Fairfax Cryobank
Donor 2715 Summary Profile






Questions
Physical
Medical
Family Medical History
Updates to Profile

Physical
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
QuestionResponse
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 AntibodyNegative
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  41   
 Health Problem
 Irregular heartbeat, treated with medication 40
 Living / Dead Living  

Your Father
QuestionResponseComment/Age Affected
 Current age or age at death  44   
 Health Problem
 High blood pressure, controlled by diet and exercise 39
 Living / Dead Living  

Your Mother's Father
QuestionResponseComment/Age Affected
 Current age or age at death  73   
 Health Problem
 Liver failure - cause of death 72
 Living / Dead Dead  

Your Mother's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  69   
 Health Problem
 Arthritis, unsure if medication taken 63
 Living / Dead Living  

Your Mother's Sisters 1
QuestionResponseComment/Age Affected
 Current age or age at death  52   
 Health Problem
 Overweight 48
 Living / Dead Living  

Your Mother's Sisters 2
QuestionResponseComment/Age Affected
 Current age or age at death  50   
 Health Problem
 Overweight 42
 Living / Dead Living  

Your Mother's Sisters 3
QuestionResponseComment/Age Affected
 Current age or age at death  48   
 Health Problem
 Sinus congestion, treated with OTC nasal spray 30
 Diagnosed with emphysema due to heavy smoking all her life, unsure of treatment 42
 Living / Dead Living  

Your Mother's Sisters 4
QuestionResponseComment/Age Affected
 Current age or age at death  44   
 Health Problem
 Allergies to pollen, grass 30
 Living / Dead Living  

Your Mother's Sisters 5
QuestionResponseComment/Age Affected
 Current age or age at death  43   
 Health Problem
 Allergies to pollen, grass 30
 Migraines, treated with medication if severe 40
 Living / Dead Living  

Your Mother's Sisters 6
QuestionResponseComment/Age Affected
 Current age or age at death  40   
 Health Problem
 Arthritis, treated with medication 37
 Living / Dead Living  

Your Mother's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  54   
 Health Problem
 High blood pressure, treated with medication 46
 Living / Dead Living  

Your Mother's Brothers 2
QuestionResponseComment/Age Affected
 Current age or age at death  50   
 Health Problem
 Allergies to pollen, grass 44
 Living / Dead Living  

Your Mother's Brothers 3
QuestionResponseComment/Age Affected
 Current age or age at death  45   
 Health Problem
 Sinus congestion, treated with OTC medication 37
 Living / Dead Living  

Your Mother's Brothers 4
QuestionResponseComment/Age Affected
 Current age or age at death  43   
 Health Problem
 Allergies to pollen, grass 35
 Mild asthma, uses inhaler 35
 Living / Dead Living  

Your Mother's Brothers 5
QuestionResponseComment/Age Affected
 Current age or age at death  41   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 6
QuestionResponseComment/Age Affected
 Current age or age at death  39   
 Health Problem
 Healthy 
 Living / Dead Living  

Your Mother's Brothers 7
QuestionResponseComment/Age Affected
 Current age or age at death  35   
 Health Problem
 Sinus congestion, treated with OTC medication 25
 Living / Dead Living  

Your Father's Father
QuestionResponseComment/Age Affected
 Current age or age at death  70   
 Health Problem
 Recovering alcoholic 40
 High blood pressure, treated with medication 40
 Living / Dead Living  

Your Father's Mother
QuestionResponseComment/Age Affected
 Current age or age at death  50   
 Health Problem
 Stroke - cause of death 50
 Living / Dead Dead  

Your Father's Sisters 1
QuestionResponseComment/Age Affected
 Current age or age at death  51   
 Health Problem
 Overweight; poor diet, lack of exercise 40
 High blood pressure, controlled with medication 40
 Living / Dead Living  

Your Father's Brothers 1
QuestionResponseComment/Age Affected
 Current age or age at death  48   
 Health Problem
 Overweight; poor diet, lack of exercise 45
 Living / Dead Living  

Updates to Profile
Update Available N/A
Updates - Personal N/A
Updates - Medical N/A
Updates - Family Medical History N/A