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KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS BRAWIJAYA
SATGAS P3 COVID - 19
Jl. Veteran, Malang, 65145, Indonesia
Telp.: +62-341-551611, 575777; Fax.: +62-341-565420
email: satgascovid@ub.ac.id

Nomor : 102/SatgasCovid19/09/2021 29 September 2021


Lampiran : 1 (satu) berkas
Perihal : Undangan Vaksinasi Dosis ke-2

Yth.
Mahasiswa dan Keluarga Civitas Akademika Universitas Brawijaya
(Terlampir)

Dimohon kehadiran Bapak/Ibu/Saudara/i pada kegiatan vaksinasi dosis ke-1 yang akan
diselenggarakan pada :
Hari, tanggal : Sabtu - Senin, 2 – 4 Oktober 2021
Tempat : Gedung Samantha Krida Universitas Brawijaya
Nama dan waktu : terlampir

Peserta Vaksinasi diwajibkan untuk :


1. Membawa KTP atau fotocopy KTP
2. Membawa e-ticket bagi yang memiliki
3. Memakai pakaian longgar dan rapi, makan pagi terlebih dahulu, istirahat yang
cukup sebelum pelaksanaan vaksin
4. Tetap menjalankan protokol kesehatan 6M :
a. Memakai masker dobel dan tidak membuka masker selama pelaksanaan dan
berada di lokasi vaksin;
b. Mencuci tangan pakai sabun dan air mengalir;
c. Menjaga jarak;
d. Menjauhi kerumunan;
e. Membatasi mobilisasi dan interaksi; sebelum, selama menunggu dan setelah
pemberian vaksin, dan
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
UNIVERSITAS BRAWIJAYA
SATGAS P3 COVID - 19
Jl. Veteran, Malang, 65145, Indonesia
Telp.: +62-341-551611, 575777; Fax.: +62-341-565420
email: satgascovid@ub.ac.id

f. Menghindari makan minum bersama.


5. Membawa surat Rekomendasi Dokter (jika membutuhkan)
6. Khusus untuk peserta dengan hipertensi (tekanan darah tinggi) batas
diperbolehkan vaksin 180/100. Peserta akan diperiksa tekanan darah 2x, jika masih
tinggi akan kami arahkan tunda vaksinasi dan periksa ke fasilitas kesehatan sesuai
rekomendasi ahli jantung pembuluh darah
7. Menunda kehadiran bila ada gejala demam, flu, batuk dan melapor pada hotline
dengan nomor WA : 0811-3699-962
Untuk info lebih lanjut dapat mengunjungi https://ruvid.ub.ac.id/vaksinasi

Demikian undangan kami, atas perhatian dan kehadirannya kami sampaikan terima kasih.

Ketua Satgas Pencegahan, Pengendalian,


dan Penanggulangan Covid 19 UB

Prof. Dr. dr. Sri Andarini, M.Kes


NIP 195804141987012001

Tembusan :
1. Rektor UB (sebagai laporan)
2. Wakil Rektor II (sebagai laporan)
LAMPIRAN DATA NAMA PENERIMA dan JADWAL VAKSINASI DOSIS 2 (2-4 Oktober 2021)
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1 J-0****23K ANANDA DHARMA WIJAYA 340405******0003 0853*****095 02/10/2021 Sesi 1 08.00 - 10.00
2 J-0****27N KELVIN HENDRA WIJAYA 357817******0010 0812*****886 02/10/2021 Sesi 1 08.00 - 10.00
3 J-0****LIG YUANDINA PUTRI NURWANTI 340216******0005 0812*****310 02/10/2021 Sesi 1 08.00 - 10.00
4 J-0****9LL MASHUDI 351111******0003 0813*****052 02/10/2021 Sesi 1 08.00 - 10.00
5 J-0****JPH IWANG LAGA SUKMA 350712******0003 0822*****825 02/10/2021 Sesi 1 08.00 - 10.00
6 J-0****PK5 ABDUL MUDJIB SULAIMAN WAHID 357302******0001 0878*****912 02/10/2021 Sesi 1 08.00 - 10.00
7 J-0****PNI IHZA AULIA RAHMAN 357303******0004 0819*****844 02/10/2021 Sesi 1 08.00 - 10.00
8 J-0****URH YULIA NURHAYATI 357305******0010 0812*****426 02/10/2021 Sesi 1 08.00 - 10.00
9 J-0****ZSR MINANU NUROKHMAN 352217******0003 0813*****0555 02/10/2021 Sesi 1 08.00 - 10.00
10 J-0****254 REYHAN SOFIAN HAQQI 357305******0002 0821*****075 02/10/2021 Sesi 1 08.00 - 10.00
11 J-0****EB7 IVAN YULFRIAN 357303******0001 0898*****50 02/10/2021 Sesi 1 08.00 - 10.00
12 J-0****SBH INDAH NURHAYATI 351608******0001 0857*****585 02/10/2021 Sesi 1 08.00 - 10.00
13 J-0****PGC AFIF ZAINUL ABIDIN 357302******0002 0858*****060 02/10/2021 Sesi 1 08.00 - 10.00
14 J-0****UZF PARISTIWAINI WULANDARI 351703******0002 0896*****125 02/10/2021 Sesi 1 08.00 - 10.00
15 J-0****ZKE NINDHI PUTRI WIGUNANTHI 357305******0004 0821*****170 02/10/2021 Sesi 1 08.00 - 10.00
16 J-0****9QB NUR IMAN HIDAYATULLAH 120702******0004 0856*****924 02/10/2021 Sesi 1 08.00 - 10.00
17 J-0****V8L LUTFI 350718******0002 0812*****428 02/10/2021 Sesi 1 08.00 - 10.00
18 J-0****WE5 YULIAN RIZKI PRANANDA 350718******0013 0817*****77 02/10/2021 Sesi 1 08.00 - 10.00
19 J-0****2WV I MADE NARENDRA PUTRA 517101******0001 0857*****303 02/10/2021 Sesi 1 08.00 - 10.00
20 J-0****ILG ADMIRAL HISYAM ZIDNY 351409******0001 0895*****0454 02/10/2021 Sesi 1 08.00 - 10.00
21 J-0****FH4 DEBBY OLIVIA HALOHO 140613******0001 0821*****090 02/10/2021 Sesi 1 08.00 - 10.00
22 J-0****UBN ADI ARDIANSYAH 520603******0003 0812*****562 02/10/2021 Sesi 1 08.00 - 10.00
23 J-0****2A8 LIA MARIANA 620206******0002 0852*****947 02/10/2021 Sesi 1 08.00 - 10.00
24 J-0****90U BAYU INDRIARKO 317404******0018 0813*****424 02/10/2021 Sesi 1 08.00 - 10.00
25 J-0****FWT MUHAMMAD DEWA PUTRA IWANA 350721******0006 0856*****664 02/10/2021 Sesi 1 08.00 - 10.00
26 J-0****HMD NOVI TEOKTISTA 731718******0002 0821*****235 02/10/2021 Sesi 1 08.00 - 10.00
27 J-0****UJY AMANDA DESTYANTI 352103******0002 0821*****829 02/10/2021 Sesi 1 08.00 - 10.00
28 J-0****4FE ISNINNOVIANA ILMI AMALIA 357301******0003 0822*****456 02/10/2021 Sesi 1 08.00 - 10.00
29 J-0****9YU LOLITA ANGGY RISKI PRADIPTO 331104******0001 0838*****110 02/10/2021 Sesi 1 08.00 - 10.00
30 J-0****SMU DISCA HERMANDA 130405******0002 0813*****134 02/10/2021 Sesi 1 08.00 - 10.00
31 J-0****UKZ MUHAMMAD RIDHO ALFARIZI 520419******0001 0853*****901 02/10/2021 Sesi 1 08.00 - 10.00
32 J-0****E0V IQBAL BIONDY 217102******0001 0-***** 02/10/2021 Sesi 1 08.00 - 10.00
33 J-0****K97 RAMADHAN MULIA FAJRI 357304******0006 0851*****355 02/10/2021 Sesi 1 08.00 - 10.00
34 J-0****V7A RIKE DIANA NAFISA 350709******0001 0812*****909 02/10/2021 Sesi 1 08.00 - 10.00
35 J-0****8N5 RHAMA SATRIA PUTRA 350722******0002 0812*****928 02/10/2021 Sesi 1 08.00 - 10.00
36 J-0****8XG MARIANA FITRI RAHMAWATI 350408******0003 0813*****234 02/10/2021 Sesi 1 08.00 - 10.00
37 J-0****9Q0 ANDI YUSUF SAEFULLAH NUGRAHA 350722******0001 0812*****110 02/10/2021 Sesi 1 08.00 - 10.00
38 J-0****GRZ AULIA RIZKI ANANDA 140705******0007 0838*****788 02/10/2021 Sesi 1 08.00 - 10.00
39 J-0****O89 JOSUA CHANDRA BUNGARAN SITORUS 120201******0001 0812*****685 02/10/2021 Sesi 1 08.00 - 10.00

Page 1 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
40 J-0****Q7N SULTHAN RAFI ADITYA 327106******0018 0896*****495 02/10/2021 Sesi 1 08.00 - 10.00
41 J-0****UMF ALFI FATHANA DZIKRA 637205******0001 0877*****936 02/10/2021 Sesi 1 08.00 - 10.00
42 J-0****VFU GUSTI NISHFI NIRMALA SARI 637103******0005 0812*****612 02/10/2021 Sesi 1 08.00 - 10.00
43 J-0****VH8 MOHAMMAD FENDIK PRISWARNO 350911******0004 0812*****650 02/10/2021 Sesi 1 08.00 - 10.00
44 J-0****49V IMAM GHAZALI 357305******0004 0823*****834 02/10/2021 Sesi 1 08.00 - 10.00
45 J-0****U4W REJEKI PUSPA DINASTY 630206******0002 0813*****565 02/10/2021 Sesi 1 08.00 - 10.00
46 J-0****033 ADISTI FITRIA DYAH AYU WULANSARI 350608******0002 0813*****847 02/10/2021 Sesi 1 08.00 - 10.00
47 J-0****198 ABHIRAMA ANDHIKA CANDRA 137111******0015 0822*****825 02/10/2021 Sesi 1 08.00 - 10.00
48 J-0****C2K RONALDO SIMATUPANG 120319******0002 0813*****323 02/10/2021 Sesi 1 08.00 - 10.00
49 J-0****YT9 HASLINA 730805******0002 0896*****377 02/10/2021 Sesi 1 08.00 - 10.00
50 J-0****0N6 NASYWA FITRI AZ ZAHRA 357813******0004 0877*****077 02/10/2021 Sesi 1 08.00 - 10.00
51 J-0****0PK MUHAMMAD RAFLI ALI 327603******0004 0818*****264 02/10/2021 Sesi 1 08.00 - 10.00
52 J-0****0PM RAYHAN SURYA RAMADHAN 357901******0002 0896*****188 02/10/2021 Sesi 1 08.00 - 10.00
53 J-0****0PO NURIL ZAINAL FANANI 351421******0002 0822*****885 02/10/2021 Sesi 1 08.00 - 10.00
54 J-0****0PU INDIRA PRAKOSO 350611******0002 0812*****375 02/10/2021 Sesi 1 08.00 - 10.00
55 J-0****0PW GARIN NAFISAH KARINA 351709******0001 0821*****960 02/10/2021 Sesi 1 08.00 - 10.00
56 J-0****0PZ RAFAEL ANUGERAH MARDIKAPUTERA 350721******0006 0822*****683 02/10/2021 Sesi 1 08.00 - 10.00
57 J-0****0Q3 CAECILLIA NANDA PRAYOGA 367103******0002 0878*****991 02/10/2021 Sesi 1 08.00 - 10.00
58 J-0****0Q6 OLIRESIANELA 350625******0001 0812*****210 02/10/2021 Sesi 1 08.00 - 10.00
59 J-0****0Q7 MAULANA PUTRA IRWANSYAH 637103******0021 0812*****830 02/10/2021 Sesi 1 08.00 - 10.00
60 J-0****0Q8 FAREL ABHINAYA 121902******0005 0811*****00 02/10/2021 Sesi 1 08.00 - 10.00
61 J-0****0QA NAUFAL HISYAM FATHAR PUTRA 140902******0004 0812*****300 02/10/2021 Sesi 1 08.00 - 10.00
62 J-0****0QF DYAH NURFITRI SOLIKHAH 357602******0006 0822*****545 02/10/2021 Sesi 1 08.00 - 10.00
63 J-0****0QG JIHAN SALSABILA 350614******0003 0822*****199 02/10/2021 Sesi 1 08.00 - 10.00
64 J-0****0QJ MUHAMMAD AMMAR HASSAN 327601******0006 0821*****707 02/10/2021 Sesi 1 08.00 - 10.00
65 J-0****0QM RIMBA MANURUNG 121209******0002 0822*****130 02/10/2021 Sesi 1 08.00 - 10.00
66 J-0****0QU MU'AAFII FADHLULLAH 647103******0004 0858*****710 02/10/2021 Sesi 1 08.00 - 10.00
67 J-0****0QV RIZKI CHANDRA MAULANA 357302******0002 0-***** 02/10/2021 Sesi 1 08.00 - 10.00
68 J-0****0QW DIMAS DWI PUTRA 210107******0003 0822*****245 02/10/2021 Sesi 1 08.00 - 10.00
69 J-0****0QX NIKY PUTRI AGUSTIN 647105******0004 0878*****655 02/10/2021 Sesi 1 08.00 - 10.00
70 J-0****0QY DESILVA ROSA AMANDA 350722******0002 0858*****856 02/10/2021 Sesi 1 08.00 - 10.00
71 J-0****0R3 FAUZIAH 350713******0002 0822*****156 02/10/2021 Sesi 1 08.00 - 10.00
72 J-0****0R4 SHAUQI ABDA'I LUBIS 120919******0001 0822*****561 02/10/2021 Sesi 1 08.00 - 10.00
73 J-0****0R5 AISYAH RIEFDA AZZAHRA 350921******0006 0816*****601 02/10/2021 Sesi 1 08.00 - 10.00
74 J-0****0RA ALFAN KURNIAWAN 350709******0003 0822*****534 02/10/2021 Sesi 1 08.00 - 10.00
75 J-0****0RH HANNA SYAKIRA SALSABILA 330313******0001 0823*****632 02/10/2021 Sesi 1 08.00 - 10.00
76 J-0****0RL WAHYU NURDIANSYAH PRATAMA SANTOSO 352506******0001 0857*****014 02/10/2021 Sesi 1 08.00 - 10.00
77 J-0****0RO KHIVA HAIDAR SHAUMA TASSNO 327512******0006 0812*****288 02/10/2021 Sesi 1 08.00 - 10.00
78 J-0****0RW BENAYN BILALAKRAM HUDOYO 327603******0001 0895*****5897 02/10/2021 Sesi 1 08.00 - 10.00
79 J-0****0RY SOBAKHTONY EKA VANSYAH 351408******0001 0852*****363 02/10/2021 Sesi 1 08.00 - 10.00
80 J-0****0S0 NIA AYU NINGTYAS 350731******0001 0813*****246 02/10/2021 Sesi 1 08.00 - 10.00
81 J-0****0SB FERIEL AULIA AMINATA 352316******0001 0812*****600 02/10/2021 Sesi 1 08.00 - 10.00

Page 2 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
82 J-0****0SD DIDIK BAGUS SAPUTRA 350912******0005 0812*****672 02/10/2021 Sesi 1 08.00 - 10.00
83 J-0****0SO DWIKY WAHANA AKBAR 357304******0003 0838*****813 02/10/2021 Sesi 1 08.00 - 10.00
84 J-0****0SR CHARIS MAULANA 357301******0009 0812*****008 02/10/2021 Sesi 1 08.00 - 10.00
85 J-0****0TG ADIKA IRGY FASHAN 357802******0001 0812*****024 02/10/2021 Sesi 1 08.00 - 10.00
86 J-0****0TT TASYA NUR KARINA 157108******0021 0812*****580 02/10/2021 Sesi 1 08.00 - 10.00
87 J-0****0U3 NADIA ELENA 640305******0002 0812*****227 02/10/2021 Sesi 1 08.00 - 10.00
88 J-0****0U6 KHOIRUN NISA' 350702******0002 0852*****320 02/10/2021 Sesi 1 08.00 - 10.00
89 J-0****0UD AHMAD MUFID MURTADHA 340202******0003 0878*****322 02/10/2021 Sesi 1 08.00 - 10.00
90 J-0****0UZ NADYA INDRASWARI 357305******0001 0812*****003 02/10/2021 Sesi 1 08.00 - 10.00
91 J-0****0V0 HASANATUL USNA 332111******0002 0853*****012 02/10/2021 Sesi 1 08.00 - 10.00
92 J-0****0V2 PRAMITA SARI 350722******0004 0812*****101 02/10/2021 Sesi 1 08.00 - 10.00
93 J-0****0V6 KIZITO ADI KURNIA YOGA 331024******0001 0821*****084 02/10/2021 Sesi 1 08.00 - 10.00
94 J-0****0VD I GEDE TOMY EKA KURNIAWAN 510807******0004 0822*****017 02/10/2021 Sesi 1 08.00 - 10.00
95 J-0****0VM AKHMAD FAIZAL 331707******0007 0823*****107 02/10/2021 Sesi 1 08.00 - 10.00
96 J-0****0VV SALWA EUGENIA RATUTRIA 331811******0001 0821*****607 02/10/2021 Sesi 1 08.00 - 10.00
97 J-0****0W9 MUHAMMAD ANDRIAN PRATAMA 357302******0004 0895*****4244 02/10/2021 Sesi 1 08.00 - 10.00
98 J-0****0WE LENI SRI PANGESTI 330904******9004 0856*****320 02/10/2021 Sesi 1 08.00 - 10.00
99 J-0****0WR ROSYIDATUL CHURRIYAH 351615******0002 0815*****009 02/10/2021 Sesi 1 08.00 - 10.00
100 J-0****0WS MUHAMMAD DIMAS PRIYASTOMO 122203******0001 0822*****219 02/10/2021 Sesi 1 08.00 - 10.00
101 J-0****0WU ZIAZAFA NASWA HAIBA 367404******0001 0812*****408 02/10/2021 Sesi 1 08.00 - 10.00
102 J-0****0WY ULFA MALIHATUS SHOLIHA 350911******0005 0858*****923 02/10/2021 Sesi 1 08.00 - 10.00
103 J-0****0XB ATHA JAUZA ARVIANTY 350725******0005 0812*****307 02/10/2021 Sesi 1 08.00 - 10.00
104 J-0****0XY NAUFAL INDRA SATRIA PUTRA 320129******0001 0857*****293 02/10/2021 Sesi 1 08.00 - 10.00
105 J-0****0Y1 NAFISATUL ISTIQOMAH 180313******0003 0857*****626 02/10/2021 Sesi 1 08.00 - 10.00
106 J-0****0Y2 ARDHI YUSUF BACHTIAR 160703******0001 0-***** 02/10/2021 Sesi 1 08.00 - 10.00
107 J-0****0Y3 SITIADIRA AULIA ALDINI 352012******0003 0857*****076 02/10/2021 Sesi 1 08.00 - 10.00
108 J-0****0Y5 RAHMAD SHOLIHUL AKBAR 351605******0005 0813*****225 02/10/2021 Sesi 1 08.00 - 10.00
109 J-0****0YE TOMY AGUS KARDIANTO 357301******0001 0896*****568 02/10/2021 Sesi 1 08.00 - 10.00
110 J-0****0YS FIKRI FADLILAH ROHMAN 357302******0002 0856*****614 02/10/2021 Sesi 1 08.00 - 10.00
111 J-0****0YU M. ROBBANI 350625******0003 0878*****897 02/10/2021 Sesi 1 08.00 - 10.00
112 J-0****0YY CHALLISTA CHRISTABELLA 357305******0002 0812*****208 02/10/2021 Sesi 1 08.00 - 10.00
113 J-0****0Z9 WAHYU DWI RISTIANINGRUM 350311******0004 0858*****285 02/10/2021 Sesi 1 08.00 - 10.00
114 J-0****0ZG ROSELINI AGUSTIA ANDINI 351004******0001 0822*****293 02/10/2021 Sesi 1 08.00 - 10.00
115 J-0****106 IDA MAR'ATUL HIDAYAH 350624******0002 0819*****359 02/10/2021 Sesi 1 08.00 - 10.00
116 J-0****107 SILVI ZAKIYATUL ILMIYAH 351412******0002 0812*****621 02/10/2021 Sesi 1 08.00 - 10.00
117 J-0****108 RHETA EVA RAMADHANI SETIAWAN 340401******0001 0858*****083 02/10/2021 Sesi 1 08.00 - 10.00
118 J-0****10O MUHAMMAD RIZALDI 351412******0004 0857*****382 02/10/2021 Sesi 1 08.00 - 10.00
119 J-0****10W ALEYDA NUR HALIZAH WAHYUDI 357301******0001 0812*****579 02/10/2021 Sesi 1 08.00 - 10.00
120 J-0****117 SYAHRILLAH MARDIYYAH AHYANI 350719******0001 0823*****364 02/10/2021 Sesi 1 08.00 - 10.00
121 J-0****11T BRILLA ISMAYA SAFITRI 351003******0001 0822*****195 02/10/2021 Sesi 1 08.00 - 10.00
122 J-0****129 SYAMITHA RESMADIANI 332007******0005 0895*****0209 02/10/2021 Sesi 1 08.00 - 10.00
123 J-0****12E AHMAD SYARWANI 351406******0004 0856*****900 02/10/2021 Sesi 1 08.00 - 10.00

Page 3 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
124 J-0****12F ROAITIN NORAVITA NIHAYA 352417******0002 0831*****064 02/10/2021 Sesi 1 08.00 - 10.00
125 J-0****12J ADRIAN ADAM INDRABAYU 357813******0002 0813*****903 02/10/2021 Sesi 1 08.00 - 10.00
126 J-0****12K NUR MUHAIMIN 357804******0002 0881*****95 02/10/2021 Sesi 1 08.00 - 10.00
127 J-0****132 MUHAMMAD KHARIS ABDURROHMAN 350414******0004 0857*****900 02/10/2021 Sesi 1 08.00 - 10.00
128 J-0****137 DIYAH AYU PUSPITASARI 350810******0010 0856*****654 02/10/2021 Sesi 1 08.00 - 10.00
129 J-0****13D AHMAD BAYU FADILLAH 357305******0022 0813*****898 02/10/2021 Sesi 1 08.00 - 10.00
130 J-0****13E DWI JANUARKO SATRIYO PRIJANTO 350722******0001 0858*****545 02/10/2021 Sesi 1 08.00 - 10.00
131 J-0****13X CUCUT MAYSAROH 357304******0010 0878*****935 02/10/2021 Sesi 1 08.00 - 10.00
132 J-0****14U ARIFAH RAMADHANI AZZAH 351514******0002 0857*****848 02/10/2021 Sesi 1 08.00 - 10.00
133 J-0****17H MAURIN ARDHINA SYAFIUDIN 357304******0007 0895*****463 02/10/2021 Sesi 1 08.00 - 10.00
134 J-0****17I RESPATI HARI YUDANTO 331305******0001 0838*****222 02/10/2021 Sesi 1 08.00 - 10.00
135 J-0****17P AISHA HAWINA RAHMA 351518******0001 0819*****013 02/10/2021 Sesi 1 08.00 - 10.00
136 J-0****183 ALIFIA NURMA ANGGRAENI 350411******0002 0895*****9532 02/10/2021 Sesi 1 08.00 - 10.00
137 J-0****18N KHOFIFAH INDAH MEI WARGIATI 352423******0002 0821*****216 02/10/2021 Sesi 1 08.00 - 10.00
138 J-0****19N ABRAR SEFFA FERNANDA 327102******0002 0856*****301 02/10/2021 Sesi 1 08.00 - 10.00
139 J-0****19U GRACESIA JESSICA PETRINA 367406******0014 0878*****197 02/10/2021 Sesi 1 08.00 - 10.00
140 J-0****1A7 WIWIK EKA SWIASRI 357305******0001 0812*****127 02/10/2021 Sesi 1 08.00 - 10.00
141 J-0****1AB NUGROHO HARTANDI 331808******0001 0812*****121 02/10/2021 Sesi 1 08.00 - 10.00
142 J-0****1B0 DIAN PERMATASARI 357901******0003 0812*****566 02/10/2021 Sesi 1 08.00 - 10.00
143 J-0****1CT ANDRI SUTANTO 357304******0002 0813*****779 02/10/2021 Sesi 1 08.00 - 10.00
144 J-0****1D1 MOHAMAD ROMADHANI PRABOWO 350719******0001 0857*****910 02/10/2021 Sesi 1 08.00 - 10.00
145 J-0****1D8 QAULAN TSAQILA TRESNA NUGRAHA 320509******0007 0853*****252 02/10/2021 Sesi 1 08.00 - 10.00
146 J-0****1DB CHALIQ CHAIRAWAN 350724******0007 0812*****703 02/10/2021 Sesi 1 08.00 - 10.00
147 J-0****1DD 3573046812010005 357304******0005 0813*****987 02/10/2021 Sesi 1 08.00 - 10.00
148 J-0****1G1 MUH. DAHRUL. M 737303******0001 0813*****599 02/10/2021 Sesi 1 08.00 - 10.00
149 J-0****1H9 AULIA ABABIL BALQIS 350817******0001 0852*****096 02/10/2021 Sesi 1 08.00 - 10.00
150 J-0****1IB FATIMA EVITARIANY AZ ZAHRA BAKHTIAR 321606******0004 0812*****313 02/10/2021 Sesi 1 08.00 - 10.00
151 J-0****1KG ALFAN ZIDNI ILMAN 332415******0001 0812*****600 02/10/2021 Sesi 1 08.00 - 10.00
152 J-0****1KN AMALINA NURIN AWANIS 350713******0003 0896*****432 02/10/2021 Sesi 1 08.00 - 10.00
153 J-0****1KZ PADANG SUKMAWAN 357305******0015 0812*****98 02/10/2021 Sesi 1 08.00 - 10.00
154 J-0****1L9 TSALATSA WILDAN MASRIQI 150208******0001 0813*****987 02/10/2021 Sesi 1 08.00 - 10.00
155 J-0****1LS ARISAH WIJAYANTI 357305******0003 0877*****436 02/10/2021 Sesi 1 08.00 - 10.00
156 J-0****1O9 NUR DHINY DEWANTARA 352211******0004 0813*****077 02/10/2021 Sesi 1 08.00 - 10.00
157 J-0****1SX DEDE ANA 320931******0004 0895*****5480 02/10/2021 Sesi 1 08.00 - 10.00
158 J-0****1T8 SURYA DEWA RAMADHAN 327503******0030 0859*****123 02/10/2021 Sesi 1 08.00 - 10.00
159 J-0****1TZ DEVANILA LISANTI JUNIELA 352018******0002 0852*****942 02/10/2021 Sesi 1 08.00 - 10.00
160 J-0****1U8 RIAN SETIA BUDI 121007******0005 0822*****538 02/10/2021 Sesi 1 08.00 - 10.00
161 J-0****1UV HARDIANTO PRAMBUDI 332203******0002 0821*****567 02/10/2021 Sesi 1 08.00 - 10.00
162 J-0****1VN MUHAMMAD AZIZ MURTADHA 360405******0003 0851*****312 02/10/2021 Sesi 1 08.00 - 10.00
163 J-0****1VO FARHAN AHMAD AL FARUQI 357305******0004 0812*****541 02/10/2021 Sesi 1 08.00 - 10.00
164 J-0****1WC VIVIT FITRIA 357302******0003 0821*****775 02/10/2021 Sesi 1 08.00 - 10.00
165 J-0****1WE BHASKARA DWI CAHYONO 352010******0001 0822*****673 02/10/2021 Sesi 1 08.00 - 10.00

Page 4 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
166 J-0****1WI BERLIANA LINDA UTAMI 351511******0001 0858*****133 02/10/2021 Sesi 1 08.00 - 10.00
167 J-0****1WP ABDUL AZIZ 332809******0006 0812*****435 02/10/2021 Sesi 1 08.00 - 10.00
168 J-0****1WQ DISMA RIZQI SAMODRA 357305******0001 0821*****995 02/10/2021 Sesi 1 08.00 - 10.00
169 J-0****1XL FITRA ZAHRA SALSABILA 357303******0003 0852*****737 02/10/2021 Sesi 1 08.00 - 10.00
170 J-0****1XS MAYSHINTA TRIENDAH KUSUMASARI 357301******0001 0896*****923 02/10/2021 Sesi 1 08.00 - 10.00
171 J-0****1YE SITI AMINAH ROHMAWATI 357303******0006 0857*****967 02/10/2021 Sesi 1 08.00 - 10.00
172 J-0****1Z2 FAQIH MUFIDAH 350722******0002 0823*****625 02/10/2021 Sesi 1 08.00 - 10.00
173 J-0****1ZE AZIZURRAHMAN RAFLI 357305******0001 0819*****981 02/10/2021 Sesi 1 08.00 - 10.00
174 J-0****1ZP WULAN PUJI LESTARI 351318******0006 0831*****295 02/10/2021 Sesi 1 08.00 - 10.00
175 J-0****20H BRIAN PRADANA 357301******0006 0856*****740 02/10/2021 Sesi 1 08.00 - 10.00
176 J-0****20S ASYAM FADHILAH AKBAR 357305******0008 0821*****2033 02/10/2021 Sesi 1 08.00 - 10.00
177 J-0****225 KIEMAS AJI ANDIKA MAHENDRA 330818******0006 0822*****897 02/10/2021 Sesi 1 08.00 - 10.00
178 J-0****23P RIZKI RAMADHAN BAGASPUTRA 327509******0016 0813*****735 02/10/2021 Sesi 1 08.00 - 10.00
179 J-0****24T RIZKY SWASTIKA 352103******0002 0822*****443 02/10/2021 Sesi 1 08.00 - 10.00
180 J-0****24U AZIZATI FIEKI RACHMATILLAH 337415******0002 0812*****992 02/10/2021 Sesi 1 08.00 - 10.00
181 J-0****25X KHUSNUL IMANIA 357303******0003 0856*****510 02/10/2021 Sesi 1 08.00 - 10.00
182 J-0****26I NURMA HAPSARI WAHYUNINGSIH 357501******0001 0821*****251 02/10/2021 Sesi 1 08.00 - 10.00
183 J-0****26P YUDO PERMEY WIJAYA 357303******0001 0822*****817 02/10/2021 Sesi 1 08.00 - 10.00
184 J-0****29H M DILAN LINOVAL 167104******0006 0895*****5971 02/10/2021 Sesi 1 08.00 - 10.00
185 J-0****29Z AULIA AYU PRAMESWARI 350722******0002 0-***** 02/10/2021 Sesi 1 08.00 - 10.00
186 J-0****2AN SANTATA RISYA ADITAMA 357304******0003 0811*****19 02/10/2021 Sesi 1 08.00 - 10.00
187 J-0****2AR AFFIE ZURAHNIA 357304******0001 0821*****268 02/10/2021 Sesi 1 08.00 - 10.00
188 J-0****2AV ANIES SA'DIJATURROHMAH 357305******0004 0821*****694 02/10/2021 Sesi 1 08.00 - 10.00
189 J-0****2B7 THUSTI DWI PURNAMI 357305******0003 0813*****079 02/10/2021 Sesi 1 08.00 - 10.00
190 J-0****2BC ACHMAD TANTOWI JAUHARI 357903******0002 0812*****376 02/10/2021 Sesi 1 08.00 - 10.00
191 J-0****2CZ RAFIDAH MIA ANDINA 357303******0001 0852*****894 02/10/2021 Sesi 1 08.00 - 10.00
192 J-0****2FQ SRI AYU AGUNG PURNAMI 331104******0002 0895*****541 02/10/2021 Sesi 1 08.00 - 10.00
193 J-0****2FX ARI IRAWAN 357301******0001 0815*****634 02/10/2021 Sesi 1 08.00 - 10.00
194 J-0****2G8 ROBY SETYO 121014******0002 0823*****422 02/10/2021 Sesi 1 08.00 - 10.00
195 J-0****2HF HAIDAR HILMY SEBAYANG 357301******0005 0812*****992 02/10/2021 Sesi 1 08.00 - 10.00
196 J-0****2HH OKTA HERMAWAN 357303******0006 0822*****986 02/10/2021 Sesi 1 08.00 - 10.00
197 J-0****2HK DINA TRI JAYANTI 350714******0002 0858*****289 02/10/2021 Sesi 1 08.00 - 10.00
198 J-0****2HP KRESNA ANGGER MARZUQNA 357304******0007 0896*****406 02/10/2021 Sesi 1 08.00 - 10.00
199 J-0****2HX DIDIK WAHYU PRIBADI 357305******0013 0812*****897 02/10/2021 Sesi 1 08.00 - 10.00
200 J-0****2JX CICI EKO SETYOWATI 350804******0009 0856*****103 02/10/2021 Sesi 1 08.00 - 10.00
201 J-0****2K8 ABDUL KHOLIS 350818******0001 0813*****211 02/10/2021 Sesi 1 08.00 - 10.00
202 J-0****2LP IMAS WAHYUNI 357303******0003 0817*****98 02/10/2021 Sesi 1 08.00 - 10.00
203 J-0****2M3 HEDDY YAHYA FIRDAUS 352302******0001 0822*****915 02/10/2021 Sesi 1 08.00 - 10.00
204 J-0****2MV DIDIK OKTARIYANTO 350724******0002 0812*****590 02/10/2021 Sesi 1 08.00 - 10.00
205 J-0****2N0 MU'AMMAR HAIDAR HANIF 357305******0001 0822*****358 02/10/2021 Sesi 1 08.00 - 10.00
206 J-0****2RJ AMELIA CAHYANI 320924******0012 0813*****177 02/10/2021 Sesi 1 08.00 - 10.00
207 J-0****2RP ALFINA RODIAH 350719******0001 0857*****541 02/10/2021 Sesi 1 08.00 - 10.00

Page 5 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
208 J-0****2SM FATIMA ZAHRA IZZA ISLAMI 350719******0002 0819*****065 02/10/2021 Sesi 1 08.00 - 10.00
209 J-0****2TI KHOLIF MUHAMMAD 352512******0003 0812*****798 02/10/2021 Sesi 1 08.00 - 10.00
210 J-0****2TM WILDA QURROTA A'YUN 350727******0004 0857*****304 02/10/2021 Sesi 1 08.00 - 10.00
211 J-0****2TP FATHIYAH LATHIFUNNISA 357304******0001 0856*****553 02/10/2021 Sesi 1 08.00 - 10.00
212 J-0****2UE NURISA ARUM WULANSARI 350619******0001 0857*****294 02/10/2021 Sesi 1 08.00 - 10.00
213 J-0****2UL AVINA MASSIROH 350722******0001 0851*****754 02/10/2021 Sesi 1 08.00 - 10.00
214 J-0****2WF MOCHAMMAD FADJAR DUWI LAKSONO 350727******0002 0812*****990 02/10/2021 Sesi 1 08.00 - 10.00
215 J-0****2WI RIFKA LUQITA SALSABILA 340412******0006 0895*****3627 02/10/2021 Sesi 1 08.00 - 10.00
216 J-0****2WM ANANTA WAHYU WISUDAWATI 351420******0002 0813*****703 02/10/2021 Sesi 1 08.00 - 10.00
217 J-0****2WU MIA MERDEKA WATI 357305******0013 0812*****231 02/10/2021 Sesi 1 08.00 - 10.00
218 J-0****2XU RATNA PALUPI 350108******0001 0813*****101 02/10/2021 Sesi 1 08.00 - 10.00
219 J-0****2Y5 AGUS SUPRAPTO 350718******0001 0896*****587 02/10/2021 Sesi 1 08.00 - 10.00
220 J-0****30H NUR RAHMAWATI 520606******1006 0822*****245 02/10/2021 Sesi 1 08.00 - 10.00
221 J-0****31N ALFANI VIVIN TIODORA MALAU 121709******0002 0821*****829 02/10/2021 Sesi 1 08.00 - 10.00
222 J-0****352 IDA 350721******0001 0821*****047 02/10/2021 Sesi 1 08.00 - 10.00
223 J-0****368 DIDIK TRI SUSANTO 351314******0003 0812*****463 02/10/2021 Sesi 1 08.00 - 10.00
224 J-0****36I MOHAMMAD MALIK ABDUL AZIZ 357303******0004 0821*****474 02/10/2021 Sesi 1 08.00 - 10.00
225 J-0****37O MUHAMMAD FIRDAUS 520307******0007 0877*****131 02/10/2021 Sesi 1 08.00 - 10.00
226 J-0****37X ZAINAL ARIFIEN 350722******0001 0857*****794 02/10/2021 Sesi 1 08.00 - 10.00
227 J-0****39J NURUL HIDAYATI 332301******0001 0813*****097 02/10/2021 Sesi 1 08.00 - 10.00
228 J-0****3CI MEILINA RIZKY FADILLAH 350713******0003 0896*****608 02/10/2021 Sesi 1 08.00 - 10.00
229 J-0****3CM MUHAMMAD MAHARDIKA 357304******0005 0877*****099 02/10/2021 Sesi 1 08.00 - 10.00
230 J-0****3F7 MUHAMMAD HAEKAL RAMADHANIE 357303******0005 0812*****542 02/10/2021 Sesi 1 08.00 - 10.00
231 J-0****3GS HAIDAR HARFI HADHIANSAH 357404******0002 0895*****9094 02/10/2021 Sesi 1 08.00 - 10.00
232 J-0****3JA DEZZALINA DYANA PARAMITA 357305******0001 0813*****184 02/10/2021 Sesi 1 08.00 - 10.00
233 J-0****3JI KARINA ANISA PRAYITNO 357303******0002 0821*****390 02/10/2021 Sesi 1 08.00 - 10.00
234 J-0****3L5 NUR HERFIANTI 357301******0001 0838*****521 02/10/2021 Sesi 1 08.00 - 10.00
235 J-0****3N8 LISTYANINGRUM 351413******0005 0813*****144 02/10/2021 Sesi 1 08.00 - 10.00
236 J-0****3NT NURYA RACHMAWATI 352417******0002 0859*****6990 02/10/2021 Sesi 1 08.00 - 10.00
237 J-0****3O4 MOHAMMAD ARIESTIAN BAGUS SANTOSO 350722******0002 0821*****231 02/10/2021 Sesi 1 08.00 - 10.00
238 J-0****3OG YOANA ALMA SALSABILA 351401******0004 0813*****904 02/10/2021 Sesi 1 08.00 - 10.00
239 J-0****3PB MUNTARI 352406******0001 0856*****509 02/10/2021 Sesi 1 08.00 - 10.00
240 J-0****3QF SHELLA DEWI CHARISMA 357305******0003 0857*****823 02/10/2021 Sesi 1 08.00 - 10.00
241 J-0****3RD SAT RESTU WAHYUNINGSIH 352404******0001 0819*****075 02/10/2021 Sesi 1 08.00 - 10.00
242 J-0****3S8 ALMER RAKHA ANANTA 350724******0005 0821*****271 02/10/2021 Sesi 1 08.00 - 10.00
243 J-0****3ST SAFIR RAHMAHUDA MACHSUN 350311******0001 0812*****019 02/10/2021 Sesi 1 08.00 - 10.00
244 J-0****406 RICKY PARMA PUTRA 640903******0002 0899*****68 02/10/2021 Sesi 1 08.00 - 10.00
245 J-0****407 NURI ARDIANTI 350733******0001 0898*****48 02/10/2021 Sesi 1 08.00 - 10.00
246 J-0****45V SITI RAHMI KASIM 717103******0002 0812*****073 02/10/2021 Sesi 1 08.00 - 10.00
247 J-0****48L PRIMA HERDIANTO 320113******0005 0812*****287 02/10/2021 Sesi 1 08.00 - 10.00
248 J-0****4AU SRI DARWATI MADURETNO 357305******0009 0812*****653 02/10/2021 Sesi 1 08.00 - 10.00
249 J-0****4HR ADITYAS RUCITRA PRADIPTA 350809******0001 0852*****417 02/10/2021 Sesi 1 08.00 - 10.00

Page 6 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
250 J-0****4L5 RIZKI HASNA SALSABIL RAKHA 357303******0007 0813*****768 02/10/2021 Sesi 1 08.00 - 10.00
251 J-0****5B0 ANINDYA PUTRI PARAMITHA 327504******0008 0812*****174 02/10/2021 Sesi 1 08.00 - 10.00
252 J-0****5ET RAFELINA DYAH PALUPI 357303******0006 0895*****3700 02/10/2021 Sesi 1 08.00 - 10.00
253 J-0****5M2 NI'MAH SORAYALAEL 647205******0001 0812*****096 02/10/2021 Sesi 1 08.00 - 10.00
254 J-0****5NL MOHAMMAD HAIDI YUZAILI 647401******0010 0853*****315 02/10/2021 Sesi 1 08.00 - 10.00
255 J-0****63M HENDRO DWI PRASETYO 351610******0001 0812*****816 02/10/2021 Sesi 1 08.00 - 10.00
256 J-0****63X MUHAJIR 731010******0002 0813*****433 02/10/2021 Sesi 1 08.00 - 10.00
257 J-0****744 RIZMA ERNAWANTI 350713******0002 0896*****015 02/10/2021 Sesi 1 08.00 - 10.00
258 J-0****7C8 ZENDY DWI ANDINI 927101******0001 0852*****018 02/10/2021 Sesi 1 08.00 - 10.00
259 J-0****851 ATHALLAH FAISAL RAVY 352318******0004 0878*****931 02/10/2021 Sesi 1 08.00 - 10.00
260 J-0****85F TIYAS ESTIYANTI 331103******0001 0882*****620 02/10/2021 Sesi 1 08.00 - 10.00
261 J-0****85W VARADILLA VIRGIA ISWANDA 357903******0003 0858*****488 02/10/2021 Sesi 1 08.00 - 10.00
262 J-0****85Y SINTYA BILLA POERWANTI 350702******0003 0822*****961 02/10/2021 Sesi 1 08.00 - 10.00
263 J-0****861 YOSI SAFITRI 357305******0004 0813*****078 02/10/2021 Sesi 1 08.00 - 10.00
264 J-0****862 CHOIRUNNIZAR ADE KURNIAWAN 647401******0007 0895*****195 02/10/2021 Sesi 1 08.00 - 10.00
265 J-0****86X LADY AINUN PARDIANA 357703******0001 0821*****710 02/10/2021 Sesi 1 08.00 - 10.00
266 J-0****874 DIO ARYA PRATAMA 130711******0001 0822*****061 02/10/2021 Sesi 1 08.00 - 10.00
267 J-0****87C NUR RAHMI 357301******0006 0878*****069 02/10/2021 Sesi 1 08.00 - 10.00
268 J-0****87E HEIDY CHRISTINA SUBEKTI 647105******0006 0821*****292 02/10/2021 Sesi 1 08.00 - 10.00
269 J-0****87R ALIFYYA FAIZA 510306******0006 0877*****088 02/10/2021 Sesi 1 08.00 - 10.00
270 J-0****87U MALIKA CALLULA LABIBA 517103******0025 0895*****263 02/10/2021 Sesi 1 08.00 - 10.00
271 J-0****87Y ATHALIA ELSA TOMBOKAN 627103******0003 0851*****496 02/10/2021 Sesi 1 08.00 - 10.00
272 J-0****88B NURUL WILADATUL WILDA 357305******0003 0897*****86 02/10/2021 Sesi 1 08.00 - 10.00
273 J-0****88I CITA AJI PANGESTI 331613******0001 0812*****128 02/10/2021 Sesi 1 08.00 - 10.00
274 J-0****88Z RONA NISRINA RAHMAWATI 350718******0002 0813*****558 02/10/2021 Sesi 1 08.00 - 10.00
275 J-0****890 CINDY CLARABEL 357703******0004 0812*****869 02/10/2021 Sesi 1 08.00 - 10.00
276 J-0****899 MUHAMMAD SYAMSUL HUDA 351813******0001 0852*****904 02/10/2021 Sesi 1 08.00 - 10.00
277 J-0****8B0 ERLYA WATI 357301******0001 0821*****325 02/10/2021 Sesi 1 08.00 - 10.00
278 J-0****8BK NASHRULLAH 137503******0001 0895*****377 02/10/2021 Sesi 1 08.00 - 10.00
279 J-0****8BM ANNISA DZATA SABRINA 351412******0002 0899*****16 02/10/2021 Sesi 1 08.00 - 10.00
280 J-0****8BO DEWI MUHFIDAH 357303******0003 0895*****335 02/10/2021 Sesi 1 08.00 - 10.00
281 J-0****8BW BAARIQ FAIRUUZ AZHAR 352601******0001 0877*****702 02/10/2021 Sesi 1 08.00 - 10.00
282 J-0****8F7 SHAFIRA AULIA INDRARTO 331311******0001 0878*****676 02/10/2021 Sesi 1 08.00 - 10.00
283 J-0****8GA KELVIN ADI PERMANA 217110******9007 0812*****300 02/10/2021 Sesi 1 08.00 - 10.00
284 J-0****8GI IMAM FARIS 121002******0004 0813*****609 02/10/2021 Sesi 1 08.00 - 10.00
285 J-0****8IG SAVINA RACHMA ANINDITA 357304******0004 0896*****005 02/10/2021 Sesi 1 08.00 - 10.00
286 J-0****8J8 ADHE PUTRI NURWAHYUDI ANSYAH 350802******0001 0878*****818 02/10/2021 Sesi 1 08.00 - 10.00
287 J-0****8LG DEDE FATHU ROCHMAN 360327******0002 0813*****889 02/10/2021 Sesi 1 08.00 - 10.00
288 J-0****8MG FIKRI AL FIANUR IHSAN 647103******0004 0898*****13 02/10/2021 Sesi 1 08.00 - 10.00
289 J-0****8O4 YAYANG ITROK DIAN S 350718******0001 0812*****278 02/10/2021 Sesi 1 08.00 - 10.00
290 J-0****8OL DINA SAPUTRI 351408******0001 0815*****444 02/10/2021 Sesi 1 08.00 - 10.00
291 J-0****8OZ NEAXEL IMANUEL RAYDICTO 351508******0004 0812*****564 02/10/2021 Sesi 1 08.00 - 10.00

Page 7 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
292 J-0****8P1 SIFIN ASTARIA 351702******0003 0856*****548 02/10/2021 Sesi 1 08.00 - 10.00
293 J-0****8PO VIRGIAWAN TRISTIANTO 357301******0002 0896*****221 02/10/2021 Sesi 1 08.00 - 10.00
294 J-0****8SU NAZIFA SYAHRANI 147105******0021 0823*****265 02/10/2021 Sesi 1 08.00 - 10.00
295 J-0****8TA YASMIN NURHALIZAH MASDUQI 357302******0003 0823*****793 02/10/2021 Sesi 1 08.00 - 10.00
296 J-0****8U1 RABIATUL ADAWIYAH 630906******0002 0822*****726 02/10/2021 Sesi 1 08.00 - 10.00
297 J-0****8U7 ZHEITAZAHRA AL MAHY 357305******0004 0882*****391 02/10/2021 Sesi 1 08.00 - 10.00
298 J-0****8UJ NAUFAL QOBUS PRABASWARA 351414******0002 0822*****730 02/10/2021 Sesi 1 08.00 - 10.00
299 J-0****8W8 DWI WIJIANING KHOLIDIYAH 351418******0002 0813*****281 02/10/2021 Sesi 1 08.00 - 10.00
300 J-0****8WT MUHAMMAD RIDHO FATKHUL HUMAM 330616******0004 0857*****224 02/10/2021 Sesi 1 08.00 - 10.00
301 J-0****92I TONI RINALDO 357903******0003 0812*****587 02/10/2021 Sesi 1 08.00 - 10.00
302 J-0****92Q NAILUVAR IZZAHARA ZANNUBIA 332415******0001 0856*****696 02/10/2021 Sesi 1 08.00 - 10.00
303 J-0****99J SYAIFUDIN EKA PRADANA 351617******0004 0812*****656 02/10/2021 Sesi 1 08.00 - 10.00
304 J-0****9BH SHOFIYYA DINI ARIFAH 350723******0001 0822*****618 02/10/2021 Sesi 1 08.00 - 10.00
305 J-0****9FW VINSENSIUS WIDI AMBAR PASUJATI 357304******0004 0888*****52 02/10/2021 Sesi 1 08.00 - 10.00
306 J-0****9PW ZAQI AULIYA' ALHABSY 350715******0001 0856*****977 02/10/2021 Sesi 1 08.00 - 10.00
307 J-0****9PY ALING ARAFAH EL GHUFRON 350714******0005 0815*****08 02/10/2021 Sesi 1 08.00 - 10.00
308 J-0****9PZ ALEXANDER DZULQORNAIN AL MADJEDY 350714******0001 0812*****715 02/10/2021 Sesi 1 08.00 - 10.00
309 J-0****9Q8 ALYA FADHILLA 357302******0001 0851*****640 02/10/2021 Sesi 1 08.00 - 10.00
310 J-0****9RP SOPHIA SEKARSARI 357503******0001 0877*****376 02/10/2021 Sesi 1 08.00 - 10.00
311 J-0****9RY GITA FITRI 357903******0001 0896*****430 02/10/2021 Sesi 1 08.00 - 10.00
312 J-0****9S4 ANGGARANI PRAMESWARI WIJAYANTI 350409******0001 0822*****507 02/10/2021 Sesi 1 08.00 - 10.00
313 J-0****9SY ZAHIDUR RAHMAN 357305******0001 0812*****619 02/10/2021 Sesi 1 08.00 - 10.00
314 J-0****9TV IVAN SINATRYA WIRANDA 357302******0002 0852*****112 02/10/2021 Sesi 1 08.00 - 10.00
315 J-0****9V7 MUJAHIDAH FAIZAH 357305******0002 0813*****808 02/10/2021 Sesi 1 08.00 - 10.00
316 J-0****9W1 M. SYABILACH PUTRA GEMILANG 737103******0001 0823*****637 02/10/2021 Sesi 1 08.00 - 10.00
317 J-0****A7O SRI WIDAYATI 351504******0001 0812*****000 02/10/2021 Sesi 1 08.00 - 10.00
318 L-0****1QQ AGUS SUGIJANTO 357817******0004 0856*****53 02/10/2021 Sesi 1 08.00 - 10.00
319 N-6****D3D drg.Kuni Ridha Andini,Sp.Ort 352516******0122 0813*****565 02/10/2021 Sesi 1 08.00 - 10.00
320 P-1****GHF DEA AYU PARAMITA 327505******0012 0812*****912 02/10/2021 Sesi 1 08.00 - 10.00
321 P-1****W38 Indarti Agustina 350723******0004 0896*****407 02/10/2021 Sesi 1 08.00 - 10.00
322 P-2****26U AYU DEWI LESTARI 331220******0002 0821*****622 02/10/2021 Sesi 1 08.00 - 10.00
323 P-2****HQY Barotul Mausyufah 350912******0005 0822*****653 02/10/2021 Sesi 1 08.00 - 10.00
324 P-2****IVZ Ainayah Bismi Anjani 167103******0004 0822*****825 02/10/2021 Sesi 1 08.00 - 10.00
325 P-2****TNA HANIATUL ULYA 331905******0001 0821*****328 02/10/2021 Sesi 1 08.00 - 10.00
326 P-2****3EY Naili Filhajati 357301******0007 0812*****523 02/10/2021 Sesi 1 08.00 - 10.00
327 P-2****RG0 Gusti Ayu Made Devta 180712******0003 0882*****300 02/10/2021 Sesi 1 08.00 - 10.00
328 P-2****VE3 DINDA SUKMAWATI 321302******0005 0831*****748 02/10/2021 Sesi 1 08.00 - 10.00
329 P-2****ZOY EXVITA WIDAWATI 350721******0001 0896*****551 02/10/2021 Sesi 1 08.00 - 10.00
330 P-2****UHF ZAHRA MUFIDAH 647402******0004 0821*****063 02/10/2021 Sesi 1 08.00 - 10.00
331 P-2****5EU Echa Valentina Gunawan 357304******0001 0895*****7579 02/10/2021 Sesi 1 08.00 - 10.00
332 P-2****LHK GRISHELDA DVITIA DEVASYA KAINGRAS 350719******0003 0897*****36 02/10/2021 Sesi 1 08.00 - 10.00
333 P-2****FX3 LATHIFA AULIA KHAIRI 330507******0001 0858*****368 02/10/2021 Sesi 1 08.00 - 10.00

