Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
5'5"
(165 cm) |
Weight:
136 lb
(61 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Wavy |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
|
Blood Type:
B-
|
Ethnic Background:
German/Scandinavian
|
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Education:
Some college
|
Occupation:
Actor, Model, Comedian
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Interests:
|
Acting, Comedy, Film, Music, Sports
|
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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: | Yes - Seasonal allergies: Cause itchy face and eyes |
| 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 |
| Current age or age at death | 61 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father
| Question | Response |
| Current age or age at death | 62 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 31 |
| 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 | 90 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural causes |
Health Problems
Healthy
Your Mother's Mother
| Question | Response |
| Current age or age at death | 91 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural causes |
Health Problems
Healthy
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 17 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Trauma |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Trauma due to car accident
17
None
Your Father's Father
| Question | Response |
| Current age or age at death | 89 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural causes |
Health Problems
Healthy
Your Father's Mother
| Question | Response |
| Current age or age at death | 90 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Natural causes |
Health Problems
Healthy
Your Father's Sisters 1
| Question | Response |
| Current age or age at death | 68 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Father's Sisters 2
| Question | Response |
| Current age or age at death | 65 |
| 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 | 74 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Christian |
| Denomination | Baptist |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to Personal Profile: August 2019, June 2020. Update received July 2022: Occupation has changed to Student Pilot. No change to donor Personal Profile: January 2023. |
| Updates - Medical | No change to Medical Profile: August 2019, June 2020, July 2022, January 2023. |
| Updates - Family Medical History | No change to Family Medical History: August 2019, June 2020, July 2022, January 2023. |