Physical
Medical
Family Medical History
Religion
Updates to ProfilePhysical
|
Height:
6'2"
(187 cm) |
Weight:
172 lb
(78 kg) |
Eye Color:
Brown
|
Hair:
Brown/
Straight |
Skin Tone:
Medium
|
Ancestry:
Caucasian
|
|
Blood Type:
O+
|
Ethnic Background:
Dutch/Dutch-French
|
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|
Education:
MBA/Business Administration
|
Occupation:
Director of IT
|
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|
Interests:
|
Biking, Boxing, Hiking, Learning knots, Live Music, Outdoor work, Running, Survival skills
|
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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: | 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 | 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 | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Miscarriage | 28 | |
| Living / Dead | Living |
Your Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 60 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Brothers
Your Brother 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 36 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 30 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Brother 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 28 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 92 | |
| Health Problem | Malaria (during WWII, treated by military) | 26 |
| Stroke (treated with stent) | 90 | |
| Cause of death: Heart failure | 92 | |
| Living / Dead | Dead |
Your Mother's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 92 | |
| Health Problem | Healthy | |
| Cause of death: Heart failure | 92 | |
| Living / Dead | Dead |
Your Mother's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 65 | |
| Health Problem | Osteoarthritis in both wrists (treated with over-the-counter remedies) | 60 |
| Living / Dead | Living |
Your Mother's Sisters 2
| Question | Response | Comment/Age Affected |
| Current age or age at death | 63 | (Identical twin) |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Mother's Sisters 3
| Question | Response | Comment/Age Affected |
| Current age or age at death | 63 | (Identical twin) |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Father
| Question | Response | Comment/Age Affected |
| Current age or age at death | 91 | |
| Health Problem | Healthy | |
| Cause of death: Heart failure | 91 | |
| Living / Dead | Dead |
Your Father's Mother
| Question | Response | Comment/Age Affected |
| Current age or age at death | 94 | |
| Health Problem | Healthy | |
| Cause of death: Heart failure | 94 | |
| Living / Dead | Dead |
Your Father's Sisters 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 58 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Your Father's Brothers 1
| Question | Response | Comment/Age Affected |
| Current age or age at death | 59 | |
| Health Problem | Healthy | |
| Living / Dead | Living |
Religion:
| Faith | Christian |
| Denomination | Protestant |
Updates to Profile
| Update Available | Yes |
| Updates - Personal | No change to donor Personal Profile: May 2016, August 2018, July 2019, April 2020, May 2021, March 2022. |
| Updates - Medical | No change to donor Medical Profile: May 2016, August 2018, July 2019, April 2020, May 2021, March 2022. |
| Updates - Family Medical History | No change to donor Family Medical History: May 2016, August 2018, July 2019, April 2020, May 2021, March 2022. |