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Donor Number: 4719

Profile:

Family Medical History

Updates to Profile

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:	Yes - Maternal grandmother, age 30
Any dietary restrictions? If yes, explain:	No
Do you wear glasses or contact lenses? Are you near or far-sighted?	Yes - Far-sighted
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	Yes - Erythromycin: Causes rash
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	62
Health Problem	Interstitial cystitis (treated with medication/diet)	50
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	High blood pressure (treated with medication)	54
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	31
Health Problem	Irritable Bowel Syndrome (treats with medication and diet)	26
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	78
Health Problem	Pneumonia (treated with hospitalization)	78
Health Problem	Cause of death: Pneumonia	78
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	72
Health Problem	Emphysema (long-term smoker, treated with hospitalization)	72
Health Problem	Cause of death: Emphysema	72
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	53
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	87
Health Problem	Chronic Obstructive Pulmonary Disease (COPD, long-term smoker, treated with oxygen)	85
Health Problem	Cause of death: COPD complications	87
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 Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	66
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 2

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

Religion:

Updates to Profile