Donor & Family Health History


Medical ProblemDonor
Family
HeartNone

Paternal Grandfather: Heart Attack

Maternal Grandfather: Stroke

Blood
NoneNone
RespiratoryNone
None
Gastrointestinal
NoneMaternal Grandmother:  Colon Cancer
Metabolic/Endocrine
NonePaternal Grandmother:  Adult onset diabetes
UrinaryNonePaternal Grandfather:  Kidney disease
Genital / ReproductiveNoneNone
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNone
None
Skin
None
None
OtherNoneNone


Test Results
Test Results
Blood TypeO-
HIV 1/2 Ab
Nonreactive/Nonreactive
ChlamydiaNegative
HTLV-1,2 Ab
Negative
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Nonreactive
CMV ScreenPositive
SGPT
Within normal limits
CMV, IgM/Culture
Negative/no growth
Sickle cell
Not applicable
Cystic FibrosisNegative for 51 Common Mutations
Syphilis, antibody  MHA-TP
Nonreactive
HbsAg
Nonreactive
Tay Sachs & Canavan
Non carrier
HbcAb
Nonreactive
Hepatitis C, Ab
Nonreactive
Thalassemia
Normal adult hemoglobin
HCVRNA/HIV-1 RNA (IDTNAT)
Nonreactive/Nonreactive
Notes


Identification #RR367


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1977
Place of BirthPhiladelphia
Height6'0"
Weight160
Eye Color
Brown
ComplexionFair olive
Hair
Brown, Wavy
Right Handed    
Left Handed      X  
Religion Born IntoJudaism
Married   No
Heritage
Russian, French-Canadian

Occupation  Law Student

Years of College  2
Interests  Music, socializing



Notes  Standard (ICI) vials available 



Family History


Family MemberOccupation
Level of Schooling
Mother
Teacher

M.A.
FatherLawyer

J.D.




Family MemberAge if LivingAge at DeathCause of Death
Mother57


Father56


Maternal Grandmother
78
Colon Cancer
Maternal Grandfather
63
Stroke
Paternal Grandmother82


Paternal Grandfather
77
Heart attack during surgery
Sisters
23, 26


Brothers