Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
6'0"
(182 cm) |
Weight:
200 lb
(90 kg) |
Eye Color:
Blue
|
Hair:
Blond/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
A+
|
Ethnic Background:
Dutch Jewish/Welsh
|
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Education:
PharmD
|
Occupation:
Pharmacy Intern
|
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Interests:
|
Cooking
|
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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: | No |
| 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: | No |
| 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 | Comment/Age Affected |
| Current age or age at death | 62 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 61 | |
| Health Problem | High cholesterol, treated with medication | 59 |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 21 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 63 | |
| Health Problem | Healthy | |
| Cause of death: Car accident | 63 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 79 | |
| Health Problem | Stroke, treated with medication | 76 |
| Living / Dead | Living |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 56 | |
| Health Problem | Healthy | |
| Cause of death: Smoke inhalation from fire at workplace | 56 | |
| Living / Dead | Dead |
Your Mother's Sisters 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 53 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 59 | |
| Health Problem | Heart failure (smoker), no treatment | 59 |
| Cause of death: Heart failure | 59 | |
| Living / Dead | Dead |
Your Mother's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 62 | |
| Health Problem | High blood pressure, controlled with medication | 56 |
| Living / Dead | Living |
Your Mother's Brothers 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 56 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 52 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 5
| Question | Response | Comment/Age Affected |
| Current age or age at death | 49 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 56 | |
| Health Problem | Heart attack, the result of smoking, poor diet and stress, no treatment | 56 |
| Cause of death: Heart attack | 56 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 94 | |
| Health Problem | Non-insulin dependent diabetes, treated with medication | 86 |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 61 | |
| Health Problem | Healthy | |
| Cause of death: Nicotine poisoning (from smoking and using the patch at the same time) | 61 | |
| Living / Dead | Dead |
Religion:
| Faith | Jewish |
| Denomination | Reformed Tradition |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: June 2015, March 2016, May 2016, October 2016, August 2020. Update received July 2021: Occupation has changed to Pharmacy Manager. Update received July 2022: Donor reports that he is now married. |
| Updates - Medical | No change to donor Medical Profile: June 2015, March 2016, May 2016, October 2016, August 2020, July 2021, July 2022. |
| Updates - Family Medical History | Update received June 2015: Maternal aunt #1 had her gall bladder removed at age 60. No change to donor Family Medical History: March 2016. Update received May 2016: Paternal grandmother has died of natural causes at age 96. No change to donor Family Medical History: October 2016. Update 2019: A child from this donor has been diagnosed with hypospadias. Any future vial shipments or sales will require an informed consent. No change to profile: August 2020. Update received July 2021: Maternal Grandmother has died from COVID-19, age unreported. No change to donor Family Medical History: July 2022. |