Fairfax Cryobank |
Donor 2715 Summary Profile |
Questions |
Physical |
Medical |
Family Medical History |
Updates to Profile |
Race | Black |
Ethnic Background | African American/African American |
Height | 6'2'' |
Weight | 167 |
Eye Color | Brown |
Hair | Black/Curly |
Skin Tone | Med |
Blood Type | B- |
Education | BS/Psychology/ |
Occupation | Student |
Interests | Cars/Computer/Clothes |
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: | Yes - Demoral, causes hives; Claritin taken for seasonal allergies this year only | |
CMV IgG Antibody | Negative | |
CMV IgM Antibody | Negative | |
Note any comments regarding above items: | N/A |
Family Medical History |
Your MotherQuestion | Response | Comment/Age Affected | Current age or age at death | 41 | | Health Problem |
Living / Dead | Living | |
|
Your FatherQuestion | Response | Comment/Age Affected | Current age or age at death | 44 | | Health Problem |
Living / Dead | Living | |
|
Your Mother's FatherQuestion | Response | Comment/Age Affected | Current age or age at death | 73 | | Health Problem |
Living / Dead | Dead | |
|
Your Mother's MotherQuestion | Response | Comment/Age Affected | Current age or age at death | 69 | | Health Problem |
Living / Dead | Living | |
|
Your Mother's Sisters 1Question | Response | Comment/Age Affected | Current age or age at death | 52 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Sisters 2Question | Response | Comment/Age Affected | Current age or age at death | 50 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Sisters 4Question | Response | Comment/Age Affected | Current age or age at death | 44 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Sisters 5Question | Response | Comment/Age Affected | Current age or age at death | 43 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Sisters 6Question | Response | Comment/Age Affected | Current age or age at death | 40 | | Health Problem |
Living / Dead | Living | |
|
Your Mother's Brothers 1Question | Response | Comment/Age Affected | Current age or age at death | 54 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Brothers 2Question | Response | Comment/Age Affected | Current age or age at death | 50 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Brothers 3Question | Response | Comment/Age Affected | Current age or age at death | 45 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Brothers 4Question | Response | Comment/Age Affected | Current age or age at death | 43 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Brothers 5Question | Response | Comment/Age Affected | Current age or age at death | 41 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Brothers 6Question | Response | Comment/Age Affected | Current age or age at death | 39 | | Health Problem |
Living / Dead | Living | | |
Your Mother's Brothers 7Question | Response | Comment/Age Affected | Current age or age at death | 35 | | Health Problem |
Living / Dead | Living | |
|
Your Father's FatherQuestion | Response | Comment/Age Affected | Current age or age at death | 70 | | Health Problem |
Living / Dead | Living | |
|
Your Father's MotherQuestion | Response | Comment/Age Affected | Current age or age at death | 50 | | Health Problem |
Living / Dead | Dead | |
|
Your Father's Sisters 1Question | Response | Comment/Age Affected | Current age or age at death | 51 | | Health Problem |
Living / Dead | Living | |
|
Your Father's Brothers 1Question | Response | Comment/Age Affected | Current age or age at death | 48 | | Health Problem |
Living / Dead | Living | |
|
Updates to Profile | ||
Update Available | N/A | |
Updates - Personal | N/A | |
Updates - Medical | N/A | |
Updates - Family Medical History | N/A |