Cryogenic Laboratories, Inc.
Donor 2681 Summary Profile






Questions
Physical
Medical
Family Medical History
Updates to Profile

Physical
Race Latino
Ethnic Background Puerto Rican/Span-Venez-Port
Height 6'0''
Weight 172
Eye Color Brown
Hair Brown/Curly
Skin Tone Med
Blood Type AB+
Education BS/ Behavl Science/
Occupation Sales
Interests Stock Mrkt/Reading

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:		 Yes - Very fine cat hair causes sneezing
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  69   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father
QuestionResponseComment/Age Affected
 Current age or age at death  69   
 Health Problem
 Stomach ulcer - stress related 50
 Living / Dead Living  

Brother(s)

Your Brother 1
QuestionResponseComment/Age Affected
 Current age or age at death  41   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Brother 2
QuestionResponseComment/Age Affected
 Current age or age at death  28   
 Health Problem
 Healthy 
 Living / Dead Living  

Sister(s)

Your Sister 1
QuestionResponseComment/Age Affected
 Current age or age at death  39   
 Health Problem
 Pollen allergies, treated with Claritin 18
 Living / Dead Living  

Son(s)

Your Son 1
QuestionResponseComment/Age Affected
 Current age or age at death  10   
 Health Problem
 Healthy 
 Living / Dead Living  

Daughter(s)

Your Daughter 1
QuestionResponseComment/Age Affected
 Current age or age at death  7   
 Health Problem
 Asthma - treated with inhaler 5
 Living / Dead Living  

Your Mother's Father
QuestionResponseComment/Age Affected
 Current age or age at death  72   
 Health Problem
 Cause of death: Heart attack 72
 Living / Dead Dead  

Your Mother's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  74   
 Health Problem
 Cause of death: Heart attack 74
 Living / Dead Dead  

Your Mother's Sisters 1
QuestionResponseComment/Age Affected
 Current age or age at death  67   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Sisters 2
QuestionResponseComment/Age Affected
 Current age or age at death  58   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  65   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 2
QuestionResponseComment/Age Affected
 Current age or age at death  62   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 3
QuestionResponseComment/Age Affected
 Current age or age at death  60   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 4
QuestionResponseComment/Age Affected
 Current age or age at death  56   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Father
QuestionResponseComment/Age Affected
 Current age or age at death  76   
 Health Problem
 Cause of death: Lung cancer, smoker 76
 Living / Dead Dead  

Your Father's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  78   
 Health Problem
 Cause of death: Lung cancer, smoker 78
 Living / Dead Dead  

Your Father's Sisters 1
QuestionResponseComment/Age Affected
 Current age or age at death  65   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  72   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Brothers 2
QuestionResponseComment/Age Affected
 Current age or age at death  67   
 Health Problem
 Healthy 
 Living / Dead Living  

Religion:
Faith  Christian
Denomination  Catholic

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