US drugs giant Merck has been ordered to pay $253.4m (£141.07m) to the widow of a man who died from a heart attack blamed on the popular painkiller Vioxx.
Mrs Ernst said the case was a "wake-up call" to pharmaceuticals
A jury in Texas found Merck negligent in the death of 59-year-old Robert Ernst, in the first of 4,200 similar lawsuits worldwide.
Vioxx was withdrawn last year after a study concluded it could double the risk of heart attack or stroke.
The company denies the drug caused Mr Ernst's death and plans to appeal.
The drug is known to have been taken by more than 20 million people worldwide before it was banned. It was used mainly to treat pain from arthritis.
Shares in Merck fell $2.35 - or 7% - on Friday.
Merck has been swamped with lawsuits since it withdrew Vioxx from the market last September following a study which showed it doubled the risk of strokes and heart attacks after 18 months of use.
It has been estimated that Vioxx could have caused 27,785 heart attacks or deaths since it was approved for use in 1999.
More than 4,200 lawsuits have been filed against the firm over the drug.
The Texas jurors made the multi-million dollar award to Mr Ernst's widow, Carol, to cover a combination of his lost pay as a Wal-Mart produce manager, mental anguish, loss of companionship and punitive damages.
When the verdict was read out in Angleton, Texas, Mrs Ernst wept and her lawyer, Mark Lanier shouted "Amen".
Mrs Ernst called the verdict a "wake-up call" for pharmaceutical companies.
"This has been a long road for me," she told reporters afterwards.
"But I felt strongly that this was the road I needed to take so other families wouldn't suffer the same pain I felt at the time."
Mr Lanier said he had pressed for such high damages to make an example of Merck.
"You've got to fine Merck and all Merck knows is money. You have got a company worth billions and billions and billions of dollars - how do you fine them?
"If you write down $10m, Merck laughs. It's a rounding error. It's got to be over $100m or they won't even pay attention."
The BBC's Guto Harri in New York says lawyers preparing similar lawsuits have been heartened by the verdict.
Some analysts believe the company could end up having to pay out $18bn, he adds.
The company said it was disappointed with the verdict in the first case of its kind against Merck over the Vioxx drug.
"We believe that we have strong points to raise on appeal and are hopeful that the appeals process will correct the verdict," said Merck's senior vice-president Kenneth C Frazier.
Merck lawyer Jonathan Skidmore added: "There is no reliable scientific evidence that shows Vioxx causes cardiac arrhythmia, which an autopsy showed was the cause of Mr Ernst's death."
He said their appeal would focus on what he called "unreliable scientific evidence" presented by the plaintiffs.
"It'll be based on the fact that we believe unqualified expert testimony was allowed in the case," he said. "We don't believe they met their burden of proof."
The next trial is due to take place next month in New Jersey, Merck's home state, and the first federal trial will begin in New Orleans in late November.