Donor Abstract
| IDENTIFICATION NO. RR146 | ORIGINAL DATE 08/90 UPDATED 12/94 | ||||
PHYSICAL AND PERSONAL CHARACTERISTICS |
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| DOB (M/Y) 01/70 | PLACE OF BIRTH New York | ||||
| HEIGHT 5'8" | WEIGHT 145 | ||||
| EYE COLOR Blue-green | COMPLEXION Fair | ||||
| HAIR Strawberry blonde, wavy | RIGHT HANDED X | LEFT HANDED | |||
| RELIGION BORN INTO Judaism | MARRIED No | NO. OF CHILDREN none | |||
| YRS OF COLLEGE 4 | OCCUPATION CPA | HERITAGE German, Russian | |||
| INTERESTS music, athletics | |||||
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TEST RESULTS |
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| Blood Type B Positive | HIV Nonreactive | ||||
| Chlamydia Ag Nonreactive | HTLV-1 Ab. Nonreactive | ||||
| CMV, IgM Culture No growth | Neisseria gonorrhea No Growth | ||||
| Cystic
Fibrosis Noncarrier of common deletion |
SGPT Within normal limits | ||||
| Group B streptococcus No Growth | Sickle cell Not Applicable | ||||
| HbsAg Nonreactive | Syphilis, antibody Nonreactive | ||||
| Hepatitis C, Ab Nonreactive | Tay Sachs Noncarrier | ||||
| Thalassemia Not applicable | |||||
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DONOR AND FAMILY HEALTH HISTORY |
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| MEDICAL PROBLEM | DONOR | RELATIVE | |||
| HEART |
None |
Grandparent: heart disease and heart attack | |||
BLOOD |
None | None | |||
| RESPIRATORY | None | None | |||
| GASTROINTESTINAL | None | None | |||
| METABOLIC/ENDOCRINE | None | None | |||
| URINARY | None | Grandfather: prostate cancer | |||
| 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 | Grandmother: died of cancer | |||
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FAMILY HISTORY |
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| LEVEL OF SCHOOLING: | Mother M.S. Degree | Father M.S. & M.D. degree | |||
| OCCUPATION: | Mother School teacher | Father Psychiatrist, Psychoanalyst | |||
| AGE IF LIVING | AGE AT DEATH | CAUSE OF DEATH | |||
| MOTHER | 49 | ||||
| FATHER | 53 | ||||
| MATERNAL GRANDFATHER | 75 | Heart attack | |||
| MATERNAL GRANDMOTHER | 83 | ||||
| PATERNAL GRANDFATHER | 85 | ||||
| PATERNAL GRANDMOTHER | 78 | Cancer | |||
| BROTHERS | 22 and 10 | ||||
| SISTERS | |||||