Summary Profile

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Donor Number: 4235

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?	Yes - Near-sighted
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	Yes - Pollens: Congestion
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	52
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	Healthy
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	30	(Half-brother)
Health Problem	Healthy
Living / Dead	Living

Your Brother 2

Question	Response	Comment/Age Affected
Current age or age at death	27	(Half-brother)
Health Problem	Healthy
Living / Dead	Living

Your Brother 3

Question	Response	Comment/Age Affected
Current age or age at death	16
Health Problem	Seizures, ages 6-10, treated with medication	6
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	81
Health Problem	Prostate cancer, treated with chemotherapy and radiation	77
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	78
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	49
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Lung cancer, no treatment received (smoker)	55
Health Problem	Cause of death: Lung cancer	57
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	92
Health Problem	Has trouble walking due to broken hip, uses a walker	89
Living / Dead	Living

Religion:

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