Summary Profile

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Donor Number: 4647

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 - Ceclor: Causes rash
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	62
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	65
Health Problem	High blood pressure, no treatment	64
	High cholesterol, treated with medication	64
	Abdominal hernia, awaiting treatment	64
	Carotid artery disease, treated with stent	65
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	28
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Staph infection contracted in hospital	70
	Stroke, treated with surgery	70
	Heart attack, during surgery for stroke	70
	Cause of death: Heart attack	70
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Heart attack, occurred during routine surgery (the reason for the surgery is unknown)	48
Health Problem	Cause of death: Heart attack	48
Living / Dead	Dead

Your Mother's Sisters 1

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

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	Diabetes, treated with insulin	45
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	85
Health Problem	(Unknown. He left when father was 6, no contact with him since)
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Heart attack, fatal, no treatment	62
Health Problem	Cause of death: Heart attack	62
Living / Dead	Dead

Religion:

Updates to Profile