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Fairfax Cryobank

Donor 2701 Summary Profile

Questions

Physical

Medical

Family Medical History

Updates to Profile

Physical
Race	Cauc
Ethnic Background	Austrian-German/Irish
Height	6'2''
Weight	185
Eye Color	Green
Hair	Brown/Straight
Skin Tone	Meddk
Blood Type	A+
Education	PhD/History/
Occupation	PhD student
Interests	Languages

Medical
Question	Response
Any dietary restrictions? If yes, explain:	No
Do you wear glasses or contact lenses? Are you near or far-sighted?	No
Allergies (medicines, food, pollens)? If yes, please list substance and reaction caused:	No
CMV IgG Antibody	Positive
CMV IgM Antibody	Negative
Note any comments regarding above items:	N/A

Family Medical History

Your Mother
Question	Response	Comment/Age Affected
Current age or age at death	57
Health Problem	Healthy
Living / Dead	Living

Your Father
Question	Response	Comment/Age Affected
Current age or age at death	59
Health Problem	Healthy
Living / Dead	Living

Brother(s)

Your Brother 1
Question	Response	Comment/Age Affected
Current age or age at death	37
Health Problem	Healthy
Living / Dead	Living

Sister(s)

Your Sister 1
Question	Response	Comment/Age Affected
Current age or age at death	27
Health Problem	Healthy
Living / Dead	Living

Your Mother's Father
Question	Response	Comment/Age Affected
Current age or age at death	85
Health Problem	Parkinson's disease  78  Cause of death - Pneumonia  85
Living / Dead	Dead

Your Mother's Mother
Question	Response	Comment/Age Affected
Current age or age at death	79
Health Problem	Loss of muscle coordination  65  Cause of Death - Heart failure  79
Living / Dead	Dead

Your Mother's Sisters 1
Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Father's Father
Question	Response	Comment/Age Affected
Current age or age at death	88
Health Problem	Healthy
Living / Dead	Living

Your Father's Mother
Question	Response	Comment/Age Affected
Current age or age at death	84
Health Problem	Depression  75  Breast cancer  75
Living / Dead	Living

Your Father's Sisters 1
Question	Response	Comment/Age Affected
Current age or age at death	62
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 2
Question	Response	Comment/Age Affected
Current age or age at death	60
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 3
Question	Response	Comment/Age Affected
Current age or age at death	52
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 4
Question	Response	Comment/Age Affected
Current age or age at death	50
Health Problem	Healthy
Living / Dead	Living

Your Father's Sisters 5
Question	Response	Comment/Age Affected
Current age or age at death	48
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 1
Question	Response	Comment/Age Affected
Current age or age at death	54
Health Problem	Healthy
Living / Dead	Living

Your Father's Brothers 2
Question	Response	Comment/Age Affected
Current age or age at death	46
Health Problem	Healthy
Living / Dead	Living

Updates to Profile
Update Available	Yes
Updates - Personal	Update received June 2022: Donor has earned a PhD in History and his occupation has changed to Professor. No change to donor Personal Profile: June 2023.
Updates - Medical	No change to donor Medical Profile: June 2022, June 2023.
Updates - Family Medical History	No change to donor Family Medical History: June 2022, June 2023.