Donor 5029 - Summary Profile

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	Negative
CMV IgM Antibody	Negative
Note any comments regarding above items:	N/A

Your Mother

Your Father

Brothers

Your Brother 1

Sisters

Your Sister 1

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Healthy
Health Problem	Cause of death: Natural causes	84
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	85
Health Problem	Healthy
Health Problem	Cause of death: Natural causes	85
Living / Dead	Dead

Your Mother's Sisters 1

Your Mother's Brothers 1

Your Mother's Brothers 2

Your Father's Father

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	90
Health Problem	Failure to thrive, palliative care only	90
Health Problem	Cause of death: Suspected kidney failure	90
Living / Dead	Dead

Your Father's Sisters 1

Your Father's Brothers 1

Height: 5'9" (175 cm)	Weight: 215 lb (97 kg)	Eye Color: Hazel	Hair: Blond/ Wavy	Skin Tone: Medium Light	Ancestry: Caucasian
	Blood Type: A-	Ethnic Background: English-French-German/Polish-Czech
	Education: MBA/Business Administration		Occupation: Senior Consultant
Interests:	Outdoors, Reading, Writing

Faith	Christian
Denomination	Catholic

Update Available	N/A
Updates - Personal	N/A
Updates - Medical	N/A
Updates - Family Medical History	Update August 2020: A recipient has reported the birth of a child with Hirschsprung's Disease. A small increased risk for other children from this donor is present. Any future sales or shipments of vials will require an informed consent.

Donor Number: 5029