Family History


Family MemberOccupation
Level of Schooling
Mother
Homemaker

3 years of college
Father
Administrator

B.A.




Family MemberAge if LivingAge at DeathCause of Death
Mother46


Father50


Maternal Grandmother76


Maternal Grandfather82


Paternal Grandmother92


Paternal Grandfather
86
Old age
Sisters
27


Brothers


Donor & Family Health History

Medical ProblemDonor
Family
Heart
None

None

Blood
NoneNone
RespiratoryPneumonia
Sister:  Asthma
Gastrointestinal
NoneNone
Metabolic/Endocrine
NoneNone
UrinaryNoneNone
Genital / ReproductiveNone
Maternal Grandfather:  Prostate cancer
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNonePaternal 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 ScreenPositive
SGPT
Within normal limits
CMV, IgM/Culture
Nonreactive; culture negative
Sickle cell
Not applicable
Cystic FibrosisNegative for 37 Common Mutations
Syphilis, antibody  MHA-TP
Nonreactive
HbsAg
Nonreactive
Tay Sachs & Canavan
Not applicable
HbcAb
Nonreactive
Hepatitis C, Ab
Nonreactive
Thalassemia
Normal adult hemoglobin
HCVRNA/HIV-1 RNA
Nonreactive/Nonreactive
Notes


Identification #RR354


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1977
Place of BirthMichigan
Height6'0"
Weight198
Eye Color
Blue-green
ComplexionMedium
Hair
Brown, wavy
Right Handed     X
Left Handed        
Religion Born IntoMethodist
Married   Yes

Heritage
English, German, Dutch, Czech, trace Native American

Occupation  College Student and in military

Years of College  1
Interests  Playing bass guitar and painting



Notes   Prewashed vials (IUI) vials available