A medical update has been received. Check the Summary Profile Update Section

Personal Behavior History

Question Response
Current alcohol use:
If yes, oz./week and type of alcohol:
Regularly - 50 oz. beer/week
Have you or any of your family members been diagnosed with alcoholism or drug addiction?
If yes, relation and age affected:
Yes - Mother (alcohol abuse), age 30, treated by abstaining from alcohol
Tobacco use: Do you smoke?
If yes, #/day and for how long:
No
If you did smoke but quit, when did you last smoke?N/A
For how many years?0
Do you sleep well?Yes
Do you exercise on regular basis?Yes
Is your diet well balanced?
If no, explain:
Yes
Are you a vegetarian?No
Any dietary restrictions?
If yes, explain:
No

Sexual History

Question Response
A partner whose sexual background you are unsure of in the past 12 months?No
Another man anal or oral, even once, since 1977?No

Donor Genetic History

Question Response
Were you or any family members born with any birth defects?
If yes, explain:
No
Have you been tested for Cystic Fibrosis?
If yes, the result:
Yes - Non-carrier for at least 97 mutations
Karyotype?
If yes, the result:
Yes - Normal karyotype
Spinal Muscular Atrophy (SMA)?
If yes, the result:
Non Carrier - Standard donor screening
Tay Sachs?
If yes, the result:
Non Carrier - Standard donor screening
Question Response
Are you of Jewish ancestry?
If yes, please note: Ashkenazi, Sephardi, or Other
No
Question Response
Tay Sachs:
If yes, result(s):
N/A
Gaucher:
If yes, result(s):
N/A
Canavan:
If yes, result(s):
N/A
Fanconi Anemia Type C:
If yes, result(s):
N/A
Niemann-Pick Type A:
If yes, result(s):
N/A
Bloom Syndrome:
If yes, result(s):
N/A
Familial Dysautonomia:
If yes, result(s):
N/A
Mucolipidosis IV:
If yes, result(s):
N/A
Maple Syrup Urine Disease 1B:
If yes, result(s):
N/A
Usher Syndrome III & 1F:
If yes, result(s):
N/A
Glycogen Storage Disease 1A:
If yes, result(s):
N/A
ABCC8-Related Hyperinsulinism:
If yes, result(s):
N/A
BRCA1/BRCA2:
If yes, result(s):
N/A
Lipoamide Dehydrogenase Deficiency:
If yes, result(s):
N/A
Question Response
Are you of African ancestry?No
If yes, have you been tested as a carrier of sickle cell anemia?Yes - Standard donor screening
If yes, result:Non Carrier
Are you of Mediterranean, Greek or Italian ancestry?No
If yes, have you been tested as a carrier of beta thalassemia?Yes - Standard donor screening
If yes, result:Non Carrier
Heart attackGrandparent - Paternal grandfather, age 62 (cause of death); Aunt/Uncle - Paternal aunt, age 65
Congenital heart diseaseNone
Hemophilia/bleeding problemNone
EmphysemaGrandparent
Cystic FibrosisNone
Alpha-1 Antitrypsin DeficiencyNone
Pyloric stenosisNone
Colon cancerN/A
Inflammatory bowel diseaseNone
Irritable Bowel SyndromeN/A
Diabetes mellitus requiring insulin therapyNone
Diabetes mellitus not requiring insulin therapyNone
PKU or inherited metabolism disorderNone
Progressive kidney diseaseNone
Polycystic kidney diseaseNone
Miscarriages or stillbornNone
Herpes simplex virus, genitalNone
MigrainesNone
Mental retardationNone
Senility or mental deterioration before age 60None
Epilepsy/seizuresNone
Neural tube defects - open spine or hydrocephalus/water on the brainNone
Huntington's diseaseNone
Tuberous sclerosisNone
NeurofibromatosisNone
Parkinson's diseaseNone
Down SyndromeNone
AutismNone
Autism Spectrum DisorderNone
Pervasive Developmental Delay (PDD)None
Asperger's SyndromeNone
SchizophreniaNone
Bipolar (manic depressive psychosis)None
Attention Deficit Disorder (ADD)N/A
Attention Deficit Hyperactivity Disorder (ADHD)N/A
Muscular DystrophyNone
Loss of muscle coordinationNone
Rheumatoid ArthritisNone
Reiter's DiseaseNone
Club footNone
Deafness before age of 60None
Cataracts before age of 60None
Blindness in both eyes before age of 60None
GlaucomaNone
Macular DegenerationN/A
AcneNone
PsoriasisNone
AlbinismNone
More than 5 purple or coffee-colored spots on the skin-1.5 cm (1/2 inch) or largerNone
Drug abuse, misuse, or addictionMother - (alcohol abuse) age 30, treated by abstaining from alcohol
Cleft palate or cleft lipNone
Serious birth defectsNone
Inguinal herniaNone
Premature degeneration of any organ systemNone
The same cancer in more than one family memberNone