Page 8 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
334 P-2****NEB NARISA AZ-ZAHRA 357815******0002 0813*****902 02/10/2021 Sesi 1 08.00 - 10.00
335 P-2****5H9 MADE INSAN GAYATRI 357503******0001 0851*****559 02/10/2021 Sesi 1 08.00 - 10.00
336 P-2****GAU andre oktavian 350301******0004 0853*****198 02/10/2021 Sesi 1 08.00 - 10.00
337 P-2****3OR ALAYDRUS RIDHO AKBAR 350804******0002 0852*****396 02/10/2021 Sesi 1 08.00 - 10.00
338 P-2****UQ8 MUHAMMAD GAZA RAHMALLAH AJI 367407******0001 0878*****989 02/10/2021 Sesi 1 08.00 - 10.00
339 P-2****MGU Ivan Prasetiyo 367104******0001 0878*****855 02/10/2021 Sesi 1 08.00 - 10.00
340 P-2****P0M NAUFAL MAHADIKA 330406******0003 0812*****750 02/10/2021 Sesi 1 08.00 - 10.00
341 P-2****SC8 GILANG KUSUMA PUTRA 337102******0001 0856*****748 02/10/2021 Sesi 1 08.00 - 10.00
342 P-2****TTS AJI PRATAMA PUTRA 351111******0001 0813*****380 02/10/2021 Sesi 1 08.00 - 10.00
343 P-2****9EA MARYANTI AFRILDA 120723******0004 0813*****196 02/10/2021 Sesi 1 08.00 - 10.00
344 P-2****AJU SAYYID MUHAMMAD DJAFAR 327610******0001 0811*****91 02/10/2021 Sesi 1 08.00 - 10.00
345 P-2****GZS ROCHMAN HADINATA 357301******0005 0896*****862 02/10/2021 Sesi 1 08.00 - 10.00
346 P-2****XFA EKA NUR RAKHMAWATI 351503******0001 0857*****196 02/10/2021 Sesi 1 08.00 - 10.00
347 P-2****R55 ELDA CANDRA ROSALINA 352404******0003 0822*****274 02/10/2021 Sesi 1 08.00 - 10.00
348 P-2****A2Y ATIK YULIATI 357305******0001 0857*****786 02/10/2021 Sesi 1 08.00 - 10.00
349 P-2****2GX Muhammad Iqbal Farizi 321607******0006 0813*****747 02/10/2021 Sesi 1 08.00 - 10.00
350 P-2****BYI Panji Ageng Putranto 357303******0001 0823*****794 02/10/2021 Sesi 1 08.00 - 10.00
351 P-2****JPQ Rizka Muizzu Aprilia 351120******0001 0822*****435 02/10/2021 Sesi 1 08.00 - 10.00
352 P-2****7OV MUHAMAD RIZKI FATONI 350411******0017 0852*****174 02/10/2021 Sesi 1 08.00 - 10.00
353 P-2****5T8 RADEN SURYO SETIAWANNOTO 351612******0005 0812*****153 02/10/2021 Sesi 1 08.00 - 10.00
354 P-2****K09 JIHAN SALSABILA 357301******0003 0812*****325 02/10/2021 Sesi 1 08.00 - 10.00
355 P-2****V46 SALNABILLAH PUTERI 350725******0003 0857*****255 02/10/2021 Sesi 1 08.00 - 10.00
356 P-2****1HC ALIFIAN IBNU ANSORI 350716******0002 0822*****564 02/10/2021 Sesi 1 08.00 - 10.00
357 P-2****UAU FEBI HERAWATI 357305******0005 0896*****649 02/10/2021 Sesi 1 08.00 - 10.00
358 P-2****N2J NONY MEILANI AULIA 352411******0001 0857*****542 02/10/2021 Sesi 1 08.00 - 10.00
359 P-2****OJ7 Dewi Fathonah Septya Rahman 351315******0002 0822*****951 02/10/2021 Sesi 1 08.00 - 10.00
360 P-2****8LX TRI OKTONESA NEHEMIA 627103******0005 0813*****682 02/10/2021 Sesi 1 08.00 - 10.00
361 P-2****DV3 HARIS AMRULLAH LUBIS 350722******0001 0896*****889 02/10/2021 Sesi 1 08.00 - 10.00
362 P-2****FT8 ALMAS BILQIS FISABILA 351408******0002 0813*****278 02/10/2021 Sesi 1 08.00 - 10.00
363 P-2****E0H ANDY MOHAMMAD FAIQ 351408******0001 0822*****960 02/10/2021 Sesi 1 08.00 - 10.00
364 P-2****6OT FIFI FARIDA FAJRIN 357703******0002 0896*****343 02/10/2021 Sesi 1 08.00 - 10.00
365 P-2****9PQ ILHAM RHAMADAN 187107******0005 0852*****304 02/10/2021 Sesi 1 08.00 - 10.00
366 P-2****FH5 Gio Alpri Naldi 150505******0001 0895*****7601 02/10/2021 Sesi 1 08.00 - 10.00
367 P-2****UGC YANI KURNIAWAN 331314******0001 0895*****1321 02/10/2021 Sesi 1 08.00 - 10.00
368 P-2****0HO HIDAYATUL ROHMANILLA SAPUTRI 350719******0003 0838*****665 02/10/2021 Sesi 1 08.00 - 10.00
369 P-2****JEG Ali Daffa' All Wafi 910909******0003 0821*****083 02/10/2021 Sesi 1 08.00 - 10.00
370 P-2****OYX RIZKY ARDIANSYAH 357301******0007 0819*****121 02/10/2021 Sesi 1 08.00 - 10.00
371 P-2****MQJ Dimas Maulana Yusup 360401******0756 0812*****885 02/10/2021 Sesi 1 08.00 - 10.00
372 P-2****VR6 ISROTUL ISNAINI 350719******0002 0877*****569 02/10/2021 Sesi 1 08.00 - 10.00
373 P-2****OI0 ARFA'ATUS MARDHATILAH 351020******0002 0813*****114 02/10/2021 Sesi 1 08.00 - 10.00
374 P-2****TZJ ARDHITYA RAMADHAN 357304******0001 0858*****504 02/10/2021 Sesi 1 08.00 - 10.00
375 P-2****FLN NATASHA LENZKY MUTIA 130103******0002 0812*****065 02/10/2021 Sesi 1 08.00 - 10.00

Page 9 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
376 P-2****JEN MUHAMMAD FARRAS SAKTI PRATAMA 357802******0003 0812*****443 02/10/2021 Sesi 1 08.00 - 10.00
377 P-2****YJA IQBAL ARIEF IRMAWAN 351508******0002 0812*****465 02/10/2021 Sesi 1 08.00 - 10.00
378 P-2****NIJ Elvi Putri Chairani 357304******0004 0821*****831 02/10/2021 Sesi 1 08.00 - 10.00
379 P-2****9PG SRI RATNA SARI 640217******0004 0813*****672 02/10/2021 Sesi 1 08.00 - 10.00
380 P-2****I1N ZAHWA FAJRIYYAH EKA PUTRI 350617******0001 0813*****948 02/10/2021 Sesi 1 08.00 - 10.00
381 P-2****ELU Adhela Marsyanda Putri 350718******0002 0821*****658 02/10/2021 Sesi 1 08.00 - 10.00
382 P-2****YQV KINANTI AMARTA PERMADI 321606******0022 0895*****660 02/10/2021 Sesi 1 08.00 - 10.00
383 P-2****WQD Aditya Cahya Wardhana 357301******0007 0896*****561 02/10/2021 Sesi 1 08.00 - 10.00
384 P-2****FH2 Muhammad Rizaldi 527102******0001 0852*****690 02/10/2021 Sesi 1 08.00 - 10.00
385 P-2****4K2 SALSABILA RAHMAH 367108******0008 0858*****290 02/10/2021 Sesi 1 08.00 - 10.00
386 P-2****JH9 ANANDA PRATAMA PUTRA ADJI M. 357303******0007 0838*****073 02/10/2021 Sesi 1 08.00 - 10.00
387 P-2****TCL RAIHAN ZHIFHANUR MUHAMMAD 337413******0005 0852*****984 02/10/2021 Sesi 1 08.00 - 10.00
388 P-2****DU2 RIKA CELINDA YUSNIA 357305******0003 0813*****383 02/10/2021 Sesi 1 08.00 - 10.00
389 P-2****I7X BAGUS DWI SAPUTRA 337604******0001 0896*****357 02/10/2021 Sesi 1 08.00 - 10.00
390 P-2****C5U HANIFAN 330511******0002 0896*****489 02/10/2021 Sesi 1 08.00 - 10.00
391 P-2****1GP DHIKA ABIYOSO RAHARDIANTO 327508******0023 0822*****986 02/10/2021 Sesi 1 08.00 - 10.00
392 P-3****CZI M. Rizqi Purwanto 357303******0001 0859*****725 02/10/2021 Sesi 1 08.00 - 10.00
393 P-3****YR9 HILMA SAJIDA CHULWA HANIN 327509******0010 0857*****089 02/10/2021 Sesi 1 08.00 - 10.00
394 P-3****CT3 BATARA SIDI LUMBAN GAOL 127207******0002 0823*****339 02/10/2021 Sesi 1 08.00 - 10.00
395 P-3****1TF George Alexander Suwito 357302******0004 0818*****055 02/10/2021 Sesi 1 08.00 - 10.00
396 P-3****N27 DIO SEPTINO HUTAPEA 120801******0002 0813*****017 02/10/2021 Sesi 1 08.00 - 10.00
397 P-3****HZV JULIA ELISABETH MANURUNG 121207******0001 0853*****045 02/10/2021 Sesi 1 08.00 - 10.00
398 P-3****M9M BIOR STEVAN SIAHAAN 627103******0005 0853*****114 02/10/2021 Sesi 1 08.00 - 10.00
399 P-3****R4D Muchammad Naufal Ali 331905******0005 0822*****055 02/10/2021 Sesi 1 08.00 - 10.00
400 P-3****MKW ADRIAWAN SONI H 352005******0005 0857*****507 02/10/2021 Sesi 1 08.00 - 10.00
401 P-3****OWK JULAIKHA 357602******0003 0812*****89 02/10/2021 Sesi 1 08.00 - 10.00
402 P-3****TKK NI KOMANG TRI WIDYA PUTRI 180114******0001 0821*****582 02/10/2021 Sesi 1 08.00 - 10.00
403 P-3****CM9 MIRANDA THERESIA BR SIANTURI 121001******0003 0853*****182 02/10/2021 Sesi 1 08.00 - 10.00
404 P-3****AHK NADILA PRATIWI 121009******0002 0813*****066 02/10/2021 Sesi 1 08.00 - 10.00
405 P-3****PRF PUTU DARMA YOGA 180712******0009 0812*****085 02/10/2021 Sesi 1 08.00 - 10.00
406 P-3****I2U Della Fortuna 367112******0004 0856*****215 02/10/2021 Sesi 1 08.00 - 10.00
407 P-3****DJM IGNACIA FARAH MARSHANISWAH 350722******0001 0858*****096 02/10/2021 Sesi 1 08.00 - 10.00
408 P-3****MDX ADAM FARREL FADHLURRAHMAN 351516******0001 0819*****795 02/10/2021 Sesi 1 08.00 - 10.00
409 P-3****OBE LULUK PUJI MANDHARENIE 351207******0003 0857*****139 02/10/2021 Sesi 1 08.00 - 10.00
410 P-3****TV1 ERNA SUGENG LESTARI 350713******0001 0813*****051 02/10/2021 Sesi 1 08.00 - 10.00
411 P-3****8U6 DELLA EKA RAHMADHANI 327601******0007 0857*****425 02/10/2021 Sesi 1 08.00 - 10.00
412 P-3****XOO AZHAR YUDHA PRAWIRA 327512******0002 0813*****603 02/10/2021 Sesi 1 08.00 - 10.00
413 P-3****FIE LELLY CATUR MEGA NURAVIFFA 350202******0001 0821*****667 02/10/2021 Sesi 1 08.00 - 10.00
414 P-3****DTW DEWANI INDAH TAWAKALNI 351505******0001 0857*****801 02/10/2021 Sesi 1 08.00 - 10.00
415 P-3****W5Z ADNIL HASNAN GHONI 352312******0002 0822*****005 02/10/2021 Sesi 1 08.00 - 10.00
416 P-3****NG5 Ardian Aprillian 337301******0001 0818*****609 02/10/2021 Sesi 1 08.00 - 10.00
417 P-3****Q0F ROMY ABDILLAH RAMADHAN 350203******0002 0888*****677 02/10/2021 Sesi 1 08.00 - 10.00

Page 10 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
418 P-3****EAR M. FIKRI ZAIN HUTASUHUT 120726******0018 0853*****809 02/10/2021 Sesi 1 08.00 - 10.00
419 P-3****5QW ALIEFIANDA ILHAMDANI ALZI P 350723******0006 0823*****501 02/10/2021 Sesi 1 08.00 - 10.00
420 P-3****FHH ANDRIANUS DIMITRI PAI 737112******0010 0853*****898 02/10/2021 Sesi 1 08.00 - 10.00
421 P-3****WGG NIDA SYARIFATUL LATHIFAH 350722******0001 0823*****486 02/10/2021 Sesi 1 08.00 - 10.00
422 P-4****76H LULU LUTHFIAH ZAHRA 320538******0005 0898*****39 02/10/2021 Sesi 1 08.00 - 10.00
423 P-4****XK5 HEMAS AZIZILA NIDHAL 350216******0003 0812*****043 02/10/2021 Sesi 1 08.00 - 10.00
424 P-4****82U DINDA MILLENIA RAHMAWATI 357305******0053 0858*****413 02/10/2021 Sesi 1 08.00 - 10.00
425 P-4****CVL SILMA AMALIA PUTRI 327105******0010 0812*****307 02/10/2021 Sesi 1 08.00 - 10.00
426 P-4****WCB NADYA SYAHIRA ZAEN 357303******0002 0877*****922 02/10/2021 Sesi 1 08.00 - 10.00
427 P-4****L57 PUTRI NOVITA ROSALIA 357303******0002 0895*****459 02/10/2021 Sesi 1 08.00 - 10.00
428 P-4****UWD MUHAMMAD RIFKY YUSUF AKBAR 357303******0005 0878*****820 02/10/2021 Sesi 1 08.00 - 10.00
429 P-4****ETY ZAKIYYATUL FITRIYAH 357305******0005 0812*****397 02/10/2021 Sesi 1 08.00 - 10.00
430 P-4****56U Seila Arumiyanti Anwar 352802******0002 0878*****773 02/10/2021 Sesi 1 08.00 - 10.00
431 P-6****7XB MOH.K.DWI NUGROHO 357305******0003 0812*****282 02/10/2021 Sesi 1 08.00 - 10.00
432 P-7****LYA YETI PUJI LESTARI 357305******0001 0812*****454 02/10/2021 Sesi 1 08.00 - 10.00
433 P-7****X1M MUHAMMAD DANDY CAHYA WIBAWA 367406******0007 0859*****767 02/10/2021 Sesi 1 08.00 - 10.00
434 P-7****UWX EKI ACHMAD BAIHAQI 627103******0007 0813*****228 02/10/2021 Sesi 1 08.00 - 10.00
435 P-7****5Z4 YOGA DENY PRASETIAWAN 357305******0002 0823*****880 02/10/2021 Sesi 1 08.00 - 10.00
436 P-7****1AJ TIARI YANWAR ISYYATIN 520307******0010 0819*****595 02/10/2021 Sesi 1 08.00 - 10.00
437 P-7****CDG RAHMA SYAMILA HANIF 367403******0016 0813*****538 02/10/2021 Sesi 1 08.00 - 10.00
438 P-7****LHK Yuanita Salsabillah Handoyo 350724******0007 0823*****809 02/10/2021 Sesi 1 08.00 - 10.00
439 P-7****Q8K SHINTYA AYU FITRIANI 357305******0002 0857*****060 02/10/2021 Sesi 1 08.00 - 10.00
440 P-7****EHN MARIANI 357305******0012 0895*****8321 02/10/2021 Sesi 1 08.00 - 10.00
441 P-7****40A IIS YUNAINI 357302******0006 0858*****903 02/10/2021 Sesi 1 08.00 - 10.00
442 P-7****4PI EKKLESIA BR SINURAYA 127113******0003 0852*****805 02/10/2021 Sesi 1 08.00 - 10.00
443 P-7****T3L ARRIVAL GUSTI ADHIKARA 327509******0012 0856*****969 02/10/2021 Sesi 1 08.00 - 10.00
444 P-7****DVQ ARY WIDYA ASTUTIK 357304******0010 0896*****522 02/10/2021 Sesi 1 08.00 - 10.00
445 P-7****RUC RIKO ADITYAR 357305******0006 0882*****8367 02/10/2021 Sesi 1 08.00 - 10.00
446 P-7****PSD SALSA EGHIDHIA RIZKY 357305******0001 0812*****551 02/10/2021 Sesi 1 08.00 - 10.00
447 P-7****4NU CITRA DWI PRATIWI 352006******0001 0821*****655 02/10/2021 Sesi 1 08.00 - 10.00
448 P-7****XLY NOVEL HULAIDA 352802******0001 0852*****968 02/10/2021 Sesi 1 08.00 - 10.00
449 P-7****DDU DINDA PALLADIUM PUTRI PERMATA MAAHURY 810807******0003 0823*****766 02/10/2021 Sesi 1 08.00 - 10.00
450 P-7****NPR SUTIYANINGSIH 327603******0001 0813*****889 02/10/2021 Sesi 1 08.00 - 10.00
451 P-7****5QL RAMTIKAINDA SURYANI 357304******0001 0856*****723 02/10/2021 Sesi 1 08.00 - 10.00
452 P-7****V0M SUMARTI 357305******0001 0896*****520 02/10/2021 Sesi 1 08.00 - 10.00
453 P-7****DKY HERU AHDIYAKA SUMITRO 720101******0001 0813*****123 02/10/2021 Sesi 1 08.00 - 10.00
454 P-7****9YT AULIA DYANROSI, S.AB 357304******0014 0813*****124 02/10/2021 Sesi 1 08.00 - 10.00
455 P-7****VXC NUR MUHAMMAD FATHURRAHMAN 357302******0005 0858*****026 02/10/2021 Sesi 1 08.00 - 10.00
456 P-7****84Y ZAENAL ABIDIN 357303******0004 0813*****221 02/10/2021 Sesi 1 08.00 - 10.00
457 P-7****GT1 EARLY TYAGITA HAKIM 357304******0006 0822*****250 02/10/2021 Sesi 1 08.00 - 10.00
458 P-8****A6T ARDANIS WARI 357903******0001 0812*****990 02/10/2021 Sesi 1 08.00 - 10.00
459 P-8****NZN ADIDTYA PRATAMA 121001******0005 0821*****391 02/10/2021 Sesi 1 08.00 - 10.00

Page 11 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
460 P-8****E2N OKI TRISNA SEKAR ARUM 332712******0002 0813*****465 02/10/2021 Sesi 1 08.00 - 10.00
461 P-8****DFE NURUL HAMIDAH 357303******0004 0823*****771 02/10/2021 Sesi 1 08.00 - 10.00
462 P-8****AS7 KUSUMA MANIK CAHYANING 350721******0003 0831*****211 02/10/2021 Sesi 1 08.00 - 10.00
463 P-8****DWM MUHAMAD FARHAN HAMID RAMADHAN 357301******0006 0895*****1333 02/10/2021 Sesi 1 08.00 - 10.00
464 P-8****4IM FARID RIZKI DARMAWAN 350724******0005 0853*****918 02/10/2021 Sesi 1 08.00 - 10.00
465 P-8****FOO FRISCHA HERLIANAWATI 351911******0001 0813*****238 02/10/2021 Sesi 1 08.00 - 10.00
466 P-8****ADK AKHADIYAH AFRILA 357303******0001 0852*****649 02/10/2021 Sesi 1 08.00 - 10.00
467 P-8****W9T ULIVIA NUSWANTARI 357302******0006 0852*****045 02/10/2021 Sesi 1 08.00 - 10.00
468 P-8****ZXQ HER MUQSITOWATI YULIASTUTI 357302******0001 0822*****974 02/10/2021 Sesi 1 08.00 - 10.00
469 P-8****3MG ANIS PRIATIN 350718******0005 0858*****008 02/10/2021 Sesi 1 08.00 - 10.00
470 P-8****D2G R BAGUS RIZKY P 357827******0001 0822*****287 02/10/2021 Sesi 1 08.00 - 10.00
471 P-8****58R ARUM EKA PRASETYANINGTYAS 351618******0001 0896*****190 02/10/2021 Sesi 1 08.00 - 10.00
472 P-8****78S PUTRI DELA ANDRIANA 357301******0001 0822*****908 02/10/2021 Sesi 1 08.00 - 10.00
473 P-8****RI1 AFIF ABDURRASYID AHMAD 327503******0022 0812*****048 02/10/2021 Sesi 1 08.00 - 10.00
474 P-8****YHT MOHAMED OMAR ABDULRAHIM 202108******0322 0813*****3221 02/10/2021 Sesi 1 08.00 - 10.00
475 P-8****6NJ AMNA MOHAMED ABUZED 202108******3221 0813*****221 02/10/2021 Sesi 1 08.00 - 10.00
476 P-8****PDE DEWI MASITHA 357304******0002 0812*****143 02/10/2021 Sesi 1 08.00 - 10.00
477 P-8****P0U RETNO KRESTYANINGSIH 350732******0001 0856*****700 02/10/2021 Sesi 1 08.00 - 10.00
478 P-8****WKY ITA DWI SUYANI 357303******0014 0895*****894 02/10/2021 Sesi 1 08.00 - 10.00
479 P-8****XCH RONA ALMAS RAMADANI 357304******0006 0856*****892 02/10/2021 Sesi 1 08.00 - 10.00
480 P-8****MT1 AGUNG ATMAJANTO 357305******0003 0878*****545 02/10/2021 Sesi 1 08.00 - 10.00
481 P-8****DBI RIA ANGGRAINI PURWANINGSIH 357602******0006 0857*****615 02/10/2021 Sesi 1 08.00 - 10.00
482 P-8****Q99 FANI ROSYIDI AZIS 357301******0007 0852*****398 02/10/2021 Sesi 1 08.00 - 10.00
483 P-8****9C2 ROBBY ROCHMANZA 357305******0003 0838*****667 02/10/2021 Sesi 1 08.00 - 10.00
484 P-8****6RN IDA NURYANTI 350718******0001 0821*****132 02/10/2021 Sesi 1 08.00 - 10.00
485 P-8****R5Q CLARISSA ANINDYA CAHYANINGRUM 357305******0006 0857*****302 02/10/2021 Sesi 1 08.00 - 10.00
486 P-8****OUP DIAN TRI LARASATI 321708******0011 0896*****417 02/10/2021 Sesi 1 08.00 - 10.00
487 P-8****GVZ MOH. LUTFI MAULANA 351608******0005 0812*****048 02/10/2021 Sesi 1 08.00 - 10.00
488 P-8****KQ0 FEBRIANA ANDIKA SARI 351811******0001 0822*****399 02/10/2021 Sesi 1 08.00 - 10.00
489 P-8****PDU TOMY TAUFIQ ISMAIL 350710******0002 0851*****309 02/10/2021 Sesi 1 08.00 - 10.00
490 P-8****OEI EKO YULIANTO 357302******0002 0821*****287 02/10/2021 Sesi 1 08.00 - 10.00
491 P-8****69A AFIF INDRA PERMANA PUTRA 357903******0003 0895*****403 02/10/2021 Sesi 1 08.00 - 10.00
492 P-8****GGW OLIVIA OKTAFISISWANTI 357303******0003 0857*****078 02/10/2021 Sesi 1 08.00 - 10.00
493 P-9****C6W HAIRUL ANWAR 352802******0004 0852*****504 02/10/2021 Sesi 1 08.00 - 10.00
494 P-9****3S7 HARIS WISANTYO 350725******0010 0896*****797 02/10/2021 Sesi 1 08.00 - 10.00
495 P-9****V8J MARIANA 350723******0001 0822*****025 02/10/2021 Sesi 1 08.00 - 10.00
496 P-9****AAT ROOFI CAHYANINGTYAS 332314******0001 0857*****663 02/10/2021 Sesi 1 08.00 - 10.00
497 P-9****PVJ GIGARANU GUNTARA 367401******0002 0896*****651 02/10/2021 Sesi 1 08.00 - 10.00
498 P-9****GNU ANI PRASETYO RINI 350722******0002 0851*****714 02/10/2021 Sesi 1 08.00 - 10.00
499 P-9****FYD UMAR HARRIS HIDAYATULLAH 520108******0001 0851*****249 02/10/2021 Sesi 1 08.00 - 10.00
500 P-9****ODC NUR FAIZ ZAMZAMI AL GHUFRONI 357305******0002 0896*****499 02/10/2021 Sesi 1 08.00 - 10.00
501 P-9****ZSQ SAYIDAH AMBARUKAYAH 357305******0007 0857*****742 02/10/2021 Sesi 1 08.00 - 10.00

Page 12 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
502 P-9****ZEY TUTIK HANDAYANI 357903******0003 0813*****615 02/10/2021 Sesi 1 08.00 - 10.00
503 P-9****96O Nurul Hidayah 357305******0003 0812*****26 02/10/2021 Sesi 1 08.00 - 10.00
504 P-9****KG8 ADAM A'BAR 357305******0001 0858*****126 02/10/2021 Sesi 1 08.00 - 10.00
505 P-9****TC4 LUCKY KRISTIAWAN 350719******0001 0813*****551 02/10/2021 Sesi 1 08.00 - 10.00
506 P-9****F4N BAYU 357305******0002 0857*****128 02/10/2021 Sesi 1 08.00 - 10.00
507 P-9****SHH WALUYO 357903******0005 0813*****609 02/10/2021 Sesi 1 08.00 - 10.00
508 P-9****DUV WINARSIH 357304******0006 0813*****801 02/10/2021 Sesi 1 08.00 - 10.00
509 P-9****IV4 ARNIS TRIWIDIYATI 357301******0002 0881*****41 02/10/2021 Sesi 1 08.00 - 10.00
510 P-9****QQU LUTHFI HIDAYAT 357901******0005 0812*****935 02/10/2021 Sesi 1 08.00 - 10.00
511 P-9****O1C YULIA TRI KARTIKANINGRUM 352104******0002 0857*****864 02/10/2021 Sesi 1 08.00 - 10.00
512 P-9****PU0 M.RIZA HANAFI, SIP 352404******0001 0819*****321 02/10/2021 Sesi 1 08.00 - 10.00
513 P-9****IKH MUHAMAD ROFIK 350719******0003 0813*****444 02/10/2021 Sesi 1 08.00 - 10.00
514 P-9****1BH LIONARDI URSA PUTRA PRATAMA 357305******0001 0857*****281 02/10/2021 Sesi 1 08.00 - 10.00
515 P-9****BAP DIAN APRI LIANTO 350725******0006 0812*****019 02/10/2021 Sesi 1 08.00 - 10.00
516 P-9****KU4 WIRA TAMTAMA ADITYA SAPUTRA 357302******0002 0895*****0197 02/10/2021 Sesi 1 08.00 - 10.00
517 P-9****AJ2 SUPIATUN 351322******0001 0823*****332 02/10/2021 Sesi 1 08.00 - 10.00
518 P-9****THR SIGIT WITONO 350615******0003 0852*****302 02/10/2021 Sesi 1 08.00 - 10.00
519 P-9****XYO ANDISTA AYU FITRI ANGGRAENI 350724******0002 0812*****891 02/10/2021 Sesi 1 08.00 - 10.00
520 P-9****3K4 ANISA ASMANIA FATMAWATI 357301******0003 0896*****067 02/10/2021 Sesi 1 08.00 - 10.00
521 P-9****J9X IGI IRAWATI 520603******1005 0852*****030 02/10/2021 Sesi 2 10.00 - 12.00
522 P-9****BG5 JHONY KRISTIONO 357101******0004 0813*****101 02/10/2021 Sesi 2 10.00 - 12.00
523 P-9****NKD ARDA FIRDAUS RAMADHAN 357305******0004 0822*****686 02/10/2021 Sesi 2 10.00 - 12.00
524 P-9****RKX FATA WAFIYYU ROCHIM 357304******0002 0896*****669 02/10/2021 Sesi 2 10.00 - 12.00
525 P-9****W0R AZIZUN NA’IMUL FAIZAH 350217******0008 0858*****223 02/10/2021 Sesi 2 10.00 - 12.00
526 P-9****TOI CHUSNIYAH 357304******0001 0878*****974 02/10/2021 Sesi 2 10.00 - 12.00
527 P-9****YT1 FAHMI FACHRUDDIN ABDUL GHONI 357304******0001 0896*****531 02/10/2021 Sesi 2 10.00 - 12.00
528 P-9****36D MUHAMMAD WAHYU MANDALA PUTRA 357305******0054 0881*****5546 02/10/2021 Sesi 2 10.00 - 12.00
529 P-9****K4P AZMI KARIM 357305******0007 0813*****844 02/10/2021 Sesi 2 10.00 - 12.00
530 P-9****9OB TRI NUR WIJAYANTI 357301******0001 0889*****780 02/10/2021 Sesi 2 10.00 - 12.00
531 P-9****JGG FITRI HANDAYANI 351807******0003 0812*****366 02/10/2021 Sesi 2 10.00 - 12.00
532 P-9****FB6 SUSIYANTI 357305******0005 0838*****161 02/10/2021 Sesi 2 10.00 - 12.00
533 P-9****QER YUSRI ALFIANSYAH 357901******0007 0852*****050 02/10/2021 Sesi 2 10.00 - 12.00
534 P-9****WTP IKHLAS MUHAMMAD SABILLY 350722******0002 0823*****065 02/10/2021 Sesi 2 10.00 - 12.00
535 P-9****UX9 OKTAVERA PRASETYOWATI 357303******0001 0856*****13 02/10/2021 Sesi 2 10.00 - 12.00
536 P-9****FD6 M. REZKI RAHMAN MIKOMUI 350718******0002 0851*****388 02/10/2021 Sesi 2 10.00 - 12.00
537 P-9****UL5 FAT HANNA MARAMI SA 357903******0001 0896*****237 02/10/2021 Sesi 2 10.00 - 12.00
538 P-9****MVJ DEWI ANGGUN PRAKARTINI 327508******0030 0822*****254 02/10/2021 Sesi 2 10.00 - 12.00
539 P-9****V9Y MUHAMMAD ZIDANE BAIHAQI 350724******0001 0852*****842 02/10/2021 Sesi 2 10.00 - 12.00
540 P-9****11Q NAZIA DEWI HARISAH 357304******0005 0889*****718 02/10/2021 Sesi 2 10.00 - 12.00
541 P-9****ZDO RIFQI IBRAHIM 350722******0004 0895*****3598 02/10/2021 Sesi 2 10.00 - 12.00
542 P-9****8YW LUTFI ZULAIKHA 351412******0002 0857*****849 02/10/2021 Sesi 2 10.00 - 12.00
543 P-9****JFP NANDA AMELIA SOFIANA 357901******0003 0856*****642 02/10/2021 Sesi 2 10.00 - 12.00

Page 13 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
544 P-9****ABN ENDIARTO WIJAYA 357304******0009 0857*****911 02/10/2021 Sesi 2 10.00 - 12.00
545 P-9****EAO 3329154802920009 332915******0009 0899*****45 02/10/2021 Sesi 2 10.00 - 12.00
546 P-9****ZEH SHINTA RAHAYU EKOWATI 357305******0004 0812*****939 02/10/2021 Sesi 2 10.00 - 12.00
547 P-9****V84 YUYUN PUJIASTUTI 352003******0001 0813*****797 02/10/2021 Sesi 2 10.00 - 12.00
548 P-9****XN2 Lutfiatul Khumaidah 350718******0001 0856*****53 02/10/2021 Sesi 2 10.00 - 12.00
549 P-9****BLS SITKUN DENI 820310******0002 0813*****790 02/10/2021 Sesi 2 10.00 - 12.00
550 P-9****QI7 LIDYA DEWI KUMALASARI 357301******0007 0852*****699 02/10/2021 Sesi 2 10.00 - 12.00
551 P-9****BUK ATIK NUR TARBIYATI 350718******0001 0813*****737 02/10/2021 Sesi 2 10.00 - 12.00
552 P-9****8DY MUHAMMAD NUR AHYAR 357305******0005 0838*****048 02/10/2021 Sesi 2 10.00 - 12.00
553 P-9****EDM HENNY PUSPITA SARI 357301******0001 0852*****987 02/10/2021 Sesi 2 10.00 - 12.00
554 P-9****P56 VINA IDAMATUSILMI 330615******0002 0882*****291 02/10/2021 Sesi 2 10.00 - 12.00
555 P-9****CT0 LAURA ESTERRITA 731506******0002 0858*****958 02/10/2021 Sesi 2 10.00 - 12.00
556 P-9****O8R YENI DWI ASTARI 350111******0005 0819*****806 02/10/2021 Sesi 2 10.00 - 12.00
557 P-9****Q2V HUDAN EZRA'ALANA PRAJA 357303******0002 0877*****613 02/10/2021 Sesi 2 10.00 - 12.00
558 P-9****LI1 ABDULLOH SYAFI'I 350724******0004 0895*****7399 02/10/2021 Sesi 2 10.00 - 12.00
559 P-9****YR8 Ir. Hj. Siti Roihanah 357305******0002 0852*****467 02/10/2021 Sesi 2 10.00 - 12.00
560 P-9****IV8 WAFA QURROTA AINI 617105******0010 0896*****817 02/10/2021 Sesi 2 10.00 - 12.00
561 P-9****JY7 GHITALIA MAHFIDASARI 351011******0006 0812*****16 02/10/2021 Sesi 2 10.00 - 12.00
562 P-9****UFZ FADLUN ABDUL AZIS 517103******0002 0838*****865 02/10/2021 Sesi 2 10.00 - 12.00
563 P-A****ZLX YOGA PERMANA 357305******0003 0821*****055 02/10/2021 Sesi 2 10.00 - 12.00
564 P-A****DAO NUGROHO AJI SURONO 357304******0006 0852*****368 02/10/2021 Sesi 2 10.00 - 12.00
565 P-B****7QK FADYA WULANDARI NURMIDIN 717105******0001 0896*****644 02/10/2021 Sesi 2 10.00 - 12.00
566 P-B****T1C FI IMANUR SIFAUNNUFUS MS 350723******0001 0812*****548 02/10/2021 Sesi 2 10.00 - 12.00
567 P-B****VVM RICARDUS AJI SATRIA 167101******0004 0821*****242 02/10/2021 Sesi 2 10.00 - 12.00
568 P-B****GRR NABILLA ADINDA RAHMADHANI 327502******0013 0819*****983 02/10/2021 Sesi 2 10.00 - 12.00
569 P-B****4VS MUHAMMAD ZAIDAN DHIAULHAQ 351508******0009 0822*****162 02/10/2021 Sesi 2 10.00 - 12.00
570 P-B****N0K BRYAN REYNALDI 910201******0001 0812*****724 02/10/2021 Sesi 2 10.00 - 12.00
571 P-B****2VD AMALIA IZDIANA MAULININGTYAS 350810******0002 0882*****740 02/10/2021 Sesi 2 10.00 - 12.00
572 P-B****L1N NYNA CIPTA ALFIDA 351410******0006 0822*****202 02/10/2021 Sesi 2 10.00 - 12.00
573 P-B****61D NURUL FADILLAH 147201******0021 0851*****757 02/10/2021 Sesi 2 10.00 - 12.00
574 P-B****YD6 M BAYU RIZKY PUTRA 367403******0011 0895*****9835 02/10/2021 Sesi 2 10.00 - 12.00
575 P-B****FWQ LAILATUL BADRIYAH 357303******0002 0819*****479 02/10/2021 Sesi 2 10.00 - 12.00
576 P-B****5M5 FARAH NUR A'INI 357304******0003 0816*****145 02/10/2021 Sesi 2 10.00 - 12.00
577 P-B****DF5 DANIEL PAJAJAKNG 327602******0002 0852*****089 02/10/2021 Sesi 2 10.00 - 12.00
578 P-B****KTY DEWI AYU ALAMANDA PURNAMA 357303******0002 0838*****315 02/10/2021 Sesi 2 10.00 - 12.00
579 P-B****G4Q PUTRI AZMI RAHMAWATI 352407******0003 0812*****190 02/10/2021 Sesi 2 10.00 - 12.00
580 P-B****3PH SINTA KAVELINA 350725******0005 0895*****3303 02/10/2021 Sesi 2 10.00 - 12.00
581 P-B****DN7 GRADY RYAN MITCHELL 206110******0010 0813*****625 02/10/2021 Sesi 2 10.00 - 12.00
582 P-B****VWQ MARWAH ZANIRAH ARYANTHA 320406******0010 0812*****522 02/10/2021 Sesi 2 10.00 - 12.00
583 P-B****QA6 CLARISA KIRANA PUTRI 180601******0002 0813*****593 02/10/2021 Sesi 2 10.00 - 12.00
584 P-B****X73 MUHAMMAD INDRA FIRDAUS 647105******0011 0821*****098 02/10/2021 Sesi 2 10.00 - 12.00
585 P-B****1TA NAW EH WAI HTOO 195120******0010 0812*****434 02/10/2021 Sesi 2 10.00 - 12.00

Page 14 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
586 P-B****4HE HILDHA RUTH MARTHA AYUNINGTYAS 351418******0001 0858*****999 02/10/2021 Sesi 2 10.00 - 12.00
587 P-B****N77 IMANUEL SYAMASTYO PUTROAJI 327508******0020 0822*****074 02/10/2021 Sesi 2 10.00 - 12.00
588 P-B****LCL KHAING THARAPHY 196030******0010 0812*****783 02/10/2021 Sesi 2 10.00 - 12.00
589 P-B****4FV INDRI RIZKI KUSUMAWARDHANI 351606******0002 0857*****666 02/10/2021 Sesi 2 10.00 - 12.00
590 P-B****73E NABILA AMALINA 357305******0006 0813*****691 02/10/2021 Sesi 2 10.00 - 12.00
591 P-B****TZV ROBIATUL WAFIYAH 357802******0002 0895*****1169 02/10/2021 Sesi 2 10.00 - 12.00
592 P-B****I09 SALMA NISRINA FAHRIYYAH 157107******0041 0882*****539 02/10/2021 Sesi 2 10.00 - 12.00
593 P-B****APV MARIA FEBRIALITA LARATSEMI 320101******0004 0821*****459 02/10/2021 Sesi 2 10.00 - 12.00
594 P-B****AMS JOSHUA FELIX POTALANGI 357301******0006 0878*****925 02/10/2021 Sesi 2 10.00 - 12.00
595 P-B****Q55 BOBY NURDIYAHYA 350718******0002 0812*****446 02/10/2021 Sesi 2 10.00 - 12.00
596 P-B****05R JABAR WICAKSONO SUKMASAE 647402******0003 0852*****424 02/10/2021 Sesi 2 10.00 - 12.00
597 P-B****VTX MUTYA WILDAN NARESWARI 351516******0001 0823*****631 02/10/2021 Sesi 2 10.00 - 12.00
598 P-B****QEM FATICHA AISSALADINA ABJAR 357305******0008 0812*****848 02/10/2021 Sesi 2 10.00 - 12.00
599 P-B****E82 NOVI IZMI DAMAYANTI 217103******9005 0878*****120 02/10/2021 Sesi 2 10.00 - 12.00
600 P-B****3KI ZUMROTUL MUYASAROH 150202******0001 0851*****989 02/10/2021 Sesi 2 10.00 - 12.00
601 P-B****JMT ZAHRA AULIA CRISNIDARA 367108******0004 0812*****770 02/10/2021 Sesi 2 10.00 - 12.00
602 P-B****E5A IKA FADILAH WAHAB 357102******0002 0899*****12 02/10/2021 Sesi 2 10.00 - 12.00
603 P-B****LAR SAFIRA NABILA 647105******0007 0811*****99 02/10/2021 Sesi 2 10.00 - 12.00
604 P-B****BPU RIF'AT AZKA MUSHANNIEF 350724******0003 0878*****571 02/10/2021 Sesi 2 10.00 - 12.00
605 P-B****AID HAFIDZ FITRIAN RAKHMAN 350714******0002 0895*****5790 02/10/2021 Sesi 2 10.00 - 12.00
606 P-B****O2C SYAHRUL IZZULHAQ 350724******0003 0821*****407 02/10/2021 Sesi 2 10.00 - 12.00
607 P-B****S47 MOHAMMAD RAMANG WIDJAYA 351009******0001 0821*****524 02/10/2021 Sesi 2 10.00 - 12.00
608 P-B****GZA DICKY PRAYOGI 350719******0001 0857*****811 02/10/2021 Sesi 2 10.00 - 12.00
609 P-B****67K KHADIJAH 357302******0003 0813*****866 02/10/2021 Sesi 2 10.00 - 12.00
610 P-B****4PQ KEBBA S. GAMBIAN 357305******0580 0816*****908 02/10/2021 Sesi 2 10.00 - 12.00
611 P-B****AFS ZAYYID FARIHIR RIDLO 351016******0002 0857*****806 02/10/2021 Sesi 2 10.00 - 12.00
612 P-B****JQ3 FEYBE MAKITALENTU 717109******0002 0822*****493 02/10/2021 Sesi 2 10.00 - 12.00
613 P-B****DE5 FARISSA MEIDHITA IRSANTRI 357304******0004 0896*****496 02/10/2021 Sesi 2 10.00 - 12.00
614 P-B****UK5 M. GILANG PRASETYO 620102******0007 0851*****776 02/10/2021 Sesi 2 10.00 - 12.00
615 P-B****FBM ANGGI KURNIAWAN 351013******0002 0813*****082 02/10/2021 Sesi 2 10.00 - 12.00
616 P-B****RGJ QONITA NUR FARHANA 331810******0012 0817*****617 02/10/2021 Sesi 2 10.00 - 12.00
617 P-B****C74 GEVAN PUTRA YUDHISTIRA 121115******0001 0812*****757 02/10/2021 Sesi 2 10.00 - 12.00
618 P-B****DCX EMI RINI KAMUTI 357305******0007 0822*****105 02/10/2021 Sesi 2 10.00 - 12.00
619 P-B****3J2 RISKI MAULANA 637103******0004 0813*****201 02/10/2021 Sesi 2 10.00 - 12.00
620 P-B****RQU TIN NAING OO 196000******0010 0895*****7500 02/10/2021 Sesi 2 10.00 - 12.00
621 P-B****IKR JAFFAR AKBAR KHARIE 317504******0004 0859*****425 02/10/2021 Sesi 2 10.00 - 12.00
622 P-B****ANS SEPTIA ANDRIANI PASARIBU 127118******0001 0853*****203 02/10/2021 Sesi 2 10.00 - 12.00
623 P-B****S62 DINAR FAIRUS SALSABILLAH 350724******0008 0896*****130 02/10/2021 Sesi 2 10.00 - 12.00
624 P-B****V0G MICHAEL DAVID 327511******0009 0812*****756 02/10/2021 Sesi 2 10.00 - 12.00
625 P-B****7X7 HERU OLOAN SIMANULLANG 121115******0002 0813*****118 02/10/2021 Sesi 2 10.00 - 12.00
626 P-B****7PX ARYA WIRA KRISNA 357302******0005 0858*****471 02/10/2021 Sesi 2 10.00 - 12.00
627 P-B****C5Q TIMOTHY BASTIAN SIANTURI 121101******0005 0822*****518 02/10/2021 Sesi 2 10.00 - 12.00

Page 15 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
628 P-B****LU1 ACHMAD GALIH WICAKSANA PUTRA 357305******0001 0813*****465 02/10/2021 Sesi 2 10.00 - 12.00
629 P-B****HYV TIARA AULIA ASLAMI 350725******0002 0822*****664 02/10/2021 Sesi 2 10.00 - 12.00
630 P-B****CNK SHOFI IZZATUS SHOLIHAH 731010******0001 0822*****136 02/10/2021 Sesi 2 10.00 - 12.00
631 P-B****MMA Abdur Rosyid Hasan 350413******0002 0858*****980 02/10/2021 Sesi 2 10.00 - 12.00
632 P-B****TON RIMA MANIAR 317405******0001 0812*****476 02/10/2021 Sesi 2 10.00 - 12.00
633 P-B****GM6 NOVIA SARASWATI 350722******0002 0857*****381 02/10/2021 Sesi 2 10.00 - 12.00
634 P-B****DZJ ASEP RANTA MUNAJAT 321609******0006 0896*****400 02/10/2021 Sesi 2 10.00 - 12.00
635 P-B****AK0 AYEZHA HALIDAR PUTRI I 351009******0002 0822*****897 02/10/2021 Sesi 2 10.00 - 12.00
636 P-B****1F9 SYEALVA SALSABILA 352215******0005 0819*****354 02/10/2021 Sesi 2 10.00 - 12.00
637 P-B****G8C FATHYA HUSNA FADHILAH 167104******0011 0821*****000 02/10/2021 Sesi 2 10.00 - 12.00
638 P-B****GWH DODY KRISTIAN MANALU 321615******0002 0851*****086 02/10/2021 Sesi 2 10.00 - 12.00
639 P-B****NOW DIMAS IVON ANGGITAMA 140309******0001 0812*****660 02/10/2021 Sesi 2 10.00 - 12.00
640 P-B****VGH Bagaskara Oki Duwi Saputra 321620******0002 0895*****7989 02/10/2021 Sesi 2 10.00 - 12.00
641 P-B****NV9 JOVANCA MANGGALA PARAMANANDA 350625******0002 0858*****609 02/10/2021 Sesi 2 10.00 - 12.00
642 P-B****IP6 AKHIROEL MOHAMMAD EFFENDI 350722******0002 0856*****990 02/10/2021 Sesi 2 10.00 - 12.00
643 P-B****9OO RIFKI KARIM RAMADHAN 321406******0003 0812*****645 02/10/2021 Sesi 2 10.00 - 12.00
644 P-B****WI4 DANDY RAMADHANY 187109******0004 0877*****435 02/10/2021 Sesi 2 10.00 - 12.00
645 P-B****XP8 MOCHAMMAD ZAVA ABBIYANSYAH 317501******0002 0859*****084 02/10/2021 Sesi 2 10.00 - 12.00
646 P-B****VAR MUHAMMAD SYAKHISK NAUFAL ADANI 647206******0002 0812*****546 02/10/2021 Sesi 2 10.00 - 12.00
647 P-B****UAJ ANUGERAH WIJAYA 167104******0003 0813*****423 02/10/2021 Sesi 2 10.00 - 12.00
648 P-B****JYL NAILI LAILIYAH 350709******0005 0896*****433 02/10/2021 Sesi 2 10.00 - 12.00
649 P-B****ZS1 RAHRAINI SIREGAR 647203******0007 0811*****87 02/10/2021 Sesi 2 10.00 - 12.00
650 P-B****Z5Y RAKHMAT BAHARUDIN 352505******0001 0896*****102 02/10/2021 Sesi 2 10.00 - 12.00
651 P-B****TK6 Mohamad Ardi 350718******0003 0895*****6454 02/10/2021 Sesi 2 10.00 - 12.00
652 P-B****2KW M. AKILA MUWAN KALE 110403******0004 0812*****680 02/10/2021 Sesi 2 10.00 - 12.00
653 P-B****P1O ACHMAD WILDAN AKFIANSYAH 357303******0010 0895*****128 02/10/2021 Sesi 2 10.00 - 12.00
654 P-B****AOA SEPTIYO BUDI PERKASA 317103******0008 0821*****916 02/10/2021 Sesi 2 10.00 - 12.00
655 P-B****NDA WILDAN AZHAR 510806******0005 0821*****277 02/10/2021 Sesi 2 10.00 - 12.00
656 P-B****GDK ANDI DWI ANGGA PRASTYA 321609******0005 0853*****889 02/10/2021 Sesi 2 10.00 - 12.00
657 P-B****PFG WISIK DEWA MAULANA 367403******0009 0858*****328 02/10/2021 Sesi 2 10.00 - 12.00
658 P-B****KPL FAHRI AULIA RAMADHAN 357302******0003 0822*****656 02/10/2021 Sesi 2 10.00 - 12.00
659 P-B****OCZ RAHMATUL BIJAK NUR KHOLIS 351914******0001 0812*****264 02/10/2021 Sesi 2 10.00 - 12.00
660 P-B****50T YOHANA ANGELINA SITORUS 127207******0003 0852*****457 02/10/2021 Sesi 2 10.00 - 12.00
661 P-B****NOZ AUJANA MAHALIA 357102******0006 0857*****162 02/10/2021 Sesi 2 10.00 - 12.00
662 P-B****N36 MUHAMMAD RIFQY RAMADANA 647204******0002 0857*****655 02/10/2021 Sesi 2 10.00 - 12.00
663 P-B****A33 DARMADANI KYAT MADANA 737113******0004 0815*****709 02/10/2021 Sesi 2 10.00 - 12.00
664 P-B****LTZ HAFIDHA ADILA RAHMA 357303******0001 0821*****309 02/10/2021 Sesi 2 10.00 - 12.00
665 P-B****MIR FAHMI ERZA 321609******0005 0896*****622 02/10/2021 Sesi 2 10.00 - 12.00
666 P-B****8RZ VERGA PUTRI OKTAVIA 350517******0004 0858*****906 02/10/2021 Sesi 2 10.00 - 12.00
667 P-B****8OY EKO WAHYU NUGROHO 350402******0001 0822*****225 02/10/2021 Sesi 2 10.00 - 12.00
668 P-B****FV2 LUCKY ANUGRAH WIBAWA 357303******0003 0877*****417 02/10/2021 Sesi 2 10.00 - 12.00
669 P-B****ZLE BALQIS SALSABILA SYANI 350732******0002 0819*****027 02/10/2021 Sesi 2 10.00 - 12.00

Page 16 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
670 P-B****9SV ERIC ADIANSYAH 357302******0004 0888*****90 02/10/2021 Sesi 2 10.00 - 12.00
671 P-B****MEY JUBRIL BIRUNI PAMBOKE 747110******0001 0821*****907 02/10/2021 Sesi 2 10.00 - 12.00
672 P-B****1DN AZIZ FIKRI MAHMUDI 327611******0001 0813*****570 02/10/2021 Sesi 2 10.00 - 12.00
673 P-B****STK JUNDAN ADIWIRATAMA 357305******0006 0812*****319 02/10/2021 Sesi 2 10.00 - 12.00
674 P-B****41G AULIYA RAHMA MAZIIDAH 531012******0001 0852*****261 02/10/2021 Sesi 2 10.00 - 12.00
675 P-B****CRZ RAHMAD ADITYA 620207******0001 0821*****948 02/10/2021 Sesi 2 10.00 - 12.00
676 P-B****W6U AMIRALL GHAPRANK TALIWANGI 357903******0001 0813*****938 02/10/2021 Sesi 2 10.00 - 12.00
677 P-B****AVC KHOIRUL MUBAROK 121809******0001 0812*****16 02/10/2021 Sesi 2 10.00 - 12.00
678 P-B****GVK Agnes Lia Maulida 351811******0005 0858*****888 02/10/2021 Sesi 2 10.00 - 12.00
679 P-B****SLN ABDILLAH ALI 120725******0001 0812*****493 02/10/2021 Sesi 2 10.00 - 12.00
680 P-B****WM1 DANI KURNIANTO 331414******0003 0822*****739 02/10/2021 Sesi 2 10.00 - 12.00
681 P-B****IBQ RENALDY DWISMA FEBRIARTA 640104******0002 0852*****194 02/10/2021 Sesi 2 10.00 - 12.00
682 P-B****H0W RIDWAN NUR ALIZHA DIMAS PANDU 350603******0001 0812*****167 02/10/2021 Sesi 2 10.00 - 12.00
683 P-B****FMY FERNANDO SEPTINO 357301******0004 0882*****271 02/10/2021 Sesi 2 10.00 - 12.00
684 P-B****NDQ BAGUS AHMAD SULTONI MAULIDI 350619******0003 0858*****627 02/10/2021 Sesi 2 10.00 - 12.00
685 P-B****OD7 RAYHAN SYAHRIZAL AMI PUTRA 357303******0002 0895*****9250 02/10/2021 Sesi 2 10.00 - 12.00
686 P-B****QRT DWI JUNI KARTIKA 352224******0002 0857*****817 02/10/2021 Sesi 2 10.00 - 12.00
687 P-B****PS2 IBRAHIMSYAH ZAIRUSSALAM 350724******0003 0812*****862 02/10/2021 Sesi 2 10.00 - 12.00
688 P-B****OFF Ummi Cholsum 357303******0006 0852*****266 02/10/2021 Sesi 2 10.00 - 12.00
689 P-B****H8D DWI TYAS FITRIYA NINGSIH 351606******0001 0815*****733 02/10/2021 Sesi 2 10.00 - 12.00
690 P-B****TC6 ARIEFANDA JUNEDIANSYAH 620701******0003 0822*****170 02/10/2021 Sesi 2 10.00 - 12.00
691 P-B****NJR RAGIL HADI PRASETYO 647401******0005 0813*****360 02/10/2021 Sesi 2 10.00 - 12.00
692 P-B****1MJ M. FAHMI CHAN WIDAYANA 350613******0003 0821*****821 02/10/2021 Sesi 2 10.00 - 12.00
693 P-B****CIA PRICYLIA WULANDA ALIFIANTI 350930******0001 0813*****923 02/10/2021 Sesi 2 10.00 - 12.00
694 P-B****FIP SULTHON AKHDAN GHALI 350921******0007 0812*****767 02/10/2021 Sesi 2 10.00 - 12.00
695 P-B****DOV GLORIA MATRI SAPUTRO 352003******0001 0857*****525 02/10/2021 Sesi 2 10.00 - 12.00
696 P-B****P9H HENDI MARYANTO 181207******0002 0822*****915 02/10/2021 Sesi 2 10.00 - 12.00
697 P-B****N5Q IVAN JOHANES SIMANJUNTAK 120918******0003 0823*****071 02/10/2021 Sesi 2 10.00 - 12.00
698 P-B****11C RANIA NADHIVA 357305******0010 0822*****139 02/10/2021 Sesi 2 10.00 - 12.00
699 P-B****NYG BIMA NUR MUHAMMAD RIZKY 737113******0011 0812*****698 02/10/2021 Sesi 2 10.00 - 12.00
700 P-B****4FF DIEN MUHAMMAD ABIZARD SAPUTRA 357301******0005 0821*****817 02/10/2021 Sesi 2 10.00 - 12.00
701 P-B****LPL ANGGIE TAMARA BLANZESKY 367109******0001 0877*****045 02/10/2021 Sesi 2 10.00 - 12.00
702 P-B****QW7 Muhammad Askar 737111******0006 0822*****122 02/10/2021 Sesi 2 10.00 - 12.00
703 P-B****ICV LILA CAHYA SAFITRI 352214******0001 0896*****082 02/10/2021 Sesi 2 10.00 - 12.00
704 P-B****RJR HUBAB NAVIS AUFAQ 332006******0004 0858*****231 02/10/2021 Sesi 2 10.00 - 12.00
705 P-B****D2K AKBAR FAJARIADI 352804******0002 0896*****865 02/10/2021 Sesi 2 10.00 - 12.00
706 P-B****YA7 MUKHAMAD ALI MABRURI 350716******0005 0812*****001 02/10/2021 Sesi 2 10.00 - 12.00
707 P-B****XED DIAN RAHMAWATI 352318******0001 0813*****437 02/10/2021 Sesi 2 10.00 - 12.00
708 P-B****E5Q MOHAMAD RISKI SAPUTRA 350721******0006 0855*****463 02/10/2021 Sesi 2 10.00 - 12.00
709 P-B****TBH MUHAMMAD FAHMY TAUFIQIL AZHAR 357304******0006 0895*****759 02/10/2021 Sesi 2 10.00 - 12.00
710 P-B****RLZ JATI NUGROHO 357302******0002 0895*****242 02/10/2021 Sesi 2 10.00 - 12.00
711 P-B****LX6 MUHAMMAD NOUVAL NORMANSYAH 327503******0034 0895*****9677 02/10/2021 Sesi 2 10.00 - 12.00

