Summary Profile

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Donor Number: 2928

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:	Yes - Penicillin: Hives; Amoxicillin: Hives
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	48
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	53
Health Problem	Deviated septum (corrected with surgery)	32
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	Lung cancer (treated with chemotherapy)	50
Health Problem	Cause of death: Complication of lung cancer	55
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Breast cancer (treated with surgery)	50
Health Problem	Cause of death: Breast cancer	54
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	52
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	42
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	37
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	73
Health Problem	Chronic osteoarthritis (treated with over-the-counter pain medication)	60
	Knee replacement (heavy laborer)	67
	Hip replacement (heavy laborer)	70
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	72
Health Problem	Adult-onset diabetes, treated with insulin	63
Health Problem	Stroke	70
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	51
Health Problem	Hernia (corrected with surgery)	51
Living / Dead	Living

Your Father's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	42
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 3

Question	Response	Comment/Age Affected
Current age or age at death	41
Health Problem	Healthy
Living / Dead	Living

Religion:

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