Summary Profile

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Donor Number: 4353

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:	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	53
Health Problem	Healthy
Health Problem	Miscarriage	25
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Bundle branch block (left), treated with surgery	50
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	27
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Colon cancer, treated with medication and surgery	62
Health Problem	Cause of death: Colon cancer	62
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	High cholesterol, treated with medication	55
Living / Dead	Living

Your Mother's Sisters 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	37
Health Problem	Hypertension, no treatment	35
	Heart attack, fatal, no treatment	37
	Cause of death: Heart attack	37
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Chronic back pain, no diagnosis made, treated only with exercise	80
	Diabetes requiring insulin treatment	80
	Atherosclerotic cardiovascular disease, no treatment	82
	Cause of death: Atherosclerotic cardiovascular disease	82
Living / Dead	Dead

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Diabetes not requiring insulin treatment, no treatment	60
Health Problem	Acid reflux, no diagnosis made, treated with over-the-counter medication	60
Living / Dead	Living

Religion:

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