| Cryogenic Laboratories, Inc. |
| Donor 1476 Summary Profile |
| Questions |
| Physical |
| Medical |
| Family Medical History |
| Updates to Profile |
| Race | Cauc |
| Ethnic Background | Latvian-Russian/Latvian |
| Height | 5'9'' |
| Weight | 160 |
| Eye Color | Brown |
| Hair | Black/Straight |
| Skin Tone | Light |
| Blood Type | A+ |
| Education | BA/Business/ |
| Occupation | Student |
| Interests | Sport/History/Travel/Art |
| Medical | ||
| Question | Response | |
| Any dietary restrictions? If yes, explain: | No | |
| Do you wear glasses or contact lenses? Are you near or far-sighted? | No | |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | No | |
| CMV IgG Antibody | Positive | |
| CMV IgM Antibody | Negative | |
| Note any comments regarding above items: | N/A | |
| Family Medical History |
Your Mother| Question | Response | Comment/Age Affected | Current age or age at death | 46 | | Health Problem |
Living / Dead | Living | |
| ||||||
Your Father| Question | Response | Comment/Age Affected | Current age or age at death | 49 | | Health Problem |
Living / Dead | Living | |
| ||||||
| Sister(s) |
Your Sister 1| Question | Response | Comment/Age Affected | Current age or age at death | 20 | | Health Problem |
Living / Dead | Living | | | ||||||
Your Sister 2| Question | Response | Comment/Age Affected | Current age or age at death | 14 | | Health Problem |
Living / Dead | Living | |
| ||||||
Your Mother's Father| Question | Response | Comment/Age Affected | Current age or age at death | 71 | | Health Problem |
Living / Dead | Dead | |
| ||||||
Your Mother's Mother| Question | Response | Comment/Age Affected | Current age or age at death | 78 | | Health Problem |
Living / Dead | Dead | |
| ||||||
Your Father's Father| Question | Response | Comment/Age Affected | Current age or age at death | 82 | | Health Problem |
Living / Dead | Living | |
| ||||||
Your Father's Mother| Question | Response | Comment/Age Affected | Current age or age at death | 76 | | Health Problem |
Living / Dead | Dead | |
| ||||||
Your Father's Sisters 1| Question | Response | Comment/Age Affected | Current age or age at death | 62 | | Health Problem |
Living / Dead | Living | |
| ||||||
Your Father's Brothers 1| Question | Response | Comment/Age Affected | Current age or age at death | 52 | | Health Problem |
Living / Dead | Living | |
| ||||||
| Updates to Profile | ||
| Update Available | N/A | |
| Updates - Personal | N/A | |
| Updates - Medical | N/A | |
| Updates - Family Medical History | N/A | |