Family History


Family MemberOccupation

Level of Schooling
Mother
Banking Industry

4 years college
Father
Businessman

4 years college




Family MemberAge if LivingAge at DeathCause of Death
Mother51


Father
50


Maternal Grandmother
73


Maternal Grandfather
71
Cirrhosis
Paternal Grandmother
71


Paternal Grandfather79


Sisters



Brothers25


Donor & Family Health History


Medical ProblemDonor
Family
Heart
None

Paternal Grandmother:  Dx. High blood pressure @ age 64

Paternal Uncle: Heart attack @ age 52

Blood
NoneNone
RespiratoryNone
None
Gastrointestinal
None
None
Metabolic/Endocrine
NonePaternal Grandfather:  Dx. with Type 2 diabetes @ age  68
UrinaryNoneNone
Genital / ReproductiveNone
None
NeurologicalNoneNone
Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNone
None
Skin
None

None


OtherNoneNone



Test Results
Test Results

Blood Type
O-
HIV 1/2 Abw. Group O
Nonreactive
Chlamydia,GC Amplification
Negative/Negative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea
Negative
CMV ScreenPositive
AST/ALT
Within normal limits
CMV, IgM/Culture
Nonreactive/Negative
Sickle cell
Not applicable
Cystic FibrosisNegative for 60 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 RNA IDTNAT
Nonreactive/Nonreactive
Notes
HBV DNA IDTNAT  
Nonreactive

Identification #RR377


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)1989
Place of Birth
Louisiana
Height6'1"
Weight
240
Eye Color
Green
ComplexionFair
Hair
Blond, wavy
Right Handed     X
Left Handed        
Religion Born IntoCatholic
Married   No

Heritage
German, Swedish

Occupation  College Student

Years of College  4
Interests  Golfing, hiking, socializing with friends and family



Notes   Standard (ICI) and Prewashed vials (IUI) vials available