This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:
Occasionally - Beer, 20 oz/week
Tobacco use: Do you smoke?
If yes, #/day and for how long:
No
If you did smoke but quit, when did you last smoke?N/A
For how many years?N/A
Do you sleep well?Yes
Do you exercise on regular basis?Yes
Is your diet well balanced?
If no, explain:
Yes
Are you a vegetarian?No
Any dietary restrictions?
If yes, explain:
No

Sexual History

Question Response
A partner whose sexual background you are unsure of in the past 12 months?No

Donor Genetic History

Question Response
Do you have a history of a speech disorder; such as a speech impediment, stuttering, delayed speech development, etc.?
If yes, explain:
No
Do you have learning differences, such as dyslexia?
If yes, explain:
No
Were you or any family members born with any birth defects?
If yes, explain:
No

Donor Medical History

Question Response
List any operations:
Age & reason:
Hand tendon repair - Age 17, hand injury in high school Lacrosse game
Hospitalization other than surgery:
Age & type of illness:
N/A
Have you ever had any broken bones?
If yes, please give age and description:
No
Have you ever had any serious illnesses?
If yes, please give age and description:
No
Are you presently under a physician's care for any reason?
If yes, please describe:
No
List all drugs you have taken in past 12 months (prescription, nonprescription, herbal, and sports supplements, and recreational). Include drug, frequency and duration taken, and reason:None - N/A; N/A; N/A
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:None - N/A; N/A; N/A
Do you wear glasses or contact lenses?
Are you near or far-sighted?
Yes - -2.0/-2.0
Birth weight lbs8
Birth weight ozs8
Recent weight loss or gain?
# of lbs and reason:
No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:
No
How many sexual partners do you currently have?1
Have you ever had a tattoo?No
Have you ever had your ear(s) or body pierced?No

Family Medical History
See list of questions asked here

Mother's Father Ethnic OriginsUkranian
Mother's Mother Ethnic OriginsUkranian
Father's Father Ethnic OriginsItalian
Father's Mother Ethnic OriginItalian
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Question Response
Current age or age at death 70
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 72
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 41
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 78
Living / DeadDead
Cause of death and any treatment prior to deathPneumonia
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Pneumonia
78
Antibiotics, fluids, mechanical ventilation
Osteoarthritis
70
Pain relief medication, walking assistive device
Question Response
Current age or age at death 82
Living / DeadDead
Cause of death and any treatment prior to deathGI infection
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Any other cancer/problem of digestive system
82
Perforated diverticulitis, surgery attempted
Question Response
Current age or age at death 69
Living / DeadDead
Cause of death and any treatment prior to deathComplications from diverticulitis surgery
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Smoker, no specific diagnoses or treatments.
Question Response
Current age or age at death 87
Living / DeadDead
Cause of death and any treatment prior to deathNatural causes, no autopsy done, old age
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Chronic cough from smoking, no known therapy.
Question Response
Current age or age at death 79
Living / DeadDead
Cause of death and any treatment prior to deathAspiration pneumonia
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Pneumonia
79
Ventilator
Other
 
Age related cognitive decline, social support provided.
Question Response
Current age or age at death 88
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 84
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Ruptured Achilles tendon, age 72, surgical repair.