Summary Profile

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Donor Number: 4885

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	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	63
Health Problem	Sjogren's syndrome, controlled with homeopathic remedies	50
Health Problem	Hysterectomy, personal choice	55
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Healthy
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	31
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	83
Health Problem	Skin cancer, treated with surgery	55
	High cholesterol, controlled with medication	65
	Heart attack, treated with quadruple bypass surgery	70
	Stroke, induced by bypass surgery, no treatment	70
	Dementia, induced by stroke, no treatment	70
	Heart failure, no treatment	83
	Cause of death: Heart failure	83
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	90
Health Problem	Glaucoma, treated with surgery and medicated eye drops	75
	Depression, controlled with medication	88
	Alzheimer's, controlled with medication	88
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	High cholesterol, controlled with medication	60
	Stroke, no treatment	62
	Cause of death: Stroke	62
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	63
Health Problem	Heart attack, no treatment	63
Health Problem	Cause of death: Heart attack	63
Living / Dead	Dead

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	69
Health Problem	Prostate cancer, no treatment	68
Health Problem	Pancreatic cancer (due to prior Agent Orange exposure), no treatment	69
Living / Dead	Living

Religion:

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