Summary Profile

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Donor Number: 4863

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 - ("Single" glasses used ages 9-12, but no longer needed)
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	44
Health Problem	Hyperthyroidism, controlled with medication	35
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	45
Health Problem	Healthy
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	13	Maternal half brother
Health Problem	Attention deficit hyperactivity disorder, no treatment	12
Living / Dead	Living

Your Brother 2

Question	Response	Comment/Age Affected
Current age or age at death	7	Paternal half brother
Health Problem	Healthy
Living / Dead	Living

Your Brother 3

Question	Response	Comment/Age Affected
Current age or age at death	2	Paternal half brother
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	12	Maternal half sister
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	66
Health Problem	Healthy
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	67
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	47
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	46
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 3

Question	Response	Comment/Age Affected
Current age or age at death	41
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	74
Health Problem	Osteoarthritis, treated with vitamin supplements	60
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	69
Health Problem	Osteoporosis, treated with calcium supplements	60
	Osteoarthritis, treated with vitamin supplements	60
	Knee replacement	66
Living / Dead	Living

Religion:

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