Summary Profile

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Número do Doador: 5026

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 - (Red-green colorblind; No other family members are colorblind)
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	Yes - Penicillin: Causes swelling, narrowing of airways
CMV IgG Antibody	Positive
CMV IgM Antibody	Negative
Note any comments regarding above items:	N/A

Family Medical History
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Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	High blood pressure (overweight), treated with medication	45
Health Problem	Type 2 diabetes, controlled with diet and lifestyle changes	53
Living / Dead	Living

Your Father

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

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	31	Maternal half brother
Health Problem	Partially deaf in one ear (side effect of a medication he took)	8
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	80
Health Problem	Colon cancer, treated with surgery	75
	Cause of death: Serious fall, his health rapidly declined afterwards	80
	Cause of death: Complications of fall	80
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Pneumonia (suspected), no treatment	70
Health Problem	Cause of death: Pneumonia	70
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Healthy
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	52
Health Problem	Stomach cancer, no treatment	52
Health Problem	Cause of death: Stomach cancer	52
Living / Dead	Dead

Your Father's Sisters 1

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

Your Father's Brothers 1

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

Religion:

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