Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
6'2"
(187 cm) |
Weight:
201 lb
(91 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Straight |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
German-Scandinavian/German-Scandinavian
|
||||
|
Education:
MBA
|
Occupation:
Student, Sales
|
||||
|
Interests:
|
Hockey, Outdoors, Running 5ks, Working out
|
||||
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? | Yes - Near-sighted |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | Yes - Ragweed: Mild, causes watery eyes, itching in eyes and nose |
| 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 |
| Current age or age at death | 53 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Blood clots
53
Medication
Your Father
| Question | Response |
| Current age or age at death | 63 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
50
Medication
Stomach cancer, currently in remission
61
Chemotherapy
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 23 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Sisters
Your Sister 1
| Question | Response |
| Current age or age at death | 21 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Mother's Father
| Question | Response |
| Current age or age at death | 67 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Car accident |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Mother's Mother
| Question | Response |
| Current age or age at death | 78 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Dementia, mild
76
Assisted living
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 55 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Mother's Brothers 2
| Question | Response |
| Current age or age at death | 47 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Mother's Brothers 3
| Question | Response |
| Current age or age at death | 45 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Father's Father
| Question | Response |
| Current age or age at death | 85 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart failure
85
None
Your Father's Mother
| Question | Response |
| Current age or age at death | 78 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Stroke |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stroke
78
None
Your Father's Brothers 1
| Question | Response |
| Current age or age at death | 61 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Father's Brothers 2
| Question | Response |
| Current age or age at death | 60 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Your Father's Brothers 3
| Question | Response |
| Current age or age at death | 58 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Healthy
N/A
Religion:
| Faith | Christian |
| Denomination | Lutheran |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to profile: November 2020. Update received December 2022: Occupation has changed to Active Duty Army. No change to donor Personal Profile: September 2023. |
| Updates - Medical | Donor's CMV status is updated to IgG Antibody positive in March 2018. CMV IgM Antibody remains negative. No change to profile: November 2020, December 2022, September 2023. |
| Updates - Family Medical History | No change to profile: November 2020. Update received December 2022: Maternal Grandmother has died at age 84, specific cause of death unreported. No change to donor Family Medical History: September 2023. |