Donor Abstract

IDENTIFICATION NO.  RR097 DATE 10/1999

 PHYSICAL AND PERSONAL CHARACTERISTICS
DOB (M/Y) 08/1967 PLACE OF BIRTH Ohio
HEIGHT 6'1" WEIGHT 200
EYE COLOR Blue COMPLEXION Fair
HAIR Light Brown, Wavy RIGHT HANDED X LEFT HANDED
RELIGION BORN INTO  Roman Catholic MARRIED Yes NO. OF CHILDREN 2
YRS OF COLLEGE 8 OCCUPATION College Professor HERITAGE Polish, German
INTERESTS Family, Soccer, Basketball, SCUBA

 TEST RESULTS
Blood Type A Negative HIV 1/2 Ab. & HIV Ag.  Nonreactive
Chlamydia Negative by PCR HTLV-1/2 Ab. Nonreactive
Chromosome analysis Normal Male 46XY Neisseria gonorrhea None Isolated
CMV, IgM/Culture Nonreactive/No Growth SGPT Normal
Cystic Fibrosis Negative for 33 Mutations Sickle cell Not Applicable
Group B streptococcus Negative Syphilis, antibody Nonreactive
HbsAg & HbcAb Nonreactive Tay Sachs Not Applicable
Hepatitis C, Ab Nonreactive Thalassemia Normal Adult Hemoglobin
Trichomonas & yeast Not Present  

 DONOR AND FAMILY HEALTH HISTORY
MEDICAL PROBLEM DONOR RELATIVE

HEART

None

  Father:  Stroke at age 52 (overweight smoker)
Grandfather:  Stroke at age 60, Heart disease

BLOOD

 None  None
RESPIRATORY None  Mother:  Lung Cancer (smoker)
GASTROINTESTINAL None  None
METABOLIC/ENDOCRINE None  Mother:  Diabetes at age 50
URINARY None   None 
GENITAL/REPRODUCTIVE SYSTEM None  None
NEUROLOGICAL None  None
MENTAL HEALTH None  None
MUSCLES/BONES/JOINTS None  None
SIGHT/SOUND/SMELL None  None
SKIN None  None
OTHER None  None

 FAMILY HISTORY
LEVEL OF SCHOOLING: Mother 2 years of College Father High School
OCCUPATION: Mother Secretary Father Owned a Small  
           Business
 
  AGE IF LIVING AGE AT DEATH CAUSE OF DEATH
MOTHER    65   Lung Cancer
FATHER   52  Stroke
MATERNAL GRANDFATHER     40's  Military Service in WWII
MATERNAL GRANDMOTHER    89  Old Age
PATERNAL GRANDFATHER    60  Stroke
PATERNAL GRANDMOTHER  93    
BROTHERS  43, 46    
SISTERS      

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