PATIENT PROVIDER · Buffalo milk L 1 L 4 Buttermilk L 6 L 6 Butternut Squash L 3 L 3 Cane sugar L 2...

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PATIENT PROVIDER

The comments in this report are meant only for potential risk mitigation.Please consult your physician for medication, treatment or life style management.

Vibrant America | 1021 Howard Ave, Ste B. San Carlos, CA 940701(866) 364-0963 | [email protected] | www.vibrant-america.com

Final Report Date: 10-28-2019 20:38 Specimen Collected: 11-30-2015

Accession ID: 1512010000 Specimen Received: 12-01-2015 00:00

LAST NAME FIRST NAME GENDER DATE OF BIRTH ACCESSION ID DATE OF SERVICE

TESTNAME PATIENT MALE 1961-01-20 1512010000 11-30-2015

Name: PATIENT TESTNAMEDate of Birth: 1961-01-20Gender: MaleAge: 58Height: 5'9'' Weight: 160 lbsTelephone #: [email protected] Address: 1021 HOWARD AVENUE SUITE BCity: SAN CARLOSState: CA Zip #: 94070Fasting: FASTING No. of hours: 12.0

Practice Name: Vibrant IT4 PracticeProvider Name: Vibrant IT4, MD (999999)Street Address: 999999 PRACTICE STREET AVECity: SAN CARLOSState: CAZip #: 94404Telephone #: 666-666-6662Fax #: 111-222-0000

For doctor's reference

High Risk Moderate N/ASUMMARY 1-3 L Low - Not Ordered

DIETARY ANTIGENALLERGEN SENSITIVITIES

IgE IgG IgAAcorn Squash L 7 L 10Agave 13 L 8Alaska pollock L 4 L 6Almond L 1 L 5Amaranth L 2 L 2Anchovy L 5 25Anise L 9 L 7Apple L 5 L 9Apricot L 1 23Arrowroot L 6 L 9Artichoke L 9 L 2Arugula L 7 L 1Asparagus L 6 L 9Avocado L 6 L 8Bamboo shoots L 2 27Banana L 6 L 2Barley L 9 L 6Bay leaf 22 L 10Beef L 1 29Beet root L 6 L 1Beta-Casein L 3 L 6Black Beans L 5 L 8Black Walnut L 5 L 1Black pepper L 6 L 6Black tea L 8 28Black-eye Peas L 6 L 1Blackberry L 8 L 9Blue mussel L 8 L 4Blueberry L 1 L 2Brazilnut L 4 L 5Broad bean L 7 27Broccoli L 5 25Brown Rice L 6 L 8Buckwheat L 4 L 9


IgE IgG IgABuffalo milk L 1 L 4Buttermilk L 6 L 6Butternut Squash L 3 L 3Cane sugar L 2 L 1Cantaloupe L 2 L 6Capers L 8 L 6Caraway L 2 L 5Carp L 3 L 7Carrot L 3 L 6Cashews L 8 L 9Casomorphin L 7 L 4Cassava L 6 L 9Catfish L 9 L 3Cauliflower L 6 L 6Cayenne pepper L 9 L 7Celery L 2 L 10Chard L 7 L 4Cheddar cheese L 3 L 10Cherry L 4 L 7Chia L 7 L 6Chicken L 5 L 5Chickpea L 5 L 1Cilantro L 10 L 8Cinnamon L 9 L 6Clam L 6 L 2Cocoa 29 L 2Coconut 25 L 7Codfish L 4 L 6Coffee L 3 22Common thyme L 8 L 2Coriander seed L 5 L 4Corn L 1 21Cous Cous L 8 L 4Cow's Milk L 7 21

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PROVIDERPATIENTNAME: PATIENT TESTNAME

DATE OF BIRTH: 01/20/1961 AGE: 58

HEIGHT: 5'9'' WEIGHT: 160 lbs

PHONE NUMBER: [email protected]

ADDRESS: 1021 HOWARD AVENUE SUITE B, SAN CARLOS, CA- 94070.

ACCESSION ID: 1512010000

SPECIMEN COLLECTION TIME: 11-30-2015

SPECIMEN RECEIVED TIME: 12-01-2015 00:00

FINAL REPORT TIME: 10-28-2019 20:38

FASTING: FASTING NO. OF HOURS: 12.0

PRACTICE NAME: Vibrant IT4 Practice

PROVIDER NAME: Vibrant IT4, MD (999999)

ADDRESS: 999999 PRACTICE STREET AVE, SAN CARLOS, CA- 94404.