Page 17 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
712 P-B****FUM Ma'rifah Husna Ribusanah 357303******0005 0822*****948 02/10/2021 Sesi 2 10.00 - 12.00
713 P-B****F3X INDRA WAHYU PRADHANA 351407******0002 0822*****145 02/10/2021 Sesi 2 10.00 - 12.00
714 P-B****05K MESTER FERDINAN 350724******0005 0896*****121 02/10/2021 Sesi 2 10.00 - 12.00
715 P-B****KRF SOFIE YUNINGRUM SAFITRI 357901******0001 0896*****528 02/10/2021 Sesi 2 10.00 - 12.00
716 P-B****MZF IWANG YOLANSYAH PUTRA 351007******0003 0853*****310 02/10/2021 Sesi 2 10.00 - 12.00
717 P-B****MZE DHIYA SURYANI PUTRI 647204******0001 0821*****119 02/10/2021 Sesi 2 10.00 - 12.00
718 P-B****AQN AHMAD JINDAN PAHLEVI 167110******0002 0811*****55 02/10/2021 Sesi 2 10.00 - 12.00
719 P-B****29C AZIZZAH NUR ISTIQOMAH 331109******0001 0895*****0681 02/10/2021 Sesi 2 10.00 - 12.00
720 P-B****BRO SABILA SYARAFINA 357802******0004 0878*****726 02/10/2021 Sesi 2 10.00 - 12.00
721 P-B****87B DIAN INDRA ZAHRA MARDLATILLA 350209******0001 0819*****847 02/10/2021 Sesi 2 10.00 - 12.00
722 P-B****PMN AMIR FIRDAUS 331206******0001 0831*****482 02/10/2021 Sesi 2 10.00 - 12.00
723 P-B****IHT Umi Kurniati 350722******0001 0895*****5361 02/10/2021 Sesi 2 10.00 - 12.00
724 P-B****J5N AFGANI FAJAR RIZKY 350724******0005 0819*****333 02/10/2021 Sesi 2 10.00 - 12.00
725 P-B****Y7T MUHAMMAD RHOBITH AGENG RIF'ATULLAH 350724******0003 0858*****419 02/10/2021 Sesi 2 10.00 - 12.00
726 P-B****73V RIZQI SHAFIRA CHAIRUNNISA 320914******0002 0812*****731 02/10/2021 Sesi 2 10.00 - 12.00
727 P-B****MKE DINDA ADILA RAMADANTI 357301******0003 0877*****505 02/10/2021 Sesi 2 10.00 - 12.00
728 P-B****KQU MUHAMMAD GUNTUR ALFARAKH 170219******0001 0852*****917 02/10/2021 Sesi 2 10.00 - 12.00
729 P-B****WSB DANDY SETIAWAN NUR ALIF 351518******0002 0819*****172 02/10/2021 Sesi 2 10.00 - 12.00
730 P-B****X4N ARINAA SABILAH GHOZALI 357305******0001 0857*****113 02/10/2021 Sesi 2 10.00 - 12.00
731 P-B****UBS MUHAMMAD FARHAN HABIBIE 352215******0012 0812*****052 02/10/2021 Sesi 2 10.00 - 12.00
732 P-B****MQU Grinaldi Wisnu Tri Prasetyo 351005******0004 0852*****622 02/10/2021 Sesi 2 10.00 - 12.00
733 P-B****QOW MEGA CHASANAH PUTRI 350723******0001 0857*****966 02/10/2021 Sesi 2 10.00 - 12.00
734 P-B****MQM KEVIN DANIEL 121101******0005 0852*****863 02/10/2021 Sesi 2 10.00 - 12.00
735 P-B****I85 I PUTU YOGA TUNAS SUGITHA 720101******0001 0822*****540 02/10/2021 Sesi 2 10.00 - 12.00
736 P-B****BEI ADVENIA 357305******0008 0813*****124 02/10/2021 Sesi 2 10.00 - 12.00
737 P-B****3H4 USWATUN CHASANAH 350723******0001 0856*****000 02/10/2021 Sesi 2 10.00 - 12.00
738 P-B****2AK ENDI KRISBIANTORO 357303******0006 0851*****561 02/10/2021 Sesi 2 10.00 - 12.00
739 P-B****F0I EDI SISWANTO 350723******0003 0812*****474 02/10/2021 Sesi 2 10.00 - 12.00
740 P-B****DP6 SRI RAHMAWATI 350723******0004 0812*****923 02/10/2021 Sesi 2 10.00 - 12.00
741 P-C****JKH RIRIEN YUNIORITA 357305******0010 0813*****469 02/10/2021 Sesi 2 10.00 - 12.00
742 P-C****XNW YUDHISTIRA TRIWIJAYA 352516******0001 0812*****678 02/10/2021 Sesi 2 10.00 - 12.00
743 P-C****8LM PUTRI ROHMAH ANINDITA SARI 332511******0001 0856*****020 02/10/2021 Sesi 2 10.00 - 12.00
744 P-C****BON R. RIANG SUDARSONO 357305******0006 0812*****178 02/10/2021 Sesi 2 10.00 - 12.00
745 P-I****OMH AGUS SUPRIANTO 350721******0007 0823*****924 02/10/2021 Sesi 2 10.00 - 12.00
746 P-K****16J ARY SUDIARGO 357304******0010 0821*****321 02/10/2021 Sesi 2 10.00 - 12.00
747 P-K****RMP HELMY DIEN ROH NOVIKO 357304******0002 0852*****299 02/10/2021 Sesi 2 10.00 - 12.00
748 P-M****FMC LILIS NUR HIDAYATI 352010******0001 0822*****594 02/10/2021 Sesi 2 10.00 - 12.00
749 P-R****3O0 BILLY KURNIANANDA 350725******0002 0823*****746 02/10/2021 Sesi 2 10.00 - 12.00
750 P-T****MW5 RIEKE AMALIA 331902******0001 0857*****952 02/10/2021 Sesi 2 10.00 - 12.00
751 S-0****9A2 TIANAH 357305******0001 0816*****888 02/10/2021 Sesi 2 10.00 - 12.00
752 S-0****CCC ABDUL MUNTAQIM AL ANSHORY 527201******0002 0853*****849 02/10/2021 Sesi 2 10.00 - 12.00
753 S-4****49C ENDANG IS SUMANINGSIH 357305******0012 0812*****85 02/10/2021 Sesi 2 10.00 - 12.00

Page 18 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
754 S-5****076 Mubdi Salim 317107******0002 0878*****545 02/10/2021 Sesi 2 10.00 - 12.00
755 S-7****ED3 MUKARTI 350606******0002 0812*****15 02/10/2021 Sesi 2 10.00 - 12.00
756 S-7****197 SUDI HERLIN RAHMAWATI 320115******0002 0813*****762 02/10/2021 Sesi 2 10.00 - 12.00
757 S-9****0FA MIS AYUN 357305******0002 0813*****172 02/10/2021 Sesi 2 10.00 - 12.00
758 S-9****A0A RIZA HARFIANSYAH 320914******0006 0898*****13 02/10/2021 Sesi 2 10.00 - 12.00
759 S-A****613 Muhammad Rizal Farah 317505******0004 0813*****745 02/10/2021 Sesi 2 10.00 - 12.00
760 S-A****BBD Iswahyudi Sumitro 350723******0001 0823*****774 02/10/2021 Sesi 2 10.00 - 12.00
761 S-A****FF7 3573040111990001 357304******0001 0895*****525 02/10/2021 Sesi 2 10.00 - 12.00
762 S-B****4DF ERIK HERMAWAN 617101******0005 0821*****917 02/10/2021 Sesi 2 10.00 - 12.00
763 S-D****301 Ellya Azizah Agustin 357302******0010 0818*****696 02/10/2021 Sesi 2 10.00 - 12.00
764 S-D****78F UMMUL MA'ANI 357303******0003 0822*****601 02/10/2021 Sesi 2 10.00 - 12.00
765 S-D****CB2 Mohammad Daffa Pratama 360312******0001 0852*****036 02/10/2021 Sesi 2 10.00 - 12.00
766 S-E****15F MOHAMMAD IQBAL 357305******0010 0811*****4 02/10/2021 Sesi 2 10.00 - 12.00
767 S-E****0A8 Ita Rosita 351202******0001 0812*****887 02/10/2021 Sesi 2 10.00 - 12.00
768 Y-0****LB0 EVELYNE LIVENIA SENTIKO 357820******0001 0896*****389 02/10/2021 Sesi 2 10.00 - 12.00
769 Y-0****853 MUHAMMAD IRSAD 320107******0003 0818*****613 02/10/2021 Sesi 2 10.00 - 12.00
770 Y-0****WTW MARCELLA 317201******0001 0878*****866 02/10/2021 Sesi 2 10.00 - 12.00
771 Y-0****JD7 MUHAMMAD WAFA ZIDNIILMAN 317301******0003 0877*****585 02/10/2021 Sesi 2 10.00 - 12.00
772 Y-0****FHI ABDURRAHMAN ABU BAKAR BAJAMAL 317501******0003 0812*****411 02/10/2021 Sesi 2 10.00 - 12.00
773 Y-0****CB6 ABDULLAH MUHAMAD FAROUK HAKIM 317301******0012 0822*****608 02/10/2021 Sesi 2 10.00 - 12.00
774 Y-0****RTS MEGAWATI ASTEO 317506******0007 0821*****724 02/10/2021 Sesi 2 10.00 - 12.00
775 Y-0****3WW DHAFIN ALAMSYAH 317502******0003 0851*****188 02/10/2021 Sesi 2 10.00 - 12.00
776 Y-0****MD7 GUARDIAN TRI ANGGORO 317502******0002 0858*****240 02/10/2021 Sesi 2 10.00 - 12.00
777 Y-0****TW0 MUHAMMAD AQIEL FADLIL 317502******0009 0857*****385 02/10/2021 Sesi 2 10.00 - 12.00
778 Y-0****T9A YURA MASSERUNGKE 317502******0003 0852*****410 02/10/2021 Sesi 2 10.00 - 12.00
779 Y-0****WCF ADIN NURFAUZI WAHYU UTAMA 327602******0008 0856*****041 02/10/2021 Sesi 2 10.00 - 12.00
780 Y-0****CWU NAUFAL AFIF BUNYAMIN 317507******0003 0813*****395 02/10/2021 Sesi 2 10.00 - 12.00
781 Y-0****IVX AFLAH FADHLURRAHMAN SUBIANTO 327512******0002 0813*****168 02/10/2021 Sesi 2 10.00 - 12.00
782 Y-0****G6R TITIS FADHILLAH ARTA 317302******0003 0896*****965 02/10/2021 Sesi 2 10.00 - 12.00
783 Y-0****NL7 SEPTIANOV PUTRA MELLYARTO 317507******0010 0877*****671 02/10/2021 Sesi 2 10.00 - 12.00
784 Y-0****P1V DENISYA EKA FATURROHMAN 317503******0001 0812*****102 02/10/2021 Sesi 2 10.00 - 12.00
785 Y-0****MMO OMAR KARIM ALFARISI FAHMI 317406******0007 0811*****50 02/10/2021 Sesi 2 10.00 - 12.00
786 Y-0****MQU AMBAR SETIOWATI 317507******0003 0812*****500 02/10/2021 Sesi 2 10.00 - 12.00
787 Y-0****W1R DZAKWAN DAFFA RAMDHANA 317103******0003 0877*****781 02/10/2021 Sesi 2 10.00 - 12.00
788 Y-0****4GJ ASTRID CATTLEYA MAHARANI WAYINDRA 317302******1001 0819*****804 02/10/2021 Sesi 2 10.00 - 12.00
789 Y-0****0SK FARAH CAMILATUL FARHAIS 317301******0003 0895*****4371 02/10/2021 Sesi 2 10.00 - 12.00
790 Y-0****KS1 FAISAL 317303******0002 0812*****133 02/10/2021 Sesi 2 10.00 - 12.00
791 Y-0****ZL6 PALOGA TREHEYA MUNTHAHA 317502******0008 0-***** 02/10/2021 Sesi 2 10.00 - 12.00
792 Y-0****F27 HENI MISAROH 317405******1006 0821*****157 02/10/2021 Sesi 2 10.00 - 12.00
793 Y-0****TWR MOCHAMAD THORIQ MALANO 317507******0007 0812*****066 02/10/2021 Sesi 2 10.00 - 12.00
794 Y-0****HA8 KATRINA PUSPITA 317502******0004 0813*****383 02/10/2021 Sesi 2 10.00 - 12.00
795 Y-0****9CI HARUN SAHAT MARULI 317507******0002 0816*****9 02/10/2021 Sesi 2 10.00 - 12.00

Page 19 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
796 Y-0****BI3 CLARISSA AUDYA 317401******1003 0813*****617 02/10/2021 Sesi 2 10.00 - 12.00
797 Y-0****OVC PRIHANDIKA SURYA WICAKSANA 317509******0008 0813*****435 02/10/2021 Sesi 2 10.00 - 12.00
798 Y-0****MJ0 IRMA HERMANA 317107******0010 0812*****579 02/10/2021 Sesi 2 10.00 - 12.00
799 Y-0****4LJ ZALFAA RIHAADATUL AISY 317505******0006 0877*****726 02/10/2021 Sesi 2 10.00 - 12.00
800 Y-0****IJ2 FITRI RIZKY AMELIA 317505******0003 0813*****881 02/10/2021 Sesi 2 10.00 - 12.00
801 Y-0****0M5 MUHAMMAD RAYHAN RAVANDIKA 317205******0003 0822*****517 02/10/2021 Sesi 2 10.00 - 12.00
802 Y-0****WMF SILVI WIRA USWATUN HASANAH 317503******0002 0858*****403 02/10/2021 Sesi 2 10.00 - 12.00
803 Y-0****YC8 AULIA RACHMAN SIDDIQ 367113******0002 0813*****596 02/10/2021 Sesi 2 10.00 - 12.00
804 Y-0****TAL EVELINE SISILIA 317108******0001 0898*****28 02/10/2021 Sesi 2 10.00 - 12.00
805 Y-0****QUO INDRA 350724******0004 0812*****702 02/10/2021 Sesi 2 10.00 - 12.00
806 Y-0****BRY AHMAD FAHRUDIN HUSEN 352414******0003 0895*****840 02/10/2021 Sesi 2 10.00 - 12.00
807 Z-E****66F BUINEM 350730******0002 0878*****536 02/10/2021 Sesi 2 10.00 - 12.00
808 J-0****KW3 AMALIA NADILA FARADILLAH 647203******0002 0813*****400 02/10/2021 Sesi 2 10.00 - 12.00
809 J-0****R00 REYNOLDS WIDHIYANURROCHMANSYACH 357305******0001 0811*****36 02/10/2021 Sesi 2 10.00 - 12.00
810 J-0****2KL NADIA TRI ANNISA 357305******0004 0859*****227 02/10/2021 Sesi 2 10.00 - 12.00
811 J-0****8O5 SHAYID ABDILLAH 320120******0003 0857*****429 02/10/2021 Sesi 2 10.00 - 12.00
812 J-0****M9P RAYMOND MARULITUA MANIK 610501******0004 0813*****473 02/10/2021 Sesi 2 10.00 - 12.00
813 J-0****PLH I KOMANG AGUS BENNY SETIAWAN 517103******0008 0857*****252 02/10/2021 Sesi 2 10.00 - 12.00
814 J-0****WD3 AZZAHRA NADINE NABILA 357301******0007 0898*****71 02/10/2021 Sesi 2 10.00 - 12.00
815 J-0****WGF GARUDA ZEIN DEWA RAKAI 357301******0006 0895*****718 02/10/2021 Sesi 2 10.00 - 12.00
816 J-0****XPR ERA REFORMA MILLENNIA M 350725******0003 0812*****081 02/10/2021 Sesi 2 10.00 - 12.00
817 J-0****287 ACHMAD IQBAL CHUSAINI 357301******0001 0813*****401 02/10/2021 Sesi 2 10.00 - 12.00
818 J-0****BQY AKHMAD RAFLY 630302******0006 0812*****385 02/10/2021 Sesi 2 10.00 - 12.00
819 J-0****7RE AKHMAD DEDY LOOJHI 351506******0001 0858*****452 02/10/2021 Sesi 2 10.00 - 12.00
820 J-0****8KC CESILIA GERDA E 357821******0004 0815*****00 02/10/2021 Sesi 2 10.00 - 12.00
821 J-0****AN0 NAURA ALMA FEBRIANTI 357301******0001 0818*****866 02/10/2021 Sesi 2 10.00 - 12.00
822 J-0****JEX ACHMAD SOLEH 357821******0001 0813*****818 02/10/2021 Sesi 2 10.00 - 12.00
823 J-0****V8U IKA PRATIWI 350731******0001 0895*****0307 02/10/2021 Sesi 2 10.00 - 12.00
824 J-0****0EH ASMONO 357304******0004 0821*****030 02/10/2021 Sesi 2 10.00 - 12.00
825 J-0****3YQ FILZAH FARAH EGALITA 350709******0001 0813*****646 02/10/2021 Sesi 2 10.00 - 12.00
826 J-0****UKV KIKI AGUNG LAKSONO 351005******0005 0812*****987 02/10/2021 Sesi 2 10.00 - 12.00
827 J-0****ISM YUNARTI 357303******0001 0878*****290 02/10/2021 Sesi 2 10.00 - 12.00
828 J-0****URP KARTIKA DWI NAWASITA 357305******0001 0896*****002 02/10/2021 Sesi 2 10.00 - 12.00
829 J-0****1SQ KEIKO DODO GUHAL 367113******0004 0851*****352 02/10/2021 Sesi 2 10.00 - 12.00
830 J-0****GBC FAJAR RIZKI FERIYANSYAH 910901******0002 0852*****156 02/10/2021 Sesi 2 10.00 - 12.00
831 J-0****TXQ SINTA SWASTIKAWARA 357305******0005 0818*****503 02/10/2021 Sesi 2 10.00 - 12.00
832 J-0****FPG KARINA DEWI SAPUTRI 180104******0006 0878*****946 02/10/2021 Sesi 2 10.00 - 12.00
833 J-0****FRJ AWAL NURFAIZI 127603******0001 0823*****121 02/10/2021 Sesi 2 10.00 - 12.00
834 J-0****R5O YULINDA NURILIA 357203******0006 0856*****988 02/10/2021 Sesi 2 10.00 - 12.00
835 J-0****0RE IMAN HARIE NAWANTO 320102******0005 0812*****989 02/10/2021 Sesi 2 10.00 - 12.00
836 J-0****1Y8 NOVI WIDI ASTUTI 352112******0001 0812*****850 02/10/2021 Sesi 2 10.00 - 12.00
837 J-0****22V WIDYA ADELLIA UCIMIDA 351002******0002 0812*****656 02/10/2021 Sesi 2 10.00 - 12.00

Page 20 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
838 J-0****2S1 SITI MEISAROH 357301******0005 0838*****657 02/10/2021 Sesi 2 10.00 - 12.00
839 J-0****2SB RAMADHAN HADI JAWANA 350722******0001 0813*****543 02/10/2021 Sesi 2 10.00 - 12.00
840 J-0****307 IZHA SUSETYO 350709******0003 0858*****733 02/10/2021 Sesi 2 10.00 - 12.00
841 J-0****34O LINGTAN AMANU PEWAJI 331109******0002 0895*****0987 02/10/2021 Sesi 2 10.00 - 12.00
842 J-0****46P LARASATI 357303******0008 0853*****720 02/10/2021 Sesi 2 10.00 - 12.00
843 J-0****49C MIFTAKHUL KHAIRI ZUBAIRI 352804******0003 0811*****99 02/10/2021 Sesi 2 10.00 - 12.00
844 J-0****4DN UMMI HANDAYANI ANGGRAININGRUM SUKANDAR 357305******0009 0812*****765 02/10/2021 Sesi 2 10.00 - 12.00
845 J-0****4HD NUZUL RACHMATIYAH 757101******0001 0822*****221 02/10/2021 Sesi 2 10.00 - 12.00
846 J-0****4IZ NURUNNISA FADILA ULYA 350721******0005 0852*****514 02/10/2021 Sesi 2 10.00 - 12.00
847 J-0****4Q4 DIKIANUR ALVIANTO 640104******0003 0813*****391 02/10/2021 Sesi 2 10.00 - 12.00
848 J-0****4S6 HARFIA NUFUS ADHANI 350731******0001 0857*****148 02/10/2021 Sesi 2 10.00 - 12.00
849 J-0****4W2 ALFI DWIAJENG PUTRI 350719******0001 0822*****138 02/10/2021 Sesi 2 10.00 - 12.00
850 J-0****5PJ NUR YUDIONO 357304******0001 0852*****800 02/10/2021 Sesi 2 10.00 - 12.00
851 J-0****66Q NOVIA ARISTA LINANDA 357602******0001 0895*****1595 02/10/2021 Sesi 2 10.00 - 12.00
852 J-0****6E3 HERMAN WINOTO 357302******0002 0812*****37 02/10/2021 Sesi 2 10.00 - 12.00
853 J-0****6FB ARNINA 617201******0003 0896*****561 02/10/2021 Sesi 2 10.00 - 12.00
854 J-0****6GP ERIKA OCTAVIONA PUTRI 351411******0001 0852*****367 02/10/2021 Sesi 2 10.00 - 12.00
855 J-0****7E9 ADDIN NAUFALISA FARIZQI 350721******0003 0822*****553 02/10/2021 Sesi 2 10.00 - 12.00
856 J-0****7I4 RAFILAH PUTRI ADIBAH 357305******0004 0813*****510 02/10/2021 Sesi 2 10.00 - 12.00
857 J-0****7S6 SUKARSIH 357301******0002 0812*****866 02/10/2021 Sesi 2 10.00 - 12.00
858 J-0****81N MOHAMMAD LUBBABUL AZHAR 350715******0001 0857*****065 02/10/2021 Sesi 2 10.00 - 12.00
859 J-0****871 ARIEF BURHAN EFFENDI 351423******0001 0815*****087 02/10/2021 Sesi 2 10.00 - 12.00
860 J-0****89J FANDI PERMANA PUTRA 351512******0002 0812*****278 02/10/2021 Sesi 2 10.00 - 12.00
861 J-0****8OY MITRA ARTHA KURNIA HUTABARAT 640804******0002 0813*****146 02/10/2021 Sesi 2 10.00 - 12.00
862 J-0****8UE AULIA WINATA 350723******0001 0812*****500 02/10/2021 Sesi 2 10.00 - 12.00
863 J-0****90K AZMI TSABITAH 367111******0009 0813*****181 02/10/2021 Sesi 2 10.00 - 12.00
864 J-0****99F MUHAMMAD DAFFA ADITYA 331710******0003 0813*****929 02/10/2021 Sesi 2 10.00 - 12.00
865 J-0****9BF FAHRINISA MUTIARA KURDI 332511******0001 0823*****195 02/10/2021 Sesi 2 10.00 - 12.00
866 J-0****9GH ADINDA MUTIARASARI 357303******0009 0812*****416 02/10/2021 Sesi 2 10.00 - 12.00
867 J-0****9GK ELBA GLORY 357303******0005 0813*****915 02/10/2021 Sesi 2 10.00 - 12.00
868 J-0****9KU SAFHIRA JIHAN NURRAFIDAH 357803******0002 0898*****32 02/10/2021 Sesi 2 10.00 - 12.00
869 J-0****9P6 DITA AMALIA SANDY 357305******0004 0856*****603 02/10/2021 Sesi 2 10.00 - 12.00
870 J-0****9VE MUHAMMAD RIFKI ASSHIDIQ 357302******0003 0838*****975 02/10/2021 Sesi 2 10.00 - 12.00
871 J-0****A07 SHAFA' HUSNUN KARDINA 350723******0001 0813*****498 02/10/2021 Sesi 2 10.00 - 12.00
872 J-0****A3T AJENG JASMINE FIRDAUSY 357903******0003 0895*****1602 02/10/2021 Sesi 2 10.00 - 12.00
873 J-0****A5E ERLAN ERLANGGA 640804******0002 0812*****038 02/10/2021 Sesi 2 10.00 - 12.00
874 J-0****AB5 NABILA AYU ASHAFIRA 357304******0006 0821*****457 02/10/2021 Sesi 2 10.00 - 12.00
875 J-0****AMT ARIPIN 350705******0003 0819*****900 02/10/2021 Sesi 2 10.00 - 12.00
876 J-0****AY1 SYAFIRA VIONIKA FADILLA 357903******0001 0823*****045 02/10/2021 Sesi 2 10.00 - 12.00
877 J-0****BJE FEBI PERMATASARI 350723******0004 0815*****589 02/10/2021 Sesi 2 10.00 - 12.00
878 J-0****BS2 MAYA ISWANDI 350709******0001 0813*****136 02/10/2021 Sesi 2 10.00 - 12.00
879 J-0****BS8 MICHAEL ANDREAS SIANTURI 127208******0001 0852*****272 02/10/2021 Sesi 2 10.00 - 12.00

Page 21 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
880 J-0****BXA MAHESWARI TRINANDA PUTRI 350414******0001 0898*****65 02/10/2021 Sesi 2 10.00 - 12.00
881 J-0****BY1 YUSUF HAIDAR ALIF 351312******0001 0822*****330 02/10/2021 Sesi 2 10.00 - 12.00
882 J-0****CJ6 FAIRUZA CITRA RAMADHANIATY 630906******0002 0878*****144 02/10/2021 Sesi 2 10.00 - 12.00
883 J-0****CS5 IMELDA GOSAL 737103******0005 0812*****800 02/10/2021 Sesi 2 10.00 - 12.00
884 J-0****CUH ITA YANI PURWANTI 357304******0003 0813*****598 02/10/2021 Sesi 2 10.00 - 12.00
885 J-0****DI7 DWIKI MADYA FATHURROHMAN 352002******0001 0858*****847 02/10/2021 Sesi 2 10.00 - 12.00
886 J-0****DNB KRISTINA DWI HANDAYANI 350713******0003 0822*****793 02/10/2021 Sesi 2 10.00 - 12.00
887 J-0****DTY DEA CITA MONITA NOIS 357304******0004 0895*****4170 02/10/2021 Sesi 2 10.00 - 12.00
888 J-0****DTZ PUTRI RIYADHUS SHALIHAH 351316******0001 0859*****082 02/10/2021 Sesi 2 10.00 - 12.00
889 J-0****DZ2 BEAUTY HIDAYAH RIZKI 357305******0001 0822*****344 02/10/2021 Sesi 2 10.00 - 12.00
890 J-0****E62 R. SITI SOLIHAH WAHYUNI PERDANA 352902******0007 0821*****302 02/10/2021 Sesi 2 10.00 - 12.00
891 J-0****EP7 FAHAR RIFQI NUGRAHA 327307******0001 0851*****125 02/10/2021 Sesi 2 10.00 - 12.00
892 J-0****EQ8 LAILY NABILAH HAYUNINGRUM 350722******0001 0812*****688 02/10/2021 Sesi 2 10.00 - 12.00
893 J-0****ETZ ANNISA AL HAKIM 350719******0001 0896*****479 02/10/2021 Sesi 2 10.00 - 12.00
894 J-0****EUC SABILA MADHANI 327502******0016 0822*****382 02/10/2021 Sesi 2 10.00 - 12.00
895 J-0****EVB MIFTA CUCU JAYANTI 357305******0002 0813*****410 02/10/2021 Sesi 2 10.00 - 12.00
896 J-0****EXY MAULANA AKBAR IMILDA SETYAWAN 357305******0002 0896*****331 02/10/2021 Sesi 2 10.00 - 12.00
897 J-0****F14 FOMALHA HARI ANDANI 357814******0001 0821*****922 02/10/2021 Sesi 2 10.00 - 12.00
898 J-0****F41 ANGGUN NUR HIDAYAH 357305******0001 0896*****549 02/10/2021 Sesi 2 10.00 - 12.00
899 J-0****F4V SYAHRECKY HIDAYAT IRAWAN 177104******0016 0896*****176 02/10/2021 Sesi 2 10.00 - 12.00
900 J-0****FFR ENDIYONO RAHARJO 357304******0010 0822*****221 02/10/2021 Sesi 2 10.00 - 12.00
901 J-0****FU0 MOH. BASRI ANSYORI 352901******0004 0877*****737 02/10/2021 Sesi 2 10.00 - 12.00
902 J-0****G7Y ZENI FARIDATUS SA'DIYAH 350510******0003 0858*****719 02/10/2021 Sesi 2 10.00 - 12.00
903 J-0****G88 YUDHA WAHYU RISDIYANSAH 357901******0004 0857*****215 02/10/2021 Sesi 2 10.00 - 12.00
904 J-0****GIZ SITI ZUNI ASTUTI 351708******0001 0895*****782 02/10/2021 Sesi 2 10.00 - 12.00
905 J-0****GJ3 NISA MAULINA 320732******0001 0823*****786 02/10/2021 Sesi 2 10.00 - 12.00
906 J-0****GQX OVI APRILIA 357901******0008 0896*****796 02/10/2021 Sesi 2 10.00 - 12.00
907 J-0****GSI NABILA NURHIDAYAH 357305******0001 0856*****100 02/10/2021 Sesi 2 10.00 - 12.00
908 J-0****H4Q AKHMAD MASYHURI JAMIL 350209******0003 0812*****541 02/10/2021 Sesi 2 10.00 - 12.00
909 J-0****H4Y MIRZA ICA AULIA 350705******0002 0852*****064 02/10/2021 Sesi 2 10.00 - 12.00
910 J-0****H8Q NUR FITA FATIMAH AZZAHRO 351410******0001 0857*****659 02/10/2021 Sesi 2 10.00 - 12.00
911 J-0****H9G REIZA LUTFITA PRIMADANI 337401******0001 0858*****697 02/10/2021 Sesi 2 10.00 - 12.00
912 J-0****HNK PONGGING DANIELA PASARIBU 120204******0001 0821*****161 02/10/2021 Sesi 2 10.00 - 12.00
913 J-0****HW2 HUSNUR RUKYAT 520307******0004 0823*****578 02/10/2021 Sesi 2 10.00 - 12.00
914 J-0****IDU SYIFA AMELIA 332804******0005 0815*****927 02/10/2021 Sesi 2 10.00 - 12.00
915 J-0****J22 AFNA HANUN NIDA 180218******0003 0852*****974 02/10/2021 Sesi 2 10.00 - 12.00
916 J-0****J48 DINA MAULIDA RAHMI 350722******0004 0822*****450 02/10/2021 Sesi 2 10.00 - 12.00
917 J-0****JQW DANY TRI PURNAMA 357401******0001 0857*****222 02/10/2021 Sesi 2 10.00 - 12.00
918 J-0****JRR FATHI SYARIFUDDIN MUFLIH 321607******0010 0811*****99 02/10/2021 Sesi 2 10.00 - 12.00
919 J-0****JXW SEPTI ARDIYANA 352103******0003 0819*****066 02/10/2021 Sesi 2 10.00 - 12.00
920 J-0****JXX WILDAN RIFKY ARIFIANSYAH 357303******0006 0856*****710 02/10/2021 Sesi 2 10.00 - 12.00
921 J-0****K2J ALIFIA NADIA TSAMARA 351709******0001 0822*****478 02/10/2021 Sesi 2 10.00 - 12.00

Page 22 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
922 J-0****K43 NOOR ALFAENI ELLA WAHIDAH 351116******0001 0813*****544 02/10/2021 Sesi 2 10.00 - 12.00
923 J-0****KCX LARISSA APSARINI MEIRINTA 357301******0002 0813*****477 02/10/2021 Sesi 2 10.00 - 12.00
924 J-0****KI4 INDAH LESTARI 130212******0002 0812*****440 02/10/2021 Sesi 2 10.00 - 12.00
925 J-0****KMO HANIF 357502******0003 0821*****120 02/10/2021 Sesi 2 10.00 - 12.00
926 J-0****KOY MARSHELLA KUMALASARI WIDJAYA 357301******0002 0813*****808 02/10/2021 Sesi 2 10.00 - 12.00
927 J-0****KVL ZULFADHLI 327604******0002 0851*****717 02/10/2021 Sesi 2 10.00 - 12.00
928 J-0****KX6 MUHAMMAD FAISAL MAULANA 647103******0005 0822*****151 02/10/2021 Sesi 2 10.00 - 12.00
929 J-0****KZW INDRA WIJAYA CAESARIO 357404******0002 0823*****678 02/10/2021 Sesi 2 10.00 - 12.00
930 J-0****LNW MOCH.RIZQI AFFANDI FATHURROZI 350713******0003 0852*****436 02/10/2021 Sesi 2 10.00 - 12.00
931 J-0****LOK RIDHO ARY SYAHPUTRA 327501******0008 0812*****108 02/10/2021 Sesi 2 10.00 - 12.00
932 J-0****LP0 ALISSA SABRINA ADEN 357304******0001 0859*****769 02/10/2021 Sesi 2 10.00 - 12.00
933 J-0****LSO YOLANDA ULFA 357301******0001 0857*****454 02/10/2021 Sesi 2 10.00 - 12.00
934 J-0****LT8 SITI NUR LAILA RAMADHANI 357304******0011 0856*****150 02/10/2021 Sesi 2 10.00 - 12.00
935 J-0****LUR DINTA ARDELIA 350724******0001 0838*****675 02/10/2021 Sesi 2 10.00 - 12.00
936 J-0****LW7 WISNU ENGGAR WIRASAPUTRA 351908******0004 0838*****352 02/10/2021 Sesi 2 10.00 - 12.00
937 J-0****LWH SUTHAN MALIK HAMONANGAN 357301******0006 0895*****5008 02/10/2021 Sesi 2 10.00 - 12.00
938 J-0****LXT MOCH SAIFUL ISLAM 350718******0002 0815*****26 02/10/2021 Sesi 2 10.00 - 12.00
939 J-0****LZ8 SYAHRUL NOOR MULYA 357304******0002 0878*****568 02/10/2021 Sesi 2 10.00 - 12.00
940 J-0****M76 MUHAMMAD HARZAH RHAMADHANI 357305******0001 0821*****401 02/10/2021 Sesi 2 10.00 - 12.00
941 J-0****M8K TRI TJAHJA PRASETYARINI 357304******0003 0812*****938 02/10/2021 Sesi 2 10.00 - 12.00
942 J-0****M8P DIANNIRA VEGA APRILIA 350719******0004 0813*****419 02/10/2021 Sesi 2 10.00 - 12.00
943 J-0****MAF SALSABILAH HANI THALIB 357302******0006 0896*****704 02/10/2021 Sesi 2 10.00 - 12.00
944 J-0****MF1 Feby Anggi Saputra 357301******0002 0813*****814 02/10/2021 Sesi 2 10.00 - 12.00
945 J-0****MGX ANDICO PUTRA PERDANA 350413******0003 0822*****712 02/10/2021 Sesi 2 10.00 - 12.00
946 J-0****MHB SELVIA BR TAMBA 177102******0006 0895*****1751 02/10/2021 Sesi 2 10.00 - 12.00
947 J-0****MJB DIMAS ANDIKA RAMADHAN 357303******0001 0823*****443 02/10/2021 Sesi 2 10.00 - 12.00
948 J-0****MK5 MIFTAH KHAIRUMAN 357703******0003 0813*****638 02/10/2021 Sesi 2 10.00 - 12.00
949 J-0****MKE CHRISTIAN JOHAN STEFANUS 317510******0005 0812*****822 02/10/2021 Sesi 2 10.00 - 12.00
950 J-0****MMN YEYEN SARMAULI ARITONANG 327509******0012 0813*****019 02/10/2021 Sesi 2 10.00 - 12.00
951 J-0****MNM FATHIN NABILAH 357305******0001 0822*****314 02/10/2021 Sesi 2 10.00 - 12.00
952 J-0****MOT ALI MUBAROK 321206******0002 0831*****955 02/10/2021 Sesi 2 10.00 - 12.00
953 J-0****MPK ANDRIAN AKBAR ROHMANSYAH 357301******0007 0895*****095 02/10/2021 Sesi 2 10.00 - 12.00
954 J-0****MPW DIKA ADRIYANA TYASARI 357403******0006 0858*****358 02/10/2021 Sesi 2 10.00 - 12.00
955 J-0****MQU ANIN DIKA LAYUAR YURISQI 350721******0004 0838*****963 02/10/2021 Sesi 2 10.00 - 12.00
956 J-0****MRK SITI MAIMUNAH 350718******0003 0812*****773 02/10/2021 Sesi 2 10.00 - 12.00
957 J-0****MRW ISNULWATI 350721******0003 0877*****019 02/10/2021 Sesi 2 10.00 - 12.00
958 J-0****MSE MUCHAMMAD ZUHRI RAMADHANI ABANAN 357304******0001 0822*****260 02/10/2021 Sesi 2 10.00 - 12.00
959 J-0****MZZ AINNAYA PUTRI HARZANTI 327605******0007 0821*****777 02/10/2021 Sesi 2 10.00 - 12.00
960 J-0****N0C AHMAD DZIKRI ZAKARIA 350502******0001 0857*****122 02/10/2021 Sesi 2 10.00 - 12.00
961 J-0****N0I MUHAMMAD NUR FAZA 317504******0002 0-***** 02/10/2021 Sesi 2 10.00 - 12.00
962 J-0****N12 RIFA VINDA AULINA 337401******0005 0813*****247 02/10/2021 Sesi 2 10.00 - 12.00
963 J-0****N18 MUHAMMAD RIFQI FADLURRAHMAN 327505******0017 0817*****67 02/10/2021 Sesi 2 10.00 - 12.00

Page 23 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
964 J-0****N2S VANDA ARUM HARDIANTY 647104******0002 0813*****663 02/10/2021 Sesi 2 10.00 - 12.00
965 J-0****N3G AKHDAN SABILULHAQ 357802******0003 0821*****051 02/10/2021 Sesi 2 10.00 - 12.00
966 J-0****N3K ODILIA DEWI PERMATA SARI 327602******0007 0813*****824 02/10/2021 Sesi 2 10.00 - 12.00
967 J-0****N3M NURFITRIANA AYUNDIRA 350718******0001 0821*****423 02/10/2021 Sesi 2 10.00 - 12.00
968 J-0****N3N WARSITO MULYONO 350723******0002 0812*****924 02/10/2021 Sesi 2 10.00 - 12.00
969 J-0****N5F ANANDA NUR HALIZA 357304******0009 0821*****849 02/10/2021 Sesi 2 10.00 - 12.00
970 J-0****N6B GUNTUR WIBOWO 327105******0008 0881*****60 02/10/2021 Sesi 2 10.00 - 12.00
971 J-0****N7K ADELIA PUTRI LORENDA 357901******0004 0813*****882 02/10/2021 Sesi 2 10.00 - 12.00
972 J-0****N7L NUGRAHENI PUJI LESTARI 327603******0007 0813*****725 02/10/2021 Sesi 2 10.00 - 12.00
973 J-0****N8W BENEDICTA PASCALIA ANNUNTIATA 357305******0005 0813*****510 02/10/2021 Sesi 2 10.00 - 12.00
974 J-0****N91 ALYA NUR AZIZAH 357301******0004 0895*****2341 02/10/2021 Sesi 2 10.00 - 12.00
975 J-0****NA2 ALIVIANSYAH YULIAN PRADANA 357305******0001 0852*****974 02/10/2021 Sesi 2 10.00 - 12.00
976 J-0****NB3 SUCI JIHAN NURNAJMI 637102******0008 0812*****982 02/10/2021 Sesi 2 10.00 - 12.00
977 J-0****NC0 DIMAS ANGGORO CEISAR 360405******0002 0821*****385 02/10/2021 Sesi 2 10.00 - 12.00
978 J-0****NC3 NENSI YULI KRISDAYANTI 350704******0003 0821*****929 02/10/2021 Sesi 2 10.00 - 12.00
979 J-0****NC4 OCTAVIA WAHYUNING RINI 357304******0001 0895*****1744 02/10/2021 Sesi 2 10.00 - 12.00
980 J-0****ND1 MUHAMMAD HARITS HILMI 357305******0003 0821*****415 02/10/2021 Sesi 2 10.00 - 12.00
981 J-0****NFS AUDYAH ELISABETH GLORIA BOLLA 530715******0001 0822*****962 02/10/2021 Sesi 2 10.00 - 12.00
982 J-0****NFX PRASTYO HUDA ROCHMATULLOH 350724******0006 0813*****980 02/10/2021 Sesi 2 10.00 - 12.00
983 J-0****NG8 DIAN MARGARET MANIK 127207******0001 0852*****401 02/10/2021 Sesi 2 10.00 - 12.00
984 J-0****NGA ALISYA MULIANI 140313******0005 0812*****561 02/10/2021 Sesi 2 10.00 - 12.00
985 J-0****NGK ALFANO YUSUF KADAFI 620206******0002 0813*****479 02/10/2021 Sesi 2 10.00 - 12.00
986 J-0****NHF JAUHARI PERMANA POERWADI 357304******0004 0812*****521 02/10/2021 Sesi 2 10.00 - 12.00
987 J-0****NIM MAYLIANA PUTRI 350722******0002 0838*****011 02/10/2021 Sesi 2 10.00 - 12.00
988 J-0****NLK DIZA SAINSTIKA 357901******0005 0851*****078 02/10/2021 Sesi 2 10.00 - 12.00
989 J-0****NNW ZAHROTUL FAWAIDAH 352503******0001 0857*****626 02/10/2021 Sesi 2 10.00 - 12.00
990 J-0****NOQ R.M.BURHIM NUR ADITYA 157101******0021 0823*****229 02/10/2021 Sesi 2 10.00 - 12.00
991 J-0****NRR MOHAMMAD BASITH DEVINNUL DJOHAR 352509******0001 0821*****771 02/10/2021 Sesi 2 10.00 - 12.00
992 J-0****NSD REZA APRILDA ISSAURA MUDA 537102******0001 0811*****93 02/10/2021 Sesi 2 10.00 - 12.00
993 J-0****NWW AQILLA CINANTYA WARA DAYINTA 357305******0003 0856*****897 02/10/2021 Sesi 2 10.00 - 12.00
994 J-0****NXV MUHAMMAD LUTHFI HAKIM ASY'ARI 332112******0002 0858*****616 02/10/2021 Sesi 2 10.00 - 12.00
995 J-0****O00 REYHAN DAFFA ARFANANDA 350810******0002 0859*****276 02/10/2021 Sesi 2 10.00 - 12.00
996 J-0****O2Z FELIANA DAMAI YANTI 350721******0005 0822*****919 02/10/2021 Sesi 2 10.00 - 12.00
997 J-0****O6E NUR AZIZAH 357903******0003 0895*****3163 02/10/2021 Sesi 2 10.00 - 12.00
998 J-0****OAP HARBANU SENO DAMARJATI 351420******0005 0822*****909 02/10/2021 Sesi 2 10.00 - 12.00
999 J-0****OBB SYARIF HIDAYATULLOH 357303******0003 0812*****323 02/10/2021 Sesi 2 10.00 - 12.00
1000 J-0****OBJ MIKAEL LABDHA WEGA GUN DUATRA 357901******0003 0858*****957 02/10/2021 Sesi 2 10.00 - 12.00
1001 J-0****OCP NIRBITO NINAR ANGGORO 350724******0001 0822*****900 02/10/2021 Sesi 2 10.00 - 12.00
1002 J-0****ODR NOVALIA MELATI 357305******0001 0812*****801 02/10/2021 Sesi 2 10.00 - 12.00
1003 J-0****OGN MUHAMMAD AHSIN SYIFA 332909******0003 0896*****700 02/10/2021 Sesi 2 10.00 - 12.00
1004 J-0****OI5 PUTRI SYAKILA 130408******0001 0813*****148 02/10/2021 Sesi 2 10.00 - 12.00
1005 J-0****OIA MOCH FAJAR IZZUL HAQ 350719******0002 0858*****297 02/10/2021 Sesi 2 10.00 - 12.00

Page 24 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1006 J-0****OMN NADIA AVIANA RISMA 350709******0002 0813*****840 02/10/2021 Sesi 2 10.00 - 12.00
1007 J-0****ONJ EYVIANISYA VERIKA VASHTI 357901******0003 0812*****942 02/10/2021 Sesi 2 10.00 - 12.00
1008 J-0****ONL JUNDA ALFIAH ZULQORNAIN 357303******0005 0895*****477 02/10/2021 Sesi 2 10.00 - 12.00
1009 J-0****ONR MONICA AGUSTIN PAN TWUARNI 357804******0001 0821*****617 02/10/2021 Sesi 2 10.00 - 12.00
1010 J-0****OOS EQUARIN ALVIONITA ROSES 350718******0004 0882*****701 02/10/2021 Sesi 2 10.00 - 12.00
1011 J-0****OP7 M. ARTHUR VALENTINO 647103******0003 0896*****760 02/10/2021 Sesi 2 10.00 - 12.00
1012 J-0****OPZ NUR ILFA TAMLIKA MAKARIMA 331710******0002 0896*****107 02/10/2021 Sesi 2 10.00 - 12.00
1013 J-0****ORF IRMA NUR RHAMADANI 357901******0003 0822*****027 02/10/2021 Sesi 2 10.00 - 12.00
1014 J-0****ORZ MUSTHOFA TRISNO JAYADI 647402******0008 0821*****912 02/10/2021 Sesi 2 10.00 - 12.00
1015 J-0****OSI DIANA RAHAYU 357303******0003 0896*****190 02/10/2021 Sesi 2 10.00 - 12.00
1016 J-0****OTU SEPTIAN HERU PRASETYO 352311******0005 0823*****677 02/10/2021 Sesi 2 10.00 - 12.00
1017 J-0****OUD MIFTAHUL ULUM 350708******0002 0851*****402 02/10/2021 Sesi 2 10.00 - 12.00
1018 J-0****OYS KHORITHUL KHAYAT 647205******0006 0813*****324 02/10/2021 Sesi 2 10.00 - 12.00
1019 J-0****P1J FENTY NUR AINI 357303******0007 0852*****912 02/10/2021 Sesi 2 10.00 - 12.00
1020 J-0****P62 JUAN RAYMOND MANURUNG 320107******0004 0857*****761 02/10/2021 Sesi 2 10.00 - 12.00
1021 J-0****P6A WILDAN NAFI' AR ROSYIDIN 352408******0003 0857*****926 02/10/2021 Sesi 3 12.00 - 14.00
1022 J-0****P6I IRHAM MANTHIQO NOOR 357305******0001 0821*****914 02/10/2021 Sesi 3 12.00 - 14.00
1023 J-0****PA7 MAMAN SIGIT PRATAMA 350722******0003 0821*****745 02/10/2021 Sesi 3 12.00 - 14.00
1024 J-0****PAF CANDIKA NOFRITE 357305******0002 0817*****48 02/10/2021 Sesi 3 12.00 - 14.00
1025 J-0****PBI ALICIA FIRSTY VARIANNY 350211******0003 0878*****593 02/10/2021 Sesi 3 12.00 - 14.00
1026 J-0****PE3 RISKY ADILIYA 350920******0006 0822*****707 02/10/2021 Sesi 3 12.00 - 14.00
1027 J-0****PFK VERONICA TUTUROONG 717107******0002 0821*****822 02/10/2021 Sesi 3 12.00 - 14.00
1028 J-0****PGA HAIRUNNISA 367208******0005 0813*****970 02/10/2021 Sesi 3 12.00 - 14.00
1029 J-0****PKI AZWA REVINDA PRATIWI 351508******0002 0899*****68 02/10/2021 Sesi 3 12.00 - 14.00
1030 J-0****PLO RIZKA AMALIA ANWAR 350724******0002 0812*****198 02/10/2021 Sesi 3 12.00 - 14.00
1031 J-0****PM7 GHAALII AZHAARI AL SYA'BAANI 320111******0001 0813*****815 02/10/2021 Sesi 3 12.00 - 14.00
1032 J-0****PME AHMAD NATHIQUE BIL HAQI 357305******0006 0813*****242 02/10/2021 Sesi 3 12.00 - 14.00
1033 J-0****PP9 ISTIFAIYAH 350724******0001 0819*****988 02/10/2021 Sesi 3 12.00 - 14.00
1034 J-0****PQ8 MUHAMMAD ADAM RAMADHANI 357305******0008 0858*****377 02/10/2021 Sesi 3 12.00 - 14.00
1035 J-0****PQP NUR WAHID SUGIANTO 357305******0001 0812*****002 02/10/2021 Sesi 3 12.00 - 14.00
1036 J-0****PTD RAKYAN HANDAKA MARHAENDRA MADYASTA 351016******0003 0821*****857 02/10/2021 Sesi 3 12.00 - 14.00
1037 J-0****PY6 GALIH ARDIANSYAH 357305******0001 0895*****1770 02/10/2021 Sesi 3 12.00 - 14.00
1038 J-0****Q0Z YULIANINGSIH 357903******0002 0818*****871 02/10/2021 Sesi 3 12.00 - 14.00
1039 J-0****Q4F NOVIAR AGUNG GITANTO 357305******0011 0813*****533 02/10/2021 Sesi 3 12.00 - 14.00
1040 J-0****Q5K DALENDRA KARDINA 350723******0002 0813*****201 02/10/2021 Sesi 3 12.00 - 14.00
1041 J-0****Q7X NURKHOLIS FAHRONI 350916******0001 0851*****613 02/10/2021 Sesi 3 12.00 - 14.00
1042 J-0****Q8F ANNISAFIRDA NAGANO ISEKO 357305******0002 0857*****453 02/10/2021 Sesi 3 12.00 - 14.00
1043 J-0****QBC PRISTIA DIAN ASTRI MEYLITA 351506******0003 0812*****72 02/10/2021 Sesi 3 12.00 - 14.00
1044 J-0****QBK NORSALEHA 630605******0002 0831*****052 02/10/2021 Sesi 3 12.00 - 14.00
1045 J-0****QBY DENY ANDRIAN SEVCENCO 350724******0007 0852*****955 02/10/2021 Sesi 3 12.00 - 14.00
1046 J-0****QCL RAYHAN EFFENDY FAZA 351414******0001 0813*****625 02/10/2021 Sesi 3 12.00 - 14.00
1047 J-0****QJ1 YUMNA RAISA NOOR 357903******0002 0878*****500 02/10/2021 Sesi 3 12.00 - 14.00

Page 25 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1048 J-0****QLA RATNA ORBANINGTIAS 357903******0001 0831*****555 02/10/2021 Sesi 3 12.00 - 14.00
1049 J-0****QO4 ROSSY NURMALA AI YULFIDA 350724******0005 0838*****566 02/10/2021 Sesi 3 12.00 - 14.00
1050 J-0****QRG LUSVITA ANGGRAINI 357201******0004 0856*****667 02/10/2021 Sesi 3 12.00 - 14.00
1051 J-0****QTD ISMIATUN 350519******0001 0856*****68 02/10/2021 Sesi 3 12.00 - 14.00
1052 J-0****QUL YESSY NOVITA ANGRAINI 357303******0010 0895*****8581 02/10/2021 Sesi 3 12.00 - 14.00
1053 J-0****QV5 LUFITA JAYANA 350718******0003 0812*****127 02/10/2021 Sesi 3 12.00 - 14.00
1054 J-0****QVJ MUHAMMAD ALIMUDDIEN RASYID 357304******0006 0812*****469 02/10/2021 Sesi 3 12.00 - 14.00
1055 J-0****QVQ KATMINI 357305******0004 0812*****359 02/10/2021 Sesi 3 12.00 - 14.00
1056 J-0****QWO RENY INDRIYANTI 357305******0002 0812*****359 02/10/2021 Sesi 3 12.00 - 14.00
1057 J-0****QYF ZWESTY ARIDASARIE 357304******0011 0852*****418 02/10/2021 Sesi 3 12.00 - 14.00
1058 J-0****QZG JENI MAULUDI YAHSYA 357304******0001 0812*****425 02/10/2021 Sesi 3 12.00 - 14.00
1059 J-0****R2T ANAS N KUSNADI 350722******0001 0813*****528 02/10/2021 Sesi 3 12.00 - 14.00
1060 J-0****R64 INA WIJAYA 357305******0020 0812*****033 02/10/2021 Sesi 3 12.00 - 14.00
1061 J-0****R6Y NADYA DINDA ALMIRA 357305******0005 0821*****722 02/10/2021 Sesi 3 12.00 - 14.00
1062 J-0****R76 FIRDAUS KURNIA ABDILLAH 357305******0001 0895*****7936 02/10/2021 Sesi 3 12.00 - 14.00
1063 J-0****R9C FARUQ AKHIMULLAH AKMAL 350722******0001 0812*****830 02/10/2021 Sesi 3 12.00 - 14.00
1064 J-0****R9H SYIFA AMATULLAH ISYMAH 350722******0001 0812*****257 02/10/2021 Sesi 3 12.00 - 14.00
1065 J-0****REZ M.DZULFIQAR NURHAFIZHIN 180301******0003 0857*****357 02/10/2021 Sesi 3 12.00 - 14.00
1066 J-0****RG3 RAHADIL PUTRA HERMANA 357305******0003 0856*****712 02/10/2021 Sesi 3 12.00 - 14.00
1067 J-0****RHC RAHMANDA ANNAFI 320129******0003 0821*****402 02/10/2021 Sesi 3 12.00 - 14.00
1068 J-0****RHN MOHAMMAD INGGIL TAUFANI 910101******0006 0822*****617 02/10/2021 Sesi 3 12.00 - 14.00
1069 J-0****RI8 DANAR TRI YUDISTIRA 351007******0002 0821*****531 02/10/2021 Sesi 3 12.00 - 14.00
1070 J-0****RJL HARRIS IMAM FATHONI 357305******0002 0812*****256 02/10/2021 Sesi 3 12.00 - 14.00
1071 J-0****RQK SUTRI 357305******0018 0881*****2389 02/10/2021 Sesi 3 12.00 - 14.00
1072 J-0****RSI ARDYAN GURUH ANDIKA RAHMA 350716******0001 0815*****000 02/10/2021 Sesi 3 12.00 - 14.00
1073 J-0****RXN SALAMIATUR ROIFAH 350714******0002 0822*****994 02/10/2021 Sesi 3 12.00 - 14.00
1074 J-0****S14 DENIUS 117501******0001 0-***** 02/10/2021 Sesi 3 12.00 - 14.00
1075 J-0****S2X SITI SALEHA 352902******0003 0813*****090 02/10/2021 Sesi 3 12.00 - 14.00
1076 J-0****S4W AULIA FONIE LAROZA 352901******0001 0822*****716 02/10/2021 Sesi 3 12.00 - 14.00
1077 J-0****S6U FERI HENDRAMAWAN 350728******0003 0813*****341 02/10/2021 Sesi 3 12.00 - 14.00
1078 J-0****SMW AHMAD ERIK YOLANDA ARI PERDANA 350707******0004 0899*****23 02/10/2021 Sesi 3 12.00 - 14.00
1079 J-0****SRI AGUNG BUDI PRASETYA 351701******0002 0813*****257 02/10/2021 Sesi 3 12.00 - 14.00
1080 J-0****SUI ISTIQOMAH NURIYAH 357305******0002 0895*****397 02/10/2021 Sesi 3 12.00 - 14.00
1081 J-0****SVS KINAJENG PARASWATI 357502******0002 0822*****711 02/10/2021 Sesi 3 12.00 - 14.00
1082 J-0****SZ2 KEVIN NAUVAL KARIM 350618******0012 0812*****877 02/10/2021 Sesi 3 12.00 - 14.00
1083 J-0****SZ6 RIZAL MAHENDRA PUTRA RIYANTO 350728******0002 0858*****798 02/10/2021 Sesi 3 12.00 - 14.00
1084 J-0****T08 RADIYYAN RAVA GHIFARI 332101******0001 0812*****103 02/10/2021 Sesi 3 12.00 - 14.00
1085 J-0****T1X SAMUEL AJI SENA 357305******0005 0857*****684 02/10/2021 Sesi 3 12.00 - 14.00
1086 J-0****T4B RIZKI AINUN NAJIB 351608******0003 0813*****857 02/10/2021 Sesi 3 12.00 - 14.00
1087 J-0****T4M FIRA AMALIA 357304******0007 0878*****080 02/10/2021 Sesi 3 12.00 - 14.00
1088 J-0****T6P RENALDA KURNIA ENCEPHALA 187111******0006 0821*****454 02/10/2021 Sesi 3 12.00 - 14.00
1089 J-0****T8G ALFIN ZAENAL KAMALA 350501******0002 0822*****330 02/10/2021 Sesi 3 12.00 - 14.00

