| Donor & Family Health History | ||
| Medical Problem | Donor | Family |
| Heart | None | Paternal Grandfather: Heart attack @ 77 Maternal Grandmother: Dx. with heart disease in 70s |
| Blood | None | None |
| Respiratory | None | Mother and Sister: Asthma |
Gastrointestinal | None | Paternal Grandmother: IBS (in her late 70s) |
Metabolic/Endocrine | None | Maternal Grandmother: Dx. with diabetes @ 39 |
| Urinary | None | None |
| Genital / Reproductive | None | None |
| Neurological | None | Paternal Uncle: Brain tumor |
| Mental Health | None | None |
| Muscles / Bones / Joints | None | Maternal Grandmother and Grandfather: Arthritis dx. in 50s |
| Sight / Sound / Smell | None | None |
| Skin | Acne | Father and siblings: Acne Father and Paternal Grandfather: Benign skin cancer |
| Other | None | Maternal Grandfather considered alcoholic (controlled for 30+ years) |
| Identification #RR375 | Pregnancy Proven - Yes | ||
| Physical & Personal Characteristics | |||
| Date of Birth (Y) | 1988 | Place of Birth | Missouri |
| Height | 5'10" | Weight | 135 |
| Eye Color | Blue | Complexion | Fair |
| Hair | Blond, wavy | Right Handed X | Left Handed |
| Religion Born Into | Catholic | Married No | |
| Heritage | German, English | Occupation College Student | Years of College 4 |
| Interests Music (Plays several instruments), song writing, singing, movies, writing fiction | |||
| Notes Prewashed vials (IUI) vials available |
| Family History | |||
| Family Member | Occupation | Level of Schooling | |
| Mother | Health Care Field | M.A. | |
| Father | Management | B.A. | |
| Family Member | Age if Living | Age at Death | Cause of Death |
| Mother | 50 | ||
| Father | 52 | ||
| Maternal Grandmother | 79 | ||
| Maternal Grandfather | 77 | Heart Attack | |
| Paternal Grandmother | 80 | ||
| Paternal Grandfather | 83 | ||
| Sisters | 20s | ||
| Brothers |
| Test Results | Test Results | ||
| Blood Type | O+ | HIV 1/2 Ab | Nonreactive |
| Chlamydia | Negative | HTLV-1,2 Ab | Nonreactive |
| Chromosome Analysis | Normal Male 46XY | Neisseria gonorrhea | Negative |
| CMV Screen | Nonreactive | AST/ALT | Within normal limits |
CMV, IgM/Culture | Not applicable | Sickle cell | Not applicable |
| Cystic Fibrosis | Negative for 70 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 IDTNAT | Nonreactive/Nonreactive |
| Notes |