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SCORE-Bench

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speculative. Dr. Shoenfeld’s opinions in this case on general causation of the injury of POTS resulting
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from vaccinations like Gardasil are neither speculative nor even in dispute in the medical community.
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To address this criticism, it is necessary to start at the beginning.
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Other studies have reported HPV vaccination as the trigger for autoimmune POTS—Noureldine
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HA et al. “Postural tachycardia syndrome (POTS) and antiphospholipid syndrome (APS): What do we
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PLAINTIFF JENNIFER ROBI'S AMENDED OPPOSITION TO MERCK DEFENDANTS’ MOTION IN LIMINE NO. 25
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know so far?” Rev Neurol (Paris). 2022;178(4):306-314.⁴
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Infections (viral or bacterial)
Vaccination (HPV vaccine) Oxidative stress
Pregnancy POTS Autoantibodies (ANA, aPL, anti-SSA, anti-SSB, anti-GPCR, anti-gAChR)
? Binding to neurons aPL
Binding to cholinergic or adrenergic receptors Tachycardia
Inflammation
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Fig. 1 – A summary to the pathological mechanisms linking antiphospholipid syndrome (APS) to postural orthostatic
tachycardia syndrome (POTS).
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Id. As shown, HPV vaccine is a specific listed cause of POTS:
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Vaccination, which leads to the same type of immune system provocation as natural infection,
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has also been documented as a risk for developing POTS. The above image from the 2022 Noureldine
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HA et al. article endorses vaccination, specifically HPV vaccination, as a trigger. As stated, POTS has