Family History


Family MemberOccupation
Level of Schooling
MotherHomemaker

High School
FatherAccountant

B.S. Degree




Family MemberAge if LivingAge at DeathCause of Death
Mother43


Father52


Maternal Grandmother
30's
Car accident
Maternal Grandfather

30's
Car accident
Paternal Grandmother

65
Unknown
Paternal Grandfather

73
Heart Attack
Sisters


Brothers22


Donor & Family Health History

Medical ProblemDonorFamily
HeartNonePaternal Grandfather: High Blood Pressure and Heart Attack
BloodNoneNone
RespiratoryNoneNone
Gastrointestinal
NoneNone
Metabolic/Endocrine
NoneNone
UrinaryNoneNone
Genital / ReproductiveNoneNone
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNoneNone
SkinNoneNone
OtherNoneNone


Test Results
Test Results
Blood TypeA+
HIV 1/2 Ab & HIV 1 Ag
Nonreactive
ChlamydiaNegative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Negative
CMV Screen
Positive
SGPT
Within normal limits
CMV, IgM/Culture
Negative
Sickle cell
Not applicable
Cystic FibrosisNoncarrier of 51 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-1RNA
Nonreactive/Nonreactive
Notes


Identification #RR363


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1979
Place of BirthIndia
Height6'2"
Weight170
Eye Color
Brown
ComplexionFair-Medium, Asian
HairBlack, wavy
Right Handed          X
Left Handed
Religion Born IntoHindu
Married   No
HeritageIndian

Occupation Graduate Student in Mechanical Engineering

Years of College  5
Interests Sports and movies



Notes Standard and Prewashed vials available.