Korean court rules for the first time that Pfizer vaccine caused death 

A Korean court has for the first time recognized a causal link between the Pfizer Covid-19 vaccine and a death from thrombosis with thrombocytopenia syndrome (TTS) — a rare but serious blood-clotting disorder — in a ruling that could open the door for others who have long sought compensation from the government.

The government had until now officially recognized TTS as causally linked only to adenovirus vector vaccines such as AstraZeneca and Johnson & Johnson, not to mRNA vaccines made by Pfizer and Moderna.

The court's decision became final this month after the Korea Disease Control and Prevention Agency (KDCA) declined to appeal. 

The victim, surnamed Hwang, was a physical education teacher at an elementary school in South Jeolla. He received his first dose of the Pfizer vaccine in July 2021 as a priority recipient under the government's vaccination program. He soon developed indigestion, vomiting and nausea, and a local hospital flagged a suspected case of TTS. His condition worsened at a university hospital, where he developed slowed blood flow to his small intestine caused by a blood clot. Hwang later underwent surgery to remove part of his small intestine. He died in September 2021 at the age of 24.

His family applied for government compensation under the Infectious Disease Control and Prevention Act, arguing his death was linked to the vaccine. The KDCA rejected the claim, saying Hwang's pre-existing condition — Kimura's disease, a rare chronic inflammatory disorder — appeared to have caused the thrombosis, making it impossible to establish a causal link with the vaccine.

The family sued, and the Seoul Administrative Court ruled in their favor, drawing on expert assessments from Seoul National University Hospital and Chungnam National University Sejong Hospital.

"A causal relationship between vaccination and illness does not have to be proven clearly through medical or natural scientific evidence," the court said. "If causation can be inferred by considering indirect facts and other circumstances, that is sufficient to establish proof."

The court found that the timing alone was significant.

"Hwang developed abnormal symptoms just nine days after receiving the vaccine and died while being treated for that thrombosis," it said. "There is clear temporal proximity between the vaccination and the death."

The court also rejected the KDCA's reliance on Kimura's disease as an alternative explanation. "Kimura's disease is not generally known to cause thrombocytopenia or extensive venous thrombosis," it said, adding that it was "difficult to conclude that Kimura's disease was the primary cause of the thrombosis that developed immediately after vaccination."

On the question of mRNA vaccines specifically, the court acknowledged that TTS has been primarily associated with adenovirus vector vaccines but said recent research had shown a potential link with mRNA vaccines as well. It added that "the fact that research has not yet been sufficiently accumulated should not be treated as a categorically stronger argument than the other evidence pointing to a causal link."

Park Cheol-hun, a former doctor and lawyer who represented the family, said Hwang "was effectively forced to be vaccinated — as a school teacher, he could not carry out his duties without being inoculated, and he was designated a priority recipient under government policy." He also criticized the KDCA's reasoning, saying it was "inappropriate to directly link Kimura's disease to thrombosis, as each disease has its own distinct mechanism."

First ruling of its kind for mRNA vaccines

"It took five years after my son's death to win this case. Winning in court doesn't bring him back, but I hope it gives a little hope to the vaccine victims who have gone through the same painful time as us," Hwang's mother told the JoongAng Ilbo. 

The government enacted the Special Act on Covid-19 Vaccination Damage Compensation last October, easing the standards for recognizing a causal link between vaccination and illness or death. People who previously applied for compensation but failed to establish causation may also apply for a review. The KDCA also said last month that it had broadened its compensation criteria under the act and reclassified 13 conditions from "support" to "compensation" status.

But victims and their families say little has fundamentally changed.

"Vaccination policy was state-led, yet the burden of proving side effects was shifted onto the public," said Kim Doo-kyeong, chairman of the Covid-19 Vaccination Victims Council. "Even with the special act, that burden still lies with the public. We ask the government to use this ruling as an opportunity to ensure that vaccine damage victims no longer have to suffer."

BY BYUN MIN-CHUL   [lee.jian@joongang.co.kr]