TELEPHONE: 666-666-6662




IgE IgG IgACrab L 4 L 10Cranberry 28 L 2Crayfish L 6 L 6Cucumber L 10 L 3Cumin L 5 L 2Curry powder L 5 L 5Dill L 6 L 9Duck meat L 5 23Eel L 2 L 5Egg White L 2 26Egg Yolk 26 L 10Eggplant L 7 L 9Endive L 7 L 5English Walnut L 5 L 8Espresso L 7 L 6Fig 25 L 2Flax seed L 3 26Flounder L 8 L 9Garlic L 4 27Ginger L 1 L 2Goat's Milk L 6 27Goose meat L 5 L 3Grape L 4 L 3Grapefruit L 4 L 9Grapevine snail L 10 L 4Green Bean L 10 L 5Green Peas L 9 L 8Green Pepper L 3 L 4Green Tea L 2 L 8Green cabbage L 2 L 5Green onion/Scallions L 3 L 4Guava 23 L 1Habanero pepper L 4 L 5Halibut L 10 L 10Hazelnut 23 L 10


IgE IgG IgAHemp L 2 L 8Honeydew melon L 2 L 5Hops L 2 L 2Hot paprika powder L 7 L 1Jalapeno pepper L 3 L 4Kale L 9 L 10Kefir L 3 28Kidney Bean L 7 L 10Kiwi fruit L 4 L 9Lake Trout L 9 L 1Lamb L 4 L 8Leek L 6 L 4Lemon L 10 20Lemon grass L 9 L 3Lentils L 9 L 7Lima Bean L 6 L 6Litchi L 3 21Lobster L 8 L 9Macadamia Nut L 4 L 1Mackerel L 2 L 8Malt L 10 L 7Mandarin L 10 28Mango 30 L 4Molasses 27 L 7Mung beans 19 24Mustard L 3 L 2Navy Bean L 3 L 4Nutmeg L 9 L 5Oats 25 L 5Octopus L 5 L 4Olive L 9 25Oolong tea L 4 L 9Orange L 1 L 5Oregano L 3 27Oyster L 6 L 3

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FULL NAME: PATIENT TESTNAME ACCESSION ID: 1512010000 DATE OF SERVICE: 11-30-2015



IgE IgG IgAPacific squid L 4 L 10Papaya L 3 L 1Parsley L 10 L 7Parsnip L 8 L 3Peach L 3 L 6Peanut L 1 24Pear L 7 L 2Pecan L 1 L 3Perch L 8 L 9Pine nut L 3 L 8Pineapple L 10 L 2Pinto Beans L 5 L 6Pistachio nut 20 L 3Plum L 6 L 1Poppy seed L 3 L 5Pork L 10 L 3Portabella Mushroom 27 L 5Purple Potato L 8 L 8Rabbit L 1 L 8Rape seed L 9 L 2Raspberry L 1 L 10Romaine lettuce L 1 L 4Rosemary L 2 L 2Rye L 4 L 9Salmon 29 L 1Sardine L 9 L 5Savoy cabbage 28 L 6Scallops L 4 L 9Sea bass 11 L 4Seaweed(Kelp) L 9 L 3Sesame L 8 L 8Shallots L 10 L 4Sheep's milk L 10 19Shiitake mushroom L 4 L 4Shrimp 30 L 1


IgE IgG IgASole L 8 L 1Soybean L 6 22Spaghetti Squash L 2 L 2Spinach L 3 L 1Squid L 1 23Strawberry L 8 L 7Sunflower seed 24 L 6Sweet Potato L 9 L 9Sweet chestnut L 10 L 7Tapioca L 10 L 6Taro Root L 4 L 4Tempeh L 9 27Tiger nut L 10 L 3Tofu L 9 L 9Tomato L 5 L 4Tuna L 5 L 7Turkey L 9 L 6Turmeric L 1 L 8Turnip L 5 L 10Vanilla Bean L 2 L 8Veal 28 L 1Vegan Cheese L 2 17Vine leaf L 7 30Watermelon L 2 L 8Whey Protein L 1 28White Potato 23 L 6White mushrooms L 5 L 8White onion L 3 L 5White radish L 5 L 7Woo-hsiang powder L 5 L 6Yeast L 1 28Yellow squash L 4 L 1Yoghurt L 2 20Zucchini L 9 L 7

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Risk and Limitations

This test has been developed and its performance characteristics determined by Vibrant America LLC., a CLIA certified lab. These assays have not been cleared or approved by the U.S. Food and Drug Administration.

