Fairfax Cryobank
Donor 2935 Summary Profile






Questions
Physical
Medical
Family Medical History
Updates to Profile

Physical
Race Cauc
Ethnic Background English-Czech-German/Scottish-Irish-English
Height 6'2''
Weight 182
Eye Color Brown
Hair Brown/Wavy
Skin Tone Medl
Blood Type O-
Education BA/Psychology/
Occupation Social Worker
Interests Singing/Acting/Cooking

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

Family Medical History

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

Your Father
QuestionResponseComment/Age Affected
 Current age or age at death  55   
 Health Problem
 Healthy 
 Living / Dead Living  

Sister(s)

Your Sister 1
QuestionResponseComment/Age Affected
 Current age or age at death  25   
 Health Problem
 Healthy 
 Living / Dead Living  

Daughter(s)

Your Daughter 1
QuestionResponseComment/Age Affected
 Current age or age at death  1   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Father
QuestionResponseComment/Age Affected
 Current age or age at death  76   
 Health Problem
 High blood pressure, treated with medication and by controlling his diet 70
 Cause of death: Heart failure 76
 Living / Dead Dead  

Your Mother's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  81   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Sisters 1
QuestionResponseComment/Age Affected
 Current age or age at death  55   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  51   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Father
QuestionResponseComment/Age Affected
 Current age or age at death  78   
 Health Problem
 Heart arythmia, treated by implanting a defibulator 72
 Cause of death: Heart failure 78
 Living / Dead Dead  

Your Father's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  78   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Father's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  52   
 Health Problem
 Healthy 
 Living / Dead Living  

Religion:
Faith  Other
Denomination  Agnostic

Updates to Profile
Update Available Yes
Updates - Personal Update received March 2023: Occupation has changed to Senior Lead Systems Analyst
Updates - Medical No change to donor Medical Profile: March 2023.
Updates - Family Medical History Update received March 2023: Maternal Grandmother has died at age 89, specific cause unreported; Paternal Grandmother has died at age 90, specific cause unreported.