Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
5'7"
(170 cm) |
Weight:
173 lb
(78 kg) |
Eye Color:
Blue
|
Hair:
Blond/
Straight |
Skin Tone:
Medium Light
|
Ancestry:
Caucasian
|
|
Blood Type:
O+
|
Ethnic Background:
Irish-Italian/English-German
|
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|
Education:
BS/Fire Protection
|
Occupation:
Firefighter/EMT
|
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|
Interests:
|
Auto repairs, Public service, Scuba Diving
|
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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 |
| Current age or age at death | 53 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Osteoarthritis
50
Hip replacement
Your Father
| Question | Response |
| Current age or age at death | 56 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Sisters
Your Sister 1
| Question | Response |
| Current age or age at death | 20 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Father
| Question | Response |
| Current age or age at death | 80 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Pulmonary hypertension |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Pulmonary hypertension
80
Medication and life support
Your Mother's Mother
| Question | Response |
| Current age or age at death | 75 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes not requiring insulin therapy
70
Managed with diet
Left ventricular hypertrophy
75
Alcohol ablation
Your Mother's Sisters 1
| Question | Response |
| Current age or age at death | 58 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 2
| Question | Response |
| Current age or age at death | 55 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 3
| Question | Response |
| Current age or age at death | 51 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 4
| Question | Response |
| Current age or age at death | 47 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Sisters 5
| Question | Response |
| Current age or age at death | 43 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Father
| Question | Response |
| Current age or age at death | 50 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Hypothermia |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Died on farm after being exposed to freezing temperatures
50
N/A
Your Father's Mother
| Question | Response |
| Current age or age at death | 83 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 49 - Maternal half sister |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Brothers 1
| Question | Response |
| Current age or age at death | 33 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Suicide |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Suicide (no history of depression or mental disturbance)
33
N/A
Your Father's Brothers 2
| Question | Response |
| Current age or age at death | 57 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | None |
| Denomination | N/A |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: April 2019, September 2020. |
| Updates - Medical | No change to donor Medical Profile: April 2019, September 2020. |
| Updates - Family Medical History | No change to donor Family Medical History: April 2019, September 2020. |