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 - 12/oz. Wine or Beer every couple of weeks
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:
Varicocelectomy - 19 years old. Varicocele found during a check-up
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:
Yes - Broke Right arm at 5 years old while falling off a slide. Broke left wrist at 12 years old while being flipped in a karate class.
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:Alegra D - Seasonally; Typically for a few weeks a year while the pollen is bad.; Allergies
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:None - None; None; None
Do you wear glasses or contact lenses?
Are you near or far-sighted?
Yes - Near-sighted, 20/175
Birth weight lbs7
Birth weight ozs15
Recent weight loss or gain?
# of lbs and reason:
No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:
Yes - Pollen. Runny nose and itchy eyes
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 OriginsIrish
Mother's Mother Ethnic OriginsIrish
Father's Father Ethnic OriginsFrench Canadian-Scottish
Father's Mother Ethnic OriginFrench Canadian
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Question Response
Current age or age at death 45
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Blood Clots
43
Blood Thinners
Any cancer not mentioned above
31
Melanoma surgically removed
Other
 
Physically disabled by car accident at age 41
Question Response
Current age or age at death 45
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 25
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Acne
16
Topical medication
Question Response
Current age or age at death 59
Living / DeadDead
Cause of death and any treatment prior to deathPancreatic Cancer
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other known health problems at time of death
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 41
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 77
Living / DeadDead
Cause of death and any treatment prior to deathLung Cancer, refused treatment
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other diagnosed health problems at time of death
Question Response
Current age or age at death 67
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 46
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 45
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Problemas de Saúde
Saudável
Question Response
Current age or age at death 18
Living / DeadDead
Cause of death and any treatment prior to deathCar Accident
Problemas de Saúde
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death