Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
6'2"
(187 cm) |
Weight:
196 lb
(88 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Straight |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
|
Blood Type:
O-
|
Ethnic Background:
French/English-Polish
|
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|
Education:
High School Diploma
|
Occupation:
Electrical Apprentice
|
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|
Interests:
|
Hockey, Reading, Rock Climbing, Soccer, Video games, 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: | No |
| Any dietary restrictions? If yes, explain: | Yes - Lactose intolerant |
| Do you wear glasses or contact lenses? Are you near or far-sighted? | Yes - Astigmatism, 15/15 |
| 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 | 49 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
Gluten intolerance at age 49, diet managed
Your Father
| Question | Response |
| Current age or age at death | 52 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High cholesterol
42
Diet managed
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 Brother 2
| Question | Response |
| Current age or age at death | 19 |
| 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 | 37 |
| 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 | 78 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Diabetes mellitus requiring insulin therapy
1
Insulin
Prostate cancer
77
Chemotherapy
Your Mother's Mother
| Question | Response |
| Current age or age at death | 68 |
| Living / Dead | Dead |
| Cause of death and any treatment prior to death | Lung cancer, stomach cancer |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Leukemia
63
Chemotherapy and radiation
Lung cancer
64
Chemotherapy and radiation
Stomach Cancer
64
Chemotherapy and radiation
Breast cancer
63
Chemotherapy and radiation
Your Mother's Brothers 1
| 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
Healthy
Your Mother'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
Your Mother's Brothers 3
| 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 Brothers 4
| 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
Healthy
Your Father's Father
| Question | Response |
| Current age or age at death | 78 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High cholesterol
64
Medication
Your Father's Mother
| Question | Response |
| Current age or age at death | 70 |
| 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 |
| 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 | 47 |
| Living / Dead | Living |
| Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy
Religion:
| Faith | Other |
| Denomination | Agnostic (raised Catholic) |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: August 2023. |
| Updates - Medical | No change to donor Medical Profile: August 2023. |
| Updates - Family Medical History | Update received August 2023: Maternal Grandfather has died from prostate cancer at age 80. |