Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
5'10"
(177 cm) |
Weight:
189 lb
(85 kg) |
Eye Color:
Hazel
|
Hair:
Brown/
Straight |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
|
Blood Type:
O+
|
Ethnic Background:
German/English-Irish
|
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Education:
BCE/Civil Engineering
|
Occupation:
Civil Engineer
|
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Interests:
|
Fitness, Outdoor Activities
|
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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 - (Near-sighted before laser surgery) |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | Yes - Cat dander, Pollen, Ragweed: Cause itchy, watery 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 | 56 | |
| Health Problem | Miscarriage, age unknown | |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 58 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 34 | |
| Health Problem | Eczema (sporadic), in his 20s, treats with over-the-counter creams | |
| Living / Dead | Living |
Your Brother 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | |
| Health Problem | Pet dander allergy | 10 |
| Asthma, treated with inhaler and nebulizer | 10 | |
| Living / Dead | Living |
Your Brother 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 29 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Daughters
Your Daughter 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 1 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 75 | |
| Health Problem | Emphysema (smoker), in his early 40s | |
| Chronic Obstructive Pulmonary Disease (COPD), in his early 40s, treated with oxygen in hospice care | ||
| Cause of death: Emphysema, COPD | 75 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 80 | |
| Health Problem | Type II Diabetes, controls with diet and medication | 70 |
| Living / Dead | Living |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 53 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 43 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 57 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 45 | |
| Health Problem | Back and neck broken in a car accident, but otherwise healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 82 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 80 | |
| Health Problem | Type II Diabetes, in her 60s, controlled with diet and medication | |
| Multiple small strokes, treated with rehabilitation | 75 | |
| Sepsis from blood infection, treated in hospital | 80 | |
| Cause of death: Sepsis from blood infection | 80 | |
| Living / Dead | Dead |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 66 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 64 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 55 | |
| 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: May 2018. |
| Updates - Medical | No change to donor Medical Profile: May 2018. January 2019: Donor's CMV status is updated to IgG Antibody positive in October 2017. CMV IgM Antibody remains negative. |
| Updates - Family Medical History | No change to donor Family Medical History: May 2018. |