This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:		Occasionally - 12oz./beer or wine
Tobacco use: Do you smoke?
If yes, #/day and for how long:		No
If you did smoke but quit, when did you last smoke?N/A
For how many years?N/A
Do you sleep well?Yes
Do you exercise on regular basis?Yes
Is your diet well balanced?
If no, explain:		Yes
Are you a vegetarian?No
Any dietary restrictions?
If yes, explain:		No

Sexual History

Have you ever had sex with:
Question Response
A partner whose sexual background you are unsure of in the past 12 months?No

Donor Genetic History

Question Response
Do you have a history of a speech disorder; such as a speech impediment, stuttering, delayed speech development, etc.?
If yes, explain:		No
Do you have learning differences, such as dyslexia?
If yes, explain:		No
Were you or any family members born with any birth defects?
If yes, explain:		No

Donor Medical History

Question Response
List any operations:
Age & reason:		Appendectomy, Wisdom teeth extraction - 9, 17
Hospitalization other than surgery:
Age & type of illness:		None - None
Have you ever had any broken bones?
If yes, please give age and description:		Yes - 6 right metatarsal and jumping off of a tall playground structure during a game of tag
Have you ever had any serious illnesses?
If yes, please give age and description:		No
Are you presently under a physician's care for any reason?
If yes, please describe:		No
List all drugs you have taken in past 12 months (prescription, nonprescription, herbal, and sports supplements, and recreational). Include drug, frequency and duration taken, and reason:None - None; Mone; None
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:None - None; None; None
Do you wear glasses or contact lenses?
Are you near or far-sighted?		Yes - 120/20, near-sighted since age 8
Birth weight lbs6
Birth weight ozs8
Recent weight loss or gain?
# of lbs and reason:		No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:		No
How many sexual partners do you currently have?1
Have you ever had a tattoo?Yes - 1998 Right arm; 2016, Right upper arm; 2020, Right anterior upper arm; 2021, Right upper arm; 2021, Right forearm; 2006 Left upper arm x2; 2018, Left upper arm and Left anterior upper arm; 2020, Left forearm x2
Have you ever had your ear(s) or body pierced?Yes - 1998 Ears

Family Medical History
See list of questions asked here

Mother's Father Ethnic OriginsNorwegian-German
Mother's Mother Ethnic OriginsGerman
Father's Father Ethnic OriginsGerman
Father's Mother Ethnic OriginNorwegian-German
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Your Mother
Question Response
Current age or age at death 68
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Father
Question Response
Current age or age at death 67
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Brothers
Your Brother 1
Question Response
Current age or age at death 41
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Sons
Your Son 1
Question Response
Current age or age at death 4
Living / DeadLiving
Health Problems
Healthy
Your Son 2
Question Response
Current age or age at death 1
Living / DeadLiving
Health Problems
Healthy
Your Mother's Father
Question Response
Current age or age at death 93
Living / DeadDead
Cause of death and any treatment prior to deathCOVID-19
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Covid-19, age 93, assisted living; Aneurysm, age 85 (surgery and recovered)
Your Mother's Mother
Question Response
Current age or age at death 93
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Miscarriages or stillborn
25
None, healthy babies prior and after
Alzheimer's
92
Therapeutic treatment
Your Mother's Sisters 1
Question Response
Current age or age at death 71
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 2
Question Response
Current age or age at death 71
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Sisters 3
Question Response
Current age or age at death 67
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Brothers 1
Question Response
Current age or age at death 66
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Your Mother's Brothers 2
Question Response
Current age or age at death 63
Living / DeadDead
Cause of death and any treatment prior to deathAccident
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Aneurysm, age 48, treated with stent
Your Father's Father
Question Response
Current age or age at death 53
Living / DeadDead
Cause of death and any treatment prior to deathDrowning accident
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death
Your Father's Mother
Question Response
Current age or age at death 93
Living / DeadDead
Cause of death and any treatment prior to deathHeart failure
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stroke
82
Caused partial paralysis, treated with physical therapy and long term care
Other heart disease
93
Heart failure, none
Macular Degeneration
75
Medication
Your Father's Sisters 1
Question Response
Current age or age at death 69
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy