Donor 5400 - 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 - (near-sighted and astigmatism before laser surgery)
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

Your Mother

Your Father

Question	Response	Comment/Age Affected
Current age or age at death	63
Health Problem	High cholesterol, controlled with medication	50
	High blood pressure, controlled with medication	55
	Gout, caused by shellfish allergy, treatment (if any) unknown	60
Living / Dead	Living

Brothers

Your Brother 1

Sisters

Your Sister 1

Your Mother's Father

Question	Response	Comment/Age Affected
Current age or age at death	78
Health Problem	Lung cancer (asbestos exposure), age at diagnosis unknown, treatment (if any) unknown
Health Problem	Cause of death: Lung cancer	78
Living / Dead	Dead

Your Mother's Mother

Question	Response	Comment/Age Affected
Current age or age at death	81
Health Problem	Influenza, treated in hospital	81
Health Problem	Cause of death: Complications of influenza	81
Living / Dead	Dead

Your Mother's Sisters 1

Your Mother's Sisters 2

Your Mother's Sisters 3

Your Father's Father

Question	Response	Comment/Age Affected
Current age or age at death	86
Health Problem	Pneumonia, treated in hospital	86
Health Problem	Cause of death: Pneumonia	86
Living / Dead	Dead

Your Father's Mother

Question	Response	Comment/Age Affected
Current age or age at death	93
Health Problem	Influenza, treated in hospital	93
Health Problem	Cause of death: Influenza	93
Living / Dead	Dead

Your Father's Brothers 1

Question	Response	Comment/Age Affected
Current age or age at death	43
Health Problem	Gunshot, at approximately age 19, treated with long-term pain medication
Health Problem	Cause of death: Drug overdose (pain medication)	43
Living / Dead	Dead

Your Father's Brothers 2

Height: 5'11" (180 cm)	Weight: 211 lb (95 kg)	Eye Color: Green	Hair: Brown/ Straight	Skin Tone: Light	Ancestry: Caucasian
	Blood Type: O+	Ethnic Background: German-Irish/Polish
	Education: BS/Management		Occupation: Train Conductor
Interests:	Electronics, Exercise, Landscaping, Learning Spanish, Movies, Reading

Faith	Christian
Denomination	Protestant

Update Available	Yes
Updates - Personal	No change to donor Personal Profile: July 2023.
Updates - Medical	No change to donor Medical Profile: July 2023.
Updates - Family Medical History	No change to donor Family Medical History: July 2023.

Donor Number: 5400