This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:
Rarely - An occasional beer
Tobacco use: Do you smoke?
If yes, #/day and for how long:
No
If you did smoke but quit, when did you last smoke?N/A
For how many years?N/A
Do you sleep well?Yes
Do you exercise on regular basis?Yes
Is your diet well balanced?
If no, explain:
Yes
Are you a vegetarian?No
Any dietary restrictions?
If yes, explain:
No

Sexual History

Question Response
A partner whose sexual background you are unsure of in the past 12 months?No

Donor Genetic History

Question Response
Do you have a history of a speech disorder; such as a speech impediment, stuttering, delayed speech development, etc.?
If yes, explain:
No
Do you have learning differences, such as dyslexia?
If yes, explain:
No
Were you or any family members born with any birth defects?
If yes, explain:
No

Donor Medical History

Question Response
List any operations:
Age & reason:
Wisdom Teeth extraction; Varicocele ligation - Age 20 routine procedure; Age 20 Varicocele Ligation due to scrotal pain
Hospitalization other than surgery:
Age & type of illness:
N/A - N/A
Have you ever had any broken bones?
If yes, please give age and description:
No
Have you ever had any serious illnesses?
If yes, please give age and description:
No
Are you presently under a physician's care for any reason?
If yes, please describe:
No
List all drugs you have taken in past 12 months (prescription, nonprescription, herbal, and sports supplements, and recreational). Include drug, frequency and duration taken, and reason:N/A - N/A; N/A; N/A
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:N/A - N/A; N/A; N/A
Do you wear glasses or contact lenses?
Are you near or far-sighted?
Yes - -1.25/-1.5, near-sighted, age 14
Birth weight lbs7
Birth weight ozs1
Recent weight loss or gain?
# of lbs and reason:
No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:
Yes - Penicillin, causes hives
How many sexual partners do you currently have?1
Have you ever had a tattoo?No
Have you ever had your ear(s) or body pierced?No

Family Medical History
Ver lista de perguntas. here

Mother's Father Ethnic OriginsUkrainian
Mother's Mother Ethnic OriginsNorwegian
Father's Father Ethnic OriginsSwedish
Father's Mother Ethnic OriginSwedish
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Question Response
Current age or age at death 67
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
65
Medication
High cholesterol
65
Medication
Question Response
Current age or age at death 59
Living / DeadDead
Cause of death and any treatment prior to deathHeart Attack
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Heart attack
59
Immediately Fatal
High blood pressure
55
Not treated
Question Response
Current age or age at death 34
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 36
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 79
Living / DeadDead
Cause of death and any treatment prior to deathStroke
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Stroke
79
Fatal, was smoker
High blood pressure
60
Medication
Progressive kidney disease
60
Medication
Drug abuse, misuse, or addiction
 
No treatment, suffered with alcoholism entire adult life
Question Response
Current age or age at death 89
Living / DeadDead
Cause of death and any treatment prior to deathOld Age. Combination of health problems below
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
75
Medication
Other lung disease
75
COPD, lifelong smoker
Dementia or degenerative disorders
85
Medication
Osteoporosis
65
Medication
Question Response
Current age or age at death 69
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 68
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 60
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 59
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 64
Living / DeadDead
Cause of death and any treatment prior to deathEsophageal Cancer
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Any other cancer/problem of digestive system
62
Esophageal cancer, treated with chemotherapy, surgery; lifelong smoker
Question Response
Current age or age at death 62
Living / DeadDead
Cause of death and any treatment prior to deathEsophageal Cancer
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Any other cancer/problem of digestive system
60
Esophageal cancer, treated with chemotherapy, surgery; lifelong smoker
Question Response
Current age or age at death 62
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 83
Living / DeadDead
Cause of death and any treatment prior to deathCar Accident
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
65
Medication
Other
 
Enlarged prostate diagnosed at age 65, treated with medication. Negative for cancer.
Question Response
Current age or age at death 81
Living / DeadDead
Cause of death and any treatment prior to deathKidney Disease, Transient Ischaemic Strokes
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
70
Medication, diet
Progressive kidney disease
75
Dialysis, medication
Dementia or degenerative disorders
75
Medication
Question Response
Current age or age at death 78
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 73
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
65
Medication