Summary Profile

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Donor Number: 4279

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 - (Near-sighted prior to Lasik surgery)
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	69
Health Problem	Glaucoma, treated with eye drops	69
Health Problem	Breast cancer, treated with surgery and radiation	69
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	76
Health Problem	Atrial fibrillation, treated with medication	75
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	86
Health Problem	Colon cancer, treated with surgery	65
	Prostate cancer, treated with radiation	68
	Congestive heart failure	86
	Cause of death: Congestive heart failure	86
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	88
Health Problem	Stroke, treated with hospitalization and medication	88
Health Problem	Cause of death: Congestive heart failure following the stroke	88
Living / Dead	Dead

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	67
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Stroke, fatal, no treatment	84
Health Problem	Cause of death: Stroke	84
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	97
Health Problem	Died of natural causes	97
Living / Dead	Dead

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Healthy
Living / Dead	Living

Religion:

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