Summary Profile

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Donor Number: 5380

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:	Yes - Although I do not have celiac disease, I have a gluten sensitivity
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:	Yes - Seasonal allergies to pollens: Causes sneezing
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	56
Health Problem	Colon polyps (benign), treated with surgery	50
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Glaucoma, treated with eye drops	49
Living / Dead	Living

Brothers

Your Brother 1

Question	Response	Comment/Age Affected
Current age or age at death	0	(fraternal triplet with donor, age not given to protect donor's anonymity)
Health Problem	Healthy
Living / Dead	Living

Your Brother 2

Question	Response	Comment/Age Affected
Current age or age at death	0	(fraternal triplet with donor, age not given to protect donor's anonymity)
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	95
Health Problem	Blood clot in leg, treated with medication	87
Living / Dead	Living

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	89
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	47
Health Problem	Overweight, no diagnosis, no treatment	42
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	70
Health Problem	Healthy
Living / Dead	Living

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	69
Health Problem	High blood pressure, controlled with dietary changes and exercise	61
Health Problem	Diabetes, controlled with dietary changes and exercise	63
Living / Dead	Living

Your Father's Sisters 1

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

Religion:

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