Summary Profile

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Donor Number: 4893

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 - (mildly red-green colorblind)
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	56
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Psoriasis on legs and feet, controlled with sock treatment	45
Health Problem	Heart attack, treated with a stent and cardiac rehabilitation	60
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	26
Health Problem	Red-green colorblindness (mild)
Health Problem	Asthma, controlled with inhaler as needed (outgrew)	13
Living / Dead	Living

Your Brother 2

Question	Response	Comment/Age Affected
Current age or age at death	24
Health Problem	Seasonal allergies to spring pollens, controlled with over-the-counter medication	13
Living / Dead	Living

Your Mother's Father

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

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Stroke, no treatment	82
Health Problem	Cause of death: Stroke	82
Living / Dead	Dead

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Prostate cancer, treated with hormone therapy	84
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Diabetes mellitus requiring insulin therapy	55
	Pulmonary fibrosis, no treatment	82
	Cause of death: Pulmonary fibrosis	82
Living / Dead	Dead

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Kidney stones, treated with surgery	60
Living / Dead	Living

Your Father's Brothers 2

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

Religion:

Updates to Profile