Family History


Family MemberOccupation
Level of Schooling
Mother
Teacher

M.S. Degree
Father
Physician
M.D. Degree




Family MemberAge if LivingAge at DeathCause of Death
Mother49


Father53


Maternal Grandmother83


Maternal Grandfather
75
Heart Attack
Paternal Grandmother
78
Cancer
Paternal Grandfather85


Sisters


Brothers10 and 22


Donor & Family Health History

Medical ProblemDonorFamily
HeartNone
Grandfather:  Heart disease and heart attack
BloodNoneNone
RespiratoryNoneNone
Gastrointestinal
NoneNone
Metabolic/Endocrine
NoneNone
UrinaryNoneGrandfather:  Prostate cancer
Genital / ReproductiveNoneNone
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNoneNone
SkinNoneNone
OtherNoneGrandmother:  Died of cancer


Test Results
Test Results

Blood TypeB+
HIV 1/2 Ab & HIV 1 Ag
Nonreactive
ChlamydiaNonreactive
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
No growth
CMV Screen
Positive
SGPT
Within normal limits
CMV, IgM/Culture
Nonreactive/No growth
Sickle cell
Not applicable
Cystic FibrosisNoncarrier of Common Mutations
Syphilis, antibody
Nonreactive
HbsAg
Nonreactive
Tay Sachs & Canavan
Noncarrier
HbcAb
Nonreactive
Hepatitis C, Ab
Nonreactive
Thalassemia
Not applicable
HCVRNA/HIV-1 RNA
Not done prior to 2004
Notes


Identification #RR146


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1970
Place of BirthNew York
Height5'8"
Weight145
Eye Color
Blue-green
Complexion
Fair
Hair
Strawberry blonde, Wavy
Right Handed   X
Left Handed
Religion Born Into
Judaism
Married   No
HeritageRussian, German

Occupation  CPA

Years of College 4

Interests music, athletics



Notes Standard vials available.