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 - 12-16 oz per week (beer)
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:
Nose - Age 12, put back in place after breaking nose
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:
Yes - Age 12, broke nose from a fall
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 - Far-sighted, Right (OD): .25 Sphere, -1.75 Cyl, Axis 105 Left (OS): .25 Sphere, -1.75 Cyl, 080 Axis
Birth weight lbs7
Birth weight ozs1
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 OriginsEnglish
Mother's Mother Ethnic OriginsEnglish
Father's Father Ethnic OriginsEnglish
Father's Mother Ethnic OriginEnglish
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Question Response
Current age or age at death 65
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 69
Living / DeadDead
Cause of death and any treatment prior to deathLung Cancer (smoker)
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
68
Chemotherapy
Question Response
Current age or age at death 26
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 66
Living / DeadDead
Cause of death and any treatment prior to deathHeart Attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other diagnosed health problems at time of death
Question Response
Current age or age at death 90
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 69
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 69
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 / DeadDead
Cause of death and any treatment prior to deathHeart Attack
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No other diagnosed health problems at time of death
Question Response
Current age or age at death 61
Living / DeadDead
Cause of death and any treatment prior to deathLung Cancer (smoker)
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
60
Chemotherapy
Question Response
Current age or age at death 69
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 61
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 53
Living / DeadDead
Cause of death and any treatment prior to deathAmyotrophic Lateral Sclerosis (ALS)
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other diseases of the nervous system
43
ALS, quality of life care