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EB 1309

Personal Information
  • Body Type
    Athletic
  • Height
    5 ft 2 in
  • Weight
    138
  • Any recent change in weight?
    Yes
  • If yes, amount gained / lost
    -25
  • Bone structure
    Large
  • Body and facial features
    Large
  • Dexterity
    Right handed
Skin & Teeth
  • Tan ability
    Medium
  • Skin condition
    Medium
  • Dimples
    No
  • Teeth condition
    Excellent
  • Orthodontic work?
    Yes
  • How old were you?
    15
Eyes, Vision and Hearing
  • Eye color
    Blue
  • Eye shape
    Oval
  • Eye size
    Average
  • Eye set
    Average
  • How is your vision?
    Fair
  • Do you need glasses or contact or have had corrective laser surgery?
    Yes
  • If yes, were/are you?
    Nearsighted
  • Do you have astigmatism?
    Yes
  • How is your hearing?
    Excellent
Hair
  • Hair color
    Light blonde
  • Hair texture
    Fine
  • Hair fullness
    Thin
  • Baldness
    No
  • Premature graying?
    No
Sexual History
  • Marital status
    Single
  • Living arrangement
    Living with parents / family
  • Sexual orientation
    Heterosexual
  • Total number of sexual partners in the last month
    1
  • Total number of sexual partners in the last 6 months
    1
  • Total number of sexual partners in the last 5 years
    2
  • Current sexual practice
    Vaginal, Oral given
  • Past sexual practice
    Vaginal, Oral given
  • Have you had sexual contact with a person who has injected drugs for a non-medical reason? (includes intravenous, intramuscular or subcutaneous injections)
    No
  • Have you had sexual contact with a person who has hemophilia or another blood clotting disorder who may have received human derived blood clotting factors?
    No
Sexual History
  • Have you engaged in sexual contact in exchange for money or drugs?
    No
  • Have you engaged in sexual contact with a person who has had sex in exchange for money or drugs?
    No
  • Have you had sexual contact with any person known or suspected to have infection with HIV (AIDS), a positive HIV test, Hepatitis B infection, Hepatitis C infection, Zika Virus, or any other sexually transmitted infection?
    No
  • In the last year, have you had vaginal intercourse without the use of a condom?
    No
  • Have you had sexual contact with a man who is homosexual or bisexual?
    No
  • Have you had sexual contact with an individual who was born in or lived in any of the following countries since 1977: Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger or Nigeria?
    No
Race and Ethnicity
  • Race
    Caucasian
  • Are you adopted?
    No
  • Mother
    German
  • Maternal grandmother
    German
Race and Ethnicity
  • Maternal grandfather
    German
  • Paternal grandmother
    German, Native American
  • Paternal grandfather
    German
  • Religion
    Christian
Menstrual
  • Age at which you had your first period
    14
  • I sometimes have bleeding after intercourse
    No
  • I sometimes have bleeding in between my normal periods
    No
  • Longest number of days of bleeding
    9
  • Shortest number of days of bleeding
    3
  • Longest time from the start of one period to the start of the next
    38
  • Shortest time from the start of one period to the start of the next
    26
Gynecologist visits
  • Have you ever been told you might have trouble having children?
    No
  • Have you ever had a pelvic exam?
    Yes
  • Have you ever had an abnormal PAP smear?
    No
Use of birth control
  • Oral Contraceptives (birth control pills)
    In the past
  • Birth Control Patches (Xulane)
    Never
  • Progesterone Injections (Depo-Provera)
    Never
  • Progesterone Implants (Implanon, Nexplanon)
    Never
  • Intrauterine Device (IUD) Paragard, Mirena, Kyleena, Liletta, Skyla
    Currently
  • Barrier contraceptives (Condoms, Diaphragms, Cervical caps)
    In the past
  • Sterilization (tubal ligation, Essure tubal plugs)
    Never
Pregnancy History
  • Tell us about your pregnancy history
    I have never been pregnant and have never tried to become pregnant
Tattoos and Piercings
  • First time
    2009-10-02
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    earlobe
  • Sterile Needles Used?
    Yes
  • Second time
    2014-12-01
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    earlobe
  • Sterile Needles Used?
    Yes
  • Third time
    2019-02-11
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    earlobe
  • Sterile Needles Used?
    Yes
  • Fourth time
    2019-12-09
  • Was this a Tattoo or Piercing?
    Piercing
  • Location on Body:
    earlobe
  • Sterile Needles Used?
    Yes
Lifestyle
  • Athletic talents
    Soccer
  • Interests or Hobbies
    Sports, Art/Crafts, Outdoors, Cuisine, Pets, Working out, Baking / Cooking
  • Amount of exercise
    Occasional
  • Type of exercise
    Running, Biking, Weight lifting, Strength training
  • Type of diet
    Any
  • Quality of diet
    Good
Drugs and Alcohol
  • Alcohol use
    Tried at least once
  • Tobacco use
    Never
  • Heroin or opiates
    Never
  • Cocaine, crack
    Never
  • Crystal meth
    Never
  • LSD / Acid
    Never
  • PCP / Angel Dust
    Never
  • Other illegal drugs not listed above
    Never
Legal history
  • I have been arrested before, but not convicted.
    No
  • I have been convicted of a crime.
    No
  • I have spent at least one hour in jail or prison.
    No
  • I have spent more than 72 consecutive hours in prison in the last year.
    No
Medical History
  • Have you injected drugs for a non-medical reason in the last 5 years?
    No
  • Do you have hemophilia and/or received human-derived clotting factor concentrates in the last 5 years?
    No
  • Have you in the last 12 months lived in the same dwelling with another person with hepatitis B infection or hepatitis C infection?
    No
  • Have you been exposed in the preceding 12 months to known or suspected HIV (AIDS), Hepatitis B, and/or Hepatitis C infected blood through a needle stick or through contact with an open wound, non-intact skin, or mucous membrane?
    No
  • Have you ever been diagnosed with any form of hepatitis?
    No
  • Have you been in juvenile detention, lock up, jail or prison in the last 12 months?
    No
