Donor & Family Health History


Medical ProblemDonor
Family
Heart
None

Paternal Grandfather: Heart attack @ 77

Maternal Grandmother:  Dx. with heart disease in 70s

Blood
NoneNone
RespiratoryNone
Mother and Sister:  Asthma
Gastrointestinal
NonePaternal Grandmother:  IBS (in her late 70s)
Metabolic/Endocrine
NoneMaternal Grandmother:  Dx. with diabetes @ 39
UrinaryNoneNone
Genital / ReproductiveNone
None
NeurologicalNonePaternal Uncle:  Brain tumor
Mental HealthNoneNone
Muscles / Bones / JointsNoneMaternal Grandmother and Grandfather:  Arthritis dx. in 50s
Sight / Sound / SmellNone
None
Skin
Acne

Father and siblings:  Acne

Father and Paternal Grandfather:  Benign skin cancer

OtherNoneMaternal Grandfather considered alcoholic (controlled for 30+ years)


Identification #RR375


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1988
Place of BirthMissouri
Height5'10"
Weight135
Eye Color
Blue
ComplexionFair
Hair
Blond, wavy
Right Handed     X
Left Handed        
Religion Born IntoCatholic
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 MemberOccupation
Level of Schooling
Mother
Health Care Field

M.A.
Father
Management

B.A.




Family MemberAge if LivingAge at DeathCause of Death
Mother50


Father52


Maternal Grandmother
79

Maternal Grandfather
77
Heart Attack
Paternal Grandmother80


Paternal Grandfather83


Sisters
20s


Brothers



Test Results
Test Results

Blood TypeO+
HIV 1/2 Ab
Nonreactive
ChlamydiaNegative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Negative
CMV ScreenNonreactive
AST/ALT
Within normal limits
CMV, IgM/Culture
Not applicable
Sickle cell
Not applicable
Cystic FibrosisNegative 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