Summary Profile

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Donor Number: 1414

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?	Yes - Near-sighted
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	Yes - Mold and pollen in childhood only
CMV IgG Antibody	Positive
CMV IgM Antibody	Negative
Note any comments regarding above items:	Donor screening did not include: HCV by NAT. For more information, visit www.cryolab.com.

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	Migraines, age of onset unknown
	Diabetes mellitus, age of diagnosis unknown
	Pneumonia, age of onset unknown
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	53
Health Problem	High blood pressure, age of onset unknown
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	29
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	78
Health Problem	Skin cancer - cause of death; age of diagnosis unknown	78
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Intestinal cancer - cause of death; age of diagnosis unknown	60
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	68
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 2

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

Your Mother's Sisters 3

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

Your Mother's Brothers 1

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

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	83
Health Problem	Rheumatoid arthritis, age of onset unknown
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	81
Health Problem	Rheumatoid arthritis, age of onset unknown
Living / Dead	Living

Your Father's Sisters 1

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

Religion:

Updates to Profile