Summary Profile

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Donor Number: 5149

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	60
Health Problem	Healthy
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	61
Health Problem	High cholesterol, controlled with medication	40
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	88
Health Problem	Osteoarthritis in hands, treated with over-the-counter medication	80
	B-Cell non-Hodgkin lymphoma, treated with chemotherapy	81
	Heart attack, treated with surgery	85
	Macular degeneration, treated with vitamins	85
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	85
Health Problem	Osteoporosis, treated with vitamin D	82
	Macular degeneration, treated with vitamins	82
	High blood pressure, controlled with medication	83
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	65
Health Problem	Ankylosing spondylitis, controlled with medication	50
	Kidney cancer, treated with surgery	64
	Kidney stone, passed naturally	65
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	High blood pressure, controlled with medication	65
	Benign prostatic hyperplasia, treated with surgery	68
	Fell in garden	82
	Cause of death: Complications of fall	82
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	89
Health Problem	High blood pressure, in her 70s, controlled with medication
	Abdominal aortic aneurysm, no treatment	81
	Cause of death: Abdominal aortic aneurysm	89
Living / Dead	Dead

Your Father's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	68
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	64
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	68
Health Problem	Benign prostatic hyperplasia, controlled with medication	58
Health Problem	Kidney stones, passed naturally	60
Living / Dead	Living

Religion:

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