Allergen-specific IgE assays do not demonstrate absolute positive and negative predictive values for allergic disease. Clinical history must be incorporated into the diagnostic determination. Quantification of specific IgG and IgA antibodies is not FDA-recognized diagnostic indicator of allergy.

Food allergen, Inhalant, Food additives, Food Sensitivity and Food Zoomers testing is performed at Vibrant America, a CLIA certified laboratory and utilizes ISO-13485 developed technology. Vibrant America has effective procedures in place to protect against technical and operational problems. However, such problems may still occur. Examples include failure to obtain the result for a specific antigen due to circumstances beyond Vibrant’s control. Vibrant may re-test a sample in order to obtain these results but upon re-testing the results may still not be obtained. As with all medical laboratory testing, there is a small chance that the laboratory could report incorrect results. A tested individual may wish to pursue further testing to verify any results.

The information in this report is intended for educational purposes only. While every attempt has been made to provide current and accurate information, neither the author nor the publisher can be held accountable for any errors or omissions.

Vibrant Wellness makes no claims as to the diagnostic or therapeutic use of its tests or other informational materials. Vibrant Wellness reports and other information do not constitute medical advice and are not a substitute for professional medical advice. Please consult your healthcare practitioner for questions regarding test results, or before beginning any course of supplementation or dietary changes.

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FOOD SENSITIVITY

Food For

Thought

1(866) [email protected]

www.vibrant-wellness.com 1360 Bayport Ave. Ste. BSan Carlos, CA 94070

PRACTICE NAME:PROVIDER NAME:ADDRESS:

Vibrant IT4 PracticeVibrant IT4, MD (999999)

999999 PRACTICE STREET AVE SANCARLOS, CA, 94404

PATIENT PROVIDER

Vibrant Wellness is pleased to present to you, Food Sensitivity Testing, to he lp yo u ma ke he althy li festyle an ddietary choices in consultation with your physicians and dietitians. It is intended to be used as a tool to encourage a general state of health and well-being.

Vibrant Food Sensitivity (Profile 1) is an array of 96 commonly consumed food antigens which offersvery specific antibody-to-antigen recognition. The panel is designed to assess an individual’s IgG and IgA sensitivity to food antigens.

Interpretation of Report: The test results of antibody levels to the individual proteins are calculated bycomparing the average intensity of the individual protein antibody to that of a healthy reference population. Reference ranges have been established using 192 healthy individuals. The results are displayed as Positive, Moderate or Negative. A Positive result indicates that you have an increased IgG/IgA reaction to the food antigen with respect to the reference range. A Moderate result indicates that you have a moderate IgG/IgA reaction to the food antigen with respect to the reference range. A Negative result indicates that you have a low IgG/IgA reaction to the food antigen with respect to the reference range. Vibrant utilizes proprietary reporter based analysis which is designed to assay specific total IgG (subclasses 1, 2, 3, 4), and total IgA (subclasses 1, 2) antibodies. The classification of Positive to Moderate to Negative denotes the level of IgG and/or IgA antibodies detected.

The Vibrant Wellness platform provides tools for you to track and analyze your general wellness profile. Testing for Food Sensitivity offered by Vibrant Wellness is performed by Vibrant America LLC, a CLIA certified lab CLIA#:05D2078809. Vibrant Wellness provides and makes available this report and any related services pursuant to the Terms of Use Agreement (the "Terms") on its website at www.vibrant-wellness.com. By accessing, browsing or otherwise using the report or website or any services, you acknowledge that you have read, understood, and agree to be bound by these terms. If you do not agree to accept these terms, you shall not access, browse or use the report or website. The statements in this report have not been evaluated by the Food and Drug Administration and are only meant to be lifestyle choices for potential risk mitigation. Please consult your Physician/Dietitian for medication, treatment or life style management. This product is not intended to diagnose, treat, or cure any disease.

Please Note - It is important that you discuss any modifications to your diet, exercise and nutritional supplementation with your physician before making any changes. To schedule an appointment with Vibrant Clinical Dietitians please call: Toll-Free 866-364-0963.

