Summary Profile

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Número do Doador: 2709

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:	Donor is not eligible to ship to New York state due to regulatory issues within the state that do not affect his semen quality or infectious/genetic disease testing

Family Medical History
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Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	49
Health Problem	Varicose veins, treated with surgery	46
Living / Dead	Living

Your Father

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

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	24
Health Problem	Migraines	10
Health Problem	Pituitary disorder (treated with growth hormone)	14
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Stroke	80
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	Cause of death: Ovarian cancer	58
Living / Dead	Dead

Your Mother's Sisters 1

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

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	76
Health Problem	Stroke	74
Health Problem	Heart attack	74
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	46
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	42
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Hip relacement, stemming from accident	41
Living / Dead	Living

Religion:

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