Donor Medical History

Question Response
List any operations:
Age & reason:
Appendectomy at age 13 due to an infection
Hospitalization other than surgery:
Age & type of illness:
Meningitis at age 7, successfully treated with medication
Have you ever had any broken bones?
If yes, please give age and description:
Yes - Broken arm at age 6 due to a sports-related/accidental injury
Have you ever had any serious illnesses?
If yes, please give age and description:
Yes
How many days in the past 12 months could you not work because of all illness (colds, flu, accidents, surgery, etc)?
Please describe:
0
Are you presently under a physician's care for any reason?
If yes, please describe:
No
List all drugs you have taken in past 12 months (prescription, nonprescription, herbal, and sports supplements, and recreational). Include drug, frequency and duration taken, and reason:None
List all current medication or treatments (include vitamins, aspirin, antacids, laxatives, herbal, sports supplements, etc.) Include drug, frequency and duration taken, and reason:None
Do you wear glasses or contact lenses?
Are you near or far-sighted?
Yes - Near-sighted
Usual weight?190
Recent weight loss or gain?
# of lbs and reason:
No
Allergies (medicines, food, pollens)?
If yes, please list substance and reaction caused:
No
Have you been tested for HIV (AIDS)?
If yes, when:
Yes - Negative, ongoing donor screening
Sexual orientation:Heterosexual
How many sexual partners do you currently have?N/A
Have you ever had a tattoo?
If yes, what year did you get the tattoo?
Yes - Both arms in 2005
Have you ever had your ear(s) or body pierced?
If yes, where and what year?
Yes - Ear, 1992

Family Medical History
See list of questions asked here

Question Response Comment/Age Affected
Current age or age at death 61
Health Problem Alcohol abuse, treated by abstaining from alcohol30
Esophageal cancer (long-time smoker), successfully treated with surgery58
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 73
Health Problem Prostate cancer, successfully treated with surgery72
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 34
Health Problem Healthy 
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 12
Health Problem Healthy 
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 7
Health Problem Healthy 
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 1
Health Problem Healthy 
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 65
Health Problem Cause of death: Cardiac arrest65
Living / DeadDead
Question Response Comment/Age Affected
Current age or age at death 83
Health Problem Emphysema (long-time smoker), controlled with a nebulizer75
Lung cancer (long-time smoker), no medication or treatment received83
Cause of death: Lung cancer83
Living / DeadDead
Question Response Comment/Age Affected
Current age or age at death 63
Health Problem Healthy 
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 62
Health Problem Healthy 
Living / DeadLiving
Question Response Comment/Age Affected
Current age or age at death 62
Health Problem Heart attack, no medication or treatment received62
Cause of death: Heart attack62
Living / DeadDead
Question Response Comment/Age Affected
Current age or age at death 60
Health Problem Pneumonia, no medication or treatment received60
Cause of death: Pneumonia60
Living / DeadDead
Question Response Comment/Age Affected
Current age or age at death 76
Health Problem Heart attack (due to a poor lifestyle), treated with valve replacement surgery65
Living / DeadLiving