Xytex Donor Profile: 5227
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1 Xytex Donor Profile: 5227 Basic Version Profile prepared on Tuesday September 20, 2016 For More Information Contact Us Website: Phone:
2 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 2 of 9 General Information Donor ID: 5227 Baby Photo Adult Photo 1980 Marital Divorced Number of Children: Religion: Protestant Occupation: 0 Blood Type: O + Professor of Business Baby Photo Available Adult Photo Available Ethnicity: Swedish, German Audio File: t Available Race: Caucasian CMV NEG Reported Pregnancy: Canadian Compliance: Identity Disclosure: Yes Yes Yes Last Medical History Update: 07/13/2016 Genetic Testing 6 photos available. Over the years, Xytex has expanded genetic testing of donors as genetic knowledge and technology have advanced. As a result, not all donors have been tested for the same conditions or with the same methods. "xygene" donors have undergone the most extensive testing. For more information about genetic testing view our "Genetics Video and FAQs." This donor has been evaluated for carrier status of the listed conditions. A negative result reduces, but does not eliminate, the likelihood of the donor being a carrier. If you are a known carrier of a genetic condition please contact us, and we will provide a copy of the donor's test reports to your physician and/or genetic counselor. Beta-Thalassemia (HBB) Bloom Syndrome (BLM) Canavan Disease (ASPA) Chromosomal Analysis Cystic Fibrosis (CFTR) ; normal complete blood count rmal male karyotype Xytex Donor Profile 5227 Page 2 of 9
3 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 3 of 9 Dihydrolipoamide Dehydrogenase Deficiency (DLD) Familial Dysautonomia (IKBKAP) Familial Hyperinsulinism, ABCC8-Related (ABCC8) Fanconi Anemia Group C (FANCC) Gaucher Disease (GBA) Glycogen Storage Disease Type Ia (G6PC) Joubert Syndrome 2 (TMEM216) Maple Syrup Urine Disease Type 1B (BCKDHB) Mucolipidosis Type IV (MCOLN1) Nemaline Myopathy, NEB-Related (NEB) Niemann-Pick Disease Type A (SMPD1) Niemann-Pick Disease Type B (SMPD1) Sickle Cell Disease (HBB) Spinal Muscular Atrophy (SMN1) Tay-Sachs Disease (HEXA) Usher Syndrome Type IF (PCDH15) Usher Syndrome Type III (CLRN1) ; normal complete blood count (exon 7 deletion not detected) Physical Attributes 5'09" ( cm) Hair Loss: ne 155 lbs (70 kg) Hair Type: Straight Eye Color: Brown, Light Brown, Freckles: Hair Texture: Fine Skin Tone: Information : Excellent te: The medical and social history was provided by the donor and cannot be verified for accuracy. Xytex Donor Profile 5227 Page 3 of 9
4 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 4 of 9 Skills Hobbies and Interest: Field Hockey, Financial Analysis Personality and Interest Attributes Education In School: In School Major: Marketing Post Graduate: Training Type: This donor holds a post graduate degree. College Degrees: Bachelor of Science, Masters, Ph.D. Immediate Medical History Brother : Brown, Dark Hair Texture: Right 1982 Age At Hair Loss: : 5' 08'' ( cm) 165 lbs. (74 kg) Occupation: Minister Body Hair: Wavy Education: Masters Eye Color: Brown Loves reading and dogs. Father : Black Hair Texture: Right Xytex Donor Profile 5227 Page 4 of 9
5 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 5 of Age At Hair Loss: : 5' 10'' ( cm) 165 lbs. (74 kg) Moderate Balding Occupation: Engineer Body Hair: Straight Education: Masters Eye Color: Brown Enjoys computers and electrical projects Mother : Brown, Light Hair Texture: Right 1959 Age At Hair Loss: : 5' 03'' ( cm) 140 lbs. (63 kg) Occupation: Math Teacher Body Hair: Wavy Education: Masters Eye Color: Brown Enjoys reading and gardening Aunt Paternal Medical History : Hair Texture: 1949 Age At Xytex Donor Profile 5227 Page 5 of 9
6 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 6 of 9 Occupation: Body Hair: Education: Eye Color: Aunt : Hair Texture: 1950 Age At Occupation: Body Hair: Education: Eye Color: Aunt : Hair Texture: 1952 Age At Occupation: Body Hair: Education: Eye Color: Grandfather : Poor Xytex Donor Profile 5227 Page 6 of 9
7 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 7 of 9 Brown, Dark Hair Texture: 1924 Age At 5' 09'' ( cm) 160 lbs. (72 kg) Condition: Cataracts On Set Age: 80 Occupation: Manager Body Hair: Right Education: College Eye Color: Brown Enjoys volunteering and reading Condition: (Glaucoma) On Set Age: 80 Grandmother : Blonde, Light Hair Texture: Fair Fair Deceased 1929 Age At 87 5' 04'' ( cm) 150 lbs. (68 kg) Occupation: Old Age Homemaker/volunteer Body Hair: Right Education: College Eye Color: Blue Enjoyed volunteering and reading Condition: Osteoarthritis On Set Age: 60 Xytex Donor Profile 5227 Page 7 of 9
8 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 8 of 9 Condition: Stroke On Set Age: 80 Uncle : Hair Texture: 1953 Age At Occupation: Body Hair: Education: Eye Color: Maternal Medical History Grandfather : Brown, Light Hair Texture: Thin Right Fair 1935 Age At : 5' 07'' ( cm) 170 lbs. (77 kg) Enjoys gardening Occupation: Brick Layer Body Hair: Education: High School Eye Color: Brown Condition: GI (Ulcerative Colitis) On Set Age: 73 Large Grandmother : Xytex Donor Profile 5227 Page 8 of 9
9 Xytex Donor Profile 5227 Basic Version as of Tuesday September 20, 2016 Page 9 of 9 Blonde, Lightest Freckles: Few Skin Tone: Fair Hair Texture: Right 1936 Age At : 5' 02'' ( cm) 130 lbs. (59 kg) Enjoys reading Uncle Occupation: Housekeeper Body Hair: Wavy Education: High School Eye Color: Blue : Hair Texture: 1962 Age At Occupation: Body Hair: Education: Eye Color: : Xytex Donor Profile 5227 Page 9 of 9
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Title. Nationality. Email
APPLICATION FORM Devonshire House, 582 Honeypot Lane, Stanmore, Middlesex, HA7 1JS PHONE NO: 020 8906 2001 FAX: 020 8905 6728 LICENSED BY CARE QUALITY COMMISSION Registered in England NO 3414273 PERSONAL
Please bring the following with you to your appointment: Completed New Patient forms A list of all prescribed medications with dosages and quantity
Mark E. Hollingshead, M.D. Cataract & Refractive Surgeon Welcome: We look forward to being of assistance to you on your first visit with Hollingshead Eye Center. In order to provide the best possible service,