Page 26 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1090 J-0****TBD ULLYA YULISTIANA 357305******0003 0878*****320 02/10/2021 Sesi 3 12.00 - 14.00
1091 J-0****TBK MUHAMMAD HAYKAL 367406******0004 0812*****572 02/10/2021 Sesi 3 12.00 - 14.00
1092 J-0****TCL MUHAMMAD RIZALUL EFENDI 357301******0003 0856*****666 02/10/2021 Sesi 3 12.00 - 14.00
1093 J-0****TE1 ANITA MUSTIKA NINGRUM 351420******0003 0822*****854 02/10/2021 Sesi 3 12.00 - 14.00
1094 J-0****TFN NABILA KHAIRUNNISA' 357305******0005 0852*****337 02/10/2021 Sesi 3 12.00 - 14.00
1095 J-0****TFT NADA A KARUNIA SARI 350718******0007 0812*****491 02/10/2021 Sesi 3 12.00 - 14.00
1096 J-0****TI6 LYDIA NOOR PRANTAMA 647301******0004 0812*****978 02/10/2021 Sesi 3 12.00 - 14.00
1097 J-0****TJ7 MIS WATI 350723******0002 0815*****04 02/10/2021 Sesi 3 12.00 - 14.00
1098 J-0****TJE SAFIRA ZULFAYA 330704******0002 0813*****917 02/10/2021 Sesi 3 12.00 - 14.00
1099 J-0****TOK FAHRUNNISAK AL-FIRDA RAZAK AN-HARU 327327******0001 0877*****331 02/10/2021 Sesi 3 12.00 - 14.00
1100 J-0****TPS KURNIA INDAH PERMATA SARI 130211******0002 0813*****893 02/10/2021 Sesi 3 12.00 - 14.00
1101 J-0****TZ7 SAYIDAH FATIMAH AYUMA AL ZAHRA 351410******0004 0851*****008 02/10/2021 Sesi 3 12.00 - 14.00
1102 J-0****U03 AYU AULIA WIJAYANTO 321412******0002 0812*****234 02/10/2021 Sesi 3 12.00 - 14.00
1103 J-0****UT8 AHMAD ROFI'I 350717******0003 0831*****459 02/10/2021 Sesi 3 12.00 - 14.00
1104 J-0****UWX RICHIE SEPTAAJI NATAARSAM 647403******0001 0851*****095 02/10/2021 Sesi 3 12.00 - 14.00
1105 J-0****UXC UNTSAA NABILLA 357303******0004 0822*****519 02/10/2021 Sesi 3 12.00 - 14.00
1106 J-0****UZW TANTRI GALIH PERKASA 350724******0001 0823*****090 02/10/2021 Sesi 3 12.00 - 14.00
1107 J-0****V5L A TRIASWARINI MULYAWATI 357302******0001 0812*****125 02/10/2021 Sesi 3 12.00 - 14.00
1108 J-0****VA0 KHAIRUL UMMAM 140413******0003 0823*****623 02/10/2021 Sesi 3 12.00 - 14.00
1109 J-0****VD4 FABIAN MAHROZI 350902******0001 0813*****310 02/10/2021 Sesi 3 12.00 - 14.00
1110 J-0****VNF DEVA FERNANDA RAHMADHAN 357903******0002 0821*****006 02/10/2021 Sesi 3 12.00 - 14.00
1111 J-0****W4U HENDRA SURAWIJAYA 630103******0012 0823*****871 02/10/2021 Sesi 3 12.00 - 14.00
1112 J-0****W4Z BAGUS WAHYU PRASETYO 350723******0001 0821*****702 02/10/2021 Sesi 3 12.00 - 14.00
1113 J-0****W6B WAFA AGYA FILHAYAT 360402******0062 0877*****028 02/10/2021 Sesi 3 12.00 - 14.00
1114 J-0****W6H NABILA TSABITA RAMADHANI 147105******0002 0822*****797 02/10/2021 Sesi 3 12.00 - 14.00
1115 J-0****W9J RIZAL FIRMAN PERDANA 350517******0001 0857*****151 02/10/2021 Sesi 3 12.00 - 14.00
1116 J-0****WAF URSULA ANGGREYNI SITUNGKIR 120201******0002 0822*****459 02/10/2021 Sesi 3 12.00 - 14.00
1117 J-0****WAJ SAFIRA NURI RAMADHANI 357305******0004 0818*****874 02/10/2021 Sesi 3 12.00 - 14.00
1118 J-0****WAK LUTFI MITRA TANJUNG 520101******0002 0812*****00 02/10/2021 Sesi 3 12.00 - 14.00
1119 J-0****WC7 KURNIA ASYAFIA FADILA 357808******0003 0812*****759 02/10/2021 Sesi 3 12.00 - 14.00
1120 J-0****WCJ DINDA ADRISTI APSARINI 350724******0004 0813*****847 02/10/2021 Sesi 3 12.00 - 14.00
1121 J-0****WE1 CELSYA AYU FIRSTANIA AMALUDIN 350417******0001 0813*****859 02/10/2021 Sesi 3 12.00 - 14.00
1122 J-0****WFN ANDI KURNIAWAN 357305******0003 0838*****724 02/10/2021 Sesi 3 12.00 - 14.00
1123 J-0****WJN M. AASYA ALDIN ISLAMY 357305******0001 0813*****252 02/10/2021 Sesi 3 12.00 - 14.00
1124 N-4****A6C ISTI KOMARIYAH 357304******0004 0821*****277 02/10/2021 Sesi 3 12.00 - 14.00
1125 N-7****8CB Fardiana Muchita 351506******0004 0822*****404 02/10/2021 Sesi 3 12.00 - 14.00
1126 N-8****E81 NABILAH AZZAHRA JATIATMAJA 350724******0001 0812*****304 02/10/2021 Sesi 3 12.00 - 14.00
1127 N-9****DEC GHEA DEWI HAPSARI 321606******0013 0856*****051 02/10/2021 Sesi 3 12.00 - 14.00
1128 N-A****D76 ZAINUR ROZIKIN 352423******0001 0878*****181 02/10/2021 Sesi 3 12.00 - 14.00
1129 N-B****32A JOSEPH MOSES 357305******0002 0822*****120 02/10/2021 Sesi 3 12.00 - 14.00
1130 N-F****E15 AISYAH NURWITASARI 357503******0002 0819*****828 02/10/2021 Sesi 3 12.00 - 14.00
1131 P-0****G1W WINDA NURTRIA UTAMI 737110******0023 0815*****555 02/10/2021 Sesi 3 12.00 - 14.00

Page 27 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1132 P-1****WBJ Nurul Hidayah 350723******0001 0858*****853 02/10/2021 Sesi 3 12.00 - 14.00
1133 P-1****T6M Annisa Azmil Mufida 350723******0002 0858*****566 02/10/2021 Sesi 3 12.00 - 14.00
1134 P-1****N4R SRI LESTARI 357305******0010 0856*****555 02/10/2021 Sesi 3 12.00 - 14.00
1135 P-1****LBF Nessa Syifa Noeraisha 357305******0006 0851*****777 02/10/2021 Sesi 3 12.00 - 14.00
1136 P-1****CD8 Wagisri 357305******0004 0896*****222 02/10/2021 Sesi 3 12.00 - 14.00
1137 P-2****OEQ LARA PUJA PRATIWI 137501******0001 0895*****1058 02/10/2021 Sesi 3 12.00 - 14.00
1138 P-2****4HR TUTUT SULEMI EKOWATI 350722******0002 0812*****931 02/10/2021 Sesi 3 12.00 - 14.00
1139 P-2****AGQ AMAS SALSABILA YA’SRI WAHYU MABFIRO 350722******0001 0813*****515 02/10/2021 Sesi 3 12.00 - 14.00
1140 P-2****EBC MIFTAKUL JANAH 357302******0002 0857*****249 02/10/2021 Sesi 3 12.00 - 14.00
1141 P-3****CTA CAHAYA KARUNIA SUCI 357302******0001 0857*****829 02/10/2021 Sesi 3 12.00 - 14.00
1142 P-3****0EE HILDA A'IDATUZ ZUHRO 350724******0002 0812*****44 02/10/2021 Sesi 3 12.00 - 14.00
1143 P-3****OTX USWATUL KHASANAH 357302******0002 0838*****388 02/10/2021 Sesi 3 12.00 - 14.00
1144 P-3****PFR HENRY PURNAMA AJI 357305******0015 0896*****561 02/10/2021 Sesi 3 12.00 - 14.00
1145 P-3****6JD ALFIN NUR FAUZI 350709******0001 0858*****189 02/10/2021 Sesi 3 12.00 - 14.00
1146 P-3****A2E FRANSISKA NATALIA JUBILIANA 351513******0005 0813*****788 02/10/2021 Sesi 3 12.00 - 14.00
1147 P-3****9FZ FABIAN OMAR BATITUSTA 350723******0003 0819*****264 02/10/2021 Sesi 3 12.00 - 14.00
1148 P-3****4FM AINA ABIDIN 350723******0001 0895*****6450 02/10/2021 Sesi 3 12.00 - 14.00
1149 P-3****F4Z WANDA NURINDAHSARI KUSUMAWARDANI 327603******0006 0821*****049 02/10/2021 Sesi 3 12.00 - 14.00
1150 P-3****NGE FIKKI RAMADHAN 357304******0002 0856*****412 02/10/2021 Sesi 3 12.00 - 14.00
1151 P-3****2ED FAJAR NUR RAMADHAN WINANDI 350724******0003 0822*****780 02/10/2021 Sesi 3 12.00 - 14.00
1152 P-3****HQN TASYA FIANE WARDAH 351417******0001 0812*****405 02/10/2021 Sesi 3 12.00 - 14.00
1153 P-3****Q6C MOCH ARIE NUGROHO 147107******0021 0823*****555 02/10/2021 Sesi 3 12.00 - 14.00
1154 P-4****KPT BERNHARD LAURENSIUS TIRA 217110******9005 0822*****344 02/10/2021 Sesi 3 12.00 - 14.00
1155 P-4****E3U IGNATIUS TITO LASMADO MARBUN 320405******0002 0821*****587 02/10/2021 Sesi 3 12.00 - 14.00
1156 P-4****FUX RR. SITI PRADISASTYA NUGRANI 340412******0002 0823*****243 02/10/2021 Sesi 3 12.00 - 14.00
1157 P-4****4BG TITIN HAMIDAH 352410******0001 0856*****297 02/10/2021 Sesi 3 12.00 - 14.00
1158 P-4****JTV DESIANA 621301******0001 0819*****666 02/10/2021 Sesi 3 12.00 - 14.00
1159 P-4****V8P SYIFA MAWADDATI 350713******0003 0812*****656 02/10/2021 Sesi 3 12.00 - 14.00
1160 P-4****ETK RUSYANA NURMA VIEKA 350212******0001 0896*****907 02/10/2021 Sesi 3 12.00 - 14.00
1161 P-4****URS RAYHAN DAFFA MUZAKKI 327102******0010 0858*****551 02/10/2021 Sesi 3 12.00 - 14.00
1162 P-4****MUF RAHNITA PERDANI 520425******0001 0852*****512 02/10/2021 Sesi 3 12.00 - 14.00
1163 P-4****EWI ANNISA ANJANI PUTRI 357302******0003 0878*****095 02/10/2021 Sesi 3 12.00 - 14.00
1164 P-4****4HI NOVITA SETYO ANGGRAENI 357303******0004 0812*****225 02/10/2021 Sesi 3 12.00 - 14.00
1165 P-4****VO4 MOCHAMMAD RAMADHAN SAPUTRA 357301******0002 0895*****1313 02/10/2021 Sesi 3 12.00 - 14.00
1166 P-5****LSB AHMAD ROAAYALA RIZKY BANDHANG 647205******0001 0812*****489 02/10/2021 Sesi 3 12.00 - 14.00
1167 P-5****2EM SITI ZAENAB 350723******0002 0858*****798 02/10/2021 Sesi 3 12.00 - 14.00
1168 P-5****PIF HAGAR ALI MARZOUK 206090******0020 0878*****520 02/10/2021 Sesi 3 12.00 - 14.00
1169 P-5****N0B MUHAMMAD RAEDY RAKHMATILLAH 647402******0003 0852*****546 02/10/2021 Sesi 3 12.00 - 14.00
1170 P-5****PUD BILLY CHANDRA WIJAYA RAHMAN 321606******0015 0813*****676 02/10/2021 Sesi 3 12.00 - 14.00
1171 P-5****VT9 SYAHDAN ABDUL HARIS SIREGAR 120304******0001 0853*****065 02/10/2021 Sesi 3 12.00 - 14.00
1172 P-5****1YY AHMED HASAN ABDULLAH ABKAR 206090******0021 0822*****997 02/10/2021 Sesi 3 12.00 - 14.00
1173 P-5****DC3 MEGA DWI ANDRIANI 357305******0001 0857*****740 02/10/2021 Sesi 3 12.00 - 14.00

Page 28 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1174 P-5****Q86 KANA OCTAFIKRI MARPHY 327505******0024 0812*****508 02/10/2021 Sesi 3 12.00 - 14.00
1175 P-6****3IJ AMIRA HASNA FARIDA 357701******0002 0822*****862 02/10/2021 Sesi 3 12.00 - 14.00
1176 P-6****SD7 ANNA BRULITA TIO FANI SALELENGGU 130904******0002 0821*****327 02/10/2021 Sesi 3 12.00 - 14.00
1177 P-6****TQ0 MEINA WIDYA CHANDRA 321606******0016 0812*****434 02/10/2021 Sesi 3 12.00 - 14.00
1178 P-6****4FM DHEA AULIA SUSANTI 351508******0002 0812*****025 02/10/2021 Sesi 3 12.00 - 14.00
1179 P-6****5SA NABILA ISLAMIATI PASHA 327105******0013 0813*****056 02/10/2021 Sesi 3 12.00 - 14.00
1180 P-7****YT2 KIKO UNTORO 327511******0007 0813*****491 02/10/2021 Sesi 3 12.00 - 14.00
1181 P-7****EF9 YULIA SAFITRI 357302******0007 0856*****485 02/10/2021 Sesi 3 12.00 - 14.00
1182 P-7****76V MICHELLE SARAH YT SIHOMBING 127111******0004 0811*****23 02/10/2021 Sesi 3 12.00 - 14.00
1183 P-7****LSQ HABIB AGUM KESUMA 321606******0019 0821*****098 02/10/2021 Sesi 3 12.00 - 14.00
1184 P-8****23T MIRANDA NOVITA SARI 350729******0003 0813*****931 02/10/2021 Sesi 3 12.00 - 14.00
1185 P-8****KVW NOVRISKA SAFITRI 180902******0006 0857*****986 02/10/2021 Sesi 3 12.00 - 14.00
1186 P-8****IA2 QONITA SHALIHAT 217110******9007 0852*****521 02/10/2021 Sesi 3 12.00 - 14.00
1187 P-8****7XF VICTORIANUS WIDIYANTOKO 330905******9002 0811*****8 02/10/2021 Sesi 3 12.00 - 14.00
1188 P-9****PEE IKA RUTH NINGTIAS 350721******0005 0823*****143 02/10/2021 Sesi 3 12.00 - 14.00
1189 P-9****KRT 3573036010990001 357303******0001 0812*****796 02/10/2021 Sesi 3 12.00 - 14.00
1190 P-A****YR6 ROUDHOTUL FUAIDA 357202******0001 0852*****249 02/10/2021 Sesi 3 12.00 - 14.00
1191 P-A****YY3 HADI UTOMO 350718******0001 0855*****84 02/10/2021 Sesi 3 12.00 - 14.00
1192 P-A****2BU DIVA TANZILLA 357303******0003 0878*****234 02/10/2021 Sesi 3 12.00 - 14.00
1193 P-A****7HO GIDION PUJA ALAM 350609******0003 0838*****477 02/10/2021 Sesi 3 12.00 - 14.00
1194 P-A****8MH BAIQ YUNITA RAHMAH 520307******0005 0819*****935 02/10/2021 Sesi 3 12.00 - 14.00
1195 P-A****QZI SALSHABILLA ALIZA ADIF 350619******0003 0822*****754 02/10/2021 Sesi 3 12.00 - 14.00
1196 P-A****2RG FANNY RAHMATIA RIZAL 130404******0002 0822*****456 02/10/2021 Sesi 3 12.00 - 14.00
1197 P-A****0CO DESSY ERVINA FEBRIYANTI 350722******0002 0897*****86 02/10/2021 Sesi 3 12.00 - 14.00
1198 P-B****OHV KHASANATUL FITRIANA 350729******0002 0822*****988 02/10/2021 Sesi 3 12.00 - 14.00
1199 P-B****5B8 NIZAM ZULFANUDDIN BAHAR 320102******0013 0853*****029 02/10/2021 Sesi 3 12.00 - 14.00
1200 P-B****HOL MAYSANDRA DWI SUTYASEH 351811******0004 0855*****41 02/10/2021 Sesi 3 12.00 - 14.00
1201 P-B****3P4 MUHAMMAD EDO EDI SRIYONO 352303******0003 0813*****353 02/10/2021 Sesi 3 12.00 - 14.00
1202 P-B****RM5 NURKHASAN 351608******0002 0857*****900 02/10/2021 Sesi 3 12.00 - 14.00
1203 P-B****AOG SRIAMAH 351608******0002 0858*****5391 02/10/2021 Sesi 3 12.00 - 14.00
1204 P-B****6EY VANKA FEDIA SYAIFULLAH 327506******0007 0859*****241 02/10/2021 Sesi 3 12.00 - 14.00
1205 P-B****EIK MAHARSI DE KHALIFA 317406******0002 0812*****434 02/10/2021 Sesi 3 12.00 - 14.00
1206 P-C****R4D LISA NURDIYANTI 350723******0001 0895*****7436 02/10/2021 Sesi 3 12.00 - 14.00
1207 P-C****DHL NINA RISTASARI 350723******0001 0896*****645 02/10/2021 Sesi 3 12.00 - 14.00
1208 P-C****VEG M. RIDHO ALFARIDZI 620203******0001 0857*****287 02/10/2021 Sesi 3 12.00 - 14.00
1209 P-C****96A HERMAWAN JULIANTO 352802******0001 0855*****38 02/10/2021 Sesi 3 12.00 - 14.00
1210 P-C****1Q4 ADI PRASETYO 357301******0003 0822*****614 02/10/2021 Sesi 3 12.00 - 14.00
1211 P-C****D9Q GATOT SUSILO 357301******0008 0822*****013 02/10/2021 Sesi 3 12.00 - 14.00
1212 P-C****HD4 Sinta Ayu Pitaloka 357305******0001 0812*****008 02/10/2021 Sesi 3 12.00 - 14.00
1213 P-C****QDL VEFTY AMRILIANA 357303******0002 0899*****76 02/10/2021 Sesi 3 12.00 - 14.00
1214 P-C****ZLB BERLIANA NARINDRAWATI ARDINA 351912******0001 0856*****150 02/10/2021 Sesi 3 12.00 - 14.00
1215 P-C****GE3 ILVY KHARISMA SAWITRI 327605******0007 0858*****520 02/10/2021 Sesi 3 12.00 - 14.00

Page 29 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1216 P-C****TSQ FAUZIAH THOHIR 357302******0003 0888*****16 02/10/2021 Sesi 3 12.00 - 14.00
1217 P-C****UU7 GHULAM IKHSANUL HAKIM 352417******0001 0821*****810 02/10/2021 Sesi 3 12.00 - 14.00
1218 P-C****G8Y ISHMA MAHLIYA RUWAIDA 350716******0007 0856*****750 02/10/2021 Sesi 3 12.00 - 14.00
1219 P-C****O20 SABITA NINDYA ATHAYANA 351507******0005 0812*****889 02/10/2021 Sesi 3 12.00 - 14.00
1220 P-C****HYR SHINTA NI'MATUL FADILAH 350716******0001 0858*****599 02/10/2021 Sesi 3 12.00 - 14.00
1221 P-C****C9E RIZZA LUTFIYATUL MUFIDAH 350618******0003 0822*****159 02/10/2021 Sesi 3 12.00 - 14.00
1222 P-C****K4A ARSITA DAMAYANTI 357305******0007 0878*****516 02/10/2021 Sesi 3 12.00 - 14.00
1223 P-C****9BE MUHAMMAD ABDULLAH RAMADHAN 647403******0002 0853*****992 02/10/2021 Sesi 3 12.00 - 14.00
1224 P-C****DMT MUSZRIKA AMPRIAWANTI 350721******0001 0896*****431 02/10/2021 Sesi 3 12.00 - 14.00
1225 P-C****60B AAN FARIDATUL MUZAIDIN 350719******0005 0821*****291 02/10/2021 Sesi 3 12.00 - 14.00
1226 P-C****7WY USEP SURYANTO 350724******0001 0881*****16 02/10/2021 Sesi 3 12.00 - 14.00
1227 P-C****MVJ RETNO WERDININGSIH 357305******0003 0856*****075 02/10/2021 Sesi 3 12.00 - 14.00
1228 P-C****MQF YULI INTAN PRAMITA 351819******0002 0877*****697 02/10/2021 Sesi 3 12.00 - 14.00
1229 P-C****TDM JUWARIYAH 350707******0008 0858*****453 02/10/2021 Sesi 3 12.00 - 14.00
1230 P-D****0RK SESARINI RAHMA INDAHSARI 357901******0001 0856*****971 02/10/2021 Sesi 3 12.00 - 14.00
1231 P-D****PGX BALIGHI AMARULLAH 367404******0006 0822*****788 02/10/2021 Sesi 3 12.00 - 14.00
1232 P-D****0W3 ARI HAMZAH 351507******0003 0838*****918 02/10/2021 Sesi 3 12.00 - 14.00
1233 P-D****N1H FIRMAN 131203******0004 0812*****083 02/10/2021 Sesi 3 12.00 - 14.00
1234 P-D****N2W AMALIA SAFIRA 357303******0007 0812*****841 02/10/2021 Sesi 3 12.00 - 14.00
1235 P-D****EFE DHIAN NOVIE LESTARI 357305******0006 0812*****661 02/10/2021 Sesi 3 12.00 - 14.00
1236 P-D****EK8 SHEILA PATRICIA HAKIM 357304******0007 0812*****567 02/10/2021 Sesi 3 12.00 - 14.00
1237 P-D****NZ4 RENI PUJIASTUTIK 357303******0013 0822*****795 02/10/2021 Sesi 3 12.00 - 14.00
1238 P-D****2J0 ELLY ROSIDA 357303******0004 0819*****069 02/10/2021 Sesi 3 12.00 - 14.00
1239 P-D****7MR NAHARUDIN 350504******0001 0856*****469 02/10/2021 Sesi 3 12.00 - 14.00
1240 P-D****6CR RIAMAN 350714******0007 0856*****576 02/10/2021 Sesi 3 12.00 - 14.00
1241 P-D****KAI BAMBANG SUPRIYADI 357903******0003 0812*****83 02/10/2021 Sesi 3 12.00 - 14.00
1242 P-D****Y50 TITIK RUSITA 331218******0002 0857*****236 02/10/2021 Sesi 3 12.00 - 14.00
1243 P-D****QOX MUDRIKAH INDAYATI 357305******0002 0821*****010 02/10/2021 Sesi 3 12.00 - 14.00
1244 P-D****GA6 ARIEF SOEBI PRASETYO WARDHONO 350724******0003 0896*****777 02/10/2021 Sesi 3 12.00 - 14.00
1245 P-D****T23 RAESULLI KAUTSAR RIANDO 357303******0003 0895*****0814 02/10/2021 Sesi 3 12.00 - 14.00
1246 P-D****7PX HENDRA ARDI FIRMANSYAH 357303******0003 0857*****168 02/10/2021 Sesi 3 12.00 - 14.00
1247 P-D****1ZG JUNIAR INDAH WULANSARI 357305******0002 0812*****154 02/10/2021 Sesi 3 12.00 - 14.00
1248 P-D****Z5L R. Dhafin Naufal Razaqa 321115******0015 0822*****011 02/10/2021 Sesi 3 12.00 - 14.00
1249 P-D****40X LUKMAN HADI WIBOWO 367406******0013 0812*****687 02/10/2021 Sesi 3 12.00 - 14.00
1250 P-D****B4S WIJI ASTUTIK 350724******0009 0895*****867 02/10/2021 Sesi 3 12.00 - 14.00
1251 P-D****SG2 MICKYATUL AFIFAH 350713******0003 0856*****959 02/10/2021 Sesi 3 12.00 - 14.00
1252 P-D****ENV ADIB FIRMAN HIDAYAT 350722******0001 0813*****387 02/10/2021 Sesi 3 12.00 - 14.00
1253 P-D****D7K LISA NUR AZIZAH 350611******0001 0815*****961 02/10/2021 Sesi 3 12.00 - 14.00
1254 P-D****V9R ASHAR AULIARAHMAN 357401******0001 0896*****370 02/10/2021 Sesi 3 12.00 - 14.00
1255 P-D****P0J ADJIE SUMANTRI 150407******0002 0821*****976 02/10/2021 Sesi 3 12.00 - 14.00
1256 P-D****39W MUHAMMAD SONA 630206******0002 0813*****779 02/10/2021 Sesi 3 12.00 - 14.00
1257 P-D****BV0 SITI JUMROTIN 350723******0004 0856*****926 02/10/2021 Sesi 3 12.00 - 14.00

Page 30 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1258 P-D****F90 FIRDAUS 357903******0004 0851*****313 02/10/2021 Sesi 3 12.00 - 14.00
1259 P-D****83X KHUSNUL KHOTIMAH 357305******0005 0851*****840 02/10/2021 Sesi 3 12.00 - 14.00
1260 P-D****IZD RIZKI WAHYU AJI SATRIO PRABOWO 350804******0006 0823*****174 02/10/2021 Sesi 3 12.00 - 14.00
1261 P-D****1QM RINA WATI 357305******0002 0822*****165 02/10/2021 Sesi 3 12.00 - 14.00
1262 P-D****5C1 HASTARI NASTITI 350714******0001 0812*****963 02/10/2021 Sesi 3 12.00 - 14.00
1263 P-D****SIN WULAN ASTRINI 357305******0025 0819*****527 02/10/2021 Sesi 3 12.00 - 14.00
1264 P-D****HDE ANNISA JASMINE SJACHPUTRI 351507******0002 0821*****250 02/10/2021 Sesi 3 12.00 - 14.00
1265 P-D****BJM M HISYAMADHIM MARTYAHAPRABU 350614******0001 0852*****997 02/10/2021 Sesi 3 12.00 - 14.00
1266 P-D****SG2 NOVE LAILY DIANA 357303******0005 0812*****903 02/10/2021 Sesi 3 12.00 - 14.00
1267 P-D****HFY IRDHINA NOVY RAMADHANA 350714******0001 0858*****667 02/10/2021 Sesi 3 12.00 - 14.00
1268 P-D****CFS SUDARMADJI 357302******0001 0822*****265 02/10/2021 Sesi 3 12.00 - 14.00
1269 P-D****W76 ADITYAR PRASETYO 357302******0001 0877*****922 02/10/2021 Sesi 3 12.00 - 14.00
1270 P-D****Y6U MAULANA ARIE MARWAH 120723******0001 0819*****930 02/10/2021 Sesi 3 12.00 - 14.00
1271 P-D****G5U WAHYU DANI WORO 350403******0002 0857*****170 02/10/2021 Sesi 3 12.00 - 14.00
1272 P-D****KQJ KAYLA PRAMNESTY 357103******0001 0856*****915 02/10/2021 Sesi 3 12.00 - 14.00
1273 P-D****BKD YULIANA 357302******0002 0812*****666 02/10/2021 Sesi 3 12.00 - 14.00
1274 P-D****MCM MUHAMMAD NUR IHSAN 357502******0004 0821*****612 02/10/2021 Sesi 3 12.00 - 14.00
1275 P-D****5WT MUCH. ANANDA FIKRI ALGHUFRONI 357305******0005 0858*****098 02/10/2021 Sesi 3 12.00 - 14.00
1276 P-D****9XA AHMAD ARIF SUYUDI 357302******0001 0859*****095 02/10/2021 Sesi 3 12.00 - 14.00
1277 P-D****GT3 LUTFAN SUYUDI 357302******0003 0822*****136 02/10/2021 Sesi 3 12.00 - 14.00
1278 P-D****ACN HERI SULISTYANI 357305******0001 0812*****297 02/10/2021 Sesi 3 12.00 - 14.00
1279 P-D****0P0 TRI MARYUNI 350724******0001 0819*****863 02/10/2021 Sesi 3 12.00 - 14.00
1280 P-D****77U LILIS SULIANI 357304******0008 0815*****41 02/10/2021 Sesi 3 12.00 - 14.00
1281 P-D****AME HENDRIYAWATI 357303******0002 0813*****288 02/10/2021 Sesi 3 12.00 - 14.00
1282 P-D****6KF MOCHAMMAD ADITYA HERNANDA 357305******0001 0831*****101 02/10/2021 Sesi 3 12.00 - 14.00
1283 P-D****ETL RIDAWATI 357305******0003 0851*****591 02/10/2021 Sesi 3 12.00 - 14.00
1284 P-D****0PE LAILA HIDAYATI FAJAR HARTININGSIH 357203******0004 0823*****718 02/10/2021 Sesi 3 12.00 - 14.00
1285 P-D****WET ANIK RUKIYATI 357203******0001 0822*****707 02/10/2021 Sesi 3 12.00 - 14.00
1286 P-D****PCI PUTRI ANGGRAINI 357305******0002 0895*****4990 02/10/2021 Sesi 3 12.00 - 14.00
1287 P-D****MTG MUHAMMAD RAFIF KURNIAWAN 357303******0002 0812*****345 02/10/2021 Sesi 3 12.00 - 14.00
1288 P-D****VHN KUKUH AJI SANTOSO 350709******0001 0853*****887 02/10/2021 Sesi 3 12.00 - 14.00
1289 P-D****HZM SALMA PURNAMASARI 350813******0001 0857*****886 02/10/2021 Sesi 3 12.00 - 14.00
1290 P-D****OBT MOHAMMAD ILHAM MAULANA 350710******0004 0812*****721 02/10/2021 Sesi 3 12.00 - 14.00
1291 P-D****NEY NABILLA KURNIASARI 357304******0005 0812*****437 02/10/2021 Sesi 3 12.00 - 14.00
1292 P-D****NHK JUWITA WULANDARI 351906******0001 0857*****301 02/10/2021 Sesi 3 12.00 - 14.00
1293 P-D****408 WIWIN APRILIA 357305******0005 0813*****734 02/10/2021 Sesi 3 12.00 - 14.00
1294 P-D****69J AFIFA RACHMA 350722******0001 0851*****057 02/10/2021 Sesi 3 12.00 - 14.00
1295 P-D****YZ6 Budiarto 350716******0002 0853*****387 02/10/2021 Sesi 3 12.00 - 14.00
1296 P-D****C6Y EVA WIDARTI BUDI WARDANI 357304******0003 0857*****787 02/10/2021 Sesi 3 12.00 - 14.00
1297 P-D****T32 ROYANI LIZA HAYATI 351711******0004 0812*****315 02/10/2021 Sesi 3 12.00 - 14.00
1298 P-D****PUF RAHMAT ARIF 357304******0005 0857*****771 02/10/2021 Sesi 3 12.00 - 14.00
1299 P-D****UQH QURINA JERI SUSANTI 357304******0003 0857*****334 02/10/2021 Sesi 3 12.00 - 14.00

Page 31 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1300 P-D****56S JUSEVIN CHRISTINAH 357305******0001 0812*****960 02/10/2021 Sesi 3 12.00 - 14.00
1301 P-D****IR7 ROSI NOVITA SARI 357304******0006 0859*****333 02/10/2021 Sesi 3 12.00 - 14.00
1302 P-D****3A7 NURUL SITI RAHAYU 357304******0009 0813*****214 02/10/2021 Sesi 3 12.00 - 14.00
1303 P-D****N3U FEBRI MIZARRO'IS 350216******0001 0852*****883 02/10/2021 Sesi 3 12.00 - 14.00
1304 P-D****BGB Fahmi Idris 357305******0004 0878*****795 02/10/2021 Sesi 3 12.00 - 14.00
1305 P-D****I75 DHEO WIDYUTA TRISDAWARMA 351804******0006 0822*****395 02/10/2021 Sesi 3 12.00 - 14.00
1306 P-D****GXV PUTRI MARIETHA NICKY PRAMAYOGA 357303******0005 0858*****315 02/10/2021 Sesi 3 12.00 - 14.00
1307 P-D****OQT FAUZUR RIDHO 350910******0003 0812*****123 02/10/2021 Sesi 3 12.00 - 14.00
1308 P-D****0Z2 HAFIZ BIMANDARU KAUTSAR GHIFFARY 217107******9002 0877*****806 02/10/2021 Sesi 3 12.00 - 14.00
1309 P-D****TCO ETANIA ADISI AGUSTIN 357304******0002 0858*****806 02/10/2021 Sesi 3 12.00 - 14.00
1310 P-D****WEN WIYONO 357301******0001 0821*****222 02/10/2021 Sesi 3 12.00 - 14.00
1311 P-D****OF4 INGGITH SASMITHA SYAMPUTRI 360403******0069 0821*****202 02/10/2021 Sesi 3 12.00 - 14.00
1312 P-D****1W5 AHMAD HERLYASA SOSRO PRATAMA 352802******0002 0813*****995 02/10/2021 Sesi 3 12.00 - 14.00
1313 P-D****H30 DINI ANGGREANI 357305******0002 0815*****409 02/10/2021 Sesi 3 12.00 - 14.00
1314 P-D****GRQ PRAMITA ARIWIJAYANTI 350217******0001 0812*****332 02/10/2021 Sesi 3 12.00 - 14.00
1315 P-D****GXF MOCHAMAD FAJAR HARIYANTO 357304******0003 0813*****597 02/10/2021 Sesi 3 12.00 - 14.00
1316 P-D****QVL TURIYANTI 357305******0003 0856*****072 02/10/2021 Sesi 3 12.00 - 14.00
1317 P-D****TRX YUNI NURWATININGSIH 357301******0006 0881*****21 02/10/2021 Sesi 3 12.00 - 14.00
1318 P-D****L1Y FIRA YUNITA RIZKI SAPUTRI 357301******0002 0813*****080 02/10/2021 Sesi 3 12.00 - 14.00
1319 P-D****3W7 AHMAD FARREL WAHYU FIRDAUS 357903******0003 0838*****624 02/10/2021 Sesi 3 12.00 - 14.00
1320 P-D****YAQ NIKEN MUSTIKAWATI 357303******0003 0888*****467 02/10/2021 Sesi 3 12.00 - 14.00
1321 P-D****3DT SHINTA PARAMITA 357304******0002 0811*****10 02/10/2021 Sesi 3 12.00 - 14.00
1322 P-D****BFF ARSI ARDINI 357304******0006 0857*****696 02/10/2021 Sesi 3 12.00 - 14.00
1323 P-D****2JP MAHDIYAFI RAHARDICAHYA 357305******0005 0812*****029 02/10/2021 Sesi 3 12.00 - 14.00
1324 P-D****FJ9 HELMI SUSANTI 357305******0002 0813*****101 02/10/2021 Sesi 3 12.00 - 14.00
1325 P-D****5V8 SHAFIRA RAHMAZHAHIRA 357305******0002 0831*****100 02/10/2021 Sesi 3 12.00 - 14.00
1326 P-D****GSH MASYITA LIONIRAHMADA 357305******0004 0852*****820 02/10/2021 Sesi 3 12.00 - 14.00
1327 P-D****KZ4 RIZKI AMALIA 350710******0009 0823*****344 02/10/2021 Sesi 3 12.00 - 14.00
1328 P-D****Q2A IDA FITRI YULIATI 357305******1002 0856*****506 02/10/2021 Sesi 3 12.00 - 14.00
1329 P-D****HRI WAHYU RAKHMADANI 357305******0006 0813*****080 02/10/2021 Sesi 3 12.00 - 14.00
1330 P-D****OKE DEVA JATUNARITA 357302******0001 0819*****282 02/10/2021 Sesi 3 12.00 - 14.00
1331 P-D****Y0L AHMAD YUNUS ALDINO 350622******0001 0819*****794 02/10/2021 Sesi 3 12.00 - 14.00
1332 P-D****FDP FITRI WULAN SUCI 350713******0006 0821*****658 02/10/2021 Sesi 3 12.00 - 14.00
1333 P-D****PKQ MUTIARA SOVIA H 357302******0001 0812*****997 02/10/2021 Sesi 3 12.00 - 14.00
1334 P-D****3Y8 ENDAH SUSILOWATI 350713******0003 0822*****780 02/10/2021 Sesi 3 12.00 - 14.00
1335 P-D****55H BANGGA PAMUNGKAS 357304******0007 0881*****80 02/10/2021 Sesi 3 12.00 - 14.00
1336 P-D****P34 MUAZ 357304******0004 0822*****014 02/10/2021 Sesi 3 12.00 - 14.00
1337 P-D****VZV VELLA ANHAR DININGRUM 352215******0002 0822*****686 02/10/2021 Sesi 3 12.00 - 14.00
1338 P-E****KSA PUJI PENY SETYANING RAHAYU 357305******0007 0812*****765 02/10/2021 Sesi 3 12.00 - 14.00
1339 P-E****ITQ AISYAH LARASATI 357305******0004 0857*****341 02/10/2021 Sesi 3 12.00 - 14.00
1340 P-E****RMW DALLA DIROSA 357305******0004 0812*****375 02/10/2021 Sesi 3 12.00 - 14.00
1341 P-E****IIZ ANDINI KURNIA AGUSTIN 357304******0005 0812*****107 02/10/2021 Sesi 3 12.00 - 14.00

Page 32 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1342 P-E****SSM AGUNG BASUKI 357301******0007 0856*****89 02/10/2021 Sesi 3 12.00 - 14.00
1343 P-E****IA6 BAIQ TRI UTAMI SAFITRI 620102******0004 0823*****428 02/10/2021 Sesi 3 12.00 - 14.00
1344 P-E****1GD ENDANG MURDANINGSIH 350725******0003 0823*****820 02/10/2021 Sesi 3 12.00 - 14.00
1345 P-E****32L NAFISAH AMALIYAH 350720******0002 0858*****460 02/10/2021 Sesi 3 12.00 - 14.00
1346 P-E****ZRH ALIF BAGAS SATRYA PAMBUDI 730608******0004 0812*****545 02/10/2021 Sesi 3 12.00 - 14.00
1347 P-E****TWC RISKA WIDYANTI 351301******0001 0813*****555 02/10/2021 Sesi 3 12.00 - 14.00
1348 P-E****JEH ACHMAD NAFIK MUBAROK 350720******0002 0858*****175 02/10/2021 Sesi 3 12.00 - 14.00
1349 P-E****05Q SUNNY THIFLIANTIN 357301******0003 0812*****891 02/10/2021 Sesi 3 12.00 - 14.00
1350 P-E****CBB EKO PURWANTO 332812******0009 0822*****867 02/10/2021 Sesi 3 12.00 - 14.00
1351 P-E****M9Z DIYANA RAHMI A.Md 350724******0001 0821*****622 02/10/2021 Sesi 3 12.00 - 14.00
1352 P-E****DI4 NURUL KHOTIMAH 357301******0004 0856*****89 02/10/2021 Sesi 3 12.00 - 14.00
1353 P-E****333 RATI PUSPITA 520603******0002 0813*****756 02/10/2021 Sesi 3 12.00 - 14.00
1354 P-E****KBQ WIGIARTI 337603******0002 0823*****466 02/10/2021 Sesi 3 12.00 - 14.00
1355 P-E****EDU Ambar Wati 357304******0001 0813*****055 02/10/2021 Sesi 3 12.00 - 14.00
1356 P-E****0PR IMAM SUPRIADI 357301******0004 0813*****564 02/10/2021 Sesi 3 12.00 - 14.00
1357 P-E****9B5 SULU BASTHIYAN ZAMARA 357301******0010 0822*****004 02/10/2021 Sesi 3 12.00 - 14.00
1358 P-E****LIA FACHRINA SALMA DINI 350721******0001 0815*****821 02/10/2021 Sesi 3 12.00 - 14.00
1359 P-E****INS IKA APRILIA 350110******0004 0813*****462 02/10/2021 Sesi 3 12.00 - 14.00
1360 P-E****Q59 ANANDA PRATAMA PUTRA 351004******0004 0822*****450 02/10/2021 Sesi 3 12.00 - 14.00
1361 P-E****DHX Tumini 350730******0041 0812*****221 02/10/2021 Sesi 3 12.00 - 14.00
1362 P-E****XBF Nurul Kusumawardani 760505******0001 0813*****488 02/10/2021 Sesi 3 12.00 - 14.00
1363 P-E****Q6W Aqil Gama r 350723******0002 0831*****234 02/10/2021 Sesi 3 12.00 - 14.00
1364 P-E****FMT JUWITA NUR INDAH SARI 357301******0005 0856*****114 02/10/2021 Sesi 3 12.00 - 14.00
1365 P-E****A9R FERNI MUSTIKA JUMRAH 357305******0002 0812*****170 02/10/2021 Sesi 3 12.00 - 14.00
1366 P-E****ODG Rani Luthfiah Khoirunnisa 357903******0005 0878*****745 02/10/2021 Sesi 3 12.00 - 14.00
1367 P-E****B2T IMROATUS ZULFA 350722******0001 0896*****844 02/10/2021 Sesi 3 12.00 - 14.00
1368 P-E****XHS MUHAMMAD HAFIZH RIZQI 357302******0003 0895*****372 02/10/2021 Sesi 3 12.00 - 14.00
1369 P-E****HCP ANITA YUNA 357302******0005 0813*****487 02/10/2021 Sesi 3 12.00 - 14.00
1370 P-E****VFH SEVEN FATHURROHMAN HIDAYAT 357305******0007 0813*****713 02/10/2021 Sesi 3 12.00 - 14.00
1371 P-E****EN9 MACHFUD AFFANDY 357304******0005 0856*****007 02/10/2021 Sesi 3 12.00 - 14.00
1372 P-E****VZ0 ASNAHWIATUL LAILI 350908******0001 0856*****690 02/10/2021 Sesi 3 12.00 - 14.00
1373 P-E****OBL DHEFYNSA ALIFIA FAJRIAN 357301******0004 0812*****404 02/10/2021 Sesi 3 12.00 - 14.00
1374 P-E****HPM ISTIQOMAH 350716******0004 0856*****178 02/10/2021 Sesi 3 12.00 - 14.00
1375 P-E****3RI BELINDA CHRISTINA 357304******0005 0821*****826 02/10/2021 Sesi 3 12.00 - 14.00
1376 P-E****NFJ NADYA YASMIN S 350725******0003 0896*****307 02/10/2021 Sesi 3 12.00 - 14.00
1377 P-E****25G MUHAMMAD LUQMAN HERMANTO 351108******0001 0895*****2083 02/10/2021 Sesi 3 12.00 - 14.00
1378 P-E****G1Q GALIH ADITYA WICAKSONO 357302******0002 0812*****5910 02/10/2021 Sesi 3 12.00 - 14.00
1379 P-E****FVB NURUL KHOTIMAH 357305******0002 0857*****015 02/10/2021 Sesi 3 12.00 - 14.00
1380 P-E****52T WINONA APRILIASTE 340215******0001 0813*****699 02/10/2021 Sesi 3 12.00 - 14.00
1381 P-E****O85 ARISTA GENOVA KAIMUDDIN 357302******0004 0896*****205 02/10/2021 Sesi 3 12.00 - 14.00
1382 P-E****C6Y EVRIS HIKMAT IMMANUEL SILITONGA 351212******0001 0821*****628 02/10/2021 Sesi 3 12.00 - 14.00
1383 P-E****I1I PUTRI DEWI GANDHAWATI 357903******0001 0821*****404 02/10/2021 Sesi 3 12.00 - 14.00

Page 33 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1384 P-E****MD6 JOHAN SUBIANTORO 357304******0006 0852*****778 02/10/2021 Sesi 3 12.00 - 14.00
1385 P-E****SKK PRIOMAS YULIONO 357301******0002 0881*****46 02/10/2021 Sesi 3 12.00 - 14.00
1386 P-E****6XR RISKI AMALIA 350707******0005 0813*****936 02/10/2021 Sesi 3 12.00 - 14.00
1387 P-E****WUH ACHMAD DJUNAEDI 357303******0003 0838*****087 02/10/2021 Sesi 3 12.00 - 14.00
1388 P-E****ASF FITROTUL AULA 350717******0002 0823*****414 02/10/2021 Sesi 3 12.00 - 14.00
1389 P-E****9DM AZAM BAHTIAR 350719******0001 0812*****68 02/10/2021 Sesi 3 12.00 - 14.00
1390 P-E****8YA Anik Rachmawati 357304******0004 0852*****818 02/10/2021 Sesi 3 12.00 - 14.00
1391 P-E****MXL SHAFIRA NADYA PUTRI 357304******0007 0812*****681 02/10/2021 Sesi 3 12.00 - 14.00
1392 P-E****0QR ASWADI ODO 140909******0001 0823*****504 02/10/2021 Sesi 3 12.00 - 14.00
1393 P-E****TQE SUNARTO 327402******0006 0831*****75 02/10/2021 Sesi 3 12.00 - 14.00
1394 P-E****QRC RENDY MAULA HABIBINSYAH 350723******0002 0822*****656 02/10/2021 Sesi 3 12.00 - 14.00
1395 P-E****BBZ DARWATI 350719******0002 0823*****795 02/10/2021 Sesi 3 12.00 - 14.00
1396 P-E****HC3 SAMSUL ARIFIN 357304******0006 0878*****000 02/10/2021 Sesi 3 12.00 - 14.00
1397 P-E****XUP ABRILIAN MAULIDHIA 350709******0001 0819*****982 02/10/2021 Sesi 3 12.00 - 14.00
1398 P-E****VJ5 SIRAPEGI OCKHTACIA WINURAI LATIP DUWIRI 917103******0003 0812*****797 02/10/2021 Sesi 3 12.00 - 14.00
1399 P-E****APC LINUPLIK RANTAUWATI 350724******0008 0812*****20 02/10/2021 Sesi 3 12.00 - 14.00
1400 P-E****5AH YESSICA DEVINA 357305******0002 0821*****922 02/10/2021 Sesi 3 12.00 - 14.00
1401 P-E****33R HENDRIK NUR CAHYANI 350406******0001 0857*****733 02/10/2021 Sesi 3 12.00 - 14.00
1402 P-E****583 ADINDA AMALIA NUR RAMADHANI 737111******0002 0822*****801 02/10/2021 Sesi 3 12.00 - 14.00
1403 P-E****ZLN FAIZAL AKBAR ARAUF FANNO 357302******0006 0812*****576 02/10/2021 Sesi 3 12.00 - 14.00
1404 P-E****W7U SYAHDIFA AISYAH QURRATA AYUN 357305******0003 0859*****259 02/10/2021 Sesi 3 12.00 - 14.00
1405 P-E****JB6 M DIVAN ABIASA HARI YUDI 637103******0016 0811*****19 02/10/2021 Sesi 3 12.00 - 14.00
1406 P-E****V3F YULI RETNO ANDAYANI 357903******0001 0813*****653 02/10/2021 Sesi 3 12.00 - 14.00
1407 P-F****EUX REFRI RIFWAN DAHARMI 327501******0018 0822*****989 02/10/2021 Sesi 3 12.00 - 14.00
1408 P-F****A86 GUNAWAN SATRIYO DWIATMOJO 350806******0002 0822*****809 02/10/2021 Sesi 3 12.00 - 14.00
1409 P-F****FF4 DYAH AYU HARIANI 351806******0002 0812*****953 02/10/2021 Sesi 3 12.00 - 14.00
1410 P-F****74Q LISMAR HANUM 130805******0002 0852*****667 02/10/2021 Sesi 3 12.00 - 14.00
1411 P-F****AEJ SRI WAHYUNING HASANAH 351708******0005 0858*****407 02/10/2021 Sesi 3 12.00 - 14.00
1412 P-F****WJY DONI MEILIYADI 137702******0003 0823*****749 02/10/2021 Sesi 3 12.00 - 14.00
1413 P-F****Y1T HUSNIA ROHMI NURAFIFAH SINDU ARYAN 331212******0000 0822*****970 02/10/2021 Sesi 3 12.00 - 14.00
1414 P-F****RUH HAFIZ BINTANG PAMUNGKAS 187102******0002 0821*****411 02/10/2021 Sesi 3 12.00 - 14.00
1415 P-F****IV0 AURELLIO BAGUS ISKANDAR PUTRA 350723******0001 0896*****312 02/10/2021 Sesi 3 12.00 - 14.00
1416 P-F****93D ALIF PUTRA ROY 357303******0010 0895*****4148 02/10/2021 Sesi 3 12.00 - 14.00
1417 P-F****NOV Siti Zabriatul Isro 357303******0004 0822*****211 02/10/2021 Sesi 3 12.00 - 14.00
1418 P-F****LIV ELIN SHELINDA MUHRIZAF 740606******0001 0822*****668 02/10/2021 Sesi 3 12.00 - 14.00
1419 P-F****JW9 JAINUL ARIFIN 357305******0003 0823*****766 02/10/2021 Sesi 3 12.00 - 14.00
1420 P-F****A2Y IVA DEWI LESTARININGSIH 350722******0002 0812*****628 02/10/2021 Sesi 3 12.00 - 14.00
1421 P-F****LNS YUSI PRASASTI 350724******0001 0813*****010 02/10/2021 Sesi 3 12.00 - 14.00
1422 P-F****KM3 DIKY PRAYOGA 350724******0001 0859*****235 02/10/2021 Sesi 3 12.00 - 14.00
1423 P-F****TFW WARTINI 357305******0006 0812*****99 02/10/2021 Sesi 3 12.00 - 14.00
1424 P-F****5D7 KHUSNUL KHOTIMAH 350703******0003 0858*****511 02/10/2021 Sesi 3 12.00 - 14.00
1425 P-F****61K MARIA HELENA AJENG PURWANTI 357301******0005 0895*****030 02/10/2021 Sesi 3 12.00 - 14.00

