Summary Profile

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Donor Number: 4869

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 - Near-sighted (slightly, glasses not necessary)
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	52
Health Problem	Miscarriage, no treatment, successful pregnancies pre- and post-miscarriage	27
	High blood pressure, controlled with diet management	40
	High cholesterol, controlled with diet management	40
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	Healthy
Living / Dead	Living

Brothers

Your Brother 1

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

Your Brother 2

Question	Response	Comment/Age Affected
Current age or age at death	24
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	77
Health Problem	Esophageal cancer, treated with surgery	40
	High blood pressure, controlled with medication	55
	High cholesterol, controlled with medication	55
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Breast cancer, treated with chemotherapy	50
	Glaucoma, controlled with medicated eye drops	63
	Breast cancer, treated with mastectomy	70
	Pre-cancerous skin cells, treated with surgery	70
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	49
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Blood clot in heart, fatal, no treatment	70
Health Problem	Cause of death: Blood clot in heart	70
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Shingles, no treatment	74
Living / Dead	Living

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 2

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

Religion:

Updates to Profile