12]]},"reference":[{"key":"ref_1","unstructured":"(2023, October 30). Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/25811679\/."},{"key":"ref_2","unstructured":"(2023, October 30). A Review of Clinical Trials of Human Papillomavirus Prophylactic Vaccines\u2014ScienceDirect. Available online: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0264410X12009516?via%3Dihub."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.1161\/CIRCULATIONAHA.107.761643","article-title":"Postural Tachycardia Syndrome","volume":"117","author":"Grubb","year":"2008","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.mayocp.2012.08.013","article-title":"Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder","volume":"87","author":"Benarroch","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_5","unstructured":"(2023, October 30). Dysautonomia International: Postural Orthostatic Tachycardia Syndrome. Available online: https:\/\/www.dysautonomiainternational.org\/page.php?ID=30."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.hrthm.2015.03.029","article-title":"2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope","volume":"12","author":"Sheldon","year":"2015","journal-title":"Heart Rhythm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/joim.13245","article-title":"Postural Orthostatic Tachycardia Syndrome is Associated with Significant Employment and Economic Loss","volume":"290","author":"Bourne","year":"2021","journal-title":"J. Intern. Med."},{"key":"ref_8","unstructured":"Zhao, S., and Tran, V.H. (2024). StatPearls, StatPearls Publishing. Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK541074\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3233\/HAB-220013","article-title":"Postural orthostatic tachycardia syndrome-like symptoms following COVID-19 vaccination: An overview of clinical literature","volume":"31","author":"Tv","year":"2023","journal-title":"Hum. Antibodies"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jadohealth.2017.08.004","article-title":"Reports of Postural Orthostatic Tachycardia Syndrome After Human Papillomavirus Vaccination in the Vaccine Adverse Event Reporting System","volume":"61","author":"Arana","year":"2017","journal-title":"J. Adolesc. Health Off. Publ. Soc. Adolesc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1159\/000328760","article-title":"Definitions, Criteria and Global Classification of Mast Cell Disorders with Special Reference to Mast Cell Activation Syndromes: A Consensus Proposal","volume":"157","author":"Valent","year":"2011","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1177\/0883073817718731","article-title":"Human Papillomavirus Vaccine and Postural Orthostatic Tachycardia Syndrome: A Review of Current Literature","volume":"32","author":"Butts","year":"2017","journal-title":"J. Child Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s40264-016-0456-3","article-title":"Current Safety Concerns With Human Papillomavirus Vaccine: A Cluster Analysis of Reports in VigiBase\u00ae","volume":"40","author":"Chandler","year":"2016","journal-title":"Drug Saf."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102550","DOI":"10.1016\/j.autneu.2019.05.002","article-title":"Human Papillomavirus (HPV) Vaccine and Autonomic Disorders: A Position Statement From the American Autonomic Society","volume":"223","author":"Barboi","year":"2020","journal-title":"Auton. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Afrin, L.B., Dempsey, T.T., and Weinstock, L.B. (2022). Post-Hpv-Vaccination Mast Cell Activation Syndrome: Possible Vaccine-Triggered Escalation of Undiagnosed Pre-Existing Mast Cell Disease?. Vaccines, 10.","DOI":"10.3390\/vaccines10010127"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1756-8722-4-10","article-title":"Mast Cell Activation Disease: A Concise Practical Guide for Diagnostic Workup and Therapeutic Options","volume":"4","author":"Molderings","year":"2011","journal-title":"J. Hematol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"bcr-2017-221405","DOI":"10.1136\/bcr-2017-221405","article-title":"Successful Treatment of Postural Orthostatic Tachycardia and Mast Cell Activation Syndromes Using Naltrexone, Immunoglobulin and Antibiotic Treatment","volume":"2018","author":"Weinstock","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_18","unstructured":"(2024, January 12). Mast Cell Activation Disorder Archives. Available online: https:\/\/www.ehlers-danlos.org\/what-is-eds\/information-on-eds\/mast-cell-activation-disorder."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.autneu.2018.02.006","article-title":"Postural tachycardia syndrome and other forms of orthostatic intolerance in Ehlers-Danlos syndrome","volume":"215","author":"Roma","year":"2018","journal-title":"Auton. Neurosci."},{"key":"ref_20","first-page":"318","article-title":"Hypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes","volume":"250","author":"Gensemer","year":"2021","journal-title":"Dev. Dyn. Off. Publ. Am. Assoc. Anat."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/ene.12272","article-title":"Postural tachycardia syndrome following human papillomavirus vaccination","volume":"21","author":"Blitshteyn","year":"2014","journal-title":"Eur. J. Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s40264-017-0574-6","article-title":"Suspected Adverse Effects After Human Papillomavirus Vaccination: A Temporal Relationship Between Vaccine Administration and the Appearance of Symptoms in Japan","volume":"40","author":"Ozawa","year":"2017","journal-title":"Drug Saf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3399\/bjgp12X648963","article-title":"Postural tachycardia syndrome: Multiple symptoms, but easily missed","volume":"62","author":"Kavi","year":"2012","journal-title":"Br. J. Gen. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/joim.12895","article-title":"The face of postural tachycardia syndrome\u2014Insights from a large cross-sectional online community-based survey","volume":"286","author":"Shaw","year":"2019","journal-title":"J. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/bjhp.12700","article-title":"Exploring the complexities of illness identity and symptom management in seeking a diagnostic label of postural orthostatic tachycardia syndrome (POTS): An inductive approach","volume":"29","author":"Knoop","year":"2023","journal-title":"Br. J. Health Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1007\/s11999-014-3898-x","article-title":"Postural orthostatic tachycardia syndrome (POTS): Association with Ehlers-Danlos syndrome and orthopaedic considerations","volume":"473","author":"Grigoriou","year":"2015","journal-title":"Clin. 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