Page 34 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1426 P-F****BZ4 DELLAR ARCIANTIKA CAHYANI 352215******0003 0822*****806 02/10/2021 Sesi 3 12.00 - 14.00
1427 P-F****GSH NAILUS DYAH TAMARA PUTRI 331901******0004 0896*****771 02/10/2021 Sesi 3 12.00 - 14.00
1428 P-F****EYB IMAM SUHADI 357302******0004 0857*****249 02/10/2021 Sesi 3 12.00 - 14.00
1429 P-F****ANU SARI 332306******0015 0813*****044 02/10/2021 Sesi 3 12.00 - 14.00
1430 P-F****4DH DAMIASIH 351022******0013 0821*****660 02/10/2021 Sesi 3 12.00 - 14.00
1431 P-F****9BG TUBAGUS AQSHAL NURFILAILAN 367207******0002 0812*****812 02/10/2021 Sesi 3 12.00 - 14.00
1432 P-F****3JF JULIAN DWI HADI WIANTO 357304******0007 0897*****52 02/10/2021 Sesi 3 12.00 - 14.00
1433 P-F****JOE RENI DWI BUDI ASTUTI 352503******0004 0859*****425 02/10/2021 Sesi 3 12.00 - 14.00
1434 P-F****GQT SUGENG SUNTOYO 357304******0008 0877*****120 02/10/2021 Sesi 3 12.00 - 14.00
1435 P-F****4VM ALFIAN HUSNA LAILUROHIM 357304******0003 0857*****632 02/10/2021 Sesi 3 12.00 - 14.00
1436 P-F****HW7 SUPRAPTI 357903******0001 0821*****965 02/10/2021 Sesi 3 12.00 - 14.00
1437 P-F****MOM HERLINA NUR CAHYANI 357903******0003 0813*****571 02/10/2021 Sesi 3 12.00 - 14.00
1438 P-F****GZJ DWI SUJATMIKO 352223******0007 0813*****972 02/10/2021 Sesi 3 12.00 - 14.00
1439 P-F****0EO MAULUDI ABDUL RACHMAN 350724******0004 0812*****446 02/10/2021 Sesi 3 12.00 - 14.00
1440 P-F****JN7 NUR HOLIS SYAMSUL A 351213******0003 0822*****824 02/10/2021 Sesi 3 12.00 - 14.00
1441 P-F****GN9 JAWADI AHMAD WILDANNANTHA 737110******0010 0851*****522 02/10/2021 Sesi 3 12.00 - 14.00
1442 P-F****9CQ ANASTASYA NUZULA KHOIRINA 737110******0002 0838*****372 02/10/2021 Sesi 3 12.00 - 14.00
1443 P-F****5JK NELLY IVA 357903******0001 0822*****650 02/10/2021 Sesi 3 12.00 - 14.00
1444 P-F****RD3 CHANETTA NAILA PRAYOGO 357903******0002 0857*****647 02/10/2021 Sesi 3 12.00 - 14.00
1445 P-F****ATN KHOIRINA 737110******0002 0878*****097 02/10/2021 Sesi 3 12.00 - 14.00
1446 P-F****PQF MARIANA LAURINA SIAHAAN 357304******0005 0822*****795 02/10/2021 Sesi 3 12.00 - 14.00
1447 P-F****Z7T CHRISMAN BENYAMIN SIMANJUNTAK 357304******0004 0819*****938 02/10/2021 Sesi 3 12.00 - 14.00
1448 P-F****EAN ABDUL RANI 357304******0002 0812*****60 02/10/2021 Sesi 3 12.00 - 14.00
1449 P-I****UNO ULINNUHA LAILANUR MAWARNI 357301******0003 0819*****220 02/10/2021 Sesi 3 12.00 - 14.00
1450 P-I****DPE BUDI DARMAWAN 357305******0010 0857*****473 02/10/2021 Sesi 3 12.00 - 14.00
1451 P-J****RWU DIMAS ADIFIRA 350723******0002 0896*****345 02/10/2021 Sesi 3 12.00 - 14.00
1452 P-N****M1R ANASTASYA RENATA AMALIA 737109******0008 0812*****139 02/10/2021 Sesi 3 12.00 - 14.00
1453 P-N****V87 WAHYUNINGTYAS WURI A. 357305******0003 0813*****105 02/10/2021 Sesi 3 12.00 - 14.00
1454 P-X****PUN SEPTI NINGRUM DIAH LARASATI 350624******0001 0852*****777 02/10/2021 Sesi 3 12.00 - 14.00
1455 Q-2****709 MARTA PAULINA RAJAGUKGUK 317507******1002 0857*****889 02/10/2021 Sesi 3 12.00 - 14.00
1456 S-0****E47 LIZA AGNESTA KRISNA 117403******0004 0852*****095 02/10/2021 Sesi 3 12.00 - 14.00
1457 S-0****0F6 Yasnovia Imansyah 357303******0003 0853*****923 02/10/2021 Sesi 3 12.00 - 14.00
1458 S-0****A71 SRI BALISANTI SANTOSO 357305******0001 0817*****1 02/10/2021 Sesi 3 12.00 - 14.00
1459 S-1****F50 GOERID HARDJITO 357305******0002 0852*****569 02/10/2021 Sesi 3 12.00 - 14.00
1460 S-1****1F7 BAMBANG PARIANOM 357902******0001 0813*****901 02/10/2021 Sesi 3 12.00 - 14.00
1461 S-2****DCA MOCH SASMITO DJATI 350724******0002 0812*****307 02/10/2021 Sesi 3 12.00 - 14.00
1462 S-2****D05 Rahmad Wahyudi Slamet 350715******0002 0822*****567 02/10/2021 Sesi 3 12.00 - 14.00
1463 S-2****97A FEBRINA RAHADIANTI RATNAFURI 351506******0001 0813*****957 02/10/2021 Sesi 3 12.00 - 14.00
1464 S-2****18C BAGUS SUPRAJOGO SE 357305******0001 0823*****253 02/10/2021 Sesi 3 12.00 - 14.00
1465 S-3****FE9 SUDARMI 350718******0001 0852*****050 02/10/2021 Sesi 3 12.00 - 14.00
1466 S-3****3F9 TOMIRIN 357302******0002 0838*****731 02/10/2021 Sesi 3 12.00 - 14.00
1467 S-4****27D RACHMAT SOEGIARTO REKSODIHARDJO 357305******0001 0817*****1 02/10/2021 Sesi 3 12.00 - 14.00

Page 35 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1468 S-5****FE3 Ahmad Fathoni 357303******0011 0822*****409 02/10/2021 Sesi 3 12.00 - 14.00
1469 S-6****4F9 RUSMIATI 637103******0003 0853*****887 02/10/2021 Sesi 3 12.00 - 14.00
1470 S-6****E4F DJOAN DANO ANAS 820408******0002 0813*****910 02/10/2021 Sesi 3 12.00 - 14.00
1471 S-6****FB4 KUSMIATI 350217******0001 0823*****795 02/10/2021 Sesi 3 12.00 - 14.00
1472 S-7****A40 LILIK INAYATI 357305******0031 0821*****462 02/10/2021 Sesi 3 12.00 - 14.00
1473 S-7****496 ANISA FADILAH 357304******0016 0812*****28 02/10/2021 Sesi 3 12.00 - 14.00
1474 S-7****AF2 SHOLEH HADI PRAMONO 350722******0002 0812*****234 02/10/2021 Sesi 3 12.00 - 14.00
1475 S-9****8F1 Eka Prasetya 357302******0003 0812*****909 02/10/2021 Sesi 3 12.00 - 14.00
1476 S-9****9EB Aditya Bhanu Manggara 340401******0003 0813*****866 02/10/2021 Sesi 3 12.00 - 14.00
1477 S-A****BC2 Janu Akbar 331404******0002 0821*****527 02/10/2021 Sesi 3 12.00 - 14.00
1478 S-A****0E3 MULYONO 357303******0003 0853*****151 02/10/2021 Sesi 3 12.00 - 14.00
1479 S-B****7CB ETTY HERITIASTUTI 357903******0001 0822*****807 02/10/2021 Sesi 3 12.00 - 14.00
1480 S-B****A8C INDHAR WAHYU WIRA HARJO 357305******0004 0818*****799 02/10/2021 Sesi 3 12.00 - 14.00
1481 S-B****52D RADEN RORO ENDANG RATNANINGSIH 357303******0003 0851*****757 02/10/2021 Sesi 3 12.00 - 14.00
1482 S-B****A57 SUGENG SUSILO ADI 351816******0001 0812*****838 02/10/2021 Sesi 3 12.00 - 14.00
1483 S-B****9BE BINTI MAQSUDAH 350722******0001 0813*****922 02/10/2021 Sesi 3 12.00 - 14.00
1484 S-B****C23 MARTUTIK 357304******0002 0813*****287 02/10/2021 Sesi 3 12.00 - 14.00
1485 S-C****9D1 FADH AHMAD ARIFAN 357303******0001 0853*****043 02/10/2021 Sesi 3 12.00 - 14.00
1486 S-C****0B8 SUHARTONO 357903******0001 0851*****706 02/10/2021 Sesi 3 12.00 - 14.00
1487 S-D****4D0 SRIWANTI 357303******0001 0822*****650 02/10/2021 Sesi 3 12.00 - 14.00
1488 S-F****D1C Firmansyah 167106******0009 0821*****476 02/10/2021 Sesi 3 12.00 - 14.00
1489 W-9****C67 PATRICIA ERWINI EASTER PUSUNG 717109******0001 0895*****7122 02/10/2021 Sesi 3 12.00 - 14.00
1490 Y-0****FL0 AGUSTINA MARTATI 357305******0002 0859*****713 02/10/2021 Sesi 3 12.00 - 14.00
1491 Y-0****15D ANTON SASTRA WIRYAWAN 357305******0001 0812*****659 02/10/2021 Sesi 3 12.00 - 14.00
1492 Y-0****WOO MOCHAMMAD SOLEH 357303******0010 0851*****525 02/10/2021 Sesi 3 12.00 - 14.00
1493 Y-0****HQC MOCH RICO AL AKBAR 357303******0007 0813*****028 02/10/2021 Sesi 3 12.00 - 14.00
1494 Y-0****WOL AYUB BACHTIAR 357304******0005 0838*****982 02/10/2021 Sesi 3 12.00 - 14.00
1495 Y-0****PI6 Bagas Widyatmaka SPd 350211******0001 0813*****663 02/10/2021 Sesi 3 12.00 - 14.00
1496 Y-0****YMH AQSHAL RADINA PRADEWO 640804******0007 0821*****927 02/10/2021 Sesi 3 12.00 - 14.00
1497 Y-0****4O7 AULYA NURULITA 317404******0003 0877*****709 02/10/2021 Sesi 3 12.00 - 14.00
1498 Y-0****OD1 LIDYA ZEFANYA 317410******1003 0896*****271 02/10/2021 Sesi 3 12.00 - 14.00
1499 Y-0****57Y MUHAMMAD RAFI FACHMI 317301******1005 0812*****587 02/10/2021 Sesi 3 12.00 - 14.00
1500 Y-0****E66 ANDREA FELITA WIRYAWAN 317301******0015 0856*****881 02/10/2021 Sesi 3 12.00 - 14.00
1501 Y-0****8QE RAGIL FAHREZI 317507******1002 0812*****086 02/10/2021 Sesi 3 12.00 - 14.00
1502 Y-0****2RG MUHAMMAD RAFII FADHLURRAHMAN 317406******0002 0857*****850 02/10/2021 Sesi 3 12.00 - 14.00
1503 Y-0****6BE AHMAD SYADDAD KAMAL 317507******1002 0856*****58 02/10/2021 Sesi 3 12.00 - 14.00
1504 Y-0****NFS REZA FATHUR RAHMAN 317406******0003 0813*****019 02/10/2021 Sesi 3 12.00 - 14.00
1505 Y-0****JKC YOLANDA TIOVANI 317506******0006 0899*****78 02/10/2021 Sesi 3 12.00 - 14.00
1506 Y-0****KHW NURUL AULIA 317103******0001 0851*****640 02/10/2021 Sesi 3 12.00 - 14.00
1507 Y-0****RA1 VIVIAN ARDINE SAPUTRI 317502******0001 0896*****751 02/10/2021 Sesi 3 12.00 - 14.00
1508 Y-0****TTR HILMAN SYIHAN GHIFARI 317106******0002 0878*****465 02/10/2021 Sesi 3 12.00 - 14.00
1509 Y-0****UV9 MOCHAMAD NEZAR GRIBALDY 317408******0003 0851*****466 02/10/2021 Sesi 3 12.00 - 14.00

Page 36 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1510 Y-0****GEH BELLA BELINDA PUTRI 317401******1001 0812*****947 02/10/2021 Sesi 3 12.00 - 14.00
1511 Y-0****R8T ERBA FEBRIANSYAH 317509******0005 0878*****643 02/10/2021 Sesi 3 12.00 - 14.00
1512 Y-0****I6I RIZQI DWI ASSHIFA 317410******0006 0821*****708 02/10/2021 Sesi 3 12.00 - 14.00
1513 Y-0****A7M ADI ARIF FATONI 317509******0007 0858*****315 02/10/2021 Sesi 3 12.00 - 14.00
1514 Y-0****W1A RIDHO FEBRIAN 317506******1001 0812*****050 02/10/2021 Sesi 3 12.00 - 14.00
1515 Y-0****I5E MTAUFIK RRAMADHAN NASUTION 317107******0001 0812*****556 02/10/2021 Sesi 3 12.00 - 14.00
1516 Y-0****3TK BIMANSYAH SAKTIAJI RAMADHAN 317401******1001 0813*****291 02/10/2021 Sesi 3 12.00 - 14.00
1517 Y-0****4PH SITI NILAM SARI 317107******0003 0851*****115 02/10/2021 Sesi 3 12.00 - 14.00
1518 Y-0****45B PATRICK JORE IDOTA GINTING 320102******0011 0818*****022 02/10/2021 Sesi 3 12.00 - 14.00
1519 Y-0****GH7 IMAM GOZALI 357301******0005 0896*****702 02/10/2021 Sesi 3 12.00 - 14.00
1520 Z-A****D4F Kadek Putra Sanjaya 510305******0006 0857*****996 02/10/2021 Sesi 3 12.00 - 14.00
1521 J-0****2WC MUHAMMAD ALFAN NURUDDIN 357901******0001 0877*****002 03/10/2021 Sesi 1 08.00 - 10.00
1522 J-0****78Q LUTHFI WAJAR ANANDA 647302******0009 0822*****095 03/10/2021 Sesi 1 08.00 - 10.00
1523 J-0****AO5 HIDAYAT HARIAWAN 357304******0008 0882*****120 03/10/2021 Sesi 1 08.00 - 10.00
1524 J-0****F8D WIDIA PUTRI BR GINTING 120607******0001 0812*****020 03/10/2021 Sesi 1 08.00 - 10.00
1525 J-0****G94 ALDO DWI KRISTIAN 350617******0001 0851*****734 03/10/2021 Sesi 1 08.00 - 10.00
1526 J-0****OKT RAHMAT EFENDI 367205******0001 0818*****120 03/10/2021 Sesi 1 08.00 - 10.00
1527 J-0****0FQ ARISTAWIDYA PARAMITHA 350721******0002 0857*****460 03/10/2021 Sesi 1 08.00 - 10.00
1528 J-0****HSH INDAH NUR CHOMSY 357304******0002 0812*****004 03/10/2021 Sesi 1 08.00 - 10.00
1529 J-0****TYI DEDEN AGUS SAPUTRA 350722******0001 0822*****182 03/10/2021 Sesi 1 08.00 - 10.00
1530 J-0****Z1D ANDI AZZAH AQILAH MAPPATABE 730608******0002 0853*****145 03/10/2021 Sesi 1 08.00 - 10.00
1531 J-0****JEY AYU ANNISA FEBRYANA 357303******0010 0895*****855 03/10/2021 Sesi 1 08.00 - 10.00
1532 J-0****JN8 ACHMAD FIRLY ARDIANSYAH 351508******0001 0878*****338 03/10/2021 Sesi 1 08.00 - 10.00
1533 J-0****TH9 RANDIE RABSANJANI 640805******0001 0822*****290 03/10/2021 Sesi 1 08.00 - 10.00
1534 J-0****CIB ALWAN NAZIEH 321606******0032 0857*****001 03/10/2021 Sesi 1 08.00 - 10.00
1535 J-0****PUF ALI AKBAR 352901******0001 0877*****509 03/10/2021 Sesi 1 08.00 - 10.00
1536 J-0****U5V ILHAM HADI SUSETIYO 357305******0002 0858*****406 03/10/2021 Sesi 1 08.00 - 10.00
1537 J-0****YLU YOBI ADITIAS 181002******0003 0895*****3750 03/10/2021 Sesi 1 08.00 - 10.00
1538 J-0****ZW4 RINA INDRA DHINI 320101******0007 0896*****291 03/10/2021 Sesi 1 08.00 - 10.00
1539 J-0****QDQ ADAM RAIHAN NAVANTO 357303******0007 0812*****100 03/10/2021 Sesi 1 08.00 - 10.00
1540 J-0****VLO DIANA ARDILLAH 351408******0004 0823*****612 03/10/2021 Sesi 1 08.00 - 10.00
1541 J-0****W0W MULYANI 351408******0005 0858*****350 03/10/2021 Sesi 1 08.00 - 10.00
1542 J-0****JXL HAFFA SYAFANA NURSUHAIDA 517103******0003 0898*****13 03/10/2021 Sesi 1 08.00 - 10.00
1543 J-0****D57 YASINTA ALMAYSURI 357901******0002 0822*****023 03/10/2021 Sesi 1 08.00 - 10.00
1544 J-0****PDL IMADA IRAWAN 350724******0001 0877*****457 03/10/2021 Sesi 1 08.00 - 10.00
1545 J-0****DYG HANDIKA LINTANG SAPUTRA 330714******0003 0822*****949 03/10/2021 Sesi 1 08.00 - 10.00
1546 J-0****HE0 TALITHA NABILAH BALQIS 350723******0001 0812*****429 03/10/2021 Sesi 1 08.00 - 10.00
1547 J-0****OKM WAHYU EZKI APRIADI 520301******0005 0823*****735 03/10/2021 Sesi 1 08.00 - 10.00
1548 J-0****V65 ILHAMI MAULIA FATRA 180722******0001 0822*****097 03/10/2021 Sesi 1 08.00 - 10.00
1549 J-0****XG2 BAGUS CAHYO NUGROHO 350724******0002 0812*****263 03/10/2021 Sesi 1 08.00 - 10.00
1550 J-0****FS6 ZIDA BAROKATUL HIKMAH 350723******0001 0822*****327 03/10/2021 Sesi 1 08.00 - 10.00
1551 J-0****SLI FANDHY EKA WAHYONO 357305******0001 0821*****022 03/10/2021 Sesi 1 08.00 - 10.00

Page 37 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1552 J-0****ZAC WISNU RAHMAWAN 350411******0001 0852*****384 03/10/2021 Sesi 1 08.00 - 10.00
1553 J-0****60C HAFIZH MAULANA 321401******0002 0881*****66 03/10/2021 Sesi 1 08.00 - 10.00
1554 J-0****L4Z MUHAMMAD RIZAL NUR ISKANDAR 350216******0003 0855*****055 03/10/2021 Sesi 1 08.00 - 10.00
1555 J-0****H43 ARGO IMAN TRISTIANTORO 350416******0001 0815*****824 03/10/2021 Sesi 1 08.00 - 10.00
1556 J-0****5DB GITA WIDYA PALUPI 357303******0003 0812*****844 03/10/2021 Sesi 1 08.00 - 10.00
1557 J-0****L90 DHIBA ESPERANZA 340406******0008 0821*****951 03/10/2021 Sesi 1 08.00 - 10.00
1558 J-0****GVK SUCI RAMADHANI 140705******0005 0859*****8387 03/10/2021 Sesi 1 08.00 - 10.00
1559 J-0****LGF JUNITA SIJABAT 127601******0001 0813*****273 03/10/2021 Sesi 1 08.00 - 10.00
1560 J-0****297 AINUN MASRURIYAH 351720******0001 0852*****030 03/10/2021 Sesi 1 08.00 - 10.00
1561 J-0****DF1 DIMAS RYANSYACH BAGASKARA 320102******0006 0821*****935 03/10/2021 Sesi 1 08.00 - 10.00
1562 J-0****OA7 NADA RAMADHANIA HERDANI 351516******0006 0822*****806 03/10/2021 Sesi 1 08.00 - 10.00
1563 J-0****SAI NI PUTU VIDYA PRIMARISTA 510105******0005 0821*****183 03/10/2021 Sesi 1 08.00 - 10.00
1564 J-0****T2D DIVA MARINGGA RAMADHANY 351606******0001 0812*****615 03/10/2021 Sesi 1 08.00 - 10.00
1565 J-0****TJR DEVITA MARINGGA RACHMAWATY 351606******0002 0856*****945 03/10/2021 Sesi 1 08.00 - 10.00
1566 J-0****UPA AHKMAD DZULKARNAIN RIVALDI 351021******0001 0823*****828 03/10/2021 Sesi 1 08.00 - 10.00
1567 J-0****YPM SOPHI PERENISSA 637102******0007 0899*****98 03/10/2021 Sesi 1 08.00 - 10.00
1568 J-0****0VO EDI SETIAWAN 350609******0004 0858*****947 03/10/2021 Sesi 1 08.00 - 10.00
1569 J-0****5AT NAFILA FAUSTINA YULIA S. 350722******0001 0877*****626 03/10/2021 Sesi 1 08.00 - 10.00
1570 J-0****XO8 MOHAMMAD FIRDAUS ALFIAN 351506******0003 0895*****540 03/10/2021 Sesi 1 08.00 - 10.00
1571 J-0****1I2 NOVIA CINTYA ROSA 352215******0002 0881*****89 03/10/2021 Sesi 1 08.00 - 10.00
1572 J-0****4EI NITA MAYA SARI 357301******0005 0813*****806 03/10/2021 Sesi 1 08.00 - 10.00
1573 J-0****F34 M FARHAN ELFIAN 127121******0008 0853*****837 03/10/2021 Sesi 1 08.00 - 10.00
1574 J-0****JHQ SITI NUR KHOLIDAH 350615******0001 0822*****174 03/10/2021 Sesi 1 08.00 - 10.00
1575 J-0****KG3 ZIDANE MAULANA SHIDIQ 367406******0001 0812*****350 03/10/2021 Sesi 1 08.00 - 10.00
1576 J-0****HHQ WURI CAHYA HANDARU 350605******0002 0812*****589 03/10/2021 Sesi 1 08.00 - 10.00
1577 J-0****IJT NUR WAKHID HABIBULLAH 350610******0001 0856*****200 03/10/2021 Sesi 1 08.00 - 10.00
1578 J-0****MDW MUHAMMAD DAFA RIFQI 337415******0003 0823*****010 03/10/2021 Sesi 1 08.00 - 10.00
1579 J-0****SH8 FERRY KURNIAWAN 350509******0001 0812*****252 03/10/2021 Sesi 1 08.00 - 10.00
1580 J-0****1XU AHMAD ARIS SHALEH 352703******0010 0813*****392 03/10/2021 Sesi 1 08.00 - 10.00
1581 J-0****24A RIFKY MAULANA SULISTIAWAN 617105******0007 0899*****34 03/10/2021 Sesi 1 08.00 - 10.00
1582 J-0****2AP LUQMAN DWI PRANATA 351608******0002 0823*****629 03/10/2021 Sesi 1 08.00 - 10.00
1583 J-0****2GJ BAYU KURNIAWAN 350719******0003 0882*****6568 03/10/2021 Sesi 1 08.00 - 10.00
1584 J-0****2MA MUHAMMAD RAFLI RIYANDA LUBIS 127117******0002 0813*****768 03/10/2021 Sesi 1 08.00 - 10.00
1585 J-0****2MN REYZA FATIMA FRANCA ZEIN 350722******0001 0858*****606 03/10/2021 Sesi 1 08.00 - 10.00
1586 J-0****2Q8 ACHMAD ROSUL ARIF 357301******0003 0878*****495 03/10/2021 Sesi 1 08.00 - 10.00
1587 J-0****2QY AINUR ROHMAH 350725******0001 0821*****337 03/10/2021 Sesi 1 08.00 - 10.00
1588 J-0****2ZE SEFIRA PUTRI MUZDHALIFA 357703******0001 0812*****899 03/10/2021 Sesi 1 08.00 - 10.00
1589 J-0****31T MARIA ULFAH TIDAR 727101******0002 0822*****141 03/10/2021 Sesi 1 08.00 - 10.00
1590 J-0****39P FATHYA KHALISA SALSABIL 321401******0001 0856*****395 03/10/2021 Sesi 1 08.00 - 10.00
1591 J-0****3BS FUNGKY RAHAYU 350713******0001 0895*****5239 03/10/2021 Sesi 1 08.00 - 10.00
1592 J-0****3D3 TYAS NURUL ZAFIRAH 357305******0002 0878*****473 03/10/2021 Sesi 1 08.00 - 10.00
1593 J-0****45K DINI EKA RISTANTI 350311******0002 0813*****531 03/10/2021 Sesi 1 08.00 - 10.00

Page 38 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1594 J-0****49M TOMMY ADJIE RAHARDIPUTRA 180511******0005 0821*****282 03/10/2021 Sesi 1 08.00 - 10.00
1595 J-0****4JY EVA MAZIDATUL HIDAYAH 332102******0001 0857*****413 03/10/2021 Sesi 1 08.00 - 10.00
1596 J-0****4V4 INDAH AYUK RAKHMAYANTI 351511******0002 0857*****379 03/10/2021 Sesi 1 08.00 - 10.00
1597 J-0****4X6 DWI ISA AQLAMI 352408******0001 0896*****535 03/10/2021 Sesi 1 08.00 - 10.00
1598 J-0****514 OSSANA BERNICHA NUGROHO 350724******0001 0821*****234 03/10/2021 Sesi 1 08.00 - 10.00
1599 J-0****553 BRAHMATYA DIPOWALUYO 337406******0002 0812*****382 03/10/2021 Sesi 1 08.00 - 10.00
1600 J-0****569 ABDURRACHMAN FAQIH 637101******0004 0877*****647 03/10/2021 Sesi 1 08.00 - 10.00
1601 J-0****57F TENTREM HATINAH 357304******0003 0857*****839 03/10/2021 Sesi 1 08.00 - 10.00
1602 J-0****591 RAYHAN PUTRA HANDITA 317502******0002 0853*****775 03/10/2021 Sesi 1 08.00 - 10.00
1603 J-0****5F1 AUDREY SEBASTIAN TANGKE 910901******0002 0812*****469 03/10/2021 Sesi 1 08.00 - 10.00
1604 J-0****5H6 ITA HERLISTYAWATI 357304******0006 0877*****994 03/10/2021 Sesi 1 08.00 - 10.00
1605 J-0****5TP WELIYATUL AULI SASMITA 351103******0001 0822*****199 03/10/2021 Sesi 1 08.00 - 10.00
1606 J-0****5WT MIFTACHUL CHUSNA 350402******0001 0856*****606 03/10/2021 Sesi 1 08.00 - 10.00
1607 J-0****639 DWI PUTRA AMIRUL MUHTADIN 352506******0007 0858*****130 03/10/2021 Sesi 1 08.00 - 10.00
1608 J-0****6GA AMANDA BERNICHA NUGROHO 350724******0001 0822*****462 03/10/2021 Sesi 1 08.00 - 10.00
1609 J-0****6IQ MONIKA DEWITA 350517******0001 0822*****208 03/10/2021 Sesi 1 08.00 - 10.00
1610 J-0****6NZ KINDLY ANUGERAH IMANUEL PANGAUW 717104******0001 0812*****445 03/10/2021 Sesi 1 08.00 - 10.00
1611 J-0****6Q6 RIZKY BRYAN SIREGAR 121101******0002 0812*****649 03/10/2021 Sesi 1 08.00 - 10.00
1612 J-0****6TK ANDHIKA WIDYADWATMAJA 331026******0001 0899*****74 03/10/2021 Sesi 1 08.00 - 10.00
1613 J-0****6UI ZAHWA AZAHRA 357902******0002 0823*****840 03/10/2021 Sesi 1 08.00 - 10.00
1614 J-0****6VZ KARLIEZA STEPHIANI WOLOK 757104******0001 0811*****1 03/10/2021 Sesi 1 08.00 - 10.00
1615 J-0****6WU WINONA SUSANTO 360323******0001 0888*****61 03/10/2021 Sesi 1 08.00 - 10.00
1616 J-0****7HY MOCHAMAD FARIS FIRDAUS 350724******0002 0812*****441 03/10/2021 Sesi 1 08.00 - 10.00
1617 J-0****7M0 JEREMIA HATOGUAN SINAGA 127114******0005 0812*****981 03/10/2021 Sesi 1 08.00 - 10.00
1618 J-0****7UQ DAFFA SANDI LASITYA 350511******0001 0858*****123 03/10/2021 Sesi 1 08.00 - 10.00
1619 J-0****84Q LAMBANG TRISNARTANTO 350212******0001 0878*****997 03/10/2021 Sesi 1 08.00 - 10.00
1620 J-0****854 ADAM KRISHADI PRASETYO 351021******0001 0857*****742 03/10/2021 Sesi 1 08.00 - 10.00
1621 J-0****85D BIMANTIO FARIZ NUGROHO 350931******0001 0852*****930 03/10/2021 Sesi 1 08.00 - 10.00
1622 J-0****88U NIAM ZAKI ZAMANI 331519******0002 0822*****209 03/10/2021 Sesi 1 08.00 - 10.00
1623 J-0****8DF MUHAMMAD GIRI HIDAYATULLAH 357303******0002 0858*****409 03/10/2021 Sesi 1 08.00 - 10.00
1624 J-0****8K6 IIN DIAH KARINA 350724******0002 0821*****105 03/10/2021 Sesi 1 08.00 - 10.00
1625 J-0****8QP RAHMAT GRAHADI 350511******0001 0856*****094 03/10/2021 Sesi 1 08.00 - 10.00
1626 J-0****8SH HENDRI DIEGO 120728******0002 0821*****528 03/10/2021 Sesi 1 08.00 - 10.00
1627 J-0****8SX TANDA RAJA CHRISTOPHER SITUMORANG 127117******0002 0821*****568 03/10/2021 Sesi 1 08.00 - 10.00
1628 J-0****8TB SIFA'UL MAS'UD 352013******0001 0813*****424 03/10/2021 Sesi 1 08.00 - 10.00
1629 J-0****8WV RAHMAWATI INDIRA LAHITA 357304******0001 0858*****736 03/10/2021 Sesi 1 08.00 - 10.00
1630 J-0****8Z0 SAFINA SAMARA NUR FADLILA 331508******0003 0877*****776 03/10/2021 Sesi 1 08.00 - 10.00
1631 J-0****93G MUHAMMAD RAFI BAMRATAMA 350723******0002 0857*****848 03/10/2021 Sesi 1 08.00 - 10.00
1632 J-0****97B INDRA FIRMANSYAH 351111******0003 0812*****642 03/10/2021 Sesi 1 08.00 - 10.00
1633 J-0****99M EMI DWI SULISTYORINI 537102******0007 0821*****265 03/10/2021 Sesi 1 08.00 - 10.00
1634 J-0****9G6 AHMAD NAJIH DAROINI 350716******0001 0899*****24 03/10/2021 Sesi 1 08.00 - 10.00
1635 J-0****9HR AGMELIA NADYA PUTRI 332615******0004 0858*****077 03/10/2021 Sesi 1 08.00 - 10.00

Page 39 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1636 J-0****9LB RATIH ELYSATRI DAMAYANTI 351611******0001 0815*****834 03/10/2021 Sesi 1 08.00 - 10.00
1637 J-0****9P7 ZILDA AURELIA ARIYANTO 357303******0006 0822*****745 03/10/2021 Sesi 1 08.00 - 10.00
1638 J-0****9RU TIFA ERVITA MAHARANI 357304******0004 0838*****581 03/10/2021 Sesi 1 08.00 - 10.00
1639 J-0****9UA MUHAMMAD RIZKY RAMADHAN 140502******0005 0813*****761 03/10/2021 Sesi 1 08.00 - 10.00
1640 J-0****AC9 MUHAMMAD TAUFANI FIRDAUS 350724******0005 0822*****546 03/10/2021 Sesi 1 08.00 - 10.00
1641 J-0****AI3 ROBBY ABRIAN UTAMA S 127107******0002 0822*****248 03/10/2021 Sesi 1 08.00 - 10.00
1642 J-0****ANE GUNTUR RAMADHAN 332408******0001 0812*****600 03/10/2021 Sesi 1 08.00 - 10.00
1643 J-0****AOK AINUN NUR KHALIFAH 351608******0003 0812*****620 03/10/2021 Sesi 1 08.00 - 10.00
1644 J-0****AYF HELMALIA PUTRI 530906******0003 0822*****715 03/10/2021 Sesi 1 08.00 - 10.00
1645 J-0****B0Q PUTRI AGUNG KUSUMA WARDANI 357301******0007 0881*****36 03/10/2021 Sesi 1 08.00 - 10.00
1646 J-0****B7G AGIEL MARFIL PRASETYA MODOK 217107******9002 0896*****254 03/10/2021 Sesi 1 08.00 - 10.00
1647 J-0****B8R RAFIKA SUCI ANDARY 327302******0012 0856*****833 03/10/2021 Sesi 1 08.00 - 10.00
1648 J-0****BOL M. RAFI ZAIDAN MAAJID 327503******0026 0812*****880 03/10/2021 Sesi 1 08.00 - 10.00
1649 J-0****BPI ADIWENA BACHTIAR SUWANDOKO 352422******0001 0857*****662 03/10/2021 Sesi 1 08.00 - 10.00
1650 J-0****BRL RADIF ACHMAD SYAFRIYAL 350714******0003 0857*****863 03/10/2021 Sesi 1 08.00 - 10.00
1651 J-0****BTZ LAILA FARAH JIHAN 357822******0001 0898*****00 03/10/2021 Sesi 1 08.00 - 10.00
1652 J-0****C6B JOSUA SIAGIAN 120917******0006 0812*****007 03/10/2021 Sesi 1 08.00 - 10.00
1653 J-0****CDW FATHIYAH NURUL IZZAH 350722******0004 0812*****969 03/10/2021 Sesi 1 08.00 - 10.00
1654 J-0****CHG RUTMAULI HUTABARAT 630906******0003 0821*****655 03/10/2021 Sesi 1 08.00 - 10.00
1655 J-0****CLD ACHMAD DERI FATURRAHMAN 351617******0001 0821*****241 03/10/2021 Sesi 1 08.00 - 10.00
1656 J-0****COG NAUFAL ACHMAD ARROKHMAN 351515******0007 0877*****725 03/10/2021 Sesi 1 08.00 - 10.00
1657 J-0****CQ1 MUHAMMAD ZAINUSSHALIHIN 360330******0001 0838*****648 03/10/2021 Sesi 1 08.00 - 10.00
1658 J-0****CT1 ANANDA RIZQI JUMVON NEDHEA 167107******0008 0882*****607 03/10/2021 Sesi 1 08.00 - 10.00
1659 J-0****CY3 ADITYA PAKSI TOHARA 332818******0005 0816*****7 03/10/2021 Sesi 1 08.00 - 10.00
1660 J-0****DKY LOKANANTA SINARA LINGGA 357303******0006 0817*****770 03/10/2021 Sesi 1 08.00 - 10.00
1661 J-0****DMX POPPY RIZKY DAMAYANTI 351609******0001 0813*****604 03/10/2021 Sesi 1 08.00 - 10.00
1662 J-0****DUS CINDY SAGITA POMALINA 357807******0002 0878*****529 03/10/2021 Sesi 1 08.00 - 10.00
1663 J-0****EHE YUNIKE AFINA SUSANA 647403******0001 0812*****108 03/10/2021 Sesi 1 08.00 - 10.00
1664 J-0****EPI VARA ADHIMAH 352505******0001 0813*****825 03/10/2021 Sesi 1 08.00 - 10.00
1665 J-0****EPM AMELIA NUR RAHMA 350725******0001 0813*****220 03/10/2021 Sesi 1 08.00 - 10.00
1666 J-0****EQD NIZAM ADIL RAIS 350724******0003 0838*****247 03/10/2021 Sesi 1 08.00 - 10.00
1667 J-0****ER9 FATIMA HAZRATI 630904******0004 0822*****669 03/10/2021 Sesi 1 08.00 - 10.00
1668 J-0****ESY CINDY FATIKA PUTRI 170604******0001 0857*****188 03/10/2021 Sesi 1 08.00 - 10.00
1669 J-0****EYB TUBAGUS LINTANG TRENGGONO 330810******0003 0858*****304 03/10/2021 Sesi 1 08.00 - 10.00
1670 J-0****EYX DIAN FATICA 357302******0001 0812*****890 03/10/2021 Sesi 1 08.00 - 10.00
1671 J-0****F3Q RAHMAT SANDY CESAR PAMUNGKAS 351411******0002 0857*****006 03/10/2021 Sesi 1 08.00 - 10.00
1672 J-0****FC1 MUHAMMAD ILLHAMSYAH PRATAMA NUGRAHA 357302******0001 0895*****5251 03/10/2021 Sesi 1 08.00 - 10.00
1673 J-0****FCO MUHAMAD ZAIDAN FAUZAN 327703******0003 0813*****030 03/10/2021 Sesi 1 08.00 - 10.00
1674 J-0****FHJ AHMAD FAIZ RAIHAN 367406******0007 0813*****018 03/10/2021 Sesi 1 08.00 - 10.00
1675 J-0****FK3 AMALIA NURUL JANNAH 321602******0006 0821*****692 03/10/2021 Sesi 1 08.00 - 10.00
1676 J-0****FL5 NOVITA NUR ARIKHA 357304******0004 0856*****581 03/10/2021 Sesi 1 08.00 - 10.00
1677 J-0****FNV NABILA TARIZA DHEYA 331513******0004 0895*****0518 03/10/2021 Sesi 1 08.00 - 10.00

Page 40 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1678 J-0****FQ4 ROBBI RISWANDA 357301******0007 0821*****025 03/10/2021 Sesi 1 08.00 - 10.00
1679 J-0****FUD KHOLIZA ZHAHARA 520201******0003 0852*****578 03/10/2021 Sesi 1 08.00 - 10.00
1680 J-0****G4H GABRIELLA OLGA CHRISTA PUTRI 357808******0003 0821*****556 03/10/2021 Sesi 1 08.00 - 10.00
1681 J-0****G9B SHEPHIA AYRIZA 122304******0010 0852*****516 03/10/2021 Sesi 1 08.00 - 10.00
1682 J-0****GEP BERLINDA SHINTA PUTRI 357304******0006 0852*****386 03/10/2021 Sesi 1 08.00 - 10.00
1683 J-0****GEV ENDSY MARITTA 647402******0003 0853*****858 03/10/2021 Sesi 1 08.00 - 10.00
1684 J-0****GW9 ADDIENA MUFIDAH HAMZAH 320428******0003 0853*****037 03/10/2021 Sesi 1 08.00 - 10.00
1685 J-0****H9K MUFIDATUL MAUFUROH 350719******0001 0891*****911 03/10/2021 Sesi 1 08.00 - 10.00
1686 J-0****HAV MOHAMMAD BAIHAQI 331815******0001 0896*****765 03/10/2021 Sesi 1 08.00 - 10.00
1687 J-0****HME RISKA AYU FEBRIANA 357101******0005 0896*****272 03/10/2021 Sesi 1 08.00 - 10.00
1688 J-0****HXA ANANDA YUSNA DITIYAS 350705******0002 0813*****763 03/10/2021 Sesi 1 08.00 - 10.00
1689 J-0****IJL PIETER RAFAEL JOHANSZ 357303******0005 0859*****9403 03/10/2021 Sesi 1 08.00 - 10.00
1690 J-0****IKG FARISA MARDIANA RAHMA 351305******0001 0815*****396 03/10/2021 Sesi 1 08.00 - 10.00
1691 J-0****IMR ICHLASUL RIZKI JOHANSYAH S. 357810******0005 0857*****054 03/10/2021 Sesi 1 08.00 - 10.00
1692 J-0****INT MUHAMMAD IRFAAN KAMIL 320107******0011 0851*****037 03/10/2021 Sesi 1 08.00 - 10.00
1693 J-0****J0M PETRA KRISTIANTO LEMPOY 717108******0001 0851*****051 03/10/2021 Sesi 1 08.00 - 10.00
1694 J-0****JNN ALVIRA FEBRIZKI SHEISA RISMALA 357806******0006 0858*****156 03/10/2021 Sesi 1 08.00 - 10.00
1695 J-0****K0I MOHAMMAD HABIBIY IDMI 350715******0002 0815*****950 03/10/2021 Sesi 1 08.00 - 10.00
1696 J-0****K2Y NURLIA TRI UTAMI PRARIMASARI 917101******0003 0852*****232 03/10/2021 Sesi 1 08.00 - 10.00
1697 J-0****K4W SYAHRI RAMADHAN 617105******0004 0896*****978 03/10/2021 Sesi 1 08.00 - 10.00
1698 J-0****KFG HUJJATULLAH SHIDQA MUHAMMAD 331906******0001 0822*****663 03/10/2021 Sesi 1 08.00 - 10.00
1699 J-0****KJ8 FAUZAN VITO ARMIRIAWAN 331112******0002 0852*****096 03/10/2021 Sesi 1 08.00 - 10.00
1700 J-0****KJL NABILLAH PUTRI ARDIYANTI 350724******0013 0822*****866 03/10/2021 Sesi 1 08.00 - 10.00
1701 J-0****KMT ABDUL ARIF HABIBI 130505******0002 0822*****922 03/10/2021 Sesi 1 08.00 - 10.00
1702 J-0****KSP TUBAGUS MUHAMMAD NUR LUBBI 351603******0002 0821*****660 03/10/2021 Sesi 1 08.00 - 10.00
1703 J-0****KTZ MOCHAMAD ABDULLAH MUNIR 350719******0004 0851*****821 03/10/2021 Sesi 1 08.00 - 10.00
1704 J-0****KX5 BUDIMAN PRAPTO WIBOWO 327505******0017 0822*****323 03/10/2021 Sesi 1 08.00 - 10.00
1705 J-0****LTQ LU'LU'UL JANNAH 351518******0004 0813*****213 03/10/2021 Sesi 1 08.00 - 10.00
1706 J-0****LZ1 ZEPTA ADITYA 317510******1001 0812*****378 03/10/2021 Sesi 1 08.00 - 10.00
1707 J-0****M56 NURDIN HASANANTO TEGUH 352514******0002 0852*****300 03/10/2021 Sesi 1 08.00 - 10.00
1708 J-0****MIK LULUK MAYSAROH 357304******0003 0817*****880 03/10/2021 Sesi 1 08.00 - 10.00
1709 J-0****N94 AURELLY SUKMA GANTARI 350711******0003 0812*****086 03/10/2021 Sesi 1 08.00 - 10.00
1710 J-0****NMO ADJI WICAKSONO 352313******0001 0858*****120 03/10/2021 Sesi 1 08.00 - 10.00
1711 J-0****OAF RYSKY SEPTYAN JAYA 910101******0002 0821*****801 03/10/2021 Sesi 1 08.00 - 10.00
1712 J-0****QM1 FAUDZAN MUHAMMAD HASMUN 737101******0004 0851*****627 03/10/2021 Sesi 1 08.00 - 10.00
1713 J-0****QP9 APIK ILHAM RAHMATAN 350723******0003 0812*****489 03/10/2021 Sesi 1 08.00 - 10.00
1714 J-0****RH2 REKLINA DINKA HERMAWATI 357103******0001 0812*****603 03/10/2021 Sesi 1 08.00 - 10.00
1715 J-0****RKA DITA APRILA SARI 357305******0001 0878*****955 03/10/2021 Sesi 1 08.00 - 10.00
1716 J-0****RXD ROSSDANNISA ISKANDAR 350722******0001 0813*****844 03/10/2021 Sesi 1 08.00 - 10.00
1717 J-0****RZR AOREL VEREL WAFIQ AZIZI 331903******0007 0822*****311 03/10/2021 Sesi 1 08.00 - 10.00
1718 J-0****SOK ADINDA RUMANIA PURNAMA SARI 527102******0001 0858*****374 03/10/2021 Sesi 1 08.00 - 10.00
1719 J-0****UEW ANNISA RISKI 170508******0002 0812*****881 03/10/2021 Sesi 1 08.00 - 10.00

Page 41 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1720 J-0****UFE ANDRI KURNIAWAN 350519******0001 0856*****712 03/10/2021 Sesi 1 08.00 - 10.00
1721 J-0****VJL DHAFA HASDEN REIHAN NUGROHO 330603******0001 0877*****903 03/10/2021 Sesi 1 08.00 - 10.00
1722 J-0****W0F ACHMAT SOLEH HUDIN 350732******0003 0823*****681 03/10/2021 Sesi 1 08.00 - 10.00
1723 J-0****W9A IRMA FIKAYANTI 630706******0006 0821*****634 03/10/2021 Sesi 1 08.00 - 10.00
1724 J-0****WC5 LAILA 357305******0004 0895*****428 03/10/2021 Sesi 1 08.00 - 10.00
1725 J-0****WUD FATMA ZULIATI 350731******0001 0852*****880 03/10/2021 Sesi 1 08.00 - 10.00
1726 J-0****XCE ADELIA NOVIANTI KURNIA PRAMAISHEILLA 357301******0001 0897*****26 03/10/2021 Sesi 1 08.00 - 10.00
1727 J-0****XX7 NILA PUTRI GADING QUR'ANI 351412******0004 0857*****805 03/10/2021 Sesi 1 08.00 - 10.00
1728 J-0****Y7M NUR DIANA KAMILIA 357301******0002 0896*****303 03/10/2021 Sesi 1 08.00 - 10.00
1729 J-0****YEQ SUTIARNI 620602******0001 0812*****313 03/10/2021 Sesi 1 08.00 - 10.00
1730 J-0****YSH JANANI BUDI DAFFA 111302******0001 0822*****104 03/10/2021 Sesi 1 08.00 - 10.00
1731 J-0****06Y ADELLIA ENGGAR DANAVI 352504******0001 0812*****843 03/10/2021 Sesi 1 08.00 - 10.00
1732 J-0****07H DWI MURTI SARI DEWI 351606******0001 0838*****14 03/10/2021 Sesi 1 08.00 - 10.00
1733 J-0****1D8 FAISHAL HAFIZH 337407******0002 0822*****057 03/10/2021 Sesi 1 08.00 - 10.00
1734 J-0****1TJ RIZAL TOVANI 357301******0003 0822*****570 03/10/2021 Sesi 1 08.00 - 10.00
1735 J-0****2IM SINTA SITI SOLIKAH 357301******0010 0853*****211 03/10/2021 Sesi 1 08.00 - 10.00
1736 J-0****2Y9 NAUFAL AMMAR NABIL 350724******0001 0856*****842 03/10/2021 Sesi 1 08.00 - 10.00
1737 J-0****3QB ADELIA MAHANINGRUM 350727******0003 0822*****301 03/10/2021 Sesi 1 08.00 - 10.00
1738 J-0****3RM PUTRI NABILA QOMARIAH 357305******0005 0895*****6384 03/10/2021 Sesi 1 08.00 - 10.00
1739 J-0****4FM ERIKA PURWITASARI 351418******0001 0812*****538 03/10/2021 Sesi 1 08.00 - 10.00
1740 J-0****4FY ULFI DANIATI 350727******0005 0821*****428 03/10/2021 Sesi 1 08.00 - 10.00
1741 J-0****4KV YUSTINA PUTRI ARIANTO 357305******0001 0822*****882 03/10/2021 Sesi 1 08.00 - 10.00
1742 J-0****55R YASSICA MEGAWATI VINKARISMA 357301******0006 0812*****227 03/10/2021 Sesi 1 08.00 - 10.00
1743 J-0****575 DAFFA FADHIEL AGUSTIA 367401******0003 0878*****956 03/10/2021 Sesi 1 08.00 - 10.00
1744 J-0****5KC ADITYA KURNIAWAN 357901******0004 0812*****993 03/10/2021 Sesi 1 08.00 - 10.00
1745 J-0****5QN SHELBY SASANA ARTHA 357303******0004 0822*****834 03/10/2021 Sesi 1 08.00 - 10.00
1746 J-0****5SL MIFTAH SHOLAHUDDIN 332107******0001 0896*****961 03/10/2021 Sesi 1 08.00 - 10.00
1747 J-0****5U4 OMI NANDA YULISTANTI 351413******0001 0812*****192 03/10/2021 Sesi 1 08.00 - 10.00
1748 J-0****5UE ARIFANDY IRFAN ZIDAN 352510******0004 0813*****838 03/10/2021 Sesi 1 08.00 - 10.00
1749 J-0****5UL RESTYAN AHMAD FAUZI 350912******0003 0822*****088 03/10/2021 Sesi 1 08.00 - 10.00
1750 J-0****5WN DEWI KHOLILATUR ROHMANIYAH 351409******0001 0813*****390 03/10/2021 Sesi 1 08.00 - 10.00
1751 J-0****5Y8 DANDY RADITYA SAPUTRA 357804******0005 0895*****1376 03/10/2021 Sesi 1 08.00 - 10.00
1752 J-0****62S MUHAMMAD FERNANDA DANUARTA 352212******0003 0812*****67 03/10/2021 Sesi 1 08.00 - 10.00
1753 J-0****63F QATHRUNNADA SALSABILA 352514******0002 0812*****547 03/10/2021 Sesi 1 08.00 - 10.00
1754 J-0****671 SHELLA AURRELIA 350716******0002 0815*****512 03/10/2021 Sesi 1 08.00 - 10.00
1755 J-0****672 WIDIANI TAMBUN SARIBU 120815******0001 0812*****732 03/10/2021 Sesi 1 08.00 - 10.00
1756 J-0****6BH ANGELA SEMBIRING 127406******0001 0812*****492 03/10/2021 Sesi 1 08.00 - 10.00
1757 J-0****6DS ROBBY FIRMANSYAH 357305******0010 0812*****477 03/10/2021 Sesi 1 08.00 - 10.00
1758 J-0****6FI MARDIANI KRISANTI 357305******0001 0812*****088 03/10/2021 Sesi 1 08.00 - 10.00
1759 J-0****6FO FATHUL AZIZ 330217******0003 0812*****366 03/10/2021 Sesi 1 08.00 - 10.00
1760 J-0****6FS IRENA AMELIA DESTIARA 630206******0004 0821*****935 03/10/2021 Sesi 1 08.00 - 10.00
1761 J-0****6GN ROHMALILLAH FANES YADEWI 357801******0002 0878*****694 03/10/2021 Sesi 1 08.00 - 10.00

Page 42 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1762 J-0****6HH MUHAMMAD IQBAL R. SILEHU 927102******0002 0812*****428 03/10/2021 Sesi 1 08.00 - 10.00
1763 J-0****6KT MUHAMAD ZAKI 357902******0006 0858*****380 03/10/2021 Sesi 1 08.00 - 10.00
1764 J-0****6M4 DWI WAHYU UTORO 640302******0001 0823*****630 03/10/2021 Sesi 1 08.00 - 10.00
1765 J-0****6O1 AYU MEGA ARLINDA 357301******0002 0822*****090 03/10/2021 Sesi 1 08.00 - 10.00
1766 J-0****6PE FREDERIK DISWAN REGUAF RAO 537102******0002 0813*****265 03/10/2021 Sesi 1 08.00 - 10.00
1767 J-0****6RD MUHAMMAD FACHRUL GHIFFARI 320812******0004 0812*****818 03/10/2021 Sesi 1 08.00 - 10.00
1768 J-0****6RR ADEK SEPTIA ELFIRA 327606******0002 0857*****149 03/10/2021 Sesi 1 08.00 - 10.00
1769 J-0****6RU CEPURI AYU FARAH DINI 357303******0004 0857*****405 03/10/2021 Sesi 1 08.00 - 10.00
1770 J-0****6S3 SAMUEL ADITAMA RORY 350733******0003 0819*****572 03/10/2021 Sesi 1 08.00 - 10.00
1771 J-0****6S7 NEVI GANIS WINDANI 350721******0001 0812*****139 03/10/2021 Sesi 1 08.00 - 10.00
1772 J-0****6SR MUHAMMAD YUSUF ALIFRIYANTO 647103******0002 0822*****090 03/10/2021 Sesi 1 08.00 - 10.00
1773 J-0****6SS ASTI ANNISA AMALIA 127112******0003 0812*****298 03/10/2021 Sesi 1 08.00 - 10.00
1774 J-0****6UD DWI CICILIA LINGWITS PURNOMOSIDI 347114******0001 0822*****795 03/10/2021 Sesi 1 08.00 - 10.00
1775 J-0****6UX ACHDA RINI MUFLICHAH 357304******0002 0812*****247 03/10/2021 Sesi 1 08.00 - 10.00
1776 J-0****6WQ SAPHIRA INDAH PRAMEASTY 357305******0002 0812*****750 03/10/2021 Sesi 1 08.00 - 10.00
1777 J-0****6YJ ANGGA PUTRI UTAMI 357303******0003 0852*****477 03/10/2021 Sesi 1 08.00 - 10.00
1778 J-0****6YL RIZEKI ADIKA KANE 327602******0007 0822*****883 03/10/2021 Sesi 1 08.00 - 10.00
1779 J-0****6ZL AKHWILA 357302******0001 0821*****468 03/10/2021 Sesi 1 08.00 - 10.00
1780 J-0****71L ACHMAD REVIAN PRAKOSO 351806******0001 0822*****153 03/10/2021 Sesi 1 08.00 - 10.00
1781 J-0****71V ALVI KUSUMA WIJAYA 647402******0004 0851*****246 03/10/2021 Sesi 1 08.00 - 10.00
1782 J-0****72D RAHMA AL ISLAMI 350415******0001 0813*****996 03/10/2021 Sesi 1 08.00 - 10.00
1783 J-0****72X EKA YULI KURNIA PUTRI 352221******0001 0822*****325 03/10/2021 Sesi 1 08.00 - 10.00
1784 J-0****738 REVANDA PRAMANDIKA JOHANZA 351817******0001 0822*****110 03/10/2021 Sesi 1 08.00 - 10.00
1785 J-0****76O HIMAWAN AZHARI MAULANA 357303******0006 0821*****441 03/10/2021 Sesi 1 08.00 - 10.00
1786 J-0****77N SILVANUS RICO WIBISANA 357901******0002 0895*****632 03/10/2021 Sesi 1 08.00 - 10.00
1787 J-0****78L DWITIYA WORO LARASATI 317508******0006 0822*****780 03/10/2021 Sesi 1 08.00 - 10.00
1788 J-0****78Y ATMA TAUFIKA DEWI 350308******0004 0858*****716 03/10/2021 Sesi 1 08.00 - 10.00
1789 J-0****79D GLORIZKY RAMADHAN BINARDI 357301******0002 0882*****961 03/10/2021 Sesi 1 08.00 - 10.00
1790 J-0****7CP BIATIN 350724******0001 0812*****23 03/10/2021 Sesi 1 08.00 - 10.00
1791 J-0****7DC FARAH MAULIDYA FATIMAH 357301******0008 0812*****161 03/10/2021 Sesi 1 08.00 - 10.00
1792 J-0****7EG HAQIE MAMDUHI 367407******0002 0821*****911 03/10/2021 Sesi 1 08.00 - 10.00
1793 J-0****7EN DZULFIKAR ONTOSENO 331710******0002 0812*****463 03/10/2021 Sesi 1 08.00 - 10.00
1794 J-0****7I6 MARCO GUNAWAN 127118******0002 0878*****988 03/10/2021 Sesi 1 08.00 - 10.00
1795 J-0****7K6 CYNTHIA RAHMANINGTIAS 351508******0006 0819*****379 03/10/2021 Sesi 1 08.00 - 10.00
1796 J-0****7LR BILL CLINTON MONGKAREN 717109******0003 0896*****900 03/10/2021 Sesi 1 08.00 - 10.00
1797 J-0****7M6 NADAME KRISTINA SLATER LUMBAN GAOL 121606******0001 0821*****782 03/10/2021 Sesi 1 08.00 - 10.00
1798 J-0****7M8 CINDY MARTA DESI 120728******0002 0823*****202 03/10/2021 Sesi 1 08.00 - 10.00
1799 J-0****7MS ANILA SITI FATIMAH 350705******0005 0895*****9377 03/10/2021 Sesi 1 08.00 - 10.00
1800 J-0****7N7 YURDHA FADHILA HERNAWAN 137110******0004 0813*****542 03/10/2021 Sesi 1 08.00 - 10.00
1801 J-0****7NZ MURIYAH 350210******0001 0811*****19 03/10/2021 Sesi 1 08.00 - 10.00
1802 J-0****7QC TAN VARIAN KASHIRA 137104******0007 0813*****547 03/10/2021 Sesi 1 08.00 - 10.00
1803 J-0****7R0 RISMA CANDRA WALUYANI 357304******0003 0813*****891 03/10/2021 Sesi 1 08.00 - 10.00

