Doador 7356 - Medical Profile

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:	Occasionally - 12oz. Beer/week
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?	Yes
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:	Tonsil Removal; Wisdom Teeth Extraction - Age 6, Ear Infections; Age 22
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 - Age 17, nose, got elbowed on accident
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 - Near-sighted, -3.5/-3.5
Birth weight lbs	9
Birth weight ozs	8
Recent weight loss or gain? # of lbs and reason:	No
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	Yes - Penicillin, Rash
How many sexual partners do you currently have?	0
Have you ever had a tattoo?	Yes - 4, both calves, left thigh, left hip
Have you ever had your ear(s) or body pierced?	Yes - 2, both ears

Family Medical History
Ver lista de perguntas. here

Mother's Father Ethnic Origins	German-Irish
Mother's Mother Ethnic Origins	German-Irish
Father's Father Ethnic Origins	Scottish-Irish-German
Father's Mother Ethnic Origin	Scottish-Irish-German
Is anyone in your family of Ashkenazai Jewish Heritage?	No
If yes, who?	N/A

Your Mother

Question	Response
Current age or age at death	52
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Father

Question	Response
Current age or age at death	55
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Brothers

Your Brother 1

Question	Response
Current age or age at death	33
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Brother 2

Question	Response
Current age or age at death	27
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Brother 3

Question	Response
Current age or age at death	20
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Disease

Age Diagnosed

Treatment For Condition

Sickle-cell anemia/other hemoglobinopathy

No treatment. Donor has tested negative.

Your Brother 4

Question	Response
Current age or age at death	15
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Mother's Father

Question	Response
Current age or age at death	70
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Mother's Mother

Question	Response
Current age or age at death	60
Living / Dead	Dead
Cause of death and any treatment prior to death	Complications from bladder infection due to paralysis

Problemas de Saúde

Disease

Age Diagnosed

Treatment For Condition

Other

Neck Injury, Age 28, resulted in becoming paraplegic

Your Mother's Brothers 1

Question	Response
Current age or age at death	48
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Mother's Brothers 2

Question	Response
Current age or age at death	46
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Father's Father

Question	Response
Current age or age at death	84
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Father's Mother

Question	Response
Current age or age at death	35
Living / Dead	Dead
Cause of death and any treatment prior to death	Brain Tumor (Astrocytoma)

Problemas de Saúde

Disease

Age Diagnosed

Treatment For Condition

Blood Clots

No treatment, caught too late

Your Father's Sisters 1

Question	Response
Current age or age at death	58
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Your Father's Brothers 1

Question	Response
Current age or age at death	60
Living / Dead	Living
Cause of death and any treatment prior to death	N/A

Problemas de Saúde

Saudável

Número do Doador: 7356

Personal Behavior History

Sexual History

Donor Genetic History

Donor Medical History

Family Medical HistoryVer lista de perguntas. here

Family Medical History
Ver lista de perguntas. here