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 |