Page 43 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1804 J-0****7S0 HEZY AMALIA RIZQY 331710******0001 0856*****442 03/10/2021 Sesi 1 08.00 - 10.00
1805 J-0****7S6 IKE DWI NURITA SARI 351617******0001 0812*****158 03/10/2021 Sesi 1 08.00 - 10.00
1806 J-0****7SM AGUNG YUANTO 350704******0001 0822*****337 03/10/2021 Sesi 1 08.00 - 10.00
1807 J-0****7T2 RACHEL NATALIA BR SITEPU 321606******0019 0812*****806 03/10/2021 Sesi 1 08.00 - 10.00
1808 J-0****7TW IVANA ALISHA 647203******0003 0853*****888 03/10/2021 Sesi 1 08.00 - 10.00
1809 J-0****7VO RACHMAH GUSVIKA KOMAR 327404******0005 0821*****951 03/10/2021 Sesi 1 08.00 - 10.00
1810 J-0****7XB MUHAMMAD THORIQ FERDYANSYAH 351409******0001 0821*****640 03/10/2021 Sesi 1 08.00 - 10.00
1811 J-0****7ZB WESTON LEVI SHARPE 350724******0005 0812*****256 03/10/2021 Sesi 1 08.00 - 10.00
1812 J-0****850 APRILIA WULANSARI 647206******0006 0851*****393 03/10/2021 Sesi 1 08.00 - 10.00
1813 J-0****865 READILIN NASFAHTI 327501******0019 0813*****670 03/10/2021 Sesi 1 08.00 - 10.00
1814 J-0****87I BUE FRIMA U. PANE 121204******0001 0812*****662 03/10/2021 Sesi 1 08.00 - 10.00
1815 J-0****894 BERLIANA PUTRI ROMADHON 357814******0001 0857*****561 03/10/2021 Sesi 1 08.00 - 10.00
1816 J-0****8A3 FIDA FAUZIA 350510******0002 0895*****449 03/10/2021 Sesi 1 08.00 - 10.00
1817 J-0****8BX RUT SUHARNI P. SIHOMBING 121605******0001 0822*****904 03/10/2021 Sesi 1 08.00 - 10.00
1818 J-0****8CO DHIKA ARIF RAMADHAN 357814******0001 0812*****982 03/10/2021 Sesi 1 08.00 - 10.00
1819 J-0****8E3 BAYU ADI PRASETYO 350512******0001 0813*****294 03/10/2021 Sesi 1 08.00 - 10.00
1820 J-0****8EJ TRISTI MAYANGSARI 367107******0003 0897*****29 03/10/2021 Sesi 1 08.00 - 10.00
1821 J-0****8F0 GUNAWAN WAHYU ANDREANTO 350720******0001 0823*****414 03/10/2021 Sesi 1 08.00 - 10.00
1822 J-0****8GS SANGRA SUCI PUTRI 137104******0006 0819*****476 03/10/2021 Sesi 1 08.00 - 10.00
1823 J-0****8H3 ADYTIA CANDRA WIBAWA 350610******0001 0812*****292 03/10/2021 Sesi 1 08.00 - 10.00
1824 J-0****8H4 CHEREN AURA DARA PAMUNGKAS 350807******0001 0816*****190 03/10/2021 Sesi 1 08.00 - 10.00
1825 J-0****8HQ LUTFIATUL NURJANNAH 350729******0001 0823*****514 03/10/2021 Sesi 1 08.00 - 10.00
1826 J-0****8IR MUHAMMAD SYAH FITRA 140104******0001 0813*****452 03/10/2021 Sesi 1 08.00 - 10.00
1827 J-0****8JV FATMA SOLEHA TUNISA 130501******0001 0821*****992 03/10/2021 Sesi 1 08.00 - 10.00
1828 J-0****8K1 DHOANS RAMA YUANTO AL HAQ 321007******0021 0813*****113 03/10/2021 Sesi 1 08.00 - 10.00
1829 J-0****8K9 REISHA MUTIARA RAMADAN 350725******0003 0822*****982 03/10/2021 Sesi 1 08.00 - 10.00
1830 J-0****8KH ENDANG 351420******0003 0882*****992 03/10/2021 Sesi 1 08.00 - 10.00
1831 J-0****8KO LILIK ASTUTIK 357503******0004 0882*****2719 03/10/2021 Sesi 1 08.00 - 10.00
1832 J-0****8L2 AHMAD AZMI ABDURRAHIM 327602******0015 0821*****299 03/10/2021 Sesi 1 08.00 - 10.00
1833 J-0****8LO NGAINUL FADILAH 350301******0004 0821*****475 03/10/2021 Sesi 1 08.00 - 10.00
1834 J-0****8ML RIZMA 350713******0004 0813*****267 03/10/2021 Sesi 1 08.00 - 10.00
1835 J-0****8NK FEBIANA YULIA KUSUMA WARDANI 517104******0001 0812*****198 03/10/2021 Sesi 1 08.00 - 10.00
1836 J-0****8P4 HANIFA NABILA 357305******0007 0813*****292 03/10/2021 Sesi 1 08.00 - 10.00
1837 J-0****8R7 ADAM RYANDI ARGA RAMADHANA 350415******0001 0822*****753 03/10/2021 Sesi 1 08.00 - 10.00
1838 J-0****8RE RAFI DZAKI ANSHARI 350724******0006 0881*****99 03/10/2021 Sesi 1 08.00 - 10.00
1839 J-0****8RH HAFISZAH ASFAHANI 350713******0002 0812*****230 03/10/2021 Sesi 1 08.00 - 10.00
1840 J-0****8S1 NAZLA ASRIN DWI PERTIWI 647104******0002 0822*****600 03/10/2021 Sesi 1 08.00 - 10.00
1841 J-0****8TN DITA NISA MUSDALIFA 510301******0001 0881*****10 03/10/2021 Sesi 1 08.00 - 10.00
1842 J-0****8VV ANGGI DWI FEBRIYANTI 350725******0001 0813*****345 03/10/2021 Sesi 1 08.00 - 10.00
1843 J-0****8WU RAZZAN WIRAGANI AHMAD 357302******0002 0812*****797 03/10/2021 Sesi 1 08.00 - 10.00
1844 J-0****8X3 FALZA NURRAHMAN 357902******0002 0878*****062 03/10/2021 Sesi 1 08.00 - 10.00
1845 J-0****8XH KRISNA ADI CANDRA 350725******0003 0813*****904 03/10/2021 Sesi 1 08.00 - 10.00

Page 44 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1846 J-0****8YN ADAM MALIK 351305******0001 0895*****735 03/10/2021 Sesi 1 08.00 - 10.00
1847 J-0****8Z2 ARIQ MONETRA 357304******0004 0896*****371 03/10/2021 Sesi 1 08.00 - 10.00
1848 J-0****91J IDHAM RIZKY YUDANTO 352306******0001 0821*****934 03/10/2021 Sesi 1 08.00 - 10.00
1849 J-0****92Q NAUFAL FARRAS RAYHAN SYAFI'I 350210******0003 0857*****627 03/10/2021 Sesi 1 08.00 - 10.00
1850 J-0****93F PAMUJI LESTARI ARUMSARI 330607******0002 0899*****94 03/10/2021 Sesi 1 08.00 - 10.00
1851 J-0****93T JOKO KURNIAWAN 180719******0003 0821*****170 03/10/2021 Sesi 1 08.00 - 10.00
1852 J-0****945 AMMAR NAJMUDDIN NAUFAL 350724******0001 0823*****365 03/10/2021 Sesi 1 08.00 - 10.00
1853 J-0****950 KHOIRIYAH 350709******0007 0856*****992 03/10/2021 Sesi 1 08.00 - 10.00
1854 J-0****961 NUNING FATMAWATI 351709******0002 0858*****408 03/10/2021 Sesi 1 08.00 - 10.00
1855 J-0****97E SEPTIAN ANDRE PRAYOGA 350503******0001 0858*****375 03/10/2021 Sesi 1 08.00 - 10.00
1856 J-0****97O IRMAYANTI 737202******0002 0853*****494 03/10/2021 Sesi 1 08.00 - 10.00
1857 J-0****97Y NAYAKA ARTHA WICESA 357203******0003 0857*****226 03/10/2021 Sesi 1 08.00 - 10.00
1858 J-0****98W FAUSTINA DE YESU PRISILA ABI 530323******0001 0853*****351 03/10/2021 Sesi 1 08.00 - 10.00
1859 J-0****9AK LEO KRISNA 627103******0002 0821*****012 03/10/2021 Sesi 1 08.00 - 10.00
1860 J-0****9B3 OCTAVA BHAKTI NUSANTARA 350724******0002 0813*****843 03/10/2021 Sesi 1 08.00 - 10.00
1861 J-0****9BS RANEESYA PHRISYA AZZAHRA 357301******0008 0877*****947 03/10/2021 Sesi 1 08.00 - 10.00
1862 J-0****9BT HADI ASYARI FADHOLLI 332315******0002 0852*****404 03/10/2021 Sesi 1 08.00 - 10.00
1863 J-0****9C3 SYACH'RAH SYAFILLA KHAIRUDIN 357304******0004 0819*****001 03/10/2021 Sesi 1 08.00 - 10.00
1864 J-0****9C5 ULFAH TRI ASMA DEWI 647302******0009 0812*****765 03/10/2021 Sesi 1 08.00 - 10.00
1865 J-0****9CE STEFANUS NGGAE 530805******0001 0823*****065 03/10/2021 Sesi 1 08.00 - 10.00
1866 J-0****9CJ AGUSTINUS PRASETYO HADI 351004******0003 0822*****051 03/10/2021 Sesi 1 08.00 - 10.00
1867 J-0****9CK NUR FITRI DESTRIANI 360322******0004 0812*****458 03/10/2021 Sesi 1 08.00 - 10.00
1868 J-0****9D4 JIHAN MUTIDAH SARI SURYA NINGRUM 351004******0002 0812*****366 03/10/2021 Sesi 1 08.00 - 10.00
1869 J-0****9DN LINDA RISALATUL MUYASAROH 357305******0003 0821*****768 03/10/2021 Sesi 1 08.00 - 10.00
1870 J-0****9DZ AISY ALKAUTSAR 327511******0005 0821*****489 03/10/2021 Sesi 1 08.00 - 10.00
1871 J-0****9E7 ICE MARIA ULFA 350921******0010 0812*****602 03/10/2021 Sesi 1 08.00 - 10.00
1872 J-0****9EL ISTI'AINA MURSYADA 357305******0003 0851*****170 03/10/2021 Sesi 1 08.00 - 10.00
1873 J-0****9EY INTAN YUNISYA 327605******0007 0851*****512 03/10/2021 Sesi 1 08.00 - 10.00
1874 J-0****9F5 DAMAI ARISTANIA 357303******0001 0857*****858 03/10/2021 Sesi 1 08.00 - 10.00
1875 J-0****9G3 TIARA MAULIDYA 357304******0007 0812*****656 03/10/2021 Sesi 1 08.00 - 10.00
1876 J-0****9GR APRILIA DWI KARUNIA 352211******0001 0812*****303 03/10/2021 Sesi 1 08.00 - 10.00
1877 J-0****9GW AUDHITA PALUPI EKASARI 357304******0007 0813*****493 03/10/2021 Sesi 1 08.00 - 10.00
1878 J-0****9JG AHMAD FAHRUDIN 317407******1001 0858*****108 03/10/2021 Sesi 1 08.00 - 10.00
1879 J-0****9KN IDA KUSUMAWATI 350723******0001 0812*****760 03/10/2021 Sesi 1 08.00 - 10.00
1880 J-0****9KT DIA NOVITA 357304******0007 0857*****906 03/10/2021 Sesi 1 08.00 - 10.00
1881 J-0****9L7 MARTHA SIMANJUNTAK 121213******0001 0823*****389 03/10/2021 Sesi 1 08.00 - 10.00
1882 J-0****9LE LAYLA 357304******0003 0856*****425 03/10/2021 Sesi 1 08.00 - 10.00
1883 J-0****9LY KARINA SETYA UTAMI 357304******0004 0855*****306 03/10/2021 Sesi 1 08.00 - 10.00
1884 J-0****9M6 MUHAMMAD FIKRY SYAFAAT 737110******0001 0877*****151 03/10/2021 Sesi 1 08.00 - 10.00
1885 J-0****9MK YUS A ZAKI 350604******0003 0813*****990 03/10/2021 Sesi 1 08.00 - 10.00
1886 J-0****9MV ELISABETH JESSLYN MANALU 121104******0002 0822*****480 03/10/2021 Sesi 1 08.00 - 10.00
1887 J-0****9OU IMAM WIDIANTORO 160314******0001 0822*****668 03/10/2021 Sesi 1 08.00 - 10.00

Page 45 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1888 J-0****9OZ SOPHIA DEWI SAPHIRA 357303******0001 0812*****334 03/10/2021 Sesi 1 08.00 - 10.00
1889 J-0****9Q1 FIRLY ALAMSYAH 350724******0004 0822*****102 03/10/2021 Sesi 1 08.00 - 10.00
1890 J-0****9QQ NURHAYATI 357304******0004 0813*****019 03/10/2021 Sesi 1 08.00 - 10.00
1891 J-0****9RA PETRUS PUREK 531309******0003 0822*****610 03/10/2021 Sesi 1 08.00 - 10.00
1892 J-0****9T2 ANNA MARIA MAGDALENA TUKAN 530820******0001 0821*****905 03/10/2021 Sesi 1 08.00 - 10.00
1893 J-0****9T8 HAFIDHA AINURRAHMA 331413******0002 0858*****504 03/10/2021 Sesi 1 08.00 - 10.00
1894 J-0****9TM HANA JESCENIA 157108******0041 0823*****913 03/10/2021 Sesi 1 08.00 - 10.00
1895 J-0****9UG HERLAMBANG MUSTIKO AJI 331212******0001 0823*****140 03/10/2021 Sesi 1 08.00 - 10.00
1896 J-0****9V9 SEVIRIO DIAN WIJAYA 357301******0014 0896*****422 03/10/2021 Sesi 1 08.00 - 10.00
1897 J-0****9WF ROKHMATUL PUTRA AWALIYA 330214******0003 0822*****358 03/10/2021 Sesi 1 08.00 - 10.00
1898 J-0****9WP ANDRIANI SUKMARIMBI WEDYAPUTRI 350723******0001 0895*****9636 03/10/2021 Sesi 1 08.00 - 10.00
1899 J-0****9WT INDRI ALIDHA RAHMANI 351601******0001 0822*****487 03/10/2021 Sesi 1 08.00 - 10.00
1900 J-0****9X0 LOLITA AURENSIA FRANELSA 351409******0001 0895*****983 03/10/2021 Sesi 1 08.00 - 10.00
1901 J-0****9X7 MILA OKTAFIANI 357304******0004 0856*****235 03/10/2021 Sesi 1 08.00 - 10.00
1902 J-0****9XE YUYUN IKA CHRISTINA 350723******0001 0858*****222 03/10/2021 Sesi 1 08.00 - 10.00
1903 J-0****9XL AQIILA ALTHOOF FATHIINATI LESTARI 357822******0001 0877*****512 03/10/2021 Sesi 1 08.00 - 10.00
1904 J-0****9YA AQUARINA KHARISMASARI 357301******0003 0817*****18 03/10/2021 Sesi 1 08.00 - 10.00
1905 J-0****9Z4 MUHAMAD RAIHAN KASIM 717109******0033 0813*****582 03/10/2021 Sesi 1 08.00 - 10.00
1906 J-0****9ZK RONALDO CANDRA WIJAYA 352314******0003 0896*****224 03/10/2021 Sesi 1 08.00 - 10.00
1907 J-0****A0E MUHAMMAD RIFQI 647203******0003 0878*****494 03/10/2021 Sesi 1 08.00 - 10.00
1908 J-0****A0T IGA PUSPITA AFFRILIANA 127603******0002 0858*****979 03/10/2021 Sesi 1 08.00 - 10.00
1909 J-0****A19 HENDI NUGROHO 350721******0002 0822*****347 03/10/2021 Sesi 1 08.00 - 10.00
1910 J-0****A1V HENDRI KHAIRUDIN 357304******0003 0812*****500 03/10/2021 Sesi 1 08.00 - 10.00
1911 J-0****A2J ALDA ELISA INTAN SARI 351811******0003 0814*****874 03/10/2021 Sesi 1 08.00 - 10.00
1912 J-0****A2T DELLA LUTFI MUQODAM 140507******0002 0822*****166 03/10/2021 Sesi 1 08.00 - 10.00
1913 J-0****A30 DWIKA PUTRI PANGESTI 147107******0021 0821*****767 03/10/2021 Sesi 1 08.00 - 10.00
1914 J-0****A3H YENI INTAN KUSUMA DEWI AFFANDY 327315******0003 0895*****030 03/10/2021 Sesi 1 08.00 - 10.00
1915 J-0****A3Z RETNO WILUJENG 520417******0003 0853*****573 03/10/2021 Sesi 1 08.00 - 10.00
1916 J-0****A4D LILY KUSUMAWARDHANI 337406******0009 0819*****114 03/10/2021 Sesi 1 08.00 - 10.00
1917 J-0****A4Q MOCH. AKBAR ARDIANSYAH 351514******0002 0896*****155 03/10/2021 Sesi 1 08.00 - 10.00
1918 J-0****A4R NUR ALIEF MARDANANTO 367402******0002 0812*****881 03/10/2021 Sesi 1 08.00 - 10.00
1919 J-0****A55 HENTISTA WIDHA KRISWANTI 357301******0004 0877*****991 03/10/2021 Sesi 1 08.00 - 10.00
1920 J-0****A57 MARIA HERLINA TEDA 531601******0001 0813*****439 03/10/2021 Sesi 1 08.00 - 10.00
1921 J-0****A5G KARINA DAMAYANTI 647202******0002 0813*****467 03/10/2021 Sesi 1 08.00 - 10.00
1922 J-0****A6O ADISTY DWI TREASA 167308******0005 0812*****936 03/10/2021 Sesi 1 08.00 - 10.00
1923 J-0****A6Q NUR AFIDA NUZULA 357304******0002 0859*****137 03/10/2021 Sesi 1 08.00 - 10.00
1924 J-0****A6W DEVI APRILIA 351511******0001 0857*****792 03/10/2021 Sesi 1 08.00 - 10.00
1925 J-0****A77 FIRDA AYU CAHYANINGSIH 351020******0004 0811*****21 03/10/2021 Sesi 1 08.00 - 10.00
1926 J-0****A7J RAIHAN NIZAR AMRILLAH 357303******0007 0896*****592 03/10/2021 Sesi 1 08.00 - 10.00
1927 J-0****A7Q ADYARTAMA PRANANDA NUGRAHA 320101******0002 0813*****025 03/10/2021 Sesi 1 08.00 - 10.00
1928 J-0****A8G VIKTORIA SEDA 530814******0001 0852*****173 03/10/2021 Sesi 1 08.00 - 10.00
1929 J-0****A8U ADVENSIA PARAMITA UTO 530601******0001 0822*****985 03/10/2021 Sesi 1 08.00 - 10.00

Page 46 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1930 J-0****AA3 GILANG ARYA RIYANTO 187108******0003 0813*****101 03/10/2021 Sesi 1 08.00 - 10.00
1931 J-0****AA4 ANGGUN NOVITASARI 331817******0001 0853*****254 03/10/2021 Sesi 1 08.00 - 10.00
1932 J-0****AA5 PUTRI SYIPA KAMILA 367113******0004 0878*****856 03/10/2021 Sesi 1 08.00 - 10.00
1933 J-0****AA7 NALA MAWADDANI 350722******0004 0812*****933 03/10/2021 Sesi 1 08.00 - 10.00
1934 J-0****AAK NAUFAL MUSHODIQ 647402******0004 0813*****214 03/10/2021 Sesi 1 08.00 - 10.00
1935 J-0****AAN SURYA FITA GIRESA 357901******0005 0877*****148 03/10/2021 Sesi 1 08.00 - 10.00
1936 J-0****AAV NUR AINI GAMA LESTARI 357302******0001 0857*****074 03/10/2021 Sesi 1 08.00 - 10.00
1937 J-0****AAY M. HERMAWAN WIDYANANDA 350510******0002 0821*****366 03/10/2021 Sesi 1 08.00 - 10.00
1938 J-0****ABQ I NYOMAN ARIJAYA PUTRA 510405******0003 0895*****8647 03/10/2021 Sesi 1 08.00 - 10.00
1939 J-0****ACA TRIVO SUKRISMA 357301******0004 0812*****954 03/10/2021 Sesi 1 08.00 - 10.00
1940 J-0****ACG AISYAH KURNIAWATI 367102******0001 0859*****510 03/10/2021 Sesi 1 08.00 - 10.00
1941 J-0****ACU GANAR ALIF WIBISONO 327405******0003 0812*****089 03/10/2021 Sesi 1 08.00 - 10.00
1942 J-0****AD8 NOR HIKMAH 620204******0001 0813*****721 03/10/2021 Sesi 1 08.00 - 10.00
1943 J-0****ADS SALWA ULAYYA 357303******0009 0831*****130 03/10/2021 Sesi 1 08.00 - 10.00
1944 J-0****AEH RIZAL NURHADIANSYAH 320717******0001 0812*****955 03/10/2021 Sesi 1 08.00 - 10.00
1945 J-0****AEZ NAILA IZZATUL MUKHOYYAROH 331804******0001 0896*****119 03/10/2021 Sesi 1 08.00 - 10.00
1946 J-0****AF7 DEA NING KESUMA 351709******0005 0821*****284 03/10/2021 Sesi 1 08.00 - 10.00
1947 J-0****AFP CATHERINE LEILANI NYOMAN 137102******0008 0822*****008 03/10/2021 Sesi 1 08.00 - 10.00
1948 J-0****AG6 CAHYO GUSTI INDRAYANTO 357304******0003 0895*****3517 03/10/2021 Sesi 1 08.00 - 10.00
1949 J-0****AGZ ELLY DWI GUSTIAR 351011******0007 0813*****980 03/10/2021 Sesi 1 08.00 - 10.00
1950 J-0****AHX ACHMAD FERDHIAN VALENSYAH 357302******0003 0819*****949 03/10/2021 Sesi 1 08.00 - 10.00
1951 J-0****AIC AYA SHOFIYAH 352517******0001 0821*****527 03/10/2021 Sesi 1 08.00 - 10.00
1952 J-0****AJD MOH. RAUSHAN FIKRI 720407******0003 0822*****041 03/10/2021 Sesi 1 08.00 - 10.00
1953 J-0****AKJ NOVELA RIZKA INDRI HAPSARI 350723******0001 0851*****794 03/10/2021 Sesi 1 08.00 - 10.00
1954 J-0****AKT ASEP RIYANDI 352920******0005 0838*****836 03/10/2021 Sesi 1 08.00 - 10.00
1955 J-0****AMR AGUS BAMBANG SUYANTONO 640304******0001 0812*****131 03/10/2021 Sesi 1 08.00 - 10.00
1956 J-0****AMU NABILA NUR SAFITRI 647102******0004 0821*****449 03/10/2021 Sesi 1 08.00 - 10.00
1957 J-0****AMW FITRI NUR AZIZAH 350411******0001 0858*****120 03/10/2021 Sesi 1 08.00 - 10.00
1958 J-0****ANG MUHAMMAD WILDAN IZAMUDIN 630302******0003 0858*****981 03/10/2021 Sesi 1 08.00 - 10.00
1959 J-0****ANO ORYZA SATIVA ILMA 357810******0002 0857*****909 03/10/2021 Sesi 1 08.00 - 10.00
1960 J-0****ANZ HESTI WIYARTI 367111******0005 0822*****522 03/10/2021 Sesi 1 08.00 - 10.00
1961 J-0****AOU NUR HAFIZH YUDHISTIRA 332709******0008 0895*****9968 03/10/2021 Sesi 1 08.00 - 10.00
1962 J-0****AP0 TANTI SULISTYORINI 350718******0001 0857*****199 03/10/2021 Sesi 1 08.00 - 10.00
1963 J-0****AP5 SHEVA SASANKA DOAN RAMADHAN 350724******0005 0895*****335 03/10/2021 Sesi 1 08.00 - 10.00
1964 J-0****APM ELYZA ERMA FATIMAH 350111******0003 0822*****585 03/10/2021 Sesi 1 08.00 - 10.00
1965 J-0****APW AYU IKE DAYANTI 350709******0003 0813*****930 03/10/2021 Sesi 1 08.00 - 10.00
1966 J-0****AQF FRISKA MEILANI PUTRI KUSUMA 917103******0005 0813*****614 03/10/2021 Sesi 1 08.00 - 10.00
1967 J-0****AQI MAR'ATUS SHOLIHAH AL MISHBAHRIYAH 357301******0004 0857*****125 03/10/2021 Sesi 1 08.00 - 10.00
1968 J-0****AQJ AHMAD FAUZAN WAFIRUR R 350714******0001 0813*****603 03/10/2021 Sesi 1 08.00 - 10.00
1969 J-0****AQS DELLA REFA HENDRIANTI 350718******0002 0857*****199 03/10/2021 Sesi 1 08.00 - 10.00
1970 J-0****AQV M. BUDIHARTO PUGUH HANUNG WIJAYA 352104******0001 0822*****1160 03/10/2021 Sesi 1 08.00 - 10.00
1971 J-0****ARA SARI AMALIA AFIFAH 357302******0003 0812*****280 03/10/2021 Sesi 1 08.00 - 10.00

Page 47 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
1972 J-0****ARF ANDREE DIAN PRATAMA PUTRA 332915******0001 0823*****639 03/10/2021 Sesi 1 08.00 - 10.00
1973 J-0****AST FINA INDRIANI 357901******0001 0813*****511 03/10/2021 Sesi 1 08.00 - 10.00
1974 J-0****ASZ NADIYAH ZUHROH 352514******0002 0838*****801 03/10/2021 Sesi 1 08.00 - 10.00
1975 J-0****AT1 RIZAL SALSABILA 352103******0001 0857*****470 03/10/2021 Sesi 1 08.00 - 10.00
1976 J-0****AT8 MEGA DWI UTARI 351809******0001 0878*****541 03/10/2021 Sesi 1 08.00 - 10.00
1977 J-0****AUR FABIAN ARYA MAULANA 327605******0008 0818*****582 03/10/2021 Sesi 1 08.00 - 10.00
1978 J-0****AUT M. FATHONI 357304******0001 0857*****305 03/10/2021 Sesi 1 08.00 - 10.00
1979 J-0****AUX ZYANA FITHRI NUR FAIZAH 350707******0001 0851*****756 03/10/2021 Sesi 1 08.00 - 10.00
1980 J-0****AUZ CANTIKA PUTRI HARIANTI 357304******0007 0813*****269 03/10/2021 Sesi 1 08.00 - 10.00
1981 J-0****AV3 QONITA RAHMAWATI 630102******0002 0821*****621 03/10/2021 Sesi 1 08.00 - 10.00
1982 J-0****AWT ESTER KEREN SIMBOLON 120805******0001 0812*****110 03/10/2021 Sesi 1 08.00 - 10.00
1983 J-0****AXA DELLA PRADYANTI DEWI MAHARI 350722******0005 0822*****680 03/10/2021 Sesi 1 08.00 - 10.00
1984 J-0****AXJ FARA ANJAR SARI 357901******0006 0856*****545 03/10/2021 Sesi 1 08.00 - 10.00
1985 J-0****AXO YOLANDA KUMALADEWI 357302******0002 0815*****329 03/10/2021 Sesi 1 08.00 - 10.00
1986 J-0****AXT TASYA PERMATA AFIFAH 357305******0007 0812*****214 03/10/2021 Sesi 1 08.00 - 10.00
1987 J-0****AYR JAKA DWIPUTRA PRAKOSO 140804******0009 0821*****002 03/10/2021 Sesi 1 08.00 - 10.00
1988 J-0****AZD SUKEMPI 357302******0002 0857*****093 03/10/2021 Sesi 1 08.00 - 10.00
1989 J-0****B0K MARISA AGUSTINE 350722******0001 0881*****58 03/10/2021 Sesi 1 08.00 - 10.00
1990 J-0****B0Q FITRIANI 120723******0004 0813*****529 03/10/2021 Sesi 1 08.00 - 10.00
1991 J-0****B1E INDAH KRISTINAWATI 350721******0003 0857*****580 03/10/2021 Sesi 1 08.00 - 10.00
1992 J-0****B1L ADINDA DWI PUTRI 321609******0003 0813*****343 03/10/2021 Sesi 1 08.00 - 10.00
1993 J-0****B24 SUTOYO 357304******0002 0895*****9292 03/10/2021 Sesi 1 08.00 - 10.00
1994 J-0****B26 FIA WULANDARI 350717******0002 0895*****7713 03/10/2021 Sesi 1 08.00 - 10.00
1995 J-0****B3E DIAN WULANDARI 527106******0002 0812*****26 03/10/2021 Sesi 1 08.00 - 10.00
1996 J-0****B42 RIZKI AMALIA 350722******0001 0895*****7622 03/10/2021 Sesi 1 08.00 - 10.00
1997 J-0****B49 MUHAMMAD FIKRI BAIHAQI 351508******0007 0813*****236 03/10/2021 Sesi 1 08.00 - 10.00
1998 J-0****B59 PAKSI ADITIYA 350724******0003 0895*****3968 03/10/2021 Sesi 1 08.00 - 10.00
1999 J-0****B61 RUSIANA 357302******0002 0812*****194 03/10/2021 Sesi 1 08.00 - 10.00
2000 J-0****B66 MOCHAMAD ARIEF SATRIAJAYA 357305******0005 0858*****950 03/10/2021 Sesi 1 08.00 - 10.00
2001 J-0****B69 WILDAN RIZKY LAZUARDI 327510******0001 0812*****114 03/10/2021 Sesi 1 08.00 - 10.00
2002 J-0****B6T DEWI ANGGRAENI 350703******0002 0812*****851 03/10/2021 Sesi 1 08.00 - 10.00
2003 J-0****B7T UMRON ADE ROMADHONA 351706******0002 0813*****366 03/10/2021 Sesi 1 08.00 - 10.00
2004 J-0****B89 SINTYA AGUSTINA EKA PUTRI 352616******0001 0812*****024 03/10/2021 Sesi 1 08.00 - 10.00
2005 J-0****B8P MIRADIAH ARIEN SHINTAJAYA 357305******0006 0858*****008 03/10/2021 Sesi 1 08.00 - 10.00
2006 J-0****B9A DONNY ACHMAD RIVALDI 350718******0002 0823*****211 03/10/2021 Sesi 1 08.00 - 10.00
2007 J-0****B9G OKTAVIANI PUTRI LESTARI 352314******0001 0851*****858 03/10/2021 Sesi 1 08.00 - 10.00
2008 J-0****B9R SRI SUGIYANTI 352316******0007 0823*****158 03/10/2021 Sesi 1 08.00 - 10.00
2009 J-0****BAC WILHELMINA RIKA BINDI SARE 531606******0001 0812*****560 03/10/2021 Sesi 1 08.00 - 10.00
2010 J-0****BB8 FINA MUYASAROH 350209******0002 0819*****449 03/10/2021 Sesi 1 08.00 - 10.00
2011 J-0****BBD DANNIARY ISMAIL FARONNY 350724******0002 0838*****680 03/10/2021 Sesi 1 08.00 - 10.00
2012 J-0****BCA PRIMA HANSEN SIMARMATA 121602******0007 0852*****252 03/10/2021 Sesi 1 08.00 - 10.00
2013 J-0****BCK M DAFA ALFARIZI 357303******0001 0895*****8973 03/10/2021 Sesi 1 08.00 - 10.00

Page 48 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2014 J-0****BDY RENGGA YANA FAUZI 351518******0007 0857*****788 03/10/2021 Sesi 2 10.00 - 12.00
2015 J-0****BE0 SHALIHA RIZQINA 110612******0001 0853*****448 03/10/2021 Sesi 2 10.00 - 12.00
2016 J-0****BE7 AQILAH GOLDY APANDRA 357305******0010 0821*****047 03/10/2021 Sesi 2 10.00 - 12.00
2017 J-0****BEX RIFALDY YUHENDRI 140309******0008 0822*****025 03/10/2021 Sesi 2 10.00 - 12.00
2018 J-0****BFF LAILATUL FITRIA 357602******0004 0858*****254 03/10/2021 Sesi 2 10.00 - 12.00
2019 J-0****BGE MUHAMMAD AZKIYA 327327******0003 0896*****765 03/10/2021 Sesi 2 10.00 - 12.00
2020 J-0****BGG Renaldo Jian Selpa 352212******0004 0895*****338 03/10/2021 Sesi 2 10.00 - 12.00
2021 J-0****BGR MIQDADI MUKHTARI 360405******0003 0851*****615 03/10/2021 Sesi 2 10.00 - 12.00
2022 J-0****BGY DIAN ARTAMEVIA EKA PUTRI 351020******0004 0821*****928 03/10/2021 Sesi 2 10.00 - 12.00
2023 J-0****BHM FURQON AYATULLOH 350718******0004 0819*****864 03/10/2021 Sesi 2 10.00 - 12.00
2024 J-0****BHV SHINTA NOVADIANTI 350724******0004 0856*****923 03/10/2021 Sesi 2 10.00 - 12.00
2025 J-0****BJP HERI JULISTIYAN BIMA PUTRA 350309******0001 0877*****606 03/10/2021 Sesi 2 10.00 - 12.00
2026 J-0****BK7 ALBERDO NOMENSEN NAIBAHO 121605******0001 0852*****040 03/10/2021 Sesi 2 10.00 - 12.00
2027 J-0****BKD YAHYA HARYANTO 331908******0003 0896*****594 03/10/2021 Sesi 2 10.00 - 12.00
2028 J-0****BKR MUHAMAD ARDY DHARMAWAN 350723******0002 0821*****275 03/10/2021 Sesi 2 10.00 - 12.00
2029 J-0****BL4 FAADHILAH YOGA RAMADHANI 352514******0004 0896*****316 03/10/2021 Sesi 2 10.00 - 12.00
2030 J-0****BLQ PULJAYATI 357305******0003 0812*****073 03/10/2021 Sesi 2 10.00 - 12.00
2031 J-0****BLV ASSABIKUL AWALUN 190104******0001 0821*****706 03/10/2021 Sesi 2 10.00 - 12.00
2032 J-0****BN9 AHNAF LENTERA JAGAD 352220******0003 0898*****17 03/10/2021 Sesi 2 10.00 - 12.00
2033 J-0****BND CHRISANTUS FEMIYAJI UTAMA 140804******0012 0812*****623 03/10/2021 Sesi 2 10.00 - 12.00
2034 J-0****BO6 EGA BUDIILHAM PAMUNGKAS 327504******0013 0896*****274 03/10/2021 Sesi 2 10.00 - 12.00
2035 J-0****BOA SALLYGRESYA THEODORA DWIFELITA MATONDANG 367406******0007 0813*****818 03/10/2021 Sesi 2 10.00 - 12.00
2036 J-0****BOF AINUN QISTHI ROSYIDAH 350724******0004 0822*****017 03/10/2021 Sesi 2 10.00 - 12.00
2037 J-0****BOO SANG AYU PUTU ARISTYA DEWI 510603******0002 0821*****668 03/10/2021 Sesi 2 10.00 - 12.00
2038 J-0****BOQ STEFANNA DEWI ANDRIANTI 321606******0012 0899*****36 03/10/2021 Sesi 2 10.00 - 12.00
2039 J-0****BP8 SYAUQINA SALSABILA 327509******0006 0878*****005 03/10/2021 Sesi 2 10.00 - 12.00
2040 J-0****BPK OKTAVAN SETYA HABIBURROCHMAN 351617******0001 0812*****454 03/10/2021 Sesi 2 10.00 - 12.00
2041 J-0****BR1 MUHAMMAD FAISAL IRSYAD 327502******0019 0851*****242 03/10/2021 Sesi 2 10.00 - 12.00
2042 J-0****BR4 NICOLAS R SIBARANI 127107******0001 0878*****964 03/10/2021 Sesi 2 10.00 - 12.00
2043 J-0****BRP DONGAN HAMONANGAN SIAHAAN 121809******0002 0812*****640 03/10/2021 Sesi 2 10.00 - 12.00
2044 J-0****BS5 ANGGI KRISDIANTIKA 357304******0006 0851*****600 03/10/2021 Sesi 2 10.00 - 12.00
2045 J-0****BS6 ACHMAD SYAHREZA RAMADHAN 327503******0024 0812*****150 03/10/2021 Sesi 2 10.00 - 12.00
2046 J-0****BSO YEREMIA KEVIN SUSANTO 357810******0005 0851*****030 03/10/2021 Sesi 2 10.00 - 12.00
2047 J-0****BSR AGE MAULAL MUSTOFA 352206******0001 0881*****10 03/10/2021 Sesi 2 10.00 - 12.00
2048 J-0****BTN ASRO LAYALIL AZIZAH 520313******0002 0817*****950 03/10/2021 Sesi 2 10.00 - 12.00
2049 J-0****BU8 MIFTA MUTIARA ANNISA 627103******0003 0813*****957 03/10/2021 Sesi 2 10.00 - 12.00
2050 J-0****BUI MARIA GLORIA FALIN NUGRAENI 330122******0001 0851*****025 03/10/2021 Sesi 2 10.00 - 12.00
2051 J-0****BUM RAISA FRISKA. AR 357819******0001 0895*****9258 03/10/2021 Sesi 2 10.00 - 12.00
2052 J-0****BV9 VIA LAILI KHUSNYA 350721******0001 0857*****101 03/10/2021 Sesi 2 10.00 - 12.00
2053 J-0****BW2 BIAGGI TAKWA A 320102******0005 0813*****254 03/10/2021 Sesi 2 10.00 - 12.00
2054 J-0****BWT FAJAR OKKY MASHURY 330108******0003 0821*****860 03/10/2021 Sesi 2 10.00 - 12.00
2055 J-0****BX9 AFFAN MAULANA 367103******0002 0813*****974 03/10/2021 Sesi 2 10.00 - 12.00

Page 49 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2056 J-0****BXI ALDA EPRIDELLA 147110******0001 0823*****818 03/10/2021 Sesi 2 10.00 - 12.00
2057 J-0****BY6 IKA NUR HALIZA 350709******0004 0831*****928 03/10/2021 Sesi 2 10.00 - 12.00
2058 J-0****BYG LALU MUH. GEGER WIRETATAS 520206******0003 0859*****525 03/10/2021 Sesi 2 10.00 - 12.00
2059 J-0****BZ0 IRDHAM REIHANSYAH FAHMI 320229******0009 0813*****737 03/10/2021 Sesi 2 10.00 - 12.00
2060 J-0****BZ8 ZOHDY GOKTA SINAGA 120602******0001 0812*****452 03/10/2021 Sesi 2 10.00 - 12.00
2061 J-0****BZF MUHAMMAD HUSIEN ABDILLAH 630206******0003 0853*****637 03/10/2021 Sesi 2 10.00 - 12.00
2062 J-0****BZL JOSUA MARADEN PUTRA PANJAITAN 121219******1002 0813*****474 03/10/2021 Sesi 2 10.00 - 12.00
2063 J-0****BZX SHABRINA SISWAPUTRI 327505******0018 0896*****798 03/10/2021 Sesi 2 10.00 - 12.00
2064 J-0****C04 EVA MERIANTI SITORUS 120809******0002 0812*****921 03/10/2021 Sesi 2 10.00 - 12.00
2065 J-0****C09 GITTA MALEM ANGELIA TARIGAN 127102******0007 0896*****239 03/10/2021 Sesi 2 10.00 - 12.00
2066 J-0****C0A DHYMA ERLIAN SUSILO 350414******0003 0823*****967 03/10/2021 Sesi 2 10.00 - 12.00
2067 J-0****C0D RAINA PURBA 120820******0001 0852*****389 03/10/2021 Sesi 2 10.00 - 12.00
2068 J-0****C0N DIAN SARI GLADYS S 127103******0004 0821*****309 03/10/2021 Sesi 2 10.00 - 12.00
2069 J-0****C0V YARA ELVIANA RANI 357304******0004 0851*****506 03/10/2021 Sesi 2 10.00 - 12.00
2070 J-0****C11 DAVID RINALDY 647301******0003 0822*****623 03/10/2021 Sesi 2 10.00 - 12.00
2071 J-0****C1A NUR INTAN FITRIYANI 352426******0001 0852*****450 03/10/2021 Sesi 2 10.00 - 12.00
2072 J-0****C1B FUTUHIYAH 360412******0003 0895*****490 03/10/2021 Sesi 2 10.00 - 12.00
2073 J-0****C1F BRAMASTA ADYA DEWANTA 327611******0001 0812*****330 03/10/2021 Sesi 2 10.00 - 12.00
2074 J-0****C1N RIDHO FAHREZA RAHAWARIN 357305******0004 0851*****178 03/10/2021 Sesi 2 10.00 - 12.00
2075 J-0****C23 DIMAS ANDREAS PANGGABEAN 327703******0005 0813*****526 03/10/2021 Sesi 2 10.00 - 12.00
2076 J-0****C2I ULFIE SAFITRI 357901******0004 0819*****194 03/10/2021 Sesi 2 10.00 - 12.00
2077 J-0****C2T TANTRI HENDRAWATI 357303******0003 0817*****03 03/10/2021 Sesi 2 10.00 - 12.00
2078 J-0****C3Y MOCHAMMAD BAGAS WIDIYAKTO 327503******0012 0813*****268 03/10/2021 Sesi 2 10.00 - 12.00
2079 J-0****C4J BHISMA ALFATHAN DEWANTORO 640405******0003 0812*****449 03/10/2021 Sesi 2 10.00 - 12.00
2080 J-0****C5H BAYU SANTOSO 330602******0002 0878*****017 03/10/2021 Sesi 2 10.00 - 12.00
2081 J-0****C5P YENI LIANI SIANIPAR 127207******0001 0852*****036 03/10/2021 Sesi 2 10.00 - 12.00
2082 J-0****C6G DIMAS WAHYU BINANGUN 337304******0001 0856*****17 03/10/2021 Sesi 2 10.00 - 12.00
2083 J-0****C6U KALISTA DAMAYANTI SAPUTRA 357305******0001 0899*****96 03/10/2021 Sesi 2 10.00 - 12.00
2084 J-0****C6W FATHUL HUDA ERDIN PASA 350724******0002 0821*****139 03/10/2021 Sesi 2 10.00 - 12.00
2085 J-0****C92 JEFRI H.B. MANALU 120211******0005 0813*****089 03/10/2021 Sesi 2 10.00 - 12.00
2086 J-0****C93 HANIFAH IHZA AZIZA PURWA 357301******0008 0813*****117 03/10/2021 Sesi 2 10.00 - 12.00
2087 J-0****C9E NAHDAH MISBAHATUL LAILI 351606******0001 0813*****470 03/10/2021 Sesi 2 10.00 - 12.00
2088 J-0****C9K RISMANIA HARTANTI PUTRI YULIANING DAMAYANTI 357901******0003 0838*****179 03/10/2021 Sesi 2 10.00 - 12.00
2089 J-0****CAA DWI SATRIO MHD HAMDY 127701******0004 0813*****638 03/10/2021 Sesi 2 10.00 - 12.00
2090 J-0****CAI TAUAMANI YAMUNI SYAMS 510101******0008 0899*****12 03/10/2021 Sesi 2 10.00 - 12.00
2091 J-0****CAR MIFTACHUL ILMI 357901******0001 0838*****422 03/10/2021 Sesi 2 10.00 - 12.00
2092 J-0****CB5 MOH. IMAM ROSYIDI 352902******0002 0896*****344 03/10/2021 Sesi 2 10.00 - 12.00
2093 J-0****CB7 M LATIEFUDIN TARUNA PRATAMA 350724******0006 0896*****953 03/10/2021 Sesi 2 10.00 - 12.00
2094 J-0****CBH INTAN NURJA'A AL FARIKHAH 351008******0009 0821*****167 03/10/2021 Sesi 2 10.00 - 12.00
2095 J-0****CCF NABILA SOFIA NANDA 350725******0005 0857*****012 03/10/2021 Sesi 2 10.00 - 12.00
2096 J-0****CCJ M. Faris Mufid 157101******0041 0822*****302 03/10/2021 Sesi 2 10.00 - 12.00
2097 J-0****CCZ TITA AMALIA 357305******0002 0896*****973 03/10/2021 Sesi 2 10.00 - 12.00

Page 50 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2098 J-0****CFE jauharul majdi 640804******0009 0857*****718 03/10/2021 Sesi 2 10.00 - 12.00
2099 J-0****CGK AGUS PRAYOGA 352804******0001 0823*****223 03/10/2021 Sesi 2 10.00 - 12.00
2100 J-0****CGT DINDA MAHARTIAN YUNITA 352422******0001 0814*****256 03/10/2021 Sesi 2 10.00 - 12.00
2101 J-0****CI7 DZORIF AHSAN 367202******0002 0812*****546 03/10/2021 Sesi 2 10.00 - 12.00
2102 J-0****CIM YUDI AGUSTRI JAYA PARDEDE 910201******0001 0821*****521 03/10/2021 Sesi 2 10.00 - 12.00
2103 J-0****CIS SALMA 357304******0007 0858*****272 03/10/2021 Sesi 2 10.00 - 12.00
2104 J-0****CJF NENIK SUGIATI 357305******0001 0896*****945 03/10/2021 Sesi 2 10.00 - 12.00
2105 J-0****CJK MARTIN NARO PARDEDE 327504******0019 0821*****332 03/10/2021 Sesi 2 10.00 - 12.00
2106 J-0****CJW YOGA AFRIYANTO 367404******0003 0857*****165 03/10/2021 Sesi 2 10.00 - 12.00
2107 J-0****CJZ FATRAH SULAEMAN HUTASUHUT 127701******0003 0812*****920 03/10/2021 Sesi 2 10.00 - 12.00
2108 J-0****CK3 LORRAINE NADIA RIWIBOWO 917103******0002 0812*****685 03/10/2021 Sesi 2 10.00 - 12.00
2109 J-0****CKC LAKSAMANA FADIAN ZR 351408******0002 0851*****595 03/10/2021 Sesi 2 10.00 - 12.00
2110 J-0****CKF GRACELLA ANGELICA SAGALA 121109******0001 0852*****796 03/10/2021 Sesi 2 10.00 - 12.00
2111 J-0****CKP ERFAN NURUDIN 351023******0002 0838*****751 03/10/2021 Sesi 2 10.00 - 12.00
2112 J-0****CLB MUHAMMAD IRGA TRI OKTAMA 327328******0001 0813*****867 03/10/2021 Sesi 2 10.00 - 12.00
2113 J-0****CLK OKI DODY OCTAVIAN 351420******0005 0817*****66 03/10/2021 Sesi 2 10.00 - 12.00
2114 J-0****CLU YUDHA TRI BASKARA 121002******0002 0821*****442 03/10/2021 Sesi 2 10.00 - 12.00
2115 J-0****CLV HENDRA SAPUTRA 150904******0006 0821*****464 03/10/2021 Sesi 2 10.00 - 12.00
2116 J-0****CMQ AGUS PUTRADANA AMERTHA 517104******0004 0878*****890 03/10/2021 Sesi 2 10.00 - 12.00
2117 J-0****CN7 KARIN SANTIKA 647302******0005 0852*****728 03/10/2021 Sesi 2 10.00 - 12.00
2118 J-0****CNA ANNISA DINA KARIMAH 367403******1001 0812*****969 03/10/2021 Sesi 2 10.00 - 12.00
2119 J-0****CNT SEPHIA DEWI MEILA CHRISAPUTRI 357304******0005 0812*****893 03/10/2021 Sesi 2 10.00 - 12.00
2120 J-0****COW ERI NOVI PRIANGGA 647205******0010 0812*****482 03/10/2021 Sesi 2 10.00 - 12.00
2121 J-0****CRT BENNY ANUGRAH CHRISNAN MULIA 320103******0001 0821*****307 03/10/2021 Sesi 2 10.00 - 12.00
2122 J-0****CS4 YUDI HIDAYATULLAH 350722******0001 0858*****644 03/10/2021 Sesi 2 10.00 - 12.00
2123 J-0****CSD RENALDI YOGA WIBAWA 331025******0001 0821*****985 03/10/2021 Sesi 2 10.00 - 12.00
2124 J-0****CSJ DIAH RAHAYU WILUJENG 350719******0002 0856*****809 03/10/2021 Sesi 2 10.00 - 12.00
2125 J-0****CTK ABDUL SYUKUR 350713******0004 0812*****230 03/10/2021 Sesi 2 10.00 - 12.00
2126 J-0****CV7 SANTI AYUNING AMIN 350719******0002 0859*****239 03/10/2021 Sesi 2 10.00 - 12.00
2127 J-0****CVQ SHAFIYAH RABITH AL IZZAH 350722******0002 0838*****393 03/10/2021 Sesi 2 10.00 - 12.00
2128 J-0****CVS TALITHA SYAMSA RAHMA 330709******0002 0896*****537 03/10/2021 Sesi 2 10.00 - 12.00
2129 J-0****CVV WAHYU PUTRA MAHARDIKA 332001******0004 0857*****239 03/10/2021 Sesi 2 10.00 - 12.00
2130 J-0****CVY MUHAMAD IHSAL MAHENDRA 321309******0003 0899*****55 03/10/2021 Sesi 2 10.00 - 12.00
2131 J-0****CWF MOCH. DARIUS EVAN HANANTA 351514******0004 0877*****093 03/10/2021 Sesi 2 10.00 - 12.00
2132 J-0****CY7 HILDA SOFI 357304******0006 0857*****846 03/10/2021 Sesi 2 10.00 - 12.00
2133 J-0****CYY OSCAR YERICHO MEITRITAN 647203******0002 0878*****514 03/10/2021 Sesi 2 10.00 - 12.00
2134 J-0****D2D VINA MAFAZUTUL ULA 357501******0002 0882*****202 03/10/2021 Sesi 2 10.00 - 12.00
2135 J-0****D2R FERDINAND WIJAYA HARYONO 350606******0002 0813*****257 03/10/2021 Sesi 2 10.00 - 12.00
2136 J-0****D2X RIDWAN AZHAR 321602******0001 0813*****891 03/10/2021 Sesi 2 10.00 - 12.00
2137 J-0****D3A TRI MULYANI 357305******0015 0857*****204 03/10/2021 Sesi 2 10.00 - 12.00
2138 J-0****D6N THOHIRAH 357304******0003 0822*****665 03/10/2021 Sesi 2 10.00 - 12.00
2139 J-0****D7X RIZAL BAYU AJI PRADANA 350724******0004 0822*****548 03/10/2021 Sesi 2 10.00 - 12.00

