Summary Profile

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Donor Number: 2875

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	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	52
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Healthy
Living / Dead	Living

Sons

Your Son 1

Question	Response	Comment/Age Affected
Current age or age at death	3
Health Problem	Healthy
Living / Dead	Living

Your Son 2

Question	Response	Comment/Age Affected
Current age or age at death	0.1
Health Problem	Healthy (newborn)
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	52
Health Problem	Cause of death: Work-related accident	52
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Arthritis, no medication or treatment received	75
	Stroke	75
	Cause of death: Stroke	75
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	67
Health Problem	Cirrhosis of the liver (was a heavy drinker), no medication or treatment received	67
Health Problem	Cause of death: Cirrhosis of the liver	67
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	80
Health Problem	High blood pressure, treated with medication	70
Health Problem	Cause of death: Heart failure	80
Living / Dead	Dead

Your Father's Brothers 1

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

Religion:

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