Donor & Family Health History


Medical ProblemDonor
Family
Heart
None

Paternal and Maternal Grandmothers:  High blood pressure

Blood
NoneNone
RespiratoryNone
None
Gastrointestinal
None
None
Metabolic/Endocrine
NoneNone
UrinaryNoneNone
Genital / ReproductiveNone
Paternal Uncle:  Prostate cancer (treated)
NeurologicalNoneMaternal Grandmother:  Parkinson's disease
Mental HealthNonePaternal Cousin at birth:  Mental retardation
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellTreated for lazy eye condition as a child
None
Skin
None

None


OtherNone

Father/Uncle - Alcohol abuse (treated)

Paternal Cousin:  Drug abuse (treated)

Maternal Uncle:  Gout (treated)


Identification #RR380


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)
1990
Place of Birth
North Carolina
Height5'11"
Weight
160
Eye Color
Blue-Green
ComplexionFair
Hair
Brown, Wavy
Right Handed     X
Left Handed        
Religion Born IntoPresbyterian
Married   No

Heritage
Scot, Irish, French, German, trace Native American

Occupation  University Student

Years of College  4
Interests  Writing/playing music (plays drums & sax), travel, Formula 1 racing, sports, photography



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





Test Results
Test Results

Blood Type
A+
HIV 1/2 Abw. Group O
Nonreactive
Chlamydia,by TMA
Negative/Negative
HTLV-1,2 Ab
Nonreactive
Chromosome AnalysisNormal Male 46XY
Neisseria gonorrhea by TMA
Negative
CMV ScreenNonreactive
ALT
Within normal limits
CMV, IgM/Culture
Not applicable
Sickle cell
Not applicable
Cystic FibrosisNegative for 60 Common Mutations
Syphilis, antibody  (RPR)
Nonreactive
HbsAg
Nonreactive
Tay Sachs & Canavan
Not applicable
HbcAb
Nonreactive
Hepatitis C, Ab
Nonreactive
Thalassemia
Normal adult hemoglobin
HCVRNA/HIV RNA NAT multiplex
Nonreactive/Nonreactive
Notes
HBV DNA NAT multiplex
Nonreactive

Family History


Family MemberOccupation

Level of Schooling
Mother
Homemaker

High School
Father
Businessman

B.A.




Family MemberAge if LivingAge at DeathCause of Death
Mother51


Father
63


Maternal Grandmother

70
Complications of Parkinson's disease
Maternal Grandfather
40
Auto Accident
Paternal Grandmother

92
Had High Blood pressure/cholesterol
Paternal Grandfather
90
Natural Causes
Sisters



Brothers21, 16