Page 51 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2140 J-0****DAO MUSTAKIM 357302******0003 0812*****528 03/10/2021 Sesi 2 10.00 - 12.00
2141 J-0****DDB SYAMSU IMAM WAHYUDI 357305******0005 0813*****278 03/10/2021 Sesi 2 10.00 - 12.00
2142 J-0****DE0 ANDREAS LORENZO RAPHAEL PARDEDE 147109******0022 0822*****184 03/10/2021 Sesi 2 10.00 - 12.00
2143 J-0****DEI RIFANDY DWISAKSONO 367401******0001 0878*****113 03/10/2021 Sesi 2 10.00 - 12.00
2144 J-0****DPU MUHAMMAD RASYID RIDHO 357301******0002 0857*****578 03/10/2021 Sesi 2 10.00 - 12.00
2145 J-0****DQS AFIFAH RETNO UTAMI 367407******0003 0857*****723 03/10/2021 Sesi 2 10.00 - 12.00
2146 J-0****DS5 ALFA SURURINA RAMADHANA 357303******0004 0857*****202 03/10/2021 Sesi 2 10.00 - 12.00
2147 J-0****DS7 ALIFIO AL ARICKY 351816******0001 0812*****169 03/10/2021 Sesi 2 10.00 - 12.00
2148 J-0****DTF AZRA LINDU AJI 320101******0003 0812*****013 03/10/2021 Sesi 2 10.00 - 12.00
2149 J-0****DUL M. FALAH ATHTHAARIQ 357301******0002 0812*****075 03/10/2021 Sesi 2 10.00 - 12.00
2150 J-0****DVO ACHMAD TRI WAHYU WIDIARTO 350817******0001 0813*****251 03/10/2021 Sesi 2 10.00 - 12.00
2151 J-0****DXY M. RIFKI KHADAFI 330511******0002 0851*****003 03/10/2021 Sesi 2 10.00 - 12.00
2152 J-0****DYH RAKA FAUZI MITREKA 350725******0004 0813*****617 03/10/2021 Sesi 2 10.00 - 12.00
2153 J-0****DZ6 GHIFARI ADLIL BAQI 321607******0009 0813*****138 03/10/2021 Sesi 2 10.00 - 12.00
2154 J-0****DZO ADITYA BAGUS NURREZA 357303******0006 0857*****674 03/10/2021 Sesi 2 10.00 - 12.00
2155 J-0****DZU MIATIN 350409******0003 0813*****699 03/10/2021 Sesi 2 10.00 - 12.00
2156 J-0****E07 ADI SUCIPTO 352302******0002 0822*****405 03/10/2021 Sesi 2 10.00 - 12.00
2157 J-0****E0X REZA FIRDAUSI 357817******0002 0821*****889 03/10/2021 Sesi 2 10.00 - 12.00
2158 J-0****E1D ACHIRUL JAMHAR 350514******0002 0857*****106 03/10/2021 Sesi 2 10.00 - 12.00
2159 J-0****E1T DHENI FIRMANSYAH 357305******0006 0813*****354 03/10/2021 Sesi 2 10.00 - 12.00
2160 J-0****E2I EMERALDA ADHIASTRA 357803******0004 0812*****305 03/10/2021 Sesi 2 10.00 - 12.00
2161 J-0****E2O INDYANTO GADANG ALFARUKI 357301******0002 0813*****756 03/10/2021 Sesi 2 10.00 - 12.00
2162 J-0****E2W LILIS YOHANA SITINJAK 127103******0006 0819*****581 03/10/2021 Sesi 2 10.00 - 12.00
2163 J-0****E32 HARRY SETIAWAN HUTAPEA 127302******0001 0822*****442 03/10/2021 Sesi 2 10.00 - 12.00
2164 J-0****E34 ARIN WAHYUNI ARIANTO 350718******0006 0896*****596 03/10/2021 Sesi 2 10.00 - 12.00
2165 J-0****E3O EVA SAFITRI 321505******0003 0858*****847 03/10/2021 Sesi 2 10.00 - 12.00
2166 J-0****E4Z CINDY CHARLA AGNESIA 731805******0001 0813*****517 03/10/2021 Sesi 2 10.00 - 12.00
2167 J-0****E52 AHMAD MUZAKI 327505******0011 0821*****399 03/10/2021 Sesi 2 10.00 - 12.00
2168 J-0****E5A KHAIRUNNISA LUTHFIA 117405******0001 0822*****686 03/10/2021 Sesi 2 10.00 - 12.00
2169 J-0****E5J IMMANUEL TRI PUTRA SIHALOHO 121101******0002 0813*****399 03/10/2021 Sesi 2 10.00 - 12.00
2170 J-0****E85 SARAH MEGAWATI HUTAHAEAN 127108******0003 0821*****666 03/10/2021 Sesi 2 10.00 - 12.00
2171 J-0****EA6 R.E.ASI ARMANDO DAMANIK 121101******0003 0852*****733 03/10/2021 Sesi 2 10.00 - 12.00
2172 J-0****EB3 MUAMMAR IKHSAN 360312******0005 0858*****786 03/10/2021 Sesi 2 10.00 - 12.00
2173 J-0****EBM SELA VALENTINA AMBARITA 127201******0001 0859*****958 03/10/2021 Sesi 2 10.00 - 12.00
2174 J-0****EC5 NIXON PATRICK CALVIN SIANIPAR 367406******0005 0813*****458 03/10/2021 Sesi 2 10.00 - 12.00
2175 J-0****ECF NURFALAH SILITONGA 120115******0003 0822*****699 03/10/2021 Sesi 2 10.00 - 12.00
2176 J-0****ECK ANADHEA MELINDA 350626******0003 0812*****783 03/10/2021 Sesi 2 10.00 - 12.00
2177 J-0****ECV AURA ISMA SALSABILA PRIYAMBODO 357303******0004 0821*****124 03/10/2021 Sesi 2 10.00 - 12.00
2178 J-0****ED8 MUHAMMAD ZULFIKRI MAULANA 321605******0005 0812*****853 03/10/2021 Sesi 2 10.00 - 12.00
2179 J-0****EDB IDA AYU SHITADEVI 350722******0001 0878*****101 03/10/2021 Sesi 2 10.00 - 12.00
2180 J-0****EDV MUHAMMAD SYUHADA 127108******0001 0821*****583 03/10/2021 Sesi 2 10.00 - 12.00
2181 J-0****EDW NABILAH RAHMA 350724******0003 0823*****790 03/10/2021 Sesi 2 10.00 - 12.00

Page 52 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2182 J-0****EE1 ELIAS SATRIA H LUMBAN RAJA 327512******0001 0813*****823 03/10/2021 Sesi 2 10.00 - 12.00
2183 J-0****EEK ROMZI 'IZZUDDIN AUFA 350216******0001 0838*****527 03/10/2021 Sesi 2 10.00 - 12.00
2184 J-0****EEP NAWANG AJENG HAKSORO 337301******0001 0878*****007 03/10/2021 Sesi 2 10.00 - 12.00
2185 J-0****EEY DWINOVEN LUMBAN TOBING 121114******0002 0822*****164 03/10/2021 Sesi 2 10.00 - 12.00
2186 J-0****EFD RIRIS WALADATUN NAFI'AH 352419******0003 0856*****386 03/10/2021 Sesi 2 10.00 - 12.00
2187 J-0****EFH MASDALIPA RISKI SARI SIHOTANG 121609******0003 0822*****617 03/10/2021 Sesi 2 10.00 - 12.00
2188 J-0****EG0 MEILA MILLATIE FITHRI 320925******0003 0897*****51 03/10/2021 Sesi 2 10.00 - 12.00
2189 J-0****EG7 SITI JUMROATI SOLEKAH 350606******0001 0857*****460 03/10/2021 Sesi 2 10.00 - 12.00
2190 J-0****EG8 MAGDALENA SIHOTANG 367404******0003 0817*****233 03/10/2021 Sesi 2 10.00 - 12.00
2191 J-0****EGH YUDA HARTATOK 320107******0007 0822*****578 03/10/2021 Sesi 2 10.00 - 12.00
2192 J-0****EGS PUPUT NURUL HIDAYAH 350717******0005 0857*****597 03/10/2021 Sesi 2 10.00 - 12.00
2193 J-0****EHC VIANTA MANDHALIKA 351908******0003 0812*****801 03/10/2021 Sesi 2 10.00 - 12.00
2194 J-0****EHL M. RIDWAN. F 137503******0001 0852*****030 03/10/2021 Sesi 2 10.00 - 12.00
2195 J-0****EHR UNUN MULIYANA SANJAYA 350723******0001 0851*****677 03/10/2021 Sesi 2 10.00 - 12.00
2196 J-0****EID HUSNUL HIDAYATI 187201******0003 0822*****263 03/10/2021 Sesi 2 10.00 - 12.00
2197 J-0****EIE ROVIFAH MAWARIDA 352006******0001 0821*****589 03/10/2021 Sesi 2 10.00 - 12.00
2198 J-0****EII BERLANIA MAHARDIKA PUTRI 357304******0002 0896*****893 03/10/2021 Sesi 2 10.00 - 12.00
2199 J-0****EIR SARA IRAWATI 350723******0003 0821*****621 03/10/2021 Sesi 2 10.00 - 12.00
2200 J-0****EIS MUHAMMAD ZAKI PRADIPTA 327502******0013 0812*****687 03/10/2021 Sesi 2 10.00 - 12.00
2201 J-0****EIZ RAIHAN NAUFAL SHAFA 357102******0002 0812*****653 03/10/2021 Sesi 2 10.00 - 12.00
2202 J-0****EJW ANDINI WAHYU RESTUTI 350712******0001 0813*****931 03/10/2021 Sesi 2 10.00 - 12.00
2203 J-0****EK4 EGI PRADANA 357304******0006 0878*****197 03/10/2021 Sesi 2 10.00 - 12.00
2204 J-0****EK6 BELLA AISYA ROHMAWATI 357304******0003 0838*****602 03/10/2021 Sesi 2 10.00 - 12.00
2205 J-0****EL2 BENEDIKTUS HERDIANTO ADHI NUGROHO 350815******0001 0851*****536 03/10/2021 Sesi 2 10.00 - 12.00
2206 J-0****EL8 AYU MIRANDA RISKI 357305******0001 0853*****869 03/10/2021 Sesi 2 10.00 - 12.00
2207 J-0****ELA MUHAMMAD REYHAN NANDA PRATAMA 737110******0005 0812*****617 03/10/2021 Sesi 2 10.00 - 12.00
2208 J-0****ELB NAFTALIE A BILL FATA 320503******2600 0878*****531 03/10/2021 Sesi 2 10.00 - 12.00
2209 J-0****ELJ MUHAMMAD RIFKI 351508******0007 0812*****825 03/10/2021 Sesi 2 10.00 - 12.00
2210 J-0****EM9 ANGGI REKSYA 217103******0009 0812*****242 03/10/2021 Sesi 2 10.00 - 12.00
2211 J-0****EMC MUHAMMAD DIVA DALAHMAS 520412******0001 0852*****730 03/10/2021 Sesi 2 10.00 - 12.00
2212 J-0****EMI RIZKI GANDA GIRINADA 350815******0001 0813*****993 03/10/2021 Sesi 2 10.00 - 12.00
2213 J-0****EMO YUSTIZA RAHADIAN SETIAWAN 320405******0010 0877*****145 03/10/2021 Sesi 2 10.00 - 12.00
2214 J-0****EMQ IMAGO LAVELIA DEI 350613******0001 0838*****776 03/10/2021 Sesi 2 10.00 - 12.00
2215 J-0****EMS NORMAND MAULANA MASHARY 340405******0003 0813*****058 03/10/2021 Sesi 2 10.00 - 12.00
2216 J-0****EMT ADNAN FAIZ BASYARAHIL 327505******0002 0813*****270 03/10/2021 Sesi 2 10.00 - 12.00
2217 J-0****EMW YUDHI LAU LAM TAMSASHU NAR 352920******0002 0813*****384 03/10/2021 Sesi 2 10.00 - 12.00
2218 J-0****EMX RAMADHAN 130511******0001 0813*****752 03/10/2021 Sesi 2 10.00 - 12.00
2219 J-0****EN5 I GUSTI RADITYA IRSYAD PRADHANA 337402******0001 0877*****190 03/10/2021 Sesi 2 10.00 - 12.00
2220 J-0****EN6 PANGERAN RHAMA HELMI 327502******0014 0812*****297 03/10/2021 Sesi 2 10.00 - 12.00
2221 J-0****ENE YANG YANG ILALANG SYABANA 350921******0005 0813*****749 03/10/2021 Sesi 2 10.00 - 12.00
2222 J-0****ENK RIAN PRIYO HARDI 350722******0003 0813*****780 03/10/2021 Sesi 2 10.00 - 12.00
2223 J-0****ENP NAUFAL DINDAN FIRDAUS 327603******0015 0812*****863 03/10/2021 Sesi 2 10.00 - 12.00

Page 53 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2224 J-0****ENR RIFQAH RACHMAWATI 357304******0005 0813*****058 03/10/2021 Sesi 2 10.00 - 12.00
2225 J-0****ENT WAHYU FATIHAH FHOENNA 110607******0001 0851*****873 03/10/2021 Sesi 2 10.00 - 12.00
2226 J-0****ENY MUHAMMAD ALFARISY AMRUL 327325******0001 0823*****206 03/10/2021 Sesi 2 10.00 - 12.00
2227 J-0****EO5 RIDHO NUZULLAH SUHAIB 140502******0001 0821*****334 03/10/2021 Sesi 2 10.00 - 12.00
2228 J-0****EOL ARDILLAH SEPTINIA IWANDA 357303******0001 0822*****347 03/10/2021 Sesi 2 10.00 - 12.00
2229 J-0****EOP MUHAMMAD WAHYU FIKRI ANANDA 730608******0005 0853*****045 03/10/2021 Sesi 2 10.00 - 12.00
2230 J-0****EOZ HEAVEN JOSIAH HARVAN 360317******0002 0812*****945 03/10/2021 Sesi 2 10.00 - 12.00
2231 J-0****EP7 VADIA CAHYANI 357301******0006 0822*****271 03/10/2021 Sesi 2 10.00 - 12.00
2232 J-0****EPZ SILVIA KARUNIA AIDINA 350705******0001 0823*****382 03/10/2021 Sesi 2 10.00 - 12.00
2233 J-0****ERM DIMAS ADITYA NAVY ANTO 320106******0006 0821*****494 03/10/2021 Sesi 2 10.00 - 12.00
2234 J-0****ES6 MUHAMMAD FARHAN IDAMI 110802******0001 0853*****608 03/10/2021 Sesi 2 10.00 - 12.00
2235 J-0****ESI ALVIANA MAWADDATUN NAFI'AH 350313******0001 0823*****753 03/10/2021 Sesi 2 10.00 - 12.00
2236 J-0****ESP ELDHA ANDRIANA AFRISANDHY 350726******0002 0882*****602 03/10/2021 Sesi 2 10.00 - 12.00
2237 J-0****ET2 ALBERT RANDA 627101******0005 0822*****551 03/10/2021 Sesi 2 10.00 - 12.00
2238 J-0****ETH MAFAZA ABDURRAHMAN 337402******0009 0858*****143 03/10/2021 Sesi 2 10.00 - 12.00
2239 J-0****ETY ALFIAN INDRA PRASETYA 350722******0001 0812*****662 03/10/2021 Sesi 2 10.00 - 12.00
2240 J-0****EUG JAKA SURYATAMA 647302******0002 0821*****725 03/10/2021 Sesi 2 10.00 - 12.00
2241 J-0****EUH BILL KENNY HUTAGALUNG 147105******0002 0822*****444 03/10/2021 Sesi 2 10.00 - 12.00
2242 J-0****EUW MUHAMAD ZEIN ALI IDRUS 357303******0004 0857*****942 03/10/2021 Sesi 2 10.00 - 12.00
2243 J-0****EV8 HENDRI PURNOMO 527105******0003 0878*****220 03/10/2021 Sesi 2 10.00 - 12.00
2244 J-0****EV9 ADE BAGUS WIJANARTA 351413******0001 0857*****426 03/10/2021 Sesi 2 10.00 - 12.00
2245 J-0****EVG MUHAMMAD TIO SUPRATAMA 320428******0004 0856*****633 03/10/2021 Sesi 2 10.00 - 12.00
2246 J-0****EWY FAHRYL ADNAN ALIFIAR 357305******0005 0882*****881 03/10/2021 Sesi 2 10.00 - 12.00
2247 J-0****F0I ELY KUSRINI 331804******0001 0823*****236 03/10/2021 Sesi 2 10.00 - 12.00
2248 J-0****F17 HARRYSON MARTUA MANIK 127204******0001 0853*****858 03/10/2021 Sesi 2 10.00 - 12.00
2249 J-0****F1L ERSITA RAHAJENG WIBOWO 352516******0001 0851*****204 03/10/2021 Sesi 2 10.00 - 12.00
2250 J-0****F20 MUHAMMAD RAFI ADZANY 357501******0001 0898*****89 03/10/2021 Sesi 2 10.00 - 12.00
2251 J-0****F4H RESTU PURNOMO AJI DARYANTO 357301******0003 0812*****359 03/10/2021 Sesi 2 10.00 - 12.00
2252 J-0****F8P YULINDA DWI CAHYANINGTYAS 351301******0001 0856*****412 03/10/2021 Sesi 2 10.00 - 12.00
2253 J-0****F97 KUSWANTI 350716******0002 0877*****287 03/10/2021 Sesi 2 10.00 - 12.00
2254 J-0****FC0 RISANO FARISTA NANDA ILDAMA 350718******0003 0899*****14 03/10/2021 Sesi 2 10.00 - 12.00
2255 J-0****FD1 ADITYA ZULFA NAJIB 321606******0020 0851*****389 03/10/2021 Sesi 2 10.00 - 12.00
2256 J-0****FD9 AQIL GILANG PRATAMA 327503******0001 0812*****982 03/10/2021 Sesi 2 10.00 - 12.00
2257 J-0****FDT KAMILA MARITSHA 350714******0001 0858*****104 03/10/2021 Sesi 2 10.00 - 12.00
2258 J-0****FDY DENDI ALGA UTAMA 357305******0002 0856*****023 03/10/2021 Sesi 2 10.00 - 12.00
2259 J-0****FE9 CAHYA AJINUGRAHA 350308******0001 0822*****336 03/10/2021 Sesi 2 10.00 - 12.00
2260 J-0****FFH IVAN ZUNANDA AUFAR 357303******0001 0858*****316 03/10/2021 Sesi 2 10.00 - 12.00
2261 J-0****FGJ HABIB RA'UF 147101******0002 0822*****317 03/10/2021 Sesi 2 10.00 - 12.00
2262 J-0****FHX NOVITA PRAMESTININGRUM 350701******0001 0812*****163 03/10/2021 Sesi 2 10.00 - 12.00
2263 J-0****FI8 MUHAMMAD ANDHIKA GYMNASTIAR 350721******0002 0822*****399 03/10/2021 Sesi 2 10.00 - 12.00
2264 J-0****FIC AKBAR ALFAIZI 357903******0002 0821*****580 03/10/2021 Sesi 2 10.00 - 12.00
2265 J-0****FIR AGUNG MAULANA YUSUP 327105******0011 0813*****080 03/10/2021 Sesi 2 10.00 - 12.00

Page 54 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2266 J-0****FIU AHMAD FATIH HAQINAIN 320408******0011 0858*****832 03/10/2021 Sesi 2 10.00 - 12.00
2267 J-0****FJ2 AULIARIFKA AYUHILDAN THOYIBAH 357305******0007 0858*****831 03/10/2021 Sesi 2 10.00 - 12.00
2268 J-0****FJ7 AHMAD HIRSON KHOIRI 187109******0005 0822*****910 03/10/2021 Sesi 2 10.00 - 12.00
2269 J-0****FJ9 ILHAM SATRIYO PINANDITO 347114******0001 0821*****056 03/10/2021 Sesi 2 10.00 - 12.00
2270 J-0****FKX IVAN BINTANG ARFIANSYAH 350217******0004 0812*****782 03/10/2021 Sesi 2 10.00 - 12.00
2271 J-0****FN9 GOVANDO AGES DIKDAYAN 351507******0001 0878*****186 03/10/2021 Sesi 2 10.00 - 12.00
2272 J-0****FNF MUHAMMAD ILHAM 327101******0014 0878*****333 03/10/2021 Sesi 2 10.00 - 12.00
2273 J-0****FP2 AFILIA MUSAQQIFAH ZAHRA 332101******0003 0878*****496 03/10/2021 Sesi 2 10.00 - 12.00
2274 J-0****FPX HUSEIN NASHRULLAH 320512******0006 0821*****135 03/10/2021 Sesi 2 10.00 - 12.00
2275 J-0****FPY BUANA TRI NUGROHO 617105******0005 0812*****128 03/10/2021 Sesi 2 10.00 - 12.00
2276 J-0****FQH SHELYA ANDINI WIBOWO 357301******0002 0813*****859 03/10/2021 Sesi 2 10.00 - 12.00
2277 J-0****FQV M HANIF AZHARY 127102******0001 0857*****000 03/10/2021 Sesi 2 10.00 - 12.00
2278 J-0****FRP LENIA CENDRANA PRANATA 350214******0001 0853*****819 03/10/2021 Sesi 2 10.00 - 12.00
2279 J-0****FSG INDAH ANGGRESTI 617105******0003 0813*****001 03/10/2021 Sesi 2 10.00 - 12.00
2280 N-C****668 STEPHANIE DWI HAPSARI PRABOWO,S.Kep.Ners 350704******0002 0853*****568 03/10/2021 Sesi 2 10.00 - 12.00
2281 N-E****3C0 DYAH KUSUMANING WARDHANI 352219******0003 0822*****201 03/10/2021 Sesi 2 10.00 - 12.00
2282 N-F****580 ANIENTYA PROFITA ALDILLA 357302******0006 0857*****007 03/10/2021 Sesi 2 10.00 - 12.00
2283 P-0****J7Q DEA ALYA SETYANI 350726******0001 0815*****114 03/10/2021 Sesi 2 10.00 - 12.00
2284 P-0****H24 LASIATIN 357304******0008 0812*****484 03/10/2021 Sesi 2 10.00 - 12.00
2285 P-0****2PQ PRAMBUDY HARI WIDYASTANTO 357305******0003 0813*****607 03/10/2021 Sesi 2 10.00 - 12.00
2286 P-1****NUV ACHMAT TAUFIK HIDAYAT 350712******0003 0858*****237 03/10/2021 Sesi 2 10.00 - 12.00
2287 P-1****DFJ BUDI DARIYANTO WARDANI PUTRA 350712******0001 0858*****109 03/10/2021 Sesi 2 10.00 - 12.00
2288 P-1****ZR5 DAMIANUS DEWA PRATAMA 350723******0001 0823*****019 03/10/2021 Sesi 2 10.00 - 12.00
2289 P-1****6TD YOGI SAPUTRA 332710******0081 0878*****580 03/10/2021 Sesi 2 10.00 - 12.00
2290 P-1****KXN RIKA HARSO FETRIANI 350712******0003 0812*****733 03/10/2021 Sesi 2 10.00 - 12.00
2291 P-1****M17 CANIA ASFIANA PRATIWI 350724******0004 0822*****662 03/10/2021 Sesi 2 10.00 - 12.00
2292 P-1****1BE SISKA SILVIA IINDARWATI 351712******0001 0857*****655 03/10/2021 Sesi 2 10.00 - 12.00
2293 P-1****62O SISKA WIDAYANTI 351808******0002 0823*****963 03/10/2021 Sesi 2 10.00 - 12.00
2294 P-1****F6U DWI SAPTANIKA 160220******0004 0852*****131 03/10/2021 Sesi 2 10.00 - 12.00
2295 P-1****LZ9 AHMAD NUR ILHAM 357304******0002 0858*****576 03/10/2021 Sesi 2 10.00 - 12.00
2296 P-1****BEB ERLY THRESIA DEWI 621301******0011 0822*****540 03/10/2021 Sesi 2 10.00 - 12.00
2297 P-1****5UR Rizka Dian Puspita 357301******0003 0819*****148 03/10/2021 Sesi 2 10.00 - 12.00
2298 P-1****MRM TRI PENI SUDIANTI 350722******0001 0812*****44 03/10/2021 Sesi 2 10.00 - 12.00
2299 P-1****C87 ENI SULISTYAWATI 357301******0001 0812*****707 03/10/2021 Sesi 2 10.00 - 12.00
2300 P-1****WG4 RIZKIA RAMADHANI 910901******0001 0857*****173 03/10/2021 Sesi 2 10.00 - 12.00
2301 P-1****5ST DIANA 357305******0004 0896*****213 03/10/2021 Sesi 2 10.00 - 12.00
2302 P-1****X7Q KARTIKA TRI WAHYUNINGRUM 357305******0002 0812*****765 03/10/2021 Sesi 2 10.00 - 12.00
2303 P-1****LIB FADLILATUR ROCHIMAH 352516******0001 0812*****824 03/10/2021 Sesi 2 10.00 - 12.00
2304 P-1****FOI Dhea Tikha Qurrota A'yun 357305******0001 0877*****302 03/10/2021 Sesi 2 10.00 - 12.00
2305 P-1****KOP EVA APRILLIA 357305******0006 0813*****975 03/10/2021 Sesi 2 10.00 - 12.00
2306 P-1****SO7 SHIWA PANDUWIJAYA 357305******0003 0895*****0170 03/10/2021 Sesi 2 10.00 - 12.00
2307 P-2****UDB TRI HASTININGRUM 321602******0005 0857*****778 03/10/2021 Sesi 2 10.00 - 12.00

Page 55 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2308 P-2****DA5 MUHAMAD SALEH TOHA 321602******0001 0812*****454 03/10/2021 Sesi 2 10.00 - 12.00
2309 P-2****S5B RADIX FEHRNANDA DIPOYONO 327310******0004 0821*****011 03/10/2021 Sesi 2 10.00 - 12.00
2310 P-2****KL2 ADELIA AYU PRITYANI 617106******0001 0856*****569 03/10/2021 Sesi 2 10.00 - 12.00
2311 P-2****RIL RIDFANNYKA ALENSI 121315******0003 0822*****710 03/10/2021 Sesi 2 10.00 - 12.00
2312 P-2****9GY ANATHASYA MAHAR ATANTA 357304******0002 0821*****948 03/10/2021 Sesi 2 10.00 - 12.00
2313 P-2****XBK EKO WAHYU BUDI UTOMO 357305******0003 0813*****240 03/10/2021 Sesi 2 10.00 - 12.00
2314 P-2****WQ3 Rangga Wisna Prayoga 350217******0003 0821*****009 03/10/2021 Sesi 2 10.00 - 12.00
2315 P-2****2GZ FAJAR KURNIA BAIHAQI 352510******0001 0895*****101 03/10/2021 Sesi 2 10.00 - 12.00
2316 P-2****OG6 MIFTAHUL NIKMAH 357305******0003 0812*****686 03/10/2021 Sesi 2 10.00 - 12.00
2317 P-2****SXN SHINTA RATNASARI 357305******0016 0852*****003 03/10/2021 Sesi 2 10.00 - 12.00
2318 P-2****2GX IFAN MUHDHORI 350722******0002 0812*****686 03/10/2021 Sesi 2 10.00 - 12.00
2319 P-2****QBO MUKHAMMAD AMERUL BIN MOHD MOKHTAR 190070******0060 0812*****175 03/10/2021 Sesi 2 10.00 - 12.00
2320 P-2****Q61 NUR BUAT 357305******0004 0815*****299 03/10/2021 Sesi 2 10.00 - 12.00
2321 P-2****RDF AGENG PRASETYO 330902******0003 0858*****351 03/10/2021 Sesi 2 10.00 - 12.00
2322 P-2****ZXY RAFIF ADI PERMANA BERKAH 357302******0002 0877*****797 03/10/2021 Sesi 2 10.00 - 12.00
2323 P-3****J3N FITRIA RAMADHANI 357303******0003 0857*****350 03/10/2021 Sesi 2 10.00 - 12.00
2324 P-3****FSW ACHMAD MURSYIDAN AZIZI 357303******0004 0881*****5602 03/10/2021 Sesi 2 10.00 - 12.00
2325 P-3****ENP Sofika Henik Rusdiana 357305******0005 0856*****541 03/10/2021 Sesi 2 10.00 - 12.00
2326 P-3****25H REVIDYAH ANINDITA PUTRI 357303******0002 0897*****80 03/10/2021 Sesi 2 10.00 - 12.00
2327 P-3****CHG ANANTA SEBASTIAN 357301******0001 0813*****165 03/10/2021 Sesi 2 10.00 - 12.00
2328 P-3****KG3 MARJUKI 357305******0007 0852*****177 03/10/2021 Sesi 2 10.00 - 12.00
2329 P-3****YLK OTHMAN HIZBULLAH M 357305******0002 0822*****111 03/10/2021 Sesi 2 10.00 - 12.00
2330 P-3****BQS HASANUL MAARIF NAPITUPULU 120921******0001 0813*****989 03/10/2021 Sesi 2 10.00 - 12.00
2331 P-3****XAM NAILUS SA'ADAH 352516******0002 0881*****4749 03/10/2021 Sesi 2 10.00 - 12.00
2332 P-3****KU6 SAKINA KHOIRUNNISA 350619******0002 0822*****434 03/10/2021 Sesi 2 10.00 - 12.00
2333 P-3****DRL VICKA MARCELLIA INDRIAWATI 350729******0002 0822*****104 03/10/2021 Sesi 2 10.00 - 12.00
2334 P-3****9QS KARNOTO 350721******0006 0857*****845 03/10/2021 Sesi 2 10.00 - 12.00
2335 P-3****BK2 SUYARNI 350721******0009 0858*****302 03/10/2021 Sesi 2 10.00 - 12.00
2336 P-3****SHK MAKHDIYAH FITRI SHUROYANI 350821******0002 0896*****314 03/10/2021 Sesi 2 10.00 - 12.00
2337 P-3****TS5 TI'KANI 350721******0002 0815*****309 03/10/2021 Sesi 2 10.00 - 12.00
2338 P-3****7GN SADAM LAKSAMANA SUKARNO 350719******0002 0896*****974 03/10/2021 Sesi 2 10.00 - 12.00
2339 P-3****B7H SITI LAILATUS SA'ADAH 351006******0002 0821*****164 03/10/2021 Sesi 2 10.00 - 12.00
2340 P-3****KYN FIRDAUS IGNATIUS LUHUNG 351010******0005 0878*****986 03/10/2021 Sesi 2 10.00 - 12.00
2341 P-3****QIN RAHMA DIAN HANIFARIZANI 357203******0008 0853*****900 03/10/2021 Sesi 2 10.00 - 12.00
2342 P-4****YCA DINI TRI MAHARANI 350723******0002 0815*****637 03/10/2021 Sesi 2 10.00 - 12.00
2343 P-4****GTO GALUH DYAH PITALOKA HAYYU 357901******0006 0896*****947 03/10/2021 Sesi 2 10.00 - 12.00
2344 P-4****10X DWI ASIH ANDARWATI 357901******0005 0857*****349 03/10/2021 Sesi 2 10.00 - 12.00
2345 P-4****RQ4 GINA DE NISA 630305******0004 0897*****73 03/10/2021 Sesi 2 10.00 - 12.00
2346 P-4****8CP DAHNER JEREMIA SIANTURI 127107******0001 0822*****807 03/10/2021 Sesi 2 10.00 - 12.00
2347 P-4****GB2 ABID NIZAR ZUHDI 350921******0011 0822*****882 03/10/2021 Sesi 2 10.00 - 12.00
2348 P-4****C6E SITI ROCHANI 357305******0007 0855*****393 03/10/2021 Sesi 2 10.00 - 12.00
2349 P-4****CBH SUPARMAN 357305******0002 0853*****019 03/10/2021 Sesi 2 10.00 - 12.00

Page 56 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2350 P-4****P1Y ISMARANI 910901******0001 0812*****310 03/10/2021 Sesi 2 10.00 - 12.00
2351 P-4****TI2 MUCHAMMAD IMAM MUZAKKI 351408******0001 0818*****515 03/10/2021 Sesi 2 10.00 - 12.00
2352 P-4****7NX MOHAMMAD NAUFAL ATTHORIQ 357305******0004 0813*****050 03/10/2021 Sesi 2 10.00 - 12.00
2353 P-4****K8I YOYOK SUWIKNYO 352410******0002 0823*****712 03/10/2021 Sesi 2 10.00 - 12.00
2354 P-4****JJK ALFINA AYU MAGHFIROH 217104******0005 0822*****559 03/10/2021 Sesi 2 10.00 - 12.00
2355 P-4****VRJ AGUS PITOLIYUS 351408******0007 0856*****88 03/10/2021 Sesi 2 10.00 - 12.00
2356 P-4****THT M. IQBAL FIRMANSYAH 357305******0005 0813*****409 03/10/2021 Sesi 2 10.00 - 12.00
2357 P-4****OZH ERLIA MAY NOORLAYLA 357305******0004 0813*****946 03/10/2021 Sesi 2 10.00 - 12.00
2358 P-5****Z0B NURUL FAUZIAH 350724******0001 0856*****58 03/10/2021 Sesi 2 10.00 - 12.00
2359 P-5****TCF HUSNI BAHTIAR 357302******0002 0812*****244 03/10/2021 Sesi 2 10.00 - 12.00
2360 P-5****AWK ISY ZUHDAN NADHIF ASSAIFY 357801******0011 0821*****404 03/10/2021 Sesi 2 10.00 - 12.00
2361 P-5****YTA ANANDA HERYANTO 332401******0001 0812*****070 03/10/2021 Sesi 2 10.00 - 12.00
2362 P-5****NMV EKADION MAULANA 357305******0006 0815*****772 03/10/2021 Sesi 2 10.00 - 12.00
2363 P-5****WWE ILHAM MAULANA ASYARI 357301******0002 0821*****200 03/10/2021 Sesi 2 10.00 - 12.00
2364 P-5****Q7G SIYAMI FITRIYAH 357305******0004 0897*****43 03/10/2021 Sesi 2 10.00 - 12.00
2365 P-5****LG9 Chusnul Chotimah 357305******0006 0856*****305 03/10/2021 Sesi 2 10.00 - 12.00
2366 P-5****581 NURIATININGSIH 357305******0003 0896*****173 03/10/2021 Sesi 2 10.00 - 12.00
2367 P-5****QY1 WOZINUL MAULA 350733******0003 0857*****723 03/10/2021 Sesi 2 10.00 - 12.00
2368 P-5****MLM CATUR KOKO PRASETYO 350720******0001 0813*****704 03/10/2021 Sesi 2 10.00 - 12.00
2369 P-6****5MG MUCHAMAD FAUZAN ADZIM 350809******0002 0895*****040 03/10/2021 Sesi 2 10.00 - 12.00
2370 P-6****E48 AGHA THARIQ SUGIJANTO 351507******0002 0838*****746 03/10/2021 Sesi 2 10.00 - 12.00
2371 P-6****LUC IKRAR HAKIKI 321606******0010 0878*****601 03/10/2021 Sesi 2 10.00 - 12.00
2372 P-6****7L9 MUHAMMAD SHAFWAN HERNIKAIANSYAH 637101******0012 0812*****800 03/10/2021 Sesi 2 10.00 - 12.00
2373 P-6****FSW Enik Hariyati 640304******0001 0813*****354 03/10/2021 Sesi 2 10.00 - 12.00
2374 P-6****BND ACHMAD YUSTOFI 357303******0001 0812*****446 03/10/2021 Sesi 2 10.00 - 12.00
2375 P-7****60U FITRIAWATI 350723******0009 0815*****603 03/10/2021 Sesi 2 10.00 - 12.00
2376 P-7****6XF LINDA LASTRINI 350723******0001 0857*****396 03/10/2021 Sesi 2 10.00 - 12.00
2377 P-7****VK7 SUKARIAWATI 350723******0001 0822*****185 03/10/2021 Sesi 2 10.00 - 12.00
2378 P-7****ELV SYAIYAH ULFAH 357305******0007 0895*****1854 03/10/2021 Sesi 2 10.00 - 12.00
2379 P-7****0AV TITANIA RIDA AYUS'TIA 357305******0001 0812*****262 03/10/2021 Sesi 2 10.00 - 12.00
2380 P-8****818 DENIS TAUFIK TRI WIBOWO 350726******0001 0857*****134 03/10/2021 Sesi 2 10.00 - 12.00
2381 P-8****CDM CITRA BENING NATALIA 350907******0001 0857*****962 03/10/2021 Sesi 2 10.00 - 12.00
2382 P-8****66E LAKSONO PROBO PRASETYO 357301******0004 0812*****661 03/10/2021 Sesi 2 10.00 - 12.00
2383 P-8****XHR MUHAMMAD AJI DZAKY RUSIDY 327501******0011 0877*****700 03/10/2021 Sesi 2 10.00 - 12.00
2384 P-8****QDC ACHMAD FIRDAUSILLAH GALIH 357302******0003 0821*****922 03/10/2021 Sesi 2 10.00 - 12.00
2385 P-8****4ZH SYAKIRA KAMILAH HANAFIAH 167106******0009 0882*****737 03/10/2021 Sesi 2 10.00 - 12.00
2386 P-9****6CB MUH IVAN MURDIANTO 357903******0002 0815*****496 03/10/2021 Sesi 2 10.00 - 12.00
2387 P-9****ORR DZURROTUN NUR AISYAH 180301******0006 0822*****218 03/10/2021 Sesi 2 10.00 - 12.00
2388 P-9****QI1 ELVIA KHOYRUNISSA 352403******0003 0857*****494 03/10/2021 Sesi 2 10.00 - 12.00
2389 P-9****AFI MUHAMMAD YUSUF ZULFIKAR 350216******0002 0882*****753 03/10/2021 Sesi 2 10.00 - 12.00
2390 P-9****961 DAVID ARDYANTO 357302******0005 0818*****881 03/10/2021 Sesi 2 10.00 - 12.00
2391 P-9****ZA0 NUR DESIANTI 740703******0001 0822*****742 03/10/2021 Sesi 2 10.00 - 12.00

Page 57 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2392 P-9****W3U VERONICA NADILLA DAMAYANTI 357302******0001 0813*****050 03/10/2021 Sesi 2 10.00 - 12.00
2393 P-9****KSM I MADE WAHYU ANGGARAPUTRA 510201******0001 0812*****261 03/10/2021 Sesi 2 10.00 - 12.00
2394 P-9****4MJ Iswanti 350718******0002 0821*****474 03/10/2021 Sesi 2 10.00 - 12.00
2395 P-9****23G BELLA KANZA PERMATASARI 350713******0004 0813*****836 03/10/2021 Sesi 2 10.00 - 12.00
2396 P-9****API FITRI ENDRIANI 357304******0004 0821*****789 03/10/2021 Sesi 2 10.00 - 12.00
2397 P-9****B9U NAUFAL HANIF AR-RASYAD 640304******0001 0819*****655 03/10/2021 Sesi 2 10.00 - 12.00
2398 P-A****PMC MOCHAMMAD ANDHIKA BAYU ARDHA 350722******0003 0899*****62 03/10/2021 Sesi 2 10.00 - 12.00
2399 P-A****GNG Fia Aprilia Dewi 357305******0002 0895*****121 03/10/2021 Sesi 2 10.00 - 12.00
2400 P-A****MSE DWI PUSPITA KINANTI 357304******0005 0812*****039 03/10/2021 Sesi 2 10.00 - 12.00
2401 P-A****GIK YANUAR RISWADIANTO 350722******0004 0881*****91 03/10/2021 Sesi 2 10.00 - 12.00
2402 P-A****APT Iin Wahyuni 350707******0004 0814*****945 03/10/2021 Sesi 2 10.00 - 12.00
2403 P-A****MQR NINDYA PUSPORINI 350718******0004 0857*****367 03/10/2021 Sesi 2 10.00 - 12.00
2404 P-A****ZOX MIFTAH FARID ASSIDDIQY 357301******0002 0895*****6773 03/10/2021 Sesi 2 10.00 - 12.00
2405 P-A****MF3 ABDUL MUTHOLIB SHAHRONI 352318******0005 0896*****255 03/10/2021 Sesi 2 10.00 - 12.00
2406 P-A****TQY Aqiela Maura Ramadhani 357303******0009 0813*****032 03/10/2021 Sesi 2 10.00 - 12.00
2407 P-A****GAO MUHAMMAD ASYRAF RIJALULLAH 357808******0001 0812*****575 03/10/2021 Sesi 2 10.00 - 12.00
2408 P-A****VUF SRI UTAMI 357301******0005 0895*****249 03/10/2021 Sesi 2 10.00 - 12.00
2409 P-A****N9V PATRISIA KINANTHI ATMAJA 321605******0004 0895*****277 03/10/2021 Sesi 2 10.00 - 12.00
2410 P-A****8CK ASTUMI 350726******0001 0877*****307 03/10/2021 Sesi 2 10.00 - 12.00
2411 P-A****KM2 Lejar Supriono 350726******0001 0878*****607 03/10/2021 Sesi 2 10.00 - 12.00
2412 P-A****IPZ TAUFIQ NUR AQSAL SAPUTRA ACHNIF 331112******0001 0821*****762 03/10/2021 Sesi 2 10.00 - 12.00
2413 P-A****IWC Jeremy Evan Anggara 350801******0001 0812*****038 03/10/2021 Sesi 2 10.00 - 12.00
2414 P-A****E60 ANWAR HANAN 327503******0020 0896*****723 03/10/2021 Sesi 3 12.00 - 14.00
2415 P-A****0HS Ari Rudata W 357303******0003 0817*****1 03/10/2021 Sesi 3 12.00 - 14.00
2416 P-A****D4P Aulia Permata Seviera 357303******0004 0813*****444 03/10/2021 Sesi 3 12.00 - 14.00
2417 P-A****JIQ AQQIDATUL IZZAH 640310******0003 0812*****614 03/10/2021 Sesi 3 12.00 - 14.00
2418 P-A****OW7 MIKE INDAWATI 357305******0021 0819*****443 03/10/2021 Sesi 3 12.00 - 14.00
2419 P-A****J1O HARI HIKMATUN 140309******0719 0823*****975 03/10/2021 Sesi 3 12.00 - 14.00
2420 P-A****W3F Salma Febi Ardhita Maharani 357303******0002 0822*****451 03/10/2021 Sesi 3 12.00 - 14.00
2421 P-B****IVM Agus Edy Prayitno 357304******0015 0812*****543 03/10/2021 Sesi 3 12.00 - 14.00
2422 P-B****WAP HENDRA LESTARI WIDODO 350712******0002 0856*****131 03/10/2021 Sesi 3 12.00 - 14.00
2423 P-B****R5G EDI PRASETYONO 350712******0005 0823*****836 03/10/2021 Sesi 3 12.00 - 14.00
2424 P-B****C2M SUMARMI 357304******0001 0882*****574 03/10/2021 Sesi 3 12.00 - 14.00
2425 P-B****CAH GOKLAN MAMPETUA SIHOMBING 120210******0001 0822*****424 03/10/2021 Sesi 3 12.00 - 14.00
2426 P-B****VL9 SALMA NABILA 350731******0003 0812*****647 03/10/2021 Sesi 3 12.00 - 14.00
2427 P-B****61T RIZKY RAMDHAN HIDAYAT 367405******0001 0813*****456 03/10/2021 Sesi 3 12.00 - 14.00
2428 P-B****CIK YUSUF ARDIAN 357304******0001 0882*****574 03/10/2021 Sesi 3 12.00 - 14.00
2429 P-B****H7Q DEWI ALZA DIAN SELMA 350716******0001 0812*****316 03/10/2021 Sesi 3 12.00 - 14.00
2430 P-B****7AG CICI RIZKI DAMAYANTI 520414******0001 0823*****822 03/10/2021 Sesi 3 12.00 - 14.00
2431 P-B****P8F BAGINDA TITO DELIMA JINGGA PUMPIDO 350519******0001 0895*****9103 03/10/2021 Sesi 3 12.00 - 14.00
2432 P-B****CD2 DIANA RACMAWATI 351804******0002 0895*****3114 03/10/2021 Sesi 3 12.00 - 14.00
2433 P-B****SZ8 Agustinus Aditya Pradana 350723******0001 0813*****847 03/10/2021 Sesi 3 12.00 - 14.00

Page 58 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2434 P-B****98M VIGA FATMAWATI ROSANDI 357901******0003 0813*****324 03/10/2021 Sesi 3 12.00 - 14.00
2435 P-B****N9E FELIX ANDREAN SAMSI 357304******0005 0821*****925 03/10/2021 Sesi 3 12.00 - 14.00
2436 P-C****FAS PUTUT DARU NDRIYO 357901******0001 0857*****570 03/10/2021 Sesi 3 12.00 - 14.00
2437 P-C****K8F SRI WAHYUNING ASTUTIK 357304******0007 0822*****650 03/10/2021 Sesi 3 12.00 - 14.00
2438 P-C****JVW DYAH ARUM PUSPITANINGTYAS 350603******0002 0857*****301 03/10/2021 Sesi 3 12.00 - 14.00
2439 P-C****OK2 LOPIAN SABILA PUTRI SINAMBELA 357301******0001 0819*****782 03/10/2021 Sesi 3 12.00 - 14.00
2440 P-C****SZT MRADIPTA PANENGGAK DHANESWARA KURNIADI 357303******0003 0813*****274 03/10/2021 Sesi 3 12.00 - 14.00
2441 P-C****OD4 Burhani Vikrulloh 351414******0003 0813*****903 03/10/2021 Sesi 3 12.00 - 14.00
2442 P-C****L71 YARRET DIDISH PRATISTA 350721******0003 0815*****872 03/10/2021 Sesi 3 12.00 - 14.00
2443 P-C****H1G SUHADI SYAMSUDDIN 530607******0001 0812*****094 03/10/2021 Sesi 3 12.00 - 14.00
2444 P-D****B76 TRI LUTVIAH YASMIN 351409******0003 0813*****273 03/10/2021 Sesi 3 12.00 - 14.00
2445 P-D****BXE Ekkel Lintang Aisyiyah 357301******0001 0881*****38 03/10/2021 Sesi 3 12.00 - 14.00
2446 P-D****IZV FARAH AZIZAH 351507******0005 0812*****116 03/10/2021 Sesi 3 12.00 - 14.00
2447 P-D****YKD AMARLIANA NOVITA XAVIER 530819******0001 0853*****863 03/10/2021 Sesi 3 12.00 - 14.00
2448 P-D****HPO DEWI AISYAH 351411******0003 0857*****216 03/10/2021 Sesi 3 12.00 - 14.00
2449 P-D****6IR WALBURGA MARIANA WEA MITE 530819******0001 0812*****072 03/10/2021 Sesi 3 12.00 - 14.00
2450 P-D****YPK NIRA PRADITYA SARI 350719******0003 0895*****216 03/10/2021 Sesi 3 12.00 - 14.00
2451 P-D****LJ2 BONDAN ANIANTO RS 357304******0003 0812*****80 03/10/2021 Sesi 3 12.00 - 14.00
2452 P-D****4ET SELFI 357304******0002 0895*****557 03/10/2021 Sesi 3 12.00 - 14.00
2453 P-E****MHW Suharti 357901******0007 0859*****141 03/10/2021 Sesi 3 12.00 - 14.00
2454 P-E****A3G AL AZIZU SAIFULLOH 180721******0006 0813*****726 03/10/2021 Sesi 3 12.00 - 14.00
2455 P-E****OUM NUR CITRA 647301******0003 0853*****392 03/10/2021 Sesi 3 12.00 - 14.00
2456 P-E****AYK SITI ISMIATI 357903******0001 0896*****171 03/10/2021 Sesi 3 12.00 - 14.00
2457 P-E****KKM GATOT BUDI WICAKSONO 331602******0005 0896*****018 03/10/2021 Sesi 3 12.00 - 14.00
2458 P-E****JLG BANGGA YULI SURYANTONO 352009******0001 0813*****411 03/10/2021 Sesi 3 12.00 - 14.00
2459 P-E****EEY RUSDY SALEH 357903******0001 0896*****146 03/10/2021 Sesi 3 12.00 - 14.00
2460 P-E****RGH MOKH WILDAN ZUHRI 357301******0012 0822*****269 03/10/2021 Sesi 3 12.00 - 14.00
2461 P-E****GDW FRANSISKA ERVINA SERLYANA 530705******0006 0853*****551 03/10/2021 Sesi 3 12.00 - 14.00
2462 P-E****Y6L ANNISA AULIA RAHMANTI 351206******0002 0857*****780 03/10/2021 Sesi 3 12.00 - 14.00
2463 P-E****GSY HANIFA MULIA BILQIES 350716******0002 0858*****496 03/10/2021 Sesi 3 12.00 - 14.00
2464 P-E****Z1I MISBACHUL ULUM AKBAR UTAMA 350724******0009 0813*****095 03/10/2021 Sesi 3 12.00 - 14.00
2465 P-E****7NL MELI MARTINA PITAY 530128******1003 0852*****821 03/10/2021 Sesi 3 12.00 - 14.00
2466 P-E****8H0 LUCKY AZIFATHUL 350611******0002 0857*****161 03/10/2021 Sesi 3 12.00 - 14.00
2467 P-E****ZCI ALWAN GILANG BRILIANSYAH 350930******0002 0813*****346 03/10/2021 Sesi 3 12.00 - 14.00
2468 P-E****JYS DEWI ROSDHIANA 351803******0001 0857*****033 03/10/2021 Sesi 3 12.00 - 14.00
2469 P-E****HX6 JIHAN SANIYYAH OCTAVIA 170219******0002 0821*****818 03/10/2021 Sesi 3 12.00 - 14.00
2470 P-E****E8N CHOIRUNNISA 127203******0004 0821*****505 03/10/2021 Sesi 3 12.00 - 14.00
2471 P-E****4LR BAGINDA ARSYI 367402******0006 0812*****914 03/10/2021 Sesi 3 12.00 - 14.00
2472 P-E****4LM RACHMAWATI SURYO WIDJOYO 357804******0003 0896*****125 03/10/2021 Sesi 3 12.00 - 14.00
2473 P-E****IIU FITRIANA PUJI ASTUTI SUKAMTO 327502******0017 0812*****395 03/10/2021 Sesi 3 12.00 - 14.00
2474 P-E****QTY RAIH YOGA NGUDI ADITAMA 350708******0001 0822*****946 03/10/2021 Sesi 3 12.00 - 14.00
2475 P-E****EFI ANNISA MAHARANI ARYA PUTRI 350709******0001 0896*****660 03/10/2021 Sesi 3 12.00 - 14.00

Page 59 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2476 P-F****SM3 LILIS 357304******0007 0895*****1162 03/10/2021 Sesi 3 12.00 - 14.00
2477 P-F****Y9M ALVINA OKTAVIANI 351411******0005 0896*****370 03/10/2021 Sesi 3 12.00 - 14.00
2478 P-F****ZIV SITI QOMARIYAH 330312******0003 0823*****847 03/10/2021 Sesi 3 12.00 - 14.00
2479 P-F****JV4 BAYU AJI GATIADI 357203******0006 0812*****924 03/10/2021 Sesi 3 12.00 - 14.00
2480 P-F****KQV Izzah Nurul Kholifah 330313******0005 0857*****198 03/10/2021 Sesi 3 12.00 - 14.00
2481 P-F****E9T HANY SETYORINI 357305******0001 0812*****485 03/10/2021 Sesi 3 12.00 - 14.00
2482 P-F****XFL THOSORUL HUDHA 350417******0002 0812*****159 03/10/2021 Sesi 3 12.00 - 14.00
2483 P-F****JVJ FARID WAHYU ARYA PRATAMA 351411******0001 0858*****644 03/10/2021 Sesi 3 12.00 - 14.00
2484 P-F****QEP ARYAN MUSTAMIN 731503******0001 0821*****743 03/10/2021 Sesi 3 12.00 - 14.00
2485 P-F****COV ALDILA NURIS SHOUMI 357305******0008 0823*****015 03/10/2021 Sesi 3 12.00 - 14.00
2486 P-F****VCN WILFRIDUS RIA R RASO 530801******0001 0821*****209 03/10/2021 Sesi 3 12.00 - 14.00
2487 P-F****QAN SUSMIYATI MARIA ULFA 350724******0001 0813*****866 03/10/2021 Sesi 3 12.00 - 14.00
2488 P-F****5FG MUHAMMAD AINUL YAQIN 350718******0003 0822*****375 03/10/2021 Sesi 3 12.00 - 14.00
2489 P-F****DX1 FARIEZ SETIAWAN 357302******0003 0896*****366 03/10/2021 Sesi 3 12.00 - 14.00
2490 P-F****D8M AHMAD ULFI JIHAD DZULQORNAIN 357903******0003 0851*****227 03/10/2021 Sesi 3 12.00 - 14.00
2491 P-F****ZG3 NABILA AZIDIAN ISLAMI 357305******0003 0882*****194 03/10/2021 Sesi 3 12.00 - 14.00
2492 P-F****84P BERNARDINUS HARDINASETYO M 357305******0006 0877*****751 03/10/2021 Sesi 3 12.00 - 14.00
2493 P-F****PWX ULFIANA PRIHASTUTI 352314******0001 0857*****878 03/10/2021 Sesi 3 12.00 - 14.00
2494 P-F****VY2 TASYA ANGELINA MANGARE 357903******0001 0822*****632 03/10/2021 Sesi 3 12.00 - 14.00
2495 P-F****A7T Rizki Nurcahyo 350705******0001 0852*****355 03/10/2021 Sesi 3 12.00 - 14.00
2496 P-F****AUB DEDY SETIYAWAN 351003******0001 0815*****824 03/10/2021 Sesi 3 12.00 - 14.00
2497 P-F****YSZ HENDRI HERIANTO 181203******0003 0821*****559 03/10/2021 Sesi 3 12.00 - 14.00
2498 P-F****U8P FADHILAH LUTINDRA WEDIYANTI 331403******0005 0823*****892 03/10/2021 Sesi 3 12.00 - 14.00
2499 P-F****SCD M. ABDULLAH THOHA 130310******0001 0812*****241 03/10/2021 Sesi 3 12.00 - 14.00
2500 P-G****W5L ILHAM NUR SYUHADA 350725******0001 0822*****570 03/10/2021 Sesi 3 12.00 - 14.00
2501 P-G****ISV TANIA ROSSANTI SUGIARTO 357304******0001 0878*****460 03/10/2021 Sesi 3 12.00 - 14.00
2502 P-G****DC0 DIMAS DIANDRA AUDIANSYAH 367206******0001 0877*****454 03/10/2021 Sesi 3 12.00 - 14.00
2503 P-G****0KU PERY HADI SUSANTO 351508******0001 0856*****325 03/10/2021 Sesi 3 12.00 - 14.00
2504 P-G****UIJ MAMIN SUGIARSIH 350723******0001 0896*****672 03/10/2021 Sesi 3 12.00 - 14.00
2505 P-G****HLD MULIANA 350721******0003 0852*****509 03/10/2021 Sesi 3 12.00 - 14.00
2506 P-G****GJF MOCHAMMAD CHOIRI ASSIDIQI 351507******0002 0813*****569 03/10/2021 Sesi 3 12.00 - 14.00
2507 P-G****J87 RADEN RORO HANAN RAMADHAN 327505******0005 0812*****940 03/10/2021 Sesi 3 12.00 - 14.00
2508 P-G****AVH PRIHATININGSIH 357305******0007 0878*****516 03/10/2021 Sesi 3 12.00 - 14.00
2509 P-G****IV5 DINA AFIFAH PUTRI 352216******0005 0857*****613 03/10/2021 Sesi 3 12.00 - 14.00
2510 P-G****F9G WALIYUDIN MUHAIMIN AL-AZIZ 357301******0002 0822*****576 03/10/2021 Sesi 3 12.00 - 14.00
2511 P-G****IAG ANDRI HARDINATA PUTRA 130607******0001 0822*****367 03/10/2021 Sesi 3 12.00 - 14.00
2512 P-G****TFL RATNA WULANDARI 917105******0005 0852*****584 03/10/2021 Sesi 3 12.00 - 14.00
2513 P-G****9W7 TASYA 130712******0002 0813*****240 03/10/2021 Sesi 3 12.00 - 14.00
2514 P-G****AY0 Putri Rahmatul Izzah Pratiwi 357305******0004 0897*****47 03/10/2021 Sesi 3 12.00 - 14.00
2515 P-G****ZKM Marpuah 357304******0006 0895*****0753 03/10/2021 Sesi 3 12.00 - 14.00
2516 P-G****OEI FATIYATHUL SAKINAH 130703******0001 0822*****006 03/10/2021 Sesi 3 12.00 - 14.00
2517 P-G****UUH ERICA SARI 331412******2028 0813*****201 03/10/2021 Sesi 3 12.00 - 14.00

