Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
6'0"
(182 cm) |
Weight:
177 lb
(80 kg) |
Eye Color:
Brown
|
Hair:
Black/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Caucasian
|
|
Blood Type:
O+
|
Ethnic Background:
Irish/Irish
|
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Education:
MA/Social Sciences
|
Occupation:
Fundraiser
|
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Interests:
|
Sports, Time with family
|
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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: | Yes - Maternal uncle #4, age 35 (ongoing) |
| 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: | Yes - Pet dander, mold, dust: Cause sniffles, sneezing and watery eyes; Ceclor: Causes rash |
| 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 | 58 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Gallstones, age 44 or 45
Surgery
Double vision, due to recent car accident
58
None yet; considering corrective surgery
Your Father
| Question | Response |
| Current age or age at death | 67 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 32 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Sisters
Your Sister 1
| Question | Response |
| Current age or age at death | 30 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 80 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Complications of diabetes |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes (Type 2) requiring insulin therapy
57
N/A
Your Mother's Mother
| Question | Response |
| Current age or age at death | 63 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Heart attack |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Heart attack, fatal
63
None
Your Mother's Sisters 1
| Question | Response |
| Current age or age at death | 66 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 2
| Question | Response |
| Current age or age at death | 40 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Trauma |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Trauma (accidental fall)
40
None
Your Mother's Sisters 3
| 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
Healthy
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 65 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stroke, minor
62
Unknown
Your Mother's Brothers 2
| Question | Response |
| Current age or age at death | 64 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 3
| Question | Response |
| Current age or age at death | 62 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 4
| Question | Response |
| Current age or age at death | 56 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Alcoholism
35
Rehabilitation clinic, several times
Your Father's Father
| Question | Response |
| Current age or age at death | 78 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Coronary artery disease |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Coronary artery disease, in his early 70s
Medication, bypass surgery
Your Father's Mother
| Question | Response |
| Current age or age at death | 75 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Stomach cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stomach cancer, in her late 60s
Radiation, chemotherapy
Your Father's Brothers 1
| Question | Response |
| Current age or age at death | 68 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 2
| Question | Response |
| Current age or age at death | 64 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Christian |
| Denomination | Catholic |
Updates to Profile
| Update Available | N/A |
| Updates - Personal | No change to Personal Profile: November 2019, July 2021. |
| Updates - Medical | No change to Medical Profile: November 2019. Update received May 2021: Donor was diagnosed with acid reflux at age 32, treated with omeprazole. No change to donor Medical Profile: July 2021. |
| Updates - Family Medical History | No change to Family Medical History: November 2019. Update received May 2021: Donor's Brother was diagnosed with kidney stones at age 35. No change to donor Family Medical History: July 2021. |