I am writing in regards to the online form. I attempted to file one online and after filling it out  on the website something  happened that caused me to lose the entire form. I believe that my wife of 34 years passed away on Saturday March 13 2021 from a reaction to the Moderna vaccine 1st dose (010A21A), she was vaccinated on Friday Feb 26 2021 and started showing signs of a reaction on Sunday Feb 28 2021. My wife was having a fever, chills and a headache all of the signs that we were told could happen as her body was building immunity, and how it is considered a good sign. My wife was not a person who complained about pain or discomfort. My wife had worked at the same place since 1989 and had called in "sick" maybe 5 or 6 times including this issue, so she thought something wasn't right. I am not saying that the vaccine "caused any new medical issues" but I do believe that something in it may have interacted with a previously unknown issue. Unfortunately someone is not allowed to just believe something is wrong and has to follow procedure with regards to the Insurance companies and the type of care you receive and how to get it. After a couple of days of the symptoms, late Wednesday night March 3 2021 she called a 24 Nurse hotline sponsored by our Insurance and was told to take Tylenol because she was probably having a reaction and was building immunity and to call her Dr. in the morning and she did call Thursday March 4 2021 and was basically told the same thing to take Tylenol as she was probably just having a reaction and building immunity. Saturday March 6 2021 she was wondering if she actually did have COVID and went to an Urgent Care and had the 15 minute  test and also the 24 hour test the results came Saturday for the 15 test and Sunday for the 24 hour test both were negative. Monday morning she called her Dr and he said that maybe she had Pneumonia and ordered an antibiotic and ordered a chest X-ray. I picked up the prescription and the order. Tuesday March 8 2021 my wife had the chest X-ray and Wednesday she received the results and that was negative. My wife asked to speak to the Dr. and he was supposed to call her when he could. Thursday March 9 2021 my wife went to work and they sent her home which shows how she was. Her Dr called and said to go to the ER I dropped her at the ER and went home because her Mother lives with us and has dementia and and other medical concerns and cannot be alone for long periods. We had agreed to let her live with us because between the two of us we could manage her care, me during the day and my wife after work. Now it is me alone and my wife was "our" only source of income and insurance besides being my "everything" 34 years wasn't long enough and I am sorry that this is not the right place fo that but this is personally very hard on me. My wife texted me and said that they told her she had an infection and they were going to admit her. I visited her Thursday night and she was still having the fever, chills and headaches. I went home and later she texted me after I went to bed said she was hot and asked if we could we talk in the morning and what I didn't know was after I left someone came in and told her that her Dr. thought she might have a heart problem. My wife never told me so as not to worry but that was what she wanted to talk about which I found out Friday. Friday March 10 2021 1 received a phone call that my wife had complained of chest pains and they were taking her to the Heart Catheterization Lab and asked if I wanted to be there and I said that I couldn't because her mother was not awake and hadn't been fed or had any of her medication yet. After taking care of everything I called the Hospital and they said she was already in for the procedure. I received a phone call from the Dr who performed the procedure and he said she had a 100% blockage on one artery and a thickened wall of her heart that was probably hereditary and also a leaky valve but they were going look at that Monday March 15 2021 I called to speak to my wife and was told that she had to lie flat until 10:30 am because of what was done. She called me and said that she felt like she had been run over but was okay, while we were talking my wife told me what the Dr had said about maybe her having a heart problem. My wife said she had to go because someone came in to do something and she would call me later. I received a call from the nurse who said my wife had been light-headed and that her blood pressure was low and her heart rate was too high and they were going to put an IV in her neck to better control the drugs to regulate both of them. They wanted the heart rate lower and her blood pressure higher. I visited her later Friday night and she looked good all things considered we talked and I had to go home to care for her mother. Saturday March 13 20211 called to speak to her and she didn't answer so I called to speak to the nurse but was told she would call me back, I waited for about an hour and went to the Hospital. When I saw my wife she seemed in distress and had an oxygen mask on and was not