| Fairfax Cryobank |
| Donor 2190 Summary Profile |
| Questions |
| Physical |
| Medical |
| Family History |
| Physical | |
| Race | Cauc |
| Ethnic Background | German/German |
| Height | 6 ' 6 " |
| Weight | 220 |
| Eye Color | Blue |
| Hair | Blond/Wavy |
| Skin Tone | MedL |
| Blood Type | O+ |
| Education | BS Accounting |
| Occupation | CPA |
| Interests | Baseball/Travel/Read |
| Medical | ||
| QUESTION | RESPONSE | COMMENTS |
| Diet Restrictions | No | |
| Glasses | No | |
| Allergies | Yes | Possible - minor reactions to vinegar |
| Hearing Restrictions | No | |
| Dental Problem | No | |
| Other Comments | Restricted in NY | |
| Family History | ||||
| FAMILY MEMBER | AGE/AGE OF DEATH | HEALTH PROBLEMS | AGE DIAGNOSED | LIVING/DEAD |
| Mother | 61 | Healthy | L | |
| Father | 62 | Healthy | L | |
| Brother(s) | 37 | Tonsils removed | 15 | L |
| 30 | Appendicitis | 28 | L | |
| Mother's Father | 83 | Heart failure | 83 | D |
| Alzheimer's | 81 | |||
| Mother's Mother | 89 | Healthy - in nursing home | L | |
| Mother's Sister(s) | 64 | Healthy | L | |
| 40 | None - car accident | D | ||
| Mother's Brother(s) | 56 | Healthy | L | |
| Father's Father | 84 | Heart failure | D | |
| Father's Mother | 92 | Healthy - in nursing home | L | |
| Father's Brother(s) | 65 | Healthy | L | |