Summary Profile

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Donor Number: 4886

Profile:

Family Medical History

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Physical

Medical

Question	Response
Have you or any of your family members been diagnosed with alcoholism or drug addiction? If yes, relation and age affected:	No
Any dietary restrictions? If yes, explain:	No
Do you wear glasses or contact lenses? Are you near or far-sighted?	No
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	No
CMV IgG Antibody	Negative
CMV IgM Antibody	Negative
Note any comments regarding above items:	N/A

Family Medical History
See list of questions asked here

Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	64
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	64
Health Problem	High cholesterol, controlled with medication	60
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	36
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	32
Health Problem	Allergic to bee stings, treated with EpiPen when needed	18
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	89
Health Problem	Stroke, no treatment	82
	Heart attack, no treatment	89
	Cause of death: Heart attack	89
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	86
Health Problem	Heart failure, no treatment	86
Health Problem	Cause of death: Heart failure	86
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	68
Health Problem	Obese, treated with gastric bypass surgery	30
	Acute lymphoid leukemia, attempted treatment with chemotherapy	67
	Cause of death: Acute lymphoid leukemia	68
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	78
Health Problem	Heart attack, no treatment	78
Health Problem	Cause of death: Heart attack	78
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	89
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Healthy
Living / Dead	Living

Religion:

Updates to Profile