Physical
|
Height:
5'9"
(175 cm) |
Weight:
199 lb
(90 kg) |
Eye Color:
Brown
|
Hair:
Black/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Asian
|
|
Blood Type:
AB+
|
Ethnic Background:
Indian/Indian
|
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|
Education:
BA/Undeclared
|
Occupation:
Student
|
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|
Interests:
|
Film, Marine life, Reading, Theater, Travel
|
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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: | No |
| CMV IgG Antibody | Negative |
| 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 | 61 | |
| Health Problem | Asthma, controlled with inhaler | 55 |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 74 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 35 | |
| Health Problem | Lactose intolerance, outgrew symptoms at age 18 | 6 |
| Living / Dead | Living |
Your Brother 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 26 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sisters
Your Sister 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 42 | Paternal half sister |
| Health Problem | Healthy | |
| Living / Dead | Living |
Daughters
Your Daughter 1
| 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 | 53 | |
| Health Problem | Heart attack, due to smoking, no treatment | 53 |
| Cause of death: Heart attack | 53 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 93 | |
| Health Problem | Cataracts, both eyes, no treatment | 75 |
| Heart failure, no treatment | 93 | |
| Cause of death: Heart failure | 93 | |
| Living / Dead | Dead |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 68 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 67 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 66 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 65 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 5
| Question | Response | Comment/Age Affected |
| Current age or age at death | 64 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 6
| Question | Response | Comment/Age Affected |
| Current age or age at death | 62 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 7
| Question | Response | Comment/Age Affected |
| Current age or age at death | 61 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 8
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 9
| Question | Response | Comment/Age Affected |
| Current age or age at death | 59 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 10
| Question | Response | Comment/Age Affected |
| Current age or age at death | 57 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 11
| Question | Response | Comment/Age Affected |
| Current age or age at death | 56 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 12
| Question | Response | Comment/Age Affected |
| Current age or age at death | 55 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 66 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 55 | |
| Health Problem | Heart attack, no treatment | 55 |
| Cause of death: Heart attack | 55 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 90 | |
| Health Problem | Broken hip, treated in hospital | 90 |
| Cause of death: Complications from broken hip | 90 | |
| Living / Dead | Dead |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 71 | |
| Health Problem | Breast cancer, attempted treatment with surgery | 68 |
| Cause of death: Breast cancer | 71 | |
| Living / Dead | Dead |
Your Father's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 70 | |
| Health Problem | Respiratory failure, no treatment | 70 |
| Cause of death: Respiratory failure | 70 | |
| Living / Dead | Dead |
Your Father's Sisters 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 64 | Identical twin |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 64 | Identical twin |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 76 | |
| Health Problem | Diabetes mellitus requiring insulin therapy | 70 |
| Cause of death: Complications from diabetes | 76 | |
| Living / Dead | Dead |
Your Father's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 75 | |
| Health Problem | Heart failure, no treatment | 75 |
| Cause of death: Heart failure | 75 | |
| Living / Dead | Dead |
Your Father's Brothers 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 74 | |
| Health Problem | Heart failure, no treatment | 74 |
| Cause of death: Heart failure | 74 | |
| Living / Dead | Dead |
Your Father's Brothers 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 70 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | Islam |
| Denomination | Shia |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: October 2015. |
| Updates - Medical | No change to donor Medical Profile: October 2015. |
| Updates - Family Medical History | No change to donor Family Medical History: October 2015. |

Physical
Medical
Family Medical History
Religion
Updates to Profile