Donor & Family Health History


Medical ProblemDonor
Family
Heart
None

Maternal Grandfather:  High blood pressure (in his late '80s)

Blood
NoneNone
Respiratoryseasonal allergies
Paternal Grandmother and Grandfather:  Died of complications of pneumonia
Gastrointestinal
None
None
Metabolic/Endocrine
NoneMaternal Grandfather: diabetes in his late '80s (not insulin dependent)
Urinary

Post-urethral valve surgery (as a child)

None
Genital / ReproductiveNone
None
NeurologicalNone

Maternal Grandfather:  Stroke at Age 83

Maternal Cousin:  seizures

Mental HealthNoneNone
Muscles / Bones / JointsNoneNone
Sight / Sound / SmellNone
None
Skin
None

None


OtherNone

Father:  Throat cancer (in his late '6os)



Identification #RR385


Pregnancy Proven - Yes
Physical & Personal Characteristics


Date of Birth (Y)
1987
Place of Birth
Louisiana
Height
6'3"
Weight
180
Eye Color
Brown
ComplexionMedium Olive
Hair
Brown, Straight/thick
Right Handed     X
Left Handed        
Religion Born IntoCatholic
Married  
No
Heritage
Spanish, Italian, French, English, German, Native American

Occupation  Law Clerk

Years of College  5
Interests 
 Cycling, films, rowing, woodworking, video games 


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





Family History


Family Member
Occupation

Level of Schooling
Mother
Hospital worker

High School
Father
medical field

Master's degree




Family MemberAge if LivingAge at DeathCause of Death
Mother60's


Father
60's


Maternal Grandmother
85


Maternal Grandfather
86
Complications of illnesses noted above/old age
Paternal Grandmother

82
Complications of pneumonia
Paternal Grandfather
84
Complications of pneumonia
Sisters
30's


Brothers30's





Test Results
Test Results

Blood Type
O+           Rh: positive
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 ScreenNegative
SGOT/SGPT

Within normal limits
CMV, IgM/Culture
Not applicable
Sickle cell
Negative
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
T. cruzi Ab
Non-reactive
HBV DNA NAT multiplex
Nonreactive