Donor & Family Health History

Medical ProblemDonorFamily
HeartNone

Maternal Grandfather: High blood pressure, heart disease, heart attack

Paternal Grandfather:  Heart Disease

Blood
NoneNone
RespiratoryNone
None
Gastrointestinal
NoneFather:  had Colitis
Metabolic/Endocrine
NoneSister:  Recovered from thyroid cancer
UrinaryNoneNone
Genital / ReproductiveNoneNone
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneMaternal Grandmother:  Arthritis
Sight / Sound / SmellNone
None
Skin
None
None
OtherNoneNone


Test Results
Test Results
Blood TypeO+
HIV 1/2 Ab; HIV 1 Ag
Nonreactive/Nonreactive
ChlamydiaNegative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Negative
CMV ScreenNegative
SGPT
Within normal limits
CMV, IgM/Culture
Not applicable
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 #RR346


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1977
Place of BirthTennessee
Height5'7"
Weight135
Eye ColorBlue
ComplexionFair
HairBrown, Curly
Right Handed     X
Left Handed
Religion Born IntoProtestant
Married   No
HeritageEnglish, German, Swedish

Occupation  Political Science Student

Years of College  3
Interests Athletics, Chess, Film Making



Notes  PW (IUI) vials only




Family History


Family MemberOccupation
Level of Schooling
Mother
Homemaker

M.A.
FatherProfessor

Ph.D.




Family MemberAge if LivingAge at DeathCause of Death
Mother52


Father53


Maternal Grandmother74


Maternal Grandfather
73
Heart Disease
Paternal Grandmother75


Paternal Grandfather
71
Heart Disease
Sisters27


Brothers