Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
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Height:
5'10"
(177 cm) |
Weight:
165 lb
(74 kg) |
Eye Color:
Blue
|
Hair:
Blond/
Straight |
Skin Tone:
Light
|
Ancestry:
Caucasian
|
|
Blood Type:
AB+
|
Ethnic Background:
German/Dutch-German
|
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Education:
MD/Medicine
|
Occupation:
Medical Scribe
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Interests:
|
Juggling, Piano, Running, Weightlifting
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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: | Yes - Paternal uncle #2, age 40, alcohol abuse |
| Any dietary restrictions? If yes, explain: | No |
| Do you wear glasses or contact lenses? Are you near or far-sighted? | No - (Near-sighted before laser surgery) |
| Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused: | Yes - Dust mites: Asthma trigger; Seasonal allergies: Cause typical symptoms |
| 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 | 60 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Irritable Bowel Syndrome
55
Diet modification
Your Father
| Question | Response |
| Current age or age at death | 60 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Red-green color blindness (No other family members affected)
12
None
Skin cancer
55
Surgery, Blue light treatment
Brothers
Your Brother 1
| Question | Response |
| Current age or age at death | 26 |
| 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 | 32 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Bulimia (resolved)
18
Therapy
Your Sister 2
| Question | Response |
| Current age or age at death | 24 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Sons
Your Son 1
| Question | Response |
| Current age or age at death | 1 |
| Living / Dead | Living |
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 | Congestive heart failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stroke
41
None
Transient ischemic attack
55
Medication
Osteoarthritis
63
None
Diabetes mellitus not requiring insulin therapy
70
Medication
High cholesterol
75
Medication
Heart attack
75
Quadruple bypass surgery
Meningitis
82
Hospitalized
Congestive heart failure
90
None
Your Mother's Mother
| Question | Response |
| Current age or age at death | 84 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Pancreatic cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Chronic Obstructive Pulmonary Disease (smoker)
75
Oxygen
Pancreatic cancer
84
None
Your Mother's Brothers 1
| Question | Response |
| Current age or age at death | 64 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Your Mother's Brothers 2
| 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
Disease
Age Diagnosed
Treatment For Condition
Obesity
30
Diet
Your Mother's Brothers 3
| 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
Disease
Age Diagnosed
Treatment For Condition
Obesity
40
None
Your Father's Father
| Question | Response |
| Current age or age at death | 84 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Skin cancer
52
Surgery
Your Father's Mother
| Question | Response |
| Current age or age at death | 78 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Renal failure |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus requiring insulin therapy
60
N/A
Renal failure
74
None
Your Father'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 Father's Brothers 1
| 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
Disease
Age Diagnosed
Treatment For Condition
Detached retina
60
Surgery
Your Father's Brothers 2
| 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
Disease
Age Diagnosed
Treatment For Condition
Alcohol abuse
40
None
Religion:
| Faith | Christian |
| Denomination | Catholic |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to profile: July 2020. Update received June 2021: Occupation has changed to Family Medicine Resident Physician. No change to donor Personal Profile: May 2022. Update received August 2023: Occupation has changed to Family Medicine Physician. |
| Updates - Medical | No change to profile: July 2020, June 2021, May 2022, August 2023. |
| Updates - Family Medical History | No change to profile: July 2020. Update received June 2021: Donor reports birth of second healthy son. No change to donor Family Medical History: May 2022. Update received August 2023: Donor reports the birth of three health daughters. |