Fairfax Cryobank
Donor 2369 Summary Profile






Questions
Physical
Medical
Family Medical History
Updates to Profile

Physical
Race Cauc
Ethnic Background English-Irish/Italian
Height 5'9''
Weight 140
Eye Color Brown
Hair Brown/Wavy
Skin Tone Medl
Blood Type A+
Education MD/Medicine/
Occupation Physician
Interests Origami/Yo-yoing

Medical
QuestionResponse
Any dietary restrictions?
If yes, explain:		 No
Do you wear glasses or contact lenses?
Are you near or far-sighted?		 Yes - Near-sighted
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		 No
CMV IgG AntibodyNegative
CMV IgM AntibodyNegative
Note any comments regarding above items: N/A

Family Medical History

Your Mother
QuestionResponseComment/Age Affected
 Current age or age at death  48   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father
QuestionResponseComment/Age Affected
 Current age or age at death  48   
 Health Problem
 Healthy 
 Living / Dead Living  

Brother(s)

Your Brother 1
QuestionResponseComment/Age Affected
 Current age or age at death  16   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Brother 2
QuestionResponseComment/Age Affected
 Current age or age at death  19   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Brother 3
QuestionResponseComment/Age Affected
 Current age or age at death  22   
 Health Problem
 Healthy 
 Living / Dead Living  

Sister(s)

Your Sister 1
QuestionResponseComment/Age Affected
 Current age or age at death  15   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Sister 2
QuestionResponseComment/Age Affected
 Current age or age at death  25   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Father
QuestionResponseComment/Age Affected
 Current age or age at death  93   
 Health Problem
 Heart attack 81
 Died of natural causes 93
 Living / Dead Dead  

Your Mother's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  75   
 Health Problem
 Died of natural causes 75
 Living / Dead Dead  

Your Mother's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  61   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Father
QuestionResponseComment/Age Affected
 Current age or age at death  75   
 Health Problem
 Heart attack 65
 Died of natural causes 75
 Living / Dead Dead  

Your Father's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  69   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Sisters 1
QuestionResponseComment/Age Affected
 Current age or age at death  52   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Sisters 2
QuestionResponseComment/Age Affected
 Current age or age at death  50   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Sisters 3
QuestionResponseComment/Age Affected
 Current age or age at death  32   
 Health Problem
 Rhabdomysarcoma - soft tissue tumor 32
 Living / Dead Dead  

Your Father's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  43   
 Health Problem
 Healthy 
 Living / Dead Living  

Updates to Profile
Update Available N/A
Updates - Personal N/A
Updates - Medical N/A
Updates - Family Medical History N/A