1360 Bayport Ave, Ste B. San Carlos, CA 940701(866) 364-0963 | [email protected] | www. vibrant-wellness.com

Final Report Date: 10-28-2019 20:38 Specimen Collected: 11-30-2015

Accession ID: 1512010000 Specimen Received: 12-01-2015 00:00



Name: PATIENT TESTNAMEDate of Birth: 1961-01-20Gender: MaleAge: 58Height: 5'9'' Weight: 160 lbsTelephone #: [email protected] Address: 1021 HOWARD AVENUE SUITE BCity: SAN CARLOSState: CA Zip #: 94070Fasting: FASTING No. of hours: 12.0

Practice Name: Vibrant IT4 PracticeProvider Name: Vibrant IT4, MD (999999)Street Address: 999999 PRACTICE STREET AVECity: SAN CARLOSState: CAZip #: 94404Telephone #: 666-666-6662Fax #: 111-222-0000


MK-0017-20 Page 2 of 22

Positive ModerateNegative

IgG IgA IgG IgA

FishSalmon

FruitsCoconutCranberryFigGuavaMango

Gluten freegrainsOats

MeatEgg YolkVeal

MiscellaneousCocoaMolasses

NightshadesWhite Potato

Nuts (Tree)Hazelnut

SeedsSunflower seed

ShellfishShrimp

SpicesBay leaf

VegetablesSavoy cabbagePortabellaMushroom

DairyCow's MilkGoat's MilkWhey ProteinKefir

FishAnchovy

FruitsApricotOliveLitchiMandarin

Gluten freegrainsCorn

LegumesPeanutSoybeanBroad beanMung beans

MeatBeefEgg WhiteDuck meat

MiscellaneousCoffeeYeastBlack tea

MollusksSquid

SeedsFlax seed

SpicesOregano

VeganTempeh

VegetablesBroccoliGarlicBamboo shootsVine leaf

FishSea bass

LegumesMung beans

MiscellaneousAgave

Nuts (Tree)Pistachio nut

DairySheep's milkYoghurt

FruitsLemon

VeganVegan Cheese

Dairy

Beta-Casein Casomorphin Buffalo milk ButtermilkCheddar cheese

Fish

Catfish Codfish Halibut Lake TroutMackerel Perch Tuna Alaska pollock

Carp Eel Flounder SardineSole

Fruits

Apple Avocado Banana BlackberryBlueberry Cantaloupe Cherry GrapeGrapefruit Orange Peach PearPineapple Raspberry Strawberry Tomato

Watermelon Honeydewmelon Kiwi fruit Plum

Capers Papaya

Gluten containing grains

Barley Malt Rye

Gluten free alternative starches

Cassava Tapioca Tiger nut Taro RootArrowroot

Gluten free grains

Amaranth Brown Rice Buckwheat

Legumes

Kidney Bean Navy Bean Chickpea Black BeansPinto Beans Black-eye Peas Lentils

Meat

Chicken Lamb Pork TurkeyGoose meat Grapevine snail Rabbit

Miscellaneous

Hops Rosemary Vanilla Bean Cane sugarDill Lemon grass Oolong tea Parsley

Green Tea Cilantro Espresso

Mollusks

Clam Oyster Scallops Blue musselOctopus Pacific squid

Nightshades

Green Pepper Eggplant

Nuts (Tree)

Pine nut Sweet chestnut

Nuts(Tree)

Almond Black Walnut Cashews English WalnutPecan Macadamia Nut Brazilnut

Seeds

Mustard Sesame Coriander seed Poppy seedRape seed Chia Hemp

Shellfish

Crab Lobster Crayfish

Positive for IgG: Consider eliminating these foods from your diet in consultation with your physician/dietitian.Moderate for IgG: Consider rotation plan/eliminating these foods from your diet in consultation with your physician/dietitian.Positive/Moderate for IgA: Consider eliminating these foods from your diet in consultation with your physician/dietitian.

