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:
Rarely - Recently quit drinking, previously Mezcal, 4-5x per year
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

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:
N/A
Hospitalization other than surgery:
Age & type of illness:
Yes - Age 12, appendicitis (no surgery); Age 18, concussion
Have you ever had any broken bones?
If yes, please give age and description:
Yes - Age 14, left fibula, jumped off porch and landed on uneven ground.
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:Probiotic - Daily; 10/2020 to Present; Digestive health
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:Probiotic - Daily; 10/2020 to Present; Digestive health
Do you wear glasses or contact lenses?
Are you near or far-sighted?
Yes - Nearsighted, R: -2.00, -1.00, 180.00 L: -2.00, -1.00, 180.00
Birth weight lbs6
Birth weight ozs4
Recent weight loss or gain?
# of lbs and reason:
Yes - 45 pounds lost, diet and exercise
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?No
Have you ever had your ear(s) or body pierced?Yes
Piercing #1 Year2020
Piercing #1 LocationBoth ears

Family Medical History
See list of questions asked here

Mother's Father Ethnic OriginsNicaraguan
Mother's Mother Ethnic OriginsNicaraguan
Father's Father Ethnic OriginsNicaraguan
Father's Mother Ethnic OriginNicaraguan
Is anyone in your family of Ashkenazai Jewish Heritage?No
If yes, who?N/A
Question Response
Current age or age at death 46
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High cholesterol
43
Diet
Any other cancer/problem of digestive system
43
Gastritis, medication and diet
Question Response
Current age or age at death 54
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 18
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Car accident at age 18, suffered fractures to face and skull.
Question Response
Current age or age at death 12
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Depression
12
Therapy and medication
Question Response
Current age or age at death 74
Living / DeadDead
Cause of death and any treatment prior to deathStroke and ruptured ulcer
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Ulcer of stomach/duodenum
70
No treatment
Diabetes mellitus requiring insulin therapy
60
Insulin
Drug abuse, misuse, or addiction
42
Alcoholism, no treatment.
Question Response
Current age or age at death 68
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Rheumatoid Arthritis
57
Anti-inflammatory and pain medication
Question Response
Current age or age at death 56
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 53
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 51
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 50
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 49
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 52
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
45
Diet change
High cholesterol
45
Diet change
Question Response
Current age or age at death 49
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 45
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 38
Living / DeadDead
Cause of death and any treatment prior to deathMeningitis
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
Hydrocephalus and paraplegia in childhood due to medical malpractice
Question Response
Current age or age at death 82
Living / DeadDead
Cause of death and any treatment prior to deathHomicide
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
 
No diagnosed health problems at time of death.
Question Response
Current age or age at death 73
Living / DeadDead
Cause of death and any treatment prior to deathStroke
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Stroke
73
Fatal, no treatment
Question Response
Current age or age at death 67
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy
Question Response
Current age or age at death 58
Living / DeadLiving
Cause of death and any treatment prior to deathN/A
Health Problems
Healthy