Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
5'10"
(177 cm) |
Weight:
169 lb
(76 kg) |
Eye Color:
Blue
|
Hair:
Blond/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
German-Irish/Irish-Polish
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Education:
BS/Biology
|
Occupation:
Consumer Finance
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Interests:
|
Family, Fishing, Golfing, Reading, Skiing, Sports
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Medical
| Question | Response |
| Have you or any of your family members been diagnosed with alcoholism or drug addiction? If yes, relation and age affected: | No |
| 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: | Yes - Pollen, causes sneezing and itchy eyes |
| CMV IgG Antibody | Positive |
| CMV IgM Antibody | Negative |
| Note any comments regarding above items: | N/A |
Family Medical HistorySee list of questions asked here
Your Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 63 | |
| Health Problem | High blood pressure, treated with medication | 62 |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 63 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 32 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sisters
Your Sister 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 39 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Sister 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 38 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sons
Your Son 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 5 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Daughters
Your Daughter 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 9 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Daughter 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 7 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 73 | |
| Health Problem | Broken hip (due to fall), attempted treatment with surgery | 73 |
| Cause of death: Complications during hip surgery | 73 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 79 | |
| Health Problem | Brain tumor, no medication or treatment received (inoperable due to location) | 79 |
| Cause of death: Brain tumor | 79 | |
| Living / Dead | Dead |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 57 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 87 | |
| Health Problem | Diabetes mellitus requiring insulin therapy | 59 |
| Cause of death: Heart failure (partially due to occupational asbestos exposure earlier in life) | 87 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 83 | |
| Health Problem | Incontinence (overactive bladder), treated with surgery | 82 |
| Living / Dead | Living |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 58 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 53 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 50 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | Christian |
| Denomination | Catholic |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: September 2014. |
| Updates - Medical | No change to donor Medical Profile: September 2014. |
| Updates - Family Medical History | No change to donor Family Medical History: September 2014. |