Summary Profile

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Donor Number: 4892

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:	Yes - Paternal grandfather, age 55
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:	Yes - Seasonal allergies: Cause sneezing, itchy eyes
CMV IgG Antibody	Positive
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	49
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	53
Health Problem	Seasonal allergies, controlled with over-the-counter medication	5
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	0	(Donor's twin, age not given to protect donor's anonymity)
Health Problem	Migraines, controlled with over-the-counter medication	15
Health Problem	Gluten intolerance, controlled with homeopathic remedies	18
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	83
Health Problem	Prostate cancer, no treatment	83
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	76
Health Problem	High cholesterol, controlled with medication	70
	Stroke, no treatment	76
	Cause of death: Stroke	76
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Alcoholism, no treatment	55
	Alcohol poisoning, no treatment	56
	Cause of death: Alcohol poisoning	56
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Immune deficiency, controlled with medication	80
Health Problem	Cause of death: Immune deficiency	82
Living / Dead	Dead

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	Ulcerative colitis, controlled with diet modifications	50
Living / Dead	Living

Religion:

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