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 - 12 oz. beer/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

Have you ever had sex with:
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:		Appendectomy, Tympanoplasty - Appendicitis (26 years old), Torn ear drum due to accident (27 years old)
Hospitalization other than surgery:
Age & type of illness:		None - 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:Tylenol, Zyrtec, Fish Oil, Methylcobalamine, Methylfolate, Marijuana - Tylenol less than 5, Zyrtec 20, Supplements every day, Marijuana occasionally; Only when needed; Tylenol occasional headache, Zyrtec occasional seasonal allergy, supplements as recommended by Doctor, Marijuana recreational
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Vitamin D - Every day; Only when needed; Recommended by Doctor
Do you wear glasses or contact lenses?
Are you near or far-sighted?		No
Birth weight lbs7
Birth weight ozs4
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		Yes - Cedar seasonal allergies - nose congestion
How many sexual partners do you currently have?1
Have you ever had a tattoo?Yes - 2004 Right thigh
Have you ever had your ear(s) or body pierced?No

Family Medical History
See list of questions asked here

Mother's Father Ethnic OriginsGerman
Mother's Mother Ethnic OriginsWelsh
Father's Father Ethnic OriginsSwiss
Father's Mother Ethnic OriginGerman
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Your Mother
Question Response
Current age or age at death 60
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father
Question Response
Current age or age at death 66
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Brothers
Your Brother 1
Question Response
Current age or age at death 33
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Brother 2
Question Response
Current age or age at death 17
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Sons
Your Son 1
Question Response
Current age or age at death 2
Living / DeadLiving
Health Problems
Healthy
Your Mother's Father
Question Response
Current age or age at death 61
Living / DeadDead
Cause of death and any treatment prior to deathMoped accident
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death
Your Mother's Mother
Question Response
Current age or age at death 80
Living / DeadDead
Cause of death and any treatment prior to deathOrgan failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Had an unhealthy diet, no other diagnosed health problems
Your Mother's Sisters 1
Question Response
Current age or age at death 66
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Cataracts before age of 60
40
Surgery
Your Mother's Brothers 1
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Emphysema
59
Steroids and oxygen
Your Mother's Brothers 2
Question Response
Current age or age at death 52
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Father
Question Response
Current age or age at death 91
Living / DeadDead
Cause of death and any treatment prior to deathSmall Cell Carcinoma
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Ulcer of stomach/duodenum
75
Standard treatment, recovered well
Prostate cancer
60
Radiation Implant
Your Father's Mother
Question Response
Current age or age at death 82
Living / DeadDead
Cause of death and any treatment prior to deathAlzheimer's
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Alzheimer's
76
No treatment
Your Father's Brothers 1
Question Response
Current age or age at death 63
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father's Brothers 2
Question Response
Current age or age at death 60
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy