This donor is a healthy carrier for a genetic disease.
Please see his Genetic Testing Summary and Acknowledgment of Genetic Risk for details
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: | Frequently - 32oz./week, craft beer and vodka |
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: | Wisdom teeth removed - Age 22 |
Hospitalization other than surgery: Age & type of illness: | N/A - N/A |
Have you ever had any broken bones? If yes, please give age and description: | Yes - Age 9, fully broke humerus a playground tic-tac-toe roller |
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: | Alcohol; small amounts of marijuana - Two drinks a week; sharing a joint once every other month or so; Alcohol for the past couple years; marijuana for the past year; Alcohol and marijuana both for social occasions |
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason: | Daily multivitamin - Daily; Two months; Immune system support |
Do you wear glasses or contact lenses? Are you near or far-sighted? | No |
Birth weight lbs | 8 |
Birth weight ozs | 15 |
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? | 0 |
Have you ever had a tattoo? | Yes - 2018 Back left shoulder |
Have you ever had your ear(s) or body pierced? | No |
Family Medical HistorySee list of questions asked here
Mother's Father Ethnic Origins | Russian (Jewish) |
Mother's Mother Ethnic Origins | Russian (Jewish) |
Father's Father Ethnic Origins | Russian |
Father's Mother Ethnic Origin | Ukrainian |
Is anyone in your family of Ashkenazai Jewish Heritage? | Yes |
If yes, who? | All of mother's side |
Your Mother
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
Healthy
Your Father
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
Disease
Age Diagnosed
Treatment For Condition
High cholesterol
54
Less fatty diet
Brothers
Your Brother 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
Healthy
Your Brother 2
Question | Response |
Current age or age at death | 28 |
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 | 70 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Heart attack |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
High blood pressure
60
Advised to make lifestyle changes
High cholesterol
60
Advised to make lifestyle changes
Your Mother's Mother
Question | Response |
Current age or age at death | 80 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Lung cancer
75
Surgery; in complete remission
Your Mother's Sisters 1
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 | 20 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Cliff diving accident |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Early death (less than age 50)
20
Accidental death (cliff diving)
Your Father's Mother
Question | Response |
Current age or age at death | 82 |
Living / Dead | Dead |
Cause of death and any treatment prior to death | Accident (fall) |
Health Problems
Disease
Age Diagnosed
Treatment For Condition
Other
The fall was due to a blood clot caused by surgery to treat lung cancer that had been undiagnosed for some time. Exact age of cancer diagnosis unknown.
Your Father's Sisters 1
Question | Response |
Current age or age at death | 50 |
Living / Dead | Living |
Cause of death and any treatment prior to death | N/A |
Health Problems
Healthy