Summary Profile

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Donor Number: 2762

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	60
Health Problem	Pneumonia, treated in hospital	45
Living / Dead	Living

Your Father

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

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	12	(Paternal half brother)
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	38
Health Problem	Healthy
Living / Dead	Living

Your Sister 2

Question	Response	Comment/Age Affected
Current age or age at death	19	(Paternal half sister)
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	92
Health Problem	Alzheimer's disease, no treatment	91
	Pneumonia, treated with medication but did not recover	92
	Cause of death: Pneumonia	92
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	87
Health Problem	Breast cancer, treated with surgery	65
	Blood clot developed in her leg, was under treatment and surgery but did not recover	87
	Cause of death: Blood clot	87
Living / Dead	Dead

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Kidney failure, treated with dialysis	45
Health Problem	Cause of death: Kidney failure	54
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	87
Health Problem	Stroke, treated in hospital	87
Health Problem	Cause of death: Stroke	87
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	85
Health Problem	Liver cancer, treated with medication and surgery	83
Health Problem	Cause of death: Liver cancer	85
Living / Dead	Dead

Your Father's Sisters 1

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

Religion:

Updates to Profile