Summary Profile

Download AS PDF

Donor Number: 5059

Profile:

Family Medical History

Updates to Profile

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?	Yes - Near-sighted
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	No
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	60
Health Problem	Asthma, treated with an inhaler, from childhood until age 35, no longer affected
Health Problem	Hypothyroidism, treated with medication	45
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	High blood pressure, no treatment	30
	Heart attack, fatal, no treatment	55
	Cause of death: Heart attack	55
Living / Dead	Dead

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	93
Health Problem	Healthy
Health Problem	Cause of death: Heart failure (died in his sleep)	93
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	90
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 1

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

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	Amyotrophic lateral sclerosis (ALS), treated with breathing support, physical therapy and medication	55
Health Problem	Cause of death: ALS	55
Living / Dead	Dead

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Atherosclerosis, treated with surgery	48
Health Problem	Cause of death: Complications of heart surgery	48
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	71
Health Problem	Diabetes requiring insulin therapy, in her 50s
Health Problem	Cause of death: Complications of diabetes	71
Living / Dead	Dead

Your Father's Sisters 1

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

Your Father's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	66
Health Problem	Lung cancer (smoker), treated with chemotherapy	66
Health Problem	Cause of death: Metastatic lung cancer	66
Living / Dead	Dead

Religion:

Updates to Profile