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2115 M ILVIA S TREET , B ERKELEY , CA 94704 510.841.1858 WWW . THESPERMBANKOFCA . ORG D ONOR 4877 Donor Profile: 4877 The past and current personal and family medical history, physical examination, and laboratory test results determine that donor 4877 is eligible and approved for semen donation at T HE S PERM B ANK OF C ALIFORNIA . This profile was prepared in April/2014. P ERSONAL I NFORMATION • Identity-Release ® Program: Yes • Month/year of birth: September/1979 • Education: Post Graduate in History/Contemporary Philosophy, Graduate in Philosophy of Culture, BA in Philosophy • Current occupation: Editor/Co-Author, Post Graduate Student • Ethnic origin: Spanish, Mexican, Czech, Swedish, Norwegian, Scottish • Religion: Agnostic P HYSICAL C HARACTERISTICS • Height: 5’10" • Weight: 175 • Hair color: Light brown • Hair type: Wavy • Eye color: Light brown • Complexion: Fair/creamy • Body type: Medium • Blood group/Rh: O • Baby photo available: Yes • Other distinguishing features: F AMILY M EDICAL H ISTORY KEY: D donor Ch child F father M mother S sister B brother Co cousin A aunt U uncle MGF maternal grandfather MGM maternal grandmother PGF paternal grandfather PGM paternal grandmother_ _____________________________ Allergies: MU#3: Allergy (Bee sting) at 50, treated with ER treatment, avoidance, ongoing. MCo#1: Allergy (Bee sting) at 50, treated with ER treatment, avoidance, ongoing. Gastro-intestinal: F: Stomach ulcers at 63, treated with medication, ongoing. MGF: Liver cancer (metastasized to pancreas) at 63, treated with surgery, cause of death at 64. Heart: M: High cholesterol at 58, treated with diet, managed. MGM: High blood pressure at 77, treated with medication and diet, ongoing until death. MGM: Strokes (3 within 1 year) at 78, treated with hospitalization, cause of death at 78. PGF: Leaking he art valves at 83, treated with surgery and medications, managed (now 95). MU#1: High cholesterol at 60, treated with diet change, managed. MU#2: High cholesterol at 55, treated with diet change and homeopathic medications, ongoing. MU#2: Coronary artery disease at 58, treated with stent placement, medication and diet, managed well now 59. Intellectual Disability: MCo#1: Dyslexia at 18, no treatment, resolved, now 26. T HE S PERM B ANK OF C ALIFORNIA
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