Summary Profile

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Donor Number: 4599

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:	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	62
Health Problem	High blood pressure, treated with medication	55
	Diabetes mellitus not requiring insulin therapy, controlled with diet management	57
	Uterine cancer, treated with surgery	62
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	61
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	24
Health Problem	Allergy to cats, treated with over-the-counter medication as needed, since childhood	8
	Asthma, no treatment, affected during childhood ages 8-12	8
	Acne, treated with over-the-counter creams, affected during childhood ages 12-16	12
Living / Dead	Living

Your Sister 2

Question	Response	Comment/Age Affected
Current age or age at death	23
Health Problem	Seasonal allergies, treated with over-the-counter medication as needed, since childhood	8
	Asthma, no treatment, affected during childhood ages 8-12	8
	Acne, treated with over-the-counter creams, affected during childhood ages 12-16	12
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Brain hemorrhage, due to smoking, no treatment	56
Health Problem	Cause of death: Brain hemorrhage	56
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Osteoarthritis, treated with medication	65
	Heart failure, no treatment	75
	Cause of death: Heart failure	75
Living / Dead	Dead

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Heart disease, treated with pacemaker	50
Health Problem	High cholesterol, treated with medication	50
Living / Dead	Living

Your Mother's Brothers 2

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

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Alzheimer's disease, no treatment	77
	Pulmonary embolism, no treatment	82
	Cause of death: Pulmonary embolism	82
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Waldenstrom's Macroglobulinemia (a type of Non-Hodgkin Lymphoma), no treatment	84
Health Problem	Cause of death: Waldenstrom's Macroglobulinemia	84
Living / Dead	Dead

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	65
Health Problem	Heart attack, treated with hospitalization	57
Health Problem	High cholesterol, treated with medication	57
Living / Dead	Living

Your Father's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	63
Health Problem	Healthy
Living / Dead	Living

Religion:

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