Donor 4500 - Summary Profile

Physical

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:	No
CMV IgG Antibody	Positive
CMV IgM Antibody	Negative
Note any comments regarding above items:	N/A

Family Medical History
See list of questions asked here

Your Mother

Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Miscarriage, successful pregnancy following miscarriage	32
Living / Dead	Living

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	55
Health Problem	High blood pressure, treated with medication (due to being overweight)	35
Health Problem	Diabetes mellitus not requiring insulin therapy, treated with diet control	40
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	23
Health Problem	Healthy
Living / Dead	Living

Sisters

Your Sister 1

Question	Response	Comment/Age Affected
Current age or age at death	31
Health Problem	Healthy
Living / Dead	Living

Your Sister 2

Question	Response	Comment/Age Affected
Current age or age at death	27
Health Problem	Acne (ages 16-19), treated with medication	16
Living / Dead	Living

Daughters

Your Daughter 1

Question	Response	Comment/Age Affected
Current age or age at death	4
Health Problem	Healthy
Living / Dead	Living

Your Daughter 2

Question	Response	Comment/Age Affected
Current age or age at death	2
Health Problem	Healthy
Living / Dead	Living

Your Daughter 3

Question	Response	Comment/Age Affected
Current age or age at death	0.5
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	75
Health Problem	Heart disease, no medication or treatment received	75
Health Problem	Cause of death: Heart disease	75
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	82
Health Problem	Colon cancer, attempted treatment with surgery	81
Health Problem	Cause of death: Colon cancer	82
Living / Dead	Dead

Your Mother's Sisters 1

Question	Response	Comment/Age Affected
Current age or age at death	58
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 2

Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 3

Question	Response	Comment/Age Affected
Current age or age at death	52
Health Problem	Healthy
Living / Dead	Living

Your Mother's Sisters 4

Question	Response	Comment/Age Affected
Current age or age at death	49
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	61
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 3

Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 4

Question	Response	Comment/Age Affected
Current age or age at death	56
Health Problem	Healthy
Living / Dead	Living

Your Mother's Brothers 5

Question	Response	Comment/Age Affected
Current age or age at death	50
Health Problem	Healthy
Living / Dead	Living

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	81
Health Problem	High blood pressure, treated through diet control (overweight)	70
	Diabetes mellitus not requiring insulin therapy, treated with diet control	75
	Heart disease, no treatment	81
	Cause of death: Heart disease	81
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	83
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 2

Question	Response	Comment/Age Affected
Current age or age at death	53
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 3

Question	Response	Comment/Age Affected
Current age or age at death	51
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 4

Question	Response	Comment/Age Affected
Current age or age at death	50
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 5

Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Healthy
Living / Dead	Living

Height: 6'0" (182 cm)	Weight: 177 lb (80 kg)	Eye Color: Blue	Hair: Brown/ Wavy	Skin Tone: Medium Light	Ancestry: Caucasian
	Blood Type: A+	Ethnic Background: German/Irish
	Education: BS/Elementary Education		Occupation: Teacher
Interests:	Basketball, Snowboard

Faith	Christian
Denomination	Non-denominational

Update Available	Yes
Updates - Personal	No change to donor Personal Profile: October 2014, July 2019.
Updates - Medical	No change to donor Medical Profile: October 2014, July 2019.
Updates - Family Medical History	No change to donor Family Medical History: October 2014, July 2019.

Donor Number: 4500

Physical

Medical

Family Medical History
See list of questions asked here

Religion:

Updates to Profile

Donor Number: 4500

Physical

Medical

Family Medical HistorySee list of questions asked here

Religion:

Updates to Profile

Family Medical History
See list of questions asked here