Summary Profile

Download AS PDF

Donor Number: 4227

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:	No
Any dietary restrictions? If yes, explain:	No
Do you wear glasses or contact lenses? Are you near or far-sighted?	Yes - Astigmatism, glasses only used for reading or using the computer
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	55
Health Problem	Migraines, treated with over-the-counter medication	35
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Gallstone, no treatment, it passed on its own	49
Health Problem	High blood pressure, manages with diet/exercise	45
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	25
Health Problem	Healthy
Living / Dead	Living

Your Sister 2

Question	Response	Comment/Age Affected
Current age or age at death	18
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Heart attack, no treatment	54
Health Problem	Cause of death: Heart attack	54
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	79
Health Problem	Hip replacement surgery	79
Health Problem	Cause of death: Complications from hip replacement surgery	79
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Stroke, no treatment	82
Health Problem	Cause of death: Stroke	82
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	74
Health Problem	Heart failure (smoker)	74
Health Problem	Cause of death: Heart failure	74
Living / Dead	Dead

Your Father's Brothers 1

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

Your Father's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	50
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 3

Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Healthy
Living / Dead	Living

Religion:

Updates to Profile