Family History


Family MemberOccupation
Level of Schooling
MotherEngineer

B.S. Degree
FatherEngineer

M.S. Degree




Family MemberAge if LivingAge at DeathCause of Death
Mother54


Father58


Maternal Grandmother77


Maternal Grandfather78


Paternal Grandmother
55
Cancer
Paternal Grandfather
57
Heart Attack
Sisters


Brothers


Donor & Family Health History

Medical ProblemDonorFamily
HeartNonePaternal Grandfather:  Heart attack, high blood pressure, hardening of the arteries
BloodNone
Cousin:  Anemia
RespiratoryNoneNone
Gastrointestinal
NoneMother:  Ulcer
Metabolic/Endocrine
NoneNone
UrinaryNoneNone
Genital / ReproductiveUndescended testicle
None
Neurological
None
Aunt:  Migraine headaches
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNoneNone
SkinNoneNone
OtherNoneGrandmother:  Cancer


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


Identification #RR276


Pregnancy Proven - Yes
Physical & Personal Characteristics



Date of Birth (Y)
1973
Place of BirthCzechoslovakia
Height6'1"
Weight189
Eye Color
Brown
ComplexionFair
HairBrown, wavy
Right Handed      X
Left Handed
Religion Born IntoRoman Catholic
Married   No
HeritageCzech, Croatian, Italian, Greek, Gypsy

Occuation Graduate Student in Architectural Engineering

Years of College  6
Interests  Sports, reading, socializing, travel



Notes Standard (ICI) vials available