Summary Profile

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Donor Number: 4870

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
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	49
Health Problem	Uterine fibroids, no treatment	20
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	50
Health Problem	Seasonal allergies, controlled with over-the-counter medication	35
Health Problem	Gallstones, treated with surgery	38
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	23
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Healthy
	Severe trauma due to car accident, no treatment	59
	Cause of death: Severe trauma	59
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	72
Health Problem	Ovarian cancer, treated with chemotherapy	50
Health Problem	Kidney stones, treated with sonic pulse technology	55
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Heart failure, no treatment	75
Health Problem	Cause of death: Heart failure	75
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	72
Health Problem	Rheumatoid arthritis, controlled with over-the-counter medication	40
	Breast cancer, treated with surgery	60
	Stroke, no treatment	72
	Cause of death: Deterioration of health due to stroke	72
Living / Dead	Dead

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	63
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Ulcer, controlled with medication	50
Living / Dead	Living

Religion:

Updates to Profile