Summary Profile

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Donor Number: 2882

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	Positive
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	63
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	65
Health Problem	Stress-induced heart attack due to an automobile accident, no medication or treatment received	40
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	41
Health Problem	Thyroid cancer, successfully treated with surgery and medication	36
Living / Dead	Living

Your Sister 2

Question	Response	Comment/Age Affected
Current age or age at death	39
Health Problem	Healthy
Living / Dead	Living

Your Sister 3

Question	Response	Comment/Age Affected
Current age or age at death	26
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	91
Health Problem	Pneumonia, attempted treatment with medication	91
Health Problem	Cause of death: Pneumonia	91
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	88
Health Problem	Pneumonia, attempted treatment with medication	88
Health Problem	Cause of death: Pneumonia	88
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	67
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	92
Health Problem	Cause of death: Stroke	92
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	96
Health Problem	Bronchitis, treated with medication	96
	Septicemia, attempted treatment with medication	96
	Cause of death: Septicemia	96
Living / Dead	Dead

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Arthritis, treated with medication
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