Summary Profile

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Número do Doador: 2320

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:	Note that family history is not available. Paternal Donor's father is adopted therefore paternal history is not known.

Family Medical History
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Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	61
Health Problem	Migranes	50
Health Problem	Constipation	58
Living / Dead	Living

Your Father

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

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Cause of death: Heart attack	75
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	72
Health Problem	Cause of death: Heart attack	72
Living / Dead	Dead

Your Mother's Brothers 1

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

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	0	(Unknown)
Health Problem	Unknown - Donor's father was adopted
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	0	(Unknown)
Health Problem	Unknown - Donor's father was adopted
Living / Dead	Living

Religion:

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