MK-0017-20 Page 3 of 22




Positive ModerateNegative

IgG IgA IgG IgA

Spices

Black pepper Cinnamon Nutmeg AniseCaraway Cayenne pepper Common thyme Curry powder

Hot paprikapowder

Woo-hsiangpowder Turmeric Cumin

Jalapeno pepper Habaneropepper

Vegan

Cous Cous Tofu

Vegetables

Green cabbage Carrot Cauliflower CeleryCucumber Green Bean Green Peas Romaine lettuce

Lima Bean Whitemushrooms White onion Seaweed(Kelp)

Spinach Yellow squash Ginger Sweet PotatoAsparagus Beet root Endive Leek

Arugula Turnip White radish Artichoke

Chard Kale Shiitakemushroom Zucchini

Purple Potato Greenonion/Scallions Shallots Acorn Squash

ButternutSquash

SpaghettiSquash Parsnip

Positive for IgG: Consider eliminating these foods from your diet in consultation with your physician/dietitian.Moderate for IgG: Consider rotation plan/eliminating these foods from your diet in consultation with your physician/dietitian.Positive/Moderate for IgA: Consider eliminating these foods from your diet in consultation with your physician/dietitian.

MK-0017-20 Page 4 of 22




MEAT




0 10 11 20 21 30

Sensitivity Negative Moderate Positive

0 10 11 20 21 30


The values in parentheses represent previous values tested for this Food antigen.↑: Increased sensitivity compared to previous; ↓: decreased sensitivity compared to previous; ↔: Same as previous.

MK-0017-20 Page 5 of 22

SEAFISH




0 10 11 20 21 30


0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 6 of 22

SEAFISH




0 10 11 20 21 30


0 10 11 20 21 30


0 10 11 20 21 30



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DAIRY




0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 8 of 22

GRAINS




0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 9 of 22

GRAINS




0 10 11 20 21 30



MK-0017-20 Page 10 of 22

Vibrant Wellness | 1360 Bayport Ave, Ste B. San Carlos, CA 940701(866) 364-0963 | [email protected] | www. vibrant-wellness.com

LEGUMES




0 10 11 20 21 30

Sensitivity Negative Moderate Positive0 10 11 20 21 30


0 10 11 20 21 30



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NUTS




0 10 11 20 21 30


0 10 11 20 21 30


0 10 11 20 21 30



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SEEDS




0 10 11 20 21 30


0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 13 of 22

VEGETABLES




0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 14 of 22

VEGETABLES




0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 15 of 22

VEGETABLES




0 10 11 20 21 30



MK-0017-20 Page 16 of 22

FRUITS




0 10 11 20 21 30

Sensitivity Negative Moderate Positive0 10 11 20 21 30



MK-0017-20 Page 17 of 22

FRUITS




0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 18 of 22

MISCELLANEOUS




0 10 11 20 21 30


0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 19 of 22

MISCELLANEOUS




0 10 11 20 21 30


0 10 11 20 21 30


0 10 11 20 21 30



MK-0017-20 Page 20 of 22

MISCELLANEOUS




0 10 11 20 21 30


0 10 11 20 21 30

Sensitivity

Negative Moderate

Positive

0 10 11 20 21 30

Sensitivity Negative Moderate

Positive


MK-0017-20 Page 21 of 22

RISK AND LIMITATIONS

This test has been developed and its performance characteristics determined by Vibrant America LLC., a CLIA certified lab. These assays have not been cleared or approved by the U.S. Food and Drug Administration.

Quantification of specific IgG and IgA antibodies is not an FDA- recognized diagnostic indicator of allergy.

Food Sensitivity testing is performed at Vibrant America, a CLIA certified laboratory, andutilizes ISO-13485 developed technology. Vibrant America has effective procedures in place to protect against technical and operational problems. However, such problems may still occur. Examples include failure to obtain the result for a specific antigen due to circumstances beyond Vibrant’s control. Vibrant may re-test a sample in order to obtain these results but upon re-testing the results may still not be obtained. As with all medical laboratory testing, there is a small chance that the laboratory could report incorrect results. A tested individual may wish to pursue further testing to verify any results.

The information in this report is intended for educational purposes only. While every attempt has been made to provide current and accurate information, neither the author nor the publisher can be held accountable for any errors or omissions.

Vibrant Wellness makes no claims as to the diagnostic or therapeutic use of its tests or other informational materials. Vibrant Wellness reports and other information do not constitute medical advice and are not a substitute for professional medical advice. Please consult your healthcare practitioner for questions regarding test results, or before beginning any course of supplementation or dietary changes.


MK-0017-20 Page 22 of 22

PATIENT PROVIDER · Buffalo milk L 1 L 4 Buttermilk L 6 L 6 Butternut Squash L 3 L 3 Cane sugar L 2...

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