Donor & Family Health History

Medical ProblemDonorFamily
HeartNone

Maternal Grandfather: Heart Disease

Blood
NoneNone
RespiratoryNone
Maternal Grandfather:  Emphysema; Bronchitis
Gastrointestinal
NoneFather:  Gallstones
Metabolic/Endocrine
NoneNone
UrinaryNoneNone
Genital / ReproductiveNonePaternal Grandfather:  Prostate Cancer
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNone
None
Skin
Non-scarring acne as a teen
None
OtherNoneNone


Test Results
Test Results
Blood TypeA+
HIV 1/2 Ab; HIV 1 Ag
Nonreactive/Nonreactive
ChlamydiaNegative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Negative
CMV ScreenPositive
SGPT
Within normal limits
CMV, IgM/Culture
Negative
Sickle cell
Not applicable
Cystic FibrosisNegative for 37 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 #RR345


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1978
Place of BirthLouisiana
Height5'11"
Weight175
Eye ColorBrown
ComplexionMedium
HairBrown, Straight
Right Handed     X
Left Handed
Religion Born IntoMethodist
Married   No
HeritageEnglish, German, Czech

Occupation  Respiratory Therapy Student

Years of College  5
Interests Sports, Music



Notes  PW (IUI) vials only



Family History


Family MemberOccupation
Level of Schooling
Mother
Office Manager

One Year of College
FatherElectrical Engineer

B.S.




Family MemberAge if LivingAge at DeathCause of Death
Mother53


Father54


Maternal Grandmother70


Maternal Grandfather
60
Heart Disease
Paternal Grandmother72


Paternal Grandfather
73
Prostate Cancer
Sisters


Brothers31