  • In the last 12 months, have you gotten a new tattoo, ear piercing or body piercing, or had acupuncture treatment in which NON STERILE instruments may have been used?
    No
  • In the last 8 weeks, did you receive a smallpox vaccination (vaccinia virus)?
    No
  • In the last 12 months, have you had any contact with someone who received a smallpox vaccination or who was diagnosed with smallpox?
    No
  • Have you ever been diagnosed with smallpox?
    No
Defects
  • Birth defects / Congenital abnormalities
    None
  • Chromosome abnormalities
    None
  • Specific genetic mutations and variants
    None
  • Cancer
    None
CJD - Creutzfeldt–Jakob disease
  • Has one or more blood relatives been diagnosed with CJD?
    No
  • Have you ever received injections of human pituitary-derived growth hormone?
    No
  • Have you ever received a dura mater transplant?
    No
  • Have you ever been diagnosed with dementia or any degenerative or demyelinating disease of the central nervous system (CNS) or other neurological disease of unknown etiology?
    No
Medical History
  • In the last 12 months, were you diagnosed with or treated for West Nile Virus?
    No
  • In the last 12 months, were you diagnosed with or treated for Syphilis?
    No
  • In the last 12 months, were you diagnosed with or treated for Chlamydia or gonorrhea infection?
    No
  • Have you ever received a blood transfusion?
    No
  • Have you ever been turned down to be a blood donor?
    No
  • Have you ever received a transplant of any tissue, cells or fluids from a non-human, animal source?
    No
  • Have you ever had intimate contact with a recipient of a transplant of any tissue, cells or fluids from a non-human, animal source?
    No
  • Were you born in or did you live in any of the following countries since 1977?
    No
  • Did you have a blood transfusion or have any medical treatment involving blood in any of the following countries since 1977?
    No
  • Have you been vaccinated in the last 6 months?
    No
Other Risk Factors
  • Neurologic problems
    None
  • Diseases with genetic risk factors
    Alcoholism
  • Problems that affect fertility
    None
  • Psychological / Emotional problems
    I have sought counseling for emotional problems, I have used medications such as anti-anxiety or antidepressants to treat an emotional or psychological problem
  • If you answered yes to any of the above, please explain.
    I take lorazepam for anxiety. I have been on and off it for a couple years, and while I don't really feel different when off of it, my mom also encouraged me to keep taking it as she was worried about my busy schedule. As for counseling, my father died when I was 17 so my sister and I saw a grief counselor.
CJD - Creutzfeldt–Jakob disease
  • Have you ever been diagnosed with vCJD or any other form of CJD?
    No
  • Have you received any transfusion of blood or blood components in the U.K. or France between 1980 to the present?
    No
  • Have you lived cumulatively for 5 years or more in Europe from 1980 until the Present?
    No
  • Are you a current or former U.S. military member, civilian military employee, or dependent of a military member or civilian employee who resided at U.S. military bases in
    No
  • Have you spent three months or more cumulatively in the U.K. from the beginning of 1980 through the end of 1996?
    No
Family Medical
  • Family Birth defects / Congenital abnormalities
    None
  • Family Chromosome abnormalities
    None
  • Family - Specific genetic mutations and variants
    None
  • Family - Cancer
    Lung cancer
Family Medical
  • Family cancer comments
    Both of my father's parents died of lung cancer, both life long smokers
  • Family - Neurologic problems
    Depression
  • Family - Diseases with genetic risk factors
    Heart Disease
  • Family disease comments
    Dad struggled with alcoholism after military service (died sober), and became quite overweight once he started having medical issues, mostly heart related. He died of a heart attack at 56
  • Family - Diseases with genetic risk factors
    Heart Disease
  • Family disease comments
    Dad struggled with alcoholism after military service (died sober), and became quite overweight once he started having medical issues, mostly heart related. He died of a heart attack at 56
  • Family - Problems that affect fertility
    None
Education
  • High school
    Graduated high school
  • College
    Currently attending
  • What is/was your college major?
    Liberal Arts (undecided)
  • What college degrees have you earned?
    None yet
  • Trade school
    I did not attend a trade school
Education
  • Which languages do you speak?
    1
  • Musical training or talents
    Instrument
  • Artistic training or talents
    Drawing, Painting, Fashion design
  • Current employment
    I work part-time outside the home
Donor Info
  • Egg donation experience
    No previous egg donations
  • Personal statement

    I was very involved in high school, participating in leadership team (basically student government), mock trial, art club, National Honor Society, Silver Cord (volunteer hours), Youth Salute, debate, and Varsity soccer. I'm athletic and have played softball, soccer, and football through my school. Me and my sister are built in such a way that we are quick to build muscle, with a strong and broad build. I also performed very well in school, as I graduated salutatorian, got a 32 on my ACT (about 1450 on the SAT), took AP classes, and was a great student to have in class. Since elementary school, I have been placed in advanced classes (sometimes skipping classes altogether), given extra assignments for stimulation, and even tutored my classmates. I have tested out of a 12th grade reading level since around third or fourth grade. Math, reading, writing, and science (the core subjects) came easy to me. I am creative and artistic as well, as I took AP art, design clothing, and love to complete projects I think up. Finally, I've always been a problem solver and thinker, so I like to use things I've learned and logic to try and solve problems.

Donor Info
  • I am interested in becoming a donor because:
    I think it would be a rewarding experience for me
  • Access to the office
    Not so close
  • Donor Type
    Egg Donor

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