Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
5'7"
(170 cm) |
Weight:
180 lb
(81 kg) |
Eye Color:
Brown
|
Hair:
Black/
Curly |
Skin Tone:
Medium Dark
|
Ancestry:
Black
|
|
Blood Type:
O+
|
Ethnic Background:
African Amer.-Native Amer./African American
|
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|
Education:
BS/Pre-Pharmacy
|
Occupation:
Student
|
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|
Interests:
|
Boxing, Outdoor Activities
|
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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 | Negative |
| 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 | 46 | |
| Health Problem | Uterine fibroids, treated with surgery | 45 |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 46 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | Paternal half brother |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | Paternal half brother |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 18 | Paternal half brother |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 17 | Paternal half brother |
| Health Problem | Healthy | |
| Living / Dead | Living |
Sisters
Your Sister 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 26 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Sister 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 25 | Paternal half sister |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Sister 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 20 | Paternal half sister |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Sister 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 20 | Paternal half sister |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Sister 5
| Question | Response | Comment/Age Affected |
| Current age or age at death | 16 | Paternal half sister |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 70 | |
| Health Problem | Internal hemorrhage, no treatment | 70 |
| Cause of death: Internal hemorrhage | 70 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 73 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 50 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 48 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 67 | |
| Health Problem | Heart attack, no treatment | 67 |
| Cause of death: Heart attack | 67 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 70 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 35 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 47 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 34 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 4
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | Islam |
| Denomination | N/A |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: October 2018, April 2019, August 2019. |
| Updates - Medical | No change to donor Medical Profile: October 2018, April 2019, August 2019. |
| Updates - Family Medical History | No change to donor Family Medical History: October 2018, April 2019, August 2019. |