Page 60 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2518 P-G****AVC Mas'ud 357303******0001 0812*****200 03/10/2021 Sesi 3 12.00 - 14.00
2519 P-G****A3S RISYAD FIRDAUS ANANDA 357303******0005 0812*****071 03/10/2021 Sesi 3 12.00 - 14.00
2520 P-G****JW3 KANANDYA KIZZANDY 357302******0007 0821*****892 03/10/2021 Sesi 3 12.00 - 14.00
2521 P-G****HFG MORA NINDITA RAMADANTI 357303******0002 0822*****531 03/10/2021 Sesi 3 12.00 - 14.00
2522 P-G****PIC BAGJA PURNAMA AJU 357305******0012 0812*****567 03/10/2021 Sesi 3 12.00 - 14.00
2523 P-G****6IA CLARISSA FRISMA ADINDA 357303******0009 0821*****549 03/10/2021 Sesi 3 12.00 - 14.00
2524 P-G****Z6L REGHA WAHYU T P 350721******0001 0813*****487 03/10/2021 Sesi 3 12.00 - 14.00
2525 P-G****R68 EVA KOMALA DEWI 352215******0002 0813*****083 03/10/2021 Sesi 3 12.00 - 14.00
2526 P-G****A0K SOLIHAT 357301******0002 0815*****634 03/10/2021 Sesi 3 12.00 - 14.00
2527 P-G****UDV KIKI NIKA SARI 350708******0005 0857*****207 03/10/2021 Sesi 3 12.00 - 14.00
2528 P-G****DT3 FIKRI FADHLURROHMAN 350217******0003 0895*****9474 03/10/2021 Sesi 3 12.00 - 14.00
2529 P-G****Q9U SYAHRUL ARDIANSYAH 357304******0006 0899*****68 03/10/2021 Sesi 3 12.00 - 14.00
2530 P-G****TNM HUTUR GUMARA RIKKY TAMPUBOLON 121009******0007 0877*****049 03/10/2021 Sesi 3 12.00 - 14.00
2531 P-G****AQ7 ALIFIANI INDRI SUMEMI 517102******0001 0823*****118 03/10/2021 Sesi 3 12.00 - 14.00
2532 P-G****JYS DWIYAN LAKSANA NURCAHYO 330107******0001 0897*****52 03/10/2021 Sesi 3 12.00 - 14.00
2533 P-G****JA3 AFNAN DOMILI 647304******0004 0813*****073 03/10/2021 Sesi 3 12.00 - 14.00
2534 P-G****8L0 NI LUH ARINI SUKMA DEWI 520203******0001 0877*****840 03/10/2021 Sesi 3 12.00 - 14.00
2535 P-G****BV3 ARSENIO JAVI ZULFIKAR 351513******0006 0822*****217 03/10/2021 Sesi 3 12.00 - 14.00
2536 P-G****LBA Fatkhul Mu'in 351910******0001 0851*****145 03/10/2021 Sesi 3 12.00 - 14.00
2537 P-G****6XR RIKA ADELINA SIPAYUNG 120210******0002 0896*****560 03/10/2021 Sesi 3 12.00 - 14.00
2538 P-G****CF9 NUR'AINI FAIRUUZ SALSABIILA 350705******0003 0896*****184 03/10/2021 Sesi 3 12.00 - 14.00
2539 P-G****HGQ MUHAMMAD FAJAR RAMADHAN 320101******0002 0812*****961 03/10/2021 Sesi 3 12.00 - 14.00
2540 P-G****6NQ DIMAS PRAYOGI 350723******0003 0821*****809 03/10/2021 Sesi 3 12.00 - 14.00
2541 P-G****BUG ELVIRA MONICA ADOLFINA A.TOLLA 537103******0001 0812*****008 03/10/2021 Sesi 3 12.00 - 14.00
2542 P-G****IL6 IWAN SAFRIEL 357304******0008 0812*****431 03/10/2021 Sesi 3 12.00 - 14.00
2543 P-G****DUQ Afrida Indrawati 350221******0001 0888*****36 03/10/2021 Sesi 3 12.00 - 14.00
2544 P-G****E0H PRAMAISELLA TASYA A. 350726******0001 0878*****482 03/10/2021 Sesi 3 12.00 - 14.00
2545 P-G****6LZ CHARYZA BALQIS ZAHRA RAHADHATUL A'ISYI 357305******0004 0853*****480 03/10/2021 Sesi 3 12.00 - 14.00
2546 P-G****XJH ALIFATUS SHOLEHAH 352813******0001 0822*****196 03/10/2021 Sesi 3 12.00 - 14.00
2547 P-G****TU1 WAHYU FIQHI NURUDIN 350603******0001 0819*****892 03/10/2021 Sesi 3 12.00 - 14.00
2548 P-G****TY3 Hilmiyah 357304******0002 0812*****72 03/10/2021 Sesi 3 12.00 - 14.00
2549 P-G****VNF Mei Irawan 180901******0003 0895*****090 03/10/2021 Sesi 3 12.00 - 14.00
2550 P-G****MM0 RIZKI IHSAN FADILLA 330902******0003 0851*****513 03/10/2021 Sesi 3 12.00 - 14.00
2551 P-G****LWI MIFTAKUL JANAH 357301******0002 0858*****268 03/10/2021 Sesi 3 12.00 - 14.00
2552 P-G****RI1 MEUTIA AZZAHRA RIANTO 327507******0010 0851*****241 03/10/2021 Sesi 3 12.00 - 14.00
2553 P-G****ESV GAHARA GHINANDA 357304******0004 0812*****702 03/10/2021 Sesi 3 12.00 - 14.00
2554 P-G****RRM ANGGUN RIA MAGHFIROH 350701******0001 0857*****460 03/10/2021 Sesi 3 12.00 - 14.00
2555 P-G****CFF HOTBINSAR SAMUEL HUTASOIT 122304******0002 0812*****746 03/10/2021 Sesi 3 12.00 - 14.00
2556 P-G****7E3 SITI ROFIQOH 350710******0004 0823*****596 03/10/2021 Sesi 3 12.00 - 14.00
2557 P-G****905 Ahmad Musta’in 357301******0007 0813*****830 03/10/2021 Sesi 3 12.00 - 14.00
2558 P-G****H5R NILA HANA IMAS PERTIWI 350701******0001 0858*****547 03/10/2021 Sesi 3 12.00 - 14.00
2559 P-G****Z7I SUMADIYONO 350725******0004 0812*****61 03/10/2021 Sesi 3 12.00 - 14.00

Page 61 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2560 P-G****ZNO ARINI SALSABILA 352813******0004 0819*****027 03/10/2021 Sesi 3 12.00 - 14.00
2561 P-G****P8J NADIA KARTIKA PUTERI 350910******0001 0896*****020 03/10/2021 Sesi 3 12.00 - 14.00
2562 P-G****KRD MOH. HARRYS PRAMUCITRA 352425******0001 0823*****282 03/10/2021 Sesi 3 12.00 - 14.00
2563 P-G****NPX FARHAN MAVERIO DEVANO 137103******0004 0851*****921 03/10/2021 Sesi 3 12.00 - 14.00
2564 P-G****D82 JUNIAR ANNISA SALSABILLAH 327503******0011 0813*****396 03/10/2021 Sesi 3 12.00 - 14.00
2565 P-G****H0B BERNARDINO YUDIKA SOESANTO 332101******0003 0811*****01 03/10/2021 Sesi 3 12.00 - 14.00
2566 P-G****A9G SARI MELLINA TOBING 357303******0010 0857*****554 03/10/2021 Sesi 3 12.00 - 14.00
2567 P-G****YKJ CANDI NUGROHO 331802******0003 0858*****257 03/10/2021 Sesi 3 12.00 - 14.00
2568 P-G****0CK PRINGGA SETIAWAN YUSUF 357304******0002 0896*****925 03/10/2021 Sesi 3 12.00 - 14.00
2569 P-G****3GJ GALUH SWASTYAYANA 330225******0002 0812*****186 03/10/2021 Sesi 3 12.00 - 14.00
2570 P-G****KI4 NITA DWI LESTARI 350722******0002 0856*****66 03/10/2021 Sesi 3 12.00 - 14.00
2571 P-G****D2I PUSVITA LESTARI 350301******0007 0812*****038 03/10/2021 Sesi 3 12.00 - 14.00
2572 P-G****EZ9 IMAM SYAFFULLAH 357302******0001 0895*****9546 03/10/2021 Sesi 3 12.00 - 14.00
2573 P-G****WGJ RICKY ADHITYA SURYA 357305******0002 0877*****822 03/10/2021 Sesi 3 12.00 - 14.00
2574 P-G****GUZ NUR KOMARIYAH 350722******0001 0858*****257 03/10/2021 Sesi 3 12.00 - 14.00
2575 P-G****EJI DJAMILAH PUTRI 317406******0005 0821*****005 03/10/2021 Sesi 3 12.00 - 14.00
2576 P-G****58K SITI FU'AIDATUL ISMA 'AINI 350733******0006 0858*****547 03/10/2021 Sesi 3 12.00 - 14.00
2577 P-G****SFG ELA NOVDIANDA NATASYA 137102******0004 0831*****760 03/10/2021 Sesi 3 12.00 - 14.00
2578 P-G****5Q4 Ati’ul Inayah 357301******0005 0857*****720 03/10/2021 Sesi 3 12.00 - 14.00
2579 P-G****R2Y LOEDFIA PALOEPI 357302******0004 0856*****438 03/10/2021 Sesi 3 12.00 - 14.00
2580 P-G****OD9 WINARTO 357304******0009 0895*****5608 03/10/2021 Sesi 3 12.00 - 14.00
2581 P-G****PKJ LINA LISA KURNIA SARI 357302******0001 0858*****002 03/10/2021 Sesi 3 12.00 - 14.00
2582 P-G****1GM Arizal Firdaus 350724******0001 0813*****691 03/10/2021 Sesi 3 12.00 - 14.00
2583 P-G****MBL Himah Luluk Iljannah 357305******0004 0819*****975 03/10/2021 Sesi 3 12.00 - 14.00
2584 P-G****6K1 GIOVANI HARAMAIN BILADI 647206******0002 0811*****97 03/10/2021 Sesi 3 12.00 - 14.00
2585 P-G****OH1 IWAN SURYONO 351007******0007 0852*****545 03/10/2021 Sesi 3 12.00 - 14.00
2586 P-G****33C DWI NUR INDAH LESTARI 357305******0002 0857*****096 03/10/2021 Sesi 3 12.00 - 14.00
2587 P-G****5IW RISTAYUNITA 357305******0008 0812*****673 03/10/2021 Sesi 3 12.00 - 14.00
2588 P-G****VIU HENDRIK 350718******0001 0858*****815 03/10/2021 Sesi 3 12.00 - 14.00
2589 P-G****TL4 SUGIARTO 357302******0001 0838*****082 03/10/2021 Sesi 3 12.00 - 14.00
2590 P-G****6TR EINGSEN JUNIDA 357305******0005 0821*****900 03/10/2021 Sesi 3 12.00 - 14.00
2591 P-G****88Y SANDRA ANINDYA 520408******0002 0895*****2635 03/10/2021 Sesi 3 12.00 - 14.00
2592 P-G****2R4 VICTOR ADI WINATA 150303******0006 0857*****395 03/10/2021 Sesi 3 12.00 - 14.00
2593 P-G****KWR AFIFAH NUR HIDAYATI 357302******0003 0852*****188 03/10/2021 Sesi 3 12.00 - 14.00
2594 P-G****FXB SUPARDIANTO 357302******0006 0852*****188 03/10/2021 Sesi 3 12.00 - 14.00
2595 P-G****MRN ETIK MAYASARI 350723******0001 0895*****807 03/10/2021 Sesi 3 12.00 - 14.00
2596 P-G****GHK AFLI RAHMADHANI 357302******0006 0878*****985 03/10/2021 Sesi 3 12.00 - 14.00
2597 P-G****MOF MUHAMMAD A. GIBRAN 317101******1001 0812*****844 03/10/2021 Sesi 3 12.00 - 14.00
2598 P-G****R67 UMAMAH 357302******0008 0852*****188 03/10/2021 Sesi 3 12.00 - 14.00
2599 P-G****T7Z YUSAMMUHU AHMAD AM 351406******0003 0858*****273 03/10/2021 Sesi 3 12.00 - 14.00
2600 P-G****Z3Y FARIS HIDAYAT 350704******0001 0856*****304 03/10/2021 Sesi 3 12.00 - 14.00
2601 P-G****RC2 Dzakka Al Muqaffi 357903******0002 0877*****111 03/10/2021 Sesi 3 12.00 - 14.00

Page 62 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2602 P-G****S2K RIZKY REFIZA 357303******0004 0812*****232 03/10/2021 Sesi 3 12.00 - 14.00
2603 P-G****VSH MUHAMMAD YUSUF ZAKARIA 357304******0002 0822*****555 03/10/2021 Sesi 3 12.00 - 14.00
2604 P-G****XYT NADYA CHRISYANTI PUTRI 327609******0001 0822*****323 03/10/2021 Sesi 3 12.00 - 14.00
2605 P-G****5WJ NUR KHOLIFATU JANNAH 357304******0002 0896*****419 03/10/2021 Sesi 3 12.00 - 14.00
2606 P-G****GKW TAICHA KRUSBEEK ORRILIA AUDRE AGATHA PUTRI S 350217******0005 0877*****793 03/10/2021 Sesi 3 12.00 - 14.00
2607 P-G****MZR EKA CITRA OKTAVIA DITA 350708******0001 0812*****415 03/10/2021 Sesi 3 12.00 - 14.00
2608 P-G****3DS IMADUDDIN AL MUNBAITS 332904******0009 0812*****566 03/10/2021 Sesi 3 12.00 - 14.00
2609 P-G****CET TSALISA SALSABILA PUTERI 347113******0002 0895*****9914 03/10/2021 Sesi 3 12.00 - 14.00
2610 P-G****SQN ZAHROTUS SA'ADAH 352412******0001 0813*****612 03/10/2021 Sesi 3 12.00 - 14.00
2611 P-G****7AB SLAMET UNTUNG 350710******0001 0821*****974 03/10/2021 Sesi 3 12.00 - 14.00
2612 P-G****V8J AMANDA NOVELIA DHAMAYANTI S 357304******0006 0823*****323 03/10/2021 Sesi 3 12.00 - 14.00
2613 P-G****XMA GENDYS AYU MUMPUNI 350722******0001 0823*****150 03/10/2021 Sesi 3 12.00 - 14.00
2614 P-G****WKB JENITA DWI OKTAVIANI 352006******0001 0896*****246 03/10/2021 Sesi 3 12.00 - 14.00
2615 P-G****PCO ANDRE PRATAMA 350413******0005 0812*****671 03/10/2021 Sesi 3 12.00 - 14.00
2616 P-G****ITQ RISA NURFARHEIN GUSRIANTO 327605******0004 0851*****821 03/10/2021 Sesi 3 12.00 - 14.00
2617 P-G****9S9 MOCH RIVALDY IRFAN SAPUTRA 357302******0007 0857*****667 03/10/2021 Sesi 3 12.00 - 14.00
2618 P-G****S8O YOULA ELA KAFILA 357304******0001 0813*****431 03/10/2021 Sesi 3 12.00 - 14.00
2619 P-G****E5T QONITA HAQIQOTI 351508******0001 0819*****996 03/10/2021 Sesi 3 12.00 - 14.00
2620 P-G****CJX Prisca Agdita Eka Rahma Putri 350218******0001 0858*****257 03/10/2021 Sesi 3 12.00 - 14.00
2621 P-G****WM1 Karimatul Lailiya 352421******0001 0855*****313 03/10/2021 Sesi 3 12.00 - 14.00
2622 P-G****HVB RANI SARTIKA 130409******0003 0821*****847 03/10/2021 Sesi 3 12.00 - 14.00
2623 P-G****O04 RURI RIDHA RAJWARI 357305******0002 0822*****199 03/10/2021 Sesi 3 12.00 - 14.00
2624 P-G****R7P DAFFA ICHSAN MUHAMMAD 367202******0005 0877*****864 03/10/2021 Sesi 3 12.00 - 14.00
2625 P-G****YJU MUHAMMAD RIF'AT NOR IMAMI 637104******0008 0853*****455 03/10/2021 Sesi 3 12.00 - 14.00
2626 P-G****25H M. FADLY FAHREZA 147109******0001 0819*****250 03/10/2021 Sesi 3 12.00 - 14.00
2627 P-G****3X6 IBNU SABILLI 367407******0001 0813*****606 03/10/2021 Sesi 3 12.00 - 14.00
2628 P-G****8V5 JUAN MORA MICHAEL MARBUN 160703******0003 0821*****525 03/10/2021 Sesi 3 12.00 - 14.00
2629 P-G****4G7 NAUFAN RIKZA AHMADA 357305******0004 0813*****562 03/10/2021 Sesi 3 12.00 - 14.00
2630 P-G****GZE HAEKAL HAFIDZ MOHAMMAD 367406******0005 0881*****94 03/10/2021 Sesi 3 12.00 - 14.00
2631 P-G****E50 Ali Mohamed Alsaweyah 187020******0010 0821*****047 03/10/2021 Sesi 3 12.00 - 14.00
2632 P-G****ELR SUNDARI 357305******0001 0857*****284 03/10/2021 Sesi 3 12.00 - 14.00
2633 P-G****ZGX SUPARMAN 357903******0001 0895*****571 03/10/2021 Sesi 3 12.00 - 14.00
2634 P-G****9BO EKA FATMAWATI 357304******0001 0821*****536 03/10/2021 Sesi 3 12.00 - 14.00
2635 P-G****YCM ARISTA FIDELA PUTRI 317403******0002 0877*****292 03/10/2021 Sesi 3 12.00 - 14.00
2636 P-G****B0P SUSIANAH 357305******0002 0856*****777 03/10/2021 Sesi 3 12.00 - 14.00
2637 P-G****WJN LUTHFI RICO HARDIANSYAH 350722******0002 0821*****821 03/10/2021 Sesi 3 12.00 - 14.00
2638 P-G****CIJ LUTHFAN AKBAR AZIZAN FIRDAOS 327106******0026 0812*****957 03/10/2021 Sesi 3 12.00 - 14.00
2639 P-G****HVL MIRA AISYAH NENDYA 357303******0005 0852*****163 03/10/2021 Sesi 3 12.00 - 14.00
2640 P-G****CAE INTANIA KASEDU 531702******0001 0813*****037 03/10/2021 Sesi 3 12.00 - 14.00
2641 P-G****50W MARFUAH 357301******0001 0823*****058 03/10/2021 Sesi 3 12.00 - 14.00
2642 P-G****2AL NATALIA PAULINA TEMI 530809******0001 0823*****660 03/10/2021 Sesi 3 12.00 - 14.00
2643 P-G****OPC DELIMA AYU FARADELA 351016******0001 0823*****702 03/10/2021 Sesi 3 12.00 - 14.00

Page 63 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2644 P-G****TJP RD FEBRIAN NURRIZAL 327403******0007 0857*****830 03/10/2021 Sesi 3 12.00 - 14.00
2645 P-G****1W6 RIFQY AL HAFIDZ 367405******0008 0812*****864 03/10/2021 Sesi 3 12.00 - 14.00
2646 P-G****USR SRI NUR AINI 321122******0001 0877*****273 03/10/2021 Sesi 3 12.00 - 14.00
2647 P-G****04D ANGGIT BRAHMASETIO 647401******0007 0821*****008 03/10/2021 Sesi 3 12.00 - 14.00
2648 P-G****R1P YULIUS YOHANES UKI 530805******0001 0821*****291 03/10/2021 Sesi 3 12.00 - 14.00
2649 P-G****GXA ABDUL KHALIK SEMBIRING 127110******0002 0895*****5028 03/10/2021 Sesi 3 12.00 - 14.00
2650 P-G****VQI FAHDI KUSUMAPUTRA 350724******0003 0813*****447 03/10/2021 Sesi 3 12.00 - 14.00
2651 P-H****B85 ACHMAD BACHRUDIN SYAFI'UNA 357301******0003 0821*****968 03/10/2021 Sesi 3 12.00 - 14.00
2652 P-H****LYI MUHAMAD ALDI ALFIANSYAH 350514******0003 0857*****408 03/10/2021 Sesi 3 12.00 - 14.00
2653 P-H****DE2 CANDRA VIOLITA LARASATI 352208******0006 0858*****858 03/10/2021 Sesi 3 12.00 - 14.00
2654 P-H****CUY ALDO FITO 357301******0008 0812*****831 03/10/2021 Sesi 3 12.00 - 14.00
2655 P-H****3KD YUZRIL IHZHA MAHENDRA 351208******0002 0895*****262 03/10/2021 Sesi 3 12.00 - 14.00
2656 P-H****2MQ MUSYAROH 352412******0002 0831*****306 03/10/2021 Sesi 3 12.00 - 14.00
2657 P-H****SS3 3508186908970001 350818******0001 0851*****020 03/10/2021 Sesi 3 12.00 - 14.00
2658 P-H****YOY KARMI 350701******0007 0857*****649 03/10/2021 Sesi 3 12.00 - 14.00
2659 P-H****TFW IKA DWI CAHYANTI 351410******0004 0896*****253 03/10/2021 Sesi 3 12.00 - 14.00
2660 P-H****B9O MUHAMMAD FAIZAL REZA 357305******0006 0878*****122 03/10/2021 Sesi 3 12.00 - 14.00
2661 P-H****VNR EARLY BRILLIANNA NUR LAILA WAHYUDIN 350724******0002 0857*****233 03/10/2021 Sesi 3 12.00 - 14.00
2662 P-H****CMJ Lathifa shinta nuria 351807******0003 0852*****712 03/10/2021 Sesi 3 12.00 - 14.00
2663 P-H****M5S FARIED FAJAR 357703******0001 0857*****871 03/10/2021 Sesi 3 12.00 - 14.00
2664 P-H****DN1 LABIB ROBBANI MUHAMMADY 330711******0001 0856*****760 03/10/2021 Sesi 3 12.00 - 14.00
2665 P-H****8UG AINUL KHATIMAH 520508******0001 0853*****770 03/10/2021 Sesi 3 12.00 - 14.00
2666 P-H****357 ADITYA FADLANI 627103******0006 0812*****097 03/10/2021 Sesi 3 12.00 - 14.00
2667 P-H****R9F CANTYA PARAMITA MARHENDRA 350722******0001 0812*****591 03/10/2021 Sesi 3 12.00 - 14.00
2668 P-H****LU5 SYARAH ZULFIA SALSABILA 350718******0005 0823*****305 03/10/2021 Sesi 3 12.00 - 14.00
2669 P-H****K3Q MATTALA NEZHA W 350724******0003 0878*****675 03/10/2021 Sesi 3 12.00 - 14.00
2670 P-H****XSV DION PRIHARTADY 527101******0002 0853*****236 03/10/2021 Sesi 3 12.00 - 14.00
2671 P-H****8IY Araffathoni Rizqi 357822******0001 0878*****707 03/10/2021 Sesi 3 12.00 - 14.00
2672 P-H****D6L DENISSA AUDREY RAHMADIAN 357303******0002 0895*****7199 03/10/2021 Sesi 3 12.00 - 14.00
2673 P-H****9GJ SITI RODIAH 357305******0006 0851*****243 03/10/2021 Sesi 3 12.00 - 14.00
2674 P-H****RH2 TALITHA OLGA ANDADHARI 357901******0001 0838*****708 03/10/2021 Sesi 3 12.00 - 14.00
2675 P-H****5UE MUHAMMAD AGUNG PUTRA YUDHA 357305******0004 0895*****7611 03/10/2021 Sesi 3 12.00 - 14.00
2676 P-H****XAN THUFEIL FIRDAUS 327306******0002 0899*****11 03/10/2021 Sesi 3 12.00 - 14.00
2677 P-H****4AQ KEVIN ALVICKO PRATAMA 170216******0001 0899*****57 03/10/2021 Sesi 3 12.00 - 14.00
2678 P-H****W2H LOLI FOURTIAS PUTRA SINAGA 121101******0004 0878*****772 03/10/2021 Sesi 3 12.00 - 14.00
2679 P-H****T3T EVRI SAHRUL RAMADRAN 357305******0001 0857*****631 03/10/2021 Sesi 3 12.00 - 14.00
2680 P-H****JX2 TANTRI PUSPITASARI 350608******0001 0857*****347 03/10/2021 Sesi 3 12.00 - 14.00
2681 P-H****KNR SITI NOER TYAS TUTI 351811******0003 0852*****115 03/10/2021 Sesi 3 12.00 - 14.00
2682 P-H****MEC NANDA ROFI AIN NUR ROHMAN 350218******0001 0822*****120 03/10/2021 Sesi 3 12.00 - 14.00
2683 P-H****AWV Novianto Tri Zat Miko 350411******0003 0882*****085 03/10/2021 Sesi 3 12.00 - 14.00
2684 P-H****QJG CANDRA ADITYA 357305******0002 0813*****991 03/10/2021 Sesi 3 12.00 - 14.00
2685 P-H****MDK PUJI LESTARI 357305******0008 0823*****669 03/10/2021 Sesi 3 12.00 - 14.00

Page 64 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2686 P-H****BCP DIMAS REZA W 332011******0004 0858*****490 03/10/2021 Sesi 3 12.00 - 14.00
2687 P-H****IKI IMAN RIZKI DERIDIATNO 357703******0005 0857*****610 03/10/2021 Sesi 3 12.00 - 14.00
2688 P-H****YEI WAHYU SEPTIYAN HANDIYOKO 357901******0006 0812*****551 03/10/2021 Sesi 3 12.00 - 14.00
2689 P-H****VG8 RETNO AYU SETYOWATI 357901******0003 0858*****817 03/10/2021 Sesi 3 12.00 - 14.00
2690 P-H****E8R WILBY ARIEZQY 357815******0004 0877*****937 03/10/2021 Sesi 3 12.00 - 14.00
2691 P-H****DTB DWI ALDY WIBISONO 350725******0006 0812*****255 03/10/2021 Sesi 3 12.00 - 14.00
2692 P-H****9E7 HANGGARA WIRA PRAJA 352215******0004 0896*****280 03/10/2021 Sesi 3 12.00 - 14.00
2693 P-H****TQT YULIA TRISNA DEWI 357304******0005 0822*****206 03/10/2021 Sesi 3 12.00 - 14.00
2694 P-H****B01 ABDUL ROFI ALFIAN NURRAHMAN 357305******0001 0819*****297 03/10/2021 Sesi 3 12.00 - 14.00
2695 P-H****3TI MISKADIANTO 357301******0010 0831*****994 03/10/2021 Sesi 3 12.00 - 14.00
2696 P-H****8RP FARHAN AL RASYID MUNTHE 357814******0008 0812*****500 03/10/2021 Sesi 3 12.00 - 14.00
2697 P-H****NFU ARDAN AGUS 130602******0005 0822*****769 03/10/2021 Sesi 3 12.00 - 14.00
2698 P-H****DPV DEVIN KURNIAWAN 357301******0004 0813*****223 03/10/2021 Sesi 3 12.00 - 14.00
2699 P-H****IWA WITA SEPTIA RAHMADA 350723******0006 0838*****861 03/10/2021 Sesi 3 12.00 - 14.00
2700 P-H****L9Q MIDA AFIFAH SARI NUR ISLAMI 357301******0008 0852*****776 03/10/2021 Sesi 3 12.00 - 14.00
2701 P-H****21Z KRISTOFEL M P DAMANIK 127202******0002 0821*****811 03/10/2021 Sesi 3 12.00 - 14.00
2702 P-H****JU1 AGUSTIN MASITA WATI 357305******0001 0838*****225 03/10/2021 Sesi 3 12.00 - 14.00
2703 P-K****YUG DWI YANTI RETNO UNTARI 350722******0002 0856*****622 03/10/2021 Sesi 3 12.00 - 14.00
2704 P-N****SXD KUSRINI 357304******0002 0812*****336 03/10/2021 Sesi 3 12.00 - 14.00
2705 P-O****F3C SALSABILA SAMSUDIN 350718******0001 0877*****537 03/10/2021 Sesi 3 12.00 - 14.00
2706 P-P****GXF FIKI HANDAYANI 350713******0003 0881*****65 03/10/2021 Sesi 3 12.00 - 14.00
2707 P-V****CMP PURNA WIDYA PUTRI BUANA 350618******0003 0858*****454 03/10/2021 Sesi 3 12.00 - 14.00
2708 P-W****2LH RIZQI FAHRUDIN 352504******0001 0822*****579 03/10/2021 Sesi 3 12.00 - 14.00
2709 Q-0****ZDP DIMAS AJI NUGRAHA 120726******0017 0878*****776 03/10/2021 Sesi 3 12.00 - 14.00
2710 Q-E****BAA NOVA HERLIANA SINAGA 140804******0015 0822*****973 03/10/2021 Sesi 3 12.00 - 14.00
2711 Q-F****4E7 LILIEK KURNIAWAN 357305******0001 0812*****001 03/10/2021 Sesi 3 12.00 - 14.00
2712 S-1****DF6 Gunardianto Sanjaya 357902******0004 0823*****819 03/10/2021 Sesi 3 12.00 - 14.00
2713 S-1****283 Muhammad Taufiq Rabbani 350307******0002 0878*****755 03/10/2021 Sesi 3 12.00 - 14.00
2714 S-2****27D Slamet Wahyudi 350723******0002 0831*****890 03/10/2021 Sesi 3 12.00 - 14.00
2715 S-2****C6E GERY DWI AYU PUTRANTI 350803******0004 0857*****527 03/10/2021 Sesi 3 12.00 - 14.00
2716 S-2****FD2 NORMAN AHMAD RINALDI 357901******0004 0813*****011 03/10/2021 Sesi 3 12.00 - 14.00
2717 S-2****238 SUMIATI 357304******0035 0812*****172 03/10/2021 Sesi 3 12.00 - 14.00
2718 S-2****C56 LILIK SUNARTI 357305******0003 0812*****616 03/10/2021 Sesi 3 12.00 - 14.00
2719 S-2****BC3 SUPARDI 357305******0004 0813*****998 03/10/2021 Sesi 3 12.00 - 14.00
2720 S-2****DB7 LISWAHJUDI 357305******0002 0851*****658 03/10/2021 Sesi 3 12.00 - 14.00
2721 S-3****5FE IRUL SITI SUMARNI 350722******0001 0813*****377 03/10/2021 Sesi 3 12.00 - 14.00
2722 S-3****CC1 SOEMIAJAH 357304******0003 0822*****50 03/10/2021 Sesi 3 12.00 - 14.00
2723 S-3****2DD MUNIAH 351412******0003 0853*****387 03/10/2021 Sesi 3 12.00 - 14.00
2724 S-3****11D EDY SUMARSONO 350722******0001 0852*****988 03/10/2021 Sesi 3 12.00 - 14.00
2725 S-4****FC7 NURENDAH NUFFIDA 357809******0002 0896*****364 03/10/2021 Sesi 3 12.00 - 14.00
2726 S-4****462 Elan Herlina 357301******0007 0856*****20 03/10/2021 Sesi 3 12.00 - 14.00
2727 S-4****492 SISWOYO ARIFIN 357305******0004 0813*****926 03/10/2021 Sesi 3 12.00 - 14.00

Page 65 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2728 S-4****794 ENDAH NURAINI 357305******0003 0858*****990 03/10/2021 Sesi 3 12.00 - 14.00
2729 S-4****45D RUSELIN 350723******0009 0814*****945 03/10/2021 Sesi 3 12.00 - 14.00
2730 S-5****7DC CHANIFAH 350724******0001 0813*****662 03/10/2021 Sesi 3 12.00 - 14.00
2731 S-6****98B MUHAMAD IMAM 357301******0004 0856*****20 03/10/2021 Sesi 3 12.00 - 14.00
2732 S-6****D79 Wulan Dwi Rahmawati 350722******0001 0851*****154 03/10/2021 Sesi 3 12.00 - 14.00
2733 S-6****529 SABARUDIN 357304******0003 0812*****26 03/10/2021 Sesi 3 12.00 - 14.00
2734 S-6****709 SRI ANDAYANI 357304******0003 0822*****678 03/10/2021 Sesi 3 12.00 - 14.00
2735 S-6****833 SUYONO ADI 351411******0001 0812*****611 03/10/2021 Sesi 3 12.00 - 14.00
2736 S-7****752 Moh Dwi Nurcholil 357302******0002 0812*****788 03/10/2021 Sesi 3 12.00 - 14.00
2737 S-7****E75 SUHARNI 357301******0001 0813*****615 03/10/2021 Sesi 3 12.00 - 14.00
2738 S-8****41D ROEKHAN 357304******0005 0812*****85 03/10/2021 Sesi 3 12.00 - 14.00
2739 S-9****B1C SITI MAESAROH 350623******0002 0818*****613 03/10/2021 Sesi 3 12.00 - 14.00
2740 S-9****A5A SITI ROCHMAH 350726******0068 0852*****496 03/10/2021 Sesi 3 12.00 - 14.00
2741 S-A****09D Ahmad Jupri 130812******0001 0823*****244 03/10/2021 Sesi 3 12.00 - 14.00
2742 S-A****626 KRISTINING BINTARI 357304******0011 0815*****475 03/10/2021 Sesi 3 12.00 - 14.00
2743 S-B****773 IBNU SUTOMO 351506******0002 0895*****8730 03/10/2021 Sesi 3 12.00 - 14.00
2744 S-B****41D IDA BAGUS SURYADHARMA 350722******0003 0856*****451 03/10/2021 Sesi 3 12.00 - 14.00
2745 S-C****6B8 DJUWARI 357305******0001 0896*****213 03/10/2021 Sesi 3 12.00 - 14.00
2746 S-C****0A3 META SUSANTI 367105******0003 0853*****227 03/10/2021 Sesi 3 12.00 - 14.00
2747 S-C****E1B Nur Huda 351710******0002 0831*****582 03/10/2021 Sesi 3 12.00 - 14.00
2748 S-E****409 SUSILO DIONO 357305******0010 0813*****550 03/10/2021 Sesi 3 12.00 - 14.00
2749 S-E****11E ALEXANDER GATOT WIBOWO IR 917103******0001 0821*****631 03/10/2021 Sesi 3 12.00 - 14.00
2750 Y-0****F37 NINUK SUDARSINI 357302******0002 0817*****15 03/10/2021 Sesi 3 12.00 - 14.00
2751 Y-0****KYU KARIYANTO 357305******0009 0813*****975 03/10/2021 Sesi 3 12.00 - 14.00
2752 Y-0****RTM MOH. NURUL IKHSANUL KHOSI'IN 350104******0002 0896*****965 03/10/2021 Sesi 3 12.00 - 14.00
2753 Y-0****DXH Rusmiati SST 647302******0004 0812*****60 03/10/2021 Sesi 3 12.00 - 14.00
2754 Y-0****QT7 ATHAYA RIFQYYA SYAFIQAH 640804******0004 0822*****40 03/10/2021 Sesi 3 12.00 - 14.00
2755 Y-0****EUH ALIF FAUZAN NUGROHO 317501******0002 0896*****789 03/10/2021 Sesi 3 12.00 - 14.00
2756 Y-0****MG3 MUHAMMAD FAZA QINTHORO ARIFIE 317404******0006 0857*****981 03/10/2021 Sesi 3 12.00 - 14.00
2757 Y-0****7BF NIZAN FADILLAH 317102******1001 0857*****565 03/10/2021 Sesi 3 12.00 - 14.00
2758 Y-0****AZ8 SULTHAN AXEL AL FARISI 317404******1001 0859*****223 03/10/2021 Sesi 3 12.00 - 14.00
2759 Y-0****MY8 THEODORE R.G. ARDEN WIDJAJA 317102******0005 0896*****065 03/10/2021 Sesi 3 12.00 - 14.00
2760 Y-0****YVM AMY RIRIS MERALDA 317501******0005 0896*****370 03/10/2021 Sesi 3 12.00 - 14.00
2761 Y-0****K2R MUHAMAD HAFIZS TAVO 317502******0004 0878*****099 03/10/2021 Sesi 3 12.00 - 14.00
2762 Y-0****0TN RABJHANY ANAQAH 317502******0004 0895*****9103 03/10/2021 Sesi 3 12.00 - 14.00
2763 Y-0****V1I LOUIS FERNANDA TAMBUNAN 321608******0003 0852*****717 03/10/2021 Sesi 3 12.00 - 14.00
2764 Y-0****Z1B RIZKY DWI SAPUTRA 317507******1002 0851*****907 03/10/2021 Sesi 3 12.00 - 14.00
2765 Y-0****391 FARHAN SUFIANSYAH 327502******0010 0823*****416 03/10/2021 Sesi 3 12.00 - 14.00
2766 Y-0****W9D DENY SWATAMA 317307******0005 0877*****545 03/10/2021 Sesi 3 12.00 - 14.00
2767 Y-0****9LR JEREMY CHRISTOPUTRA 327502******0034 0812*****790 03/10/2021 Sesi 3 12.00 - 14.00
2768 Y-0****KL1 STEIVEN MILLER 317507******1002 0857*****341 03/10/2021 Sesi 3 12.00 - 14.00
2769 Y-0****X6G EMHA ILHAMI RAIS 327604******0003 0813*****930 03/10/2021 Sesi 3 12.00 - 14.00

Page 66 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2770 Y-0****6UU EXAUDI KT SIMORANGKIR 317502******0002 0811*****25 03/10/2021 Sesi 3 12.00 - 14.00
2771 Y-0****HW2 STEPHANUS JONATHAN WILLIAM HUKOM 317104******0001 0811*****5 03/10/2021 Sesi 3 12.00 - 14.00
2772 Y-0****XJ9 ADDINAL HAFIDU 317507******0002 0877*****301 03/10/2021 Sesi 3 12.00 - 14.00
2773 Y-0****F0Z LOREN PRIFAN 317203******0007 0815*****222 03/10/2021 Sesi 3 12.00 - 14.00
2774 Y-0****A67 MUHAMMAD DZULHAN 317203******0001 0878*****868 03/10/2021 Sesi 3 12.00 - 14.00
2775 Y-0****DE6 NUR RAHMATTULLAH 317104******0002 0851*****466 03/10/2021 Sesi 3 12.00 - 14.00
2776 Y-0****AXR ALLISA ANASTASYA 317103******0002 0821*****601 03/10/2021 Sesi 3 12.00 - 14.00
2777 Y-0****GHK SEKAR MARIAM HAPSARI 317507******0005 0878*****079 03/10/2021 Sesi 3 12.00 - 14.00
2778 Y-0****NFE PUSPA AGHATA DIAH SANTIKA 317406******0002 0857*****756 03/10/2021 Sesi 3 12.00 - 14.00
2779 Y-0****R7G DHIKA ANGGI ARVIANI 330701******0005 0821*****895 03/10/2021 Sesi 3 12.00 - 14.00
2780 Y-0****D0N REZA INDRA FORMA 317308******0002 0852*****269 03/10/2021 Sesi 3 12.00 - 14.00
2781 Y-0****V47 RANGGA SAPUTRA 317105******0001 0888*****996 03/10/2021 Sesi 3 12.00 - 14.00
2782 Y-0****EWE DITA GUSTIA DEVI 317405******0002 0857*****260 03/10/2021 Sesi 3 12.00 - 14.00
2783 Y-0****N5P HANZHOLAH 317507******0002 0899*****83 03/10/2021 Sesi 3 12.00 - 14.00
2784 Y-0****THC MUHAMMAD ZAKKY ZULFIKAR 327601******0012 0895*****4671 03/10/2021 Sesi 3 12.00 - 14.00
2785 Y-0****8ZP AVI NASTITI A 317203******0004 0877*****842 03/10/2021 Sesi 3 12.00 - 14.00
2786 Y-0****Q3H AZHARI PRASETYA YUDHA 317302******0003 0813*****223 03/10/2021 Sesi 3 12.00 - 14.00
2787 Y-0****NGV ARIF RACHMANDANI 317507******0008 0821*****326 03/10/2021 Sesi 3 12.00 - 14.00
2788 Y-0****HUM CHANDRA SESAR AGUSTINUS SIPAYUNG 317508******0008 0877*****485 03/10/2021 Sesi 3 12.00 - 14.00
2789 Y-0****QES AFIA CHAIRUNISA 317503******0002 0896*****041 03/10/2021 Sesi 3 12.00 - 14.00
2790 Y-0****6NT ALIF AULIA AKBAR 317504******0007 0852*****732 03/10/2021 Sesi 3 12.00 - 14.00
2791 Y-0****F8M NADIEM HASSYA PRAMANA 317401******0012 0821*****442 03/10/2021 Sesi 3 12.00 - 14.00
2792 Y-0****7D2 DANIEL HUGO WIDJAJA 317509******1002 0813*****343 03/10/2021 Sesi 3 12.00 - 14.00
2793 Y-0****HY3 GUIDO HALIM FERNOMEL 317305******1003 0813*****968 03/10/2021 Sesi 3 12.00 - 14.00
2794 Y-0****K2G SATRIO SETYADI 317509******0003 0878*****815 03/10/2021 Sesi 3 12.00 - 14.00
2795 Y-0****5VX ARIEL PRATAMA HARDIANSA 317201******0002 0812*****177 03/10/2021 Sesi 3 12.00 - 14.00
2796 Y-0****H9C SURYA BAGUS PAMBUDI 317509******0006 0851*****020 03/10/2021 Sesi 3 12.00 - 14.00
2797 Y-0****21X ROSINA MONICA 647105******0001 0812*****745 03/10/2021 Sesi 3 12.00 - 14.00
2798 Y-0****DP5 VEBIYANTI MEGA UTAMI 317509******0004 0881*****23 03/10/2021 Sesi 3 12.00 - 14.00
2799 Y-0****5FR VALERYAN ANGELA MARTHAVANI SUMBAYAK 317510******1001 0895*****952 03/10/2021 Sesi 3 12.00 - 14.00
2800 Y-0****OTB RIZKY AMALIA UTOMO 317407******0004 0878*****442 03/10/2021 Sesi 3 12.00 - 14.00
2801 Y-0****ED1 AHMAD BYAN KAMALI 317401******0003 0812*****742 03/10/2021 Sesi 3 12.00 - 14.00
2802 Y-0****GBO AZALEA AZ ZAHRA 317508******1006 0813*****042 03/10/2021 Sesi 3 12.00 - 14.00
2803 Y-0****N4O CINDAR BUMI PUTRI WAHYUANTI 351817******0005 0822*****617 03/10/2021 Sesi 3 12.00 - 14.00
2804 Y-0****45Z BILLY IRSANDO SUBACHTY 317103******0002 0812*****149 03/10/2021 Sesi 3 12.00 - 14.00
2805 Y-0****QOE ALIYA HALIMA SADIYA 317407******0004 0813*****315 03/10/2021 Sesi 3 12.00 - 14.00
2806 Y-0****KDS MOHAMMAD AGUS SENTOSA 350919******0001 0895*****298 03/10/2021 Sesi 3 12.00 - 14.00
2807 Y-0****3KC KRESNA PUTRA BAYU 340301******0004 0822*****172 03/10/2021 Sesi 3 12.00 - 14.00
2808 Y-0****QHD ACHMAD ZUHDI MUCHTAR 317104******0002 0858*****239 03/10/2021 Sesi 3 12.00 - 14.00
2809 Y-0****X79 YNEZ JUYLETTE SIREGAR 327503******0020 0897*****57 03/10/2021 Sesi 3 12.00 - 14.00
2810 Y-0****ESL ATHAYA ISMAIL 317407******0001 0815*****833 03/10/2021 Sesi 3 12.00 - 14.00
2811 Y-0****BJM Samichah, S.Gz 332218******0002 0857*****974 03/10/2021 Sesi 3 12.00 - 14.00

Page 67 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2812 Y-0****SVR MEIRIZA PUTRI PRAHASTUTI,SST 357303******0006 0898*****77 03/10/2021 Sesi 3 12.00 - 14.00
2813 Y-0****1KH DHEA ZAHRA RAHMATIKA 647403******0001 0896*****884 03/10/2021 Sesi 3 12.00 - 14.00
2814 J-0****79D MUH FARHAN NOER 321520******0002 0877*****273 04/10/2021 Sesi 1 08.00 - 10.00
2815 J-0****FPN ABDU RAHMAN 150602******0002 0823*****138 04/10/2021 Sesi 1 08.00 - 10.00
2816 J-0****TFQ DEA PUTRI LATIFAH 357903******0002 0858*****939 04/10/2021 Sesi 1 08.00 - 10.00
2817 J-0****IXQ NANDI AHMAD NUGRAHA 187109******0004 0812*****320 04/10/2021 Sesi 1 08.00 - 10.00
2818 J-0****S71 DENTISIA OKTAVIANI 351515******0003 0821*****875 04/10/2021 Sesi 1 08.00 - 10.00
2819 J-0****SJP ALIYYA Z. E. KAKIAY 180310******0003 0851*****711 04/10/2021 Sesi 1 08.00 - 10.00
2820 J-0****X9R SELLY WIJAYA, S T 357827******0001 0812*****996 04/10/2021 Sesi 1 08.00 - 10.00
2821 J-0****8VN INES YUANTA 350921******0003 0812*****099 04/10/2021 Sesi 1 08.00 - 10.00
2822 J-0****VF9 NAJMA KHALIDA 352316******0002 0813*****200 04/10/2021 Sesi 1 08.00 - 10.00
2823 J-0****VLF RAFI NABIL HANIFI 352316******0001 0822*****426 04/10/2021 Sesi 1 08.00 - 10.00
2824 J-0****WWV HAFIDA ABDILLAH 927105******0001 0813*****435 04/10/2021 Sesi 1 08.00 - 10.00
2825 J-0****1YH FIRMANDA YULIANSYAH 352413******0001 0813*****081 04/10/2021 Sesi 1 08.00 - 10.00
2826 J-0****SYI ROSIDAH WULAN NINGRUM 157201******0002 0822*****393 04/10/2021 Sesi 1 08.00 - 10.00
2827 J-0****WD6 ALY AKBAR RHAUF 357804******0001 0821*****626 04/10/2021 Sesi 1 08.00 - 10.00
2828 J-0****3I3 NUR AMALANI SAPUTRI 331207******0002 0857*****103 04/10/2021 Sesi 1 08.00 - 10.00
2829 J-0****CZA MITHA WAHYUNINGTIAS 357303******0007 0881*****1197 04/10/2021 Sesi 1 08.00 - 10.00
2830 J-0****J9J GANDI JOKO SISWANTO 350606******0001 0857*****378 04/10/2021 Sesi 1 08.00 - 10.00
2831 J-0****HGM AL DHANI AKBAR 350612******0002 0888*****71 04/10/2021 Sesi 1 08.00 - 10.00
2832 J-0****I7P ARI WIBOWO 331211******0001 0821*****826 04/10/2021 Sesi 1 08.00 - 10.00
2833 J-0****Y91 RIZKY YULIS APRILIANTO 352208******0002 0812*****315 04/10/2021 Sesi 1 08.00 - 10.00
2834 J-0****4QM ERLIANATASYA SASKAVIONA 350725******0002 0856*****052 04/10/2021 Sesi 1 08.00 - 10.00
2835 J-0****933 NANDA SUKMA TRIYULIANA 357301******0001 0851*****904 04/10/2021 Sesi 1 08.00 - 10.00
2836 J-0****AEB ERIKO BAGAS PRATAMA 351809******0001 0822*****2075 04/10/2021 Sesi 1 08.00 - 10.00
2837 J-0****IUC MUHAMAD ILHAM SYAIFUDIN 350216******0002 0822*****435 04/10/2021 Sesi 1 08.00 - 10.00
2838 J-0****MRZ EKA MARDIANA 350726******0001 0852*****020 04/10/2021 Sesi 1 08.00 - 10.00
2839 J-0****02T REZA YUSUF MAULANA 620102******0001 0822*****745 04/10/2021 Sesi 1 08.00 - 10.00
2840 J-0****1AK YANA SITA DEWI 357303******0002 0896*****639 04/10/2021 Sesi 1 08.00 - 10.00
2841 J-0****1O7 KHARIS ALFIAN 357303******0004 0838*****312 04/10/2021 Sesi 1 08.00 - 10.00
2842 J-0****JII HIKMATUL HAKIMAH 350701******0001 0819*****324 04/10/2021 Sesi 1 08.00 - 10.00
2843 J-0****MH6 KURNIA NURULITA 351911******0002 0877*****897 04/10/2021 Sesi 1 08.00 - 10.00
2844 J-0****PIG DESY SANDRA RHOMADONA 350902******0002 0852*****103 04/10/2021 Sesi 1 08.00 - 10.00
2845 J-0****XTB DUNGA DWI BARINTA 327405******0002 0821*****083 04/10/2021 Sesi 1 08.00 - 10.00
2846 J-0****70A RINALDI PUTRA HARUM DOLOKSARIBU 121002******0002 0813*****114 04/10/2021 Sesi 1 08.00 - 10.00
2847 J-0****BBR CAHYO TRILAKSONO 360309******0001 0896*****218 04/10/2021 Sesi 1 08.00 - 10.00
2848 J-0****JLJ MOCH. RIZQI GUMILANG 350922******0001 0877*****065 04/10/2021 Sesi 1 08.00 - 10.00
2849 J-0****9OP FIRDA AYU NATALIA 357304******0010 0858*****969 04/10/2021 Sesi 1 08.00 - 10.00
2850 J-0****GT6 DANIEL MARCEL NAMORA PARDEDE 317402******0003 0877*****509 04/10/2021 Sesi 1 08.00 - 10.00
2851 J-0****KBG AGNES JUNIATI PARDEDE 910201******0001 0821*****521 04/10/2021 Sesi 1 08.00 - 10.00
2852 J-0****B9V ISNIA AL AFIF 647403******0004 0812*****526 04/10/2021 Sesi 1 08.00 - 10.00
2853 J-0****3BK RIZKY AYU DIELLA CALISTA 357304******0011 0812*****574 04/10/2021 Sesi 1 08.00 - 10.00

Page 68 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2854 J-0****BIX INDIRA WAHYU KUSUMANINGRUM 350403******0004 0858*****322 04/10/2021 Sesi 1 08.00 - 10.00
2855 J-0****BM5 ADITYA DANIAR HERLAMBANG 187102******0010 0821*****023 04/10/2021 Sesi 1 08.00 - 10.00
2856 J-0****RZB SALSABILLAH ADINDA PUTRI HARIANTO 357304******0001 0896*****166 04/10/2021 Sesi 1 08.00 - 10.00
2857 J-0****SEC DEVIANA MAYASARI 520308******0001 0817*****29 04/10/2021 Sesi 1 08.00 - 10.00
2858 J-0****SM9 DAMIANA NOVITA BIRHI 530818******0001 0823*****379 04/10/2021 Sesi 1 08.00 - 10.00
2859 J-0****VOO SITI HALIZA 127604******0002 0852*****364 04/10/2021 Sesi 1 08.00 - 10.00
2860 J-0****3N7 WANDA WIRA YUDIARTI 351610******0002 0822*****259 04/10/2021 Sesi 1 08.00 - 10.00
2861 J-0****B40 SARAH ALIEFIAH ARASY 357302******0001 0822*****266 04/10/2021 Sesi 1 08.00 - 10.00
2862 J-0****CVD ARIANI FARAH ADMARANTI 351401******0001 0895*****817 04/10/2021 Sesi 1 08.00 - 10.00
2863 J-0****J1E NAWANGSASI WINCAHYO ARTIKO AJI 352014******0001 0851*****933 04/10/2021 Sesi 1 08.00 - 10.00
2864 J-0****T2B MUHAMMAD MIFTAKHUL FALAH 331305******0001 0857*****448 04/10/2021 Sesi 1 08.00 - 10.00
2865 J-0****XQ6 AZZILA INDY RAHMADHANI 120704******0001 0821*****425 04/10/2021 Sesi 1 08.00 - 10.00
2866 J-0****ZYG ADJI SANTOSO 352213******0006 0857*****118 04/10/2021 Sesi 1 08.00 - 10.00
2867 J-0****4XQ ALFINA MUFIDAH PUTRI YANTI 350713******0002 0895*****1336 04/10/2021 Sesi 1 08.00 - 10.00
2868 J-0****7CV M FAHRI REZA PUTRA 350718******0003 0821*****616 04/10/2021 Sesi 1 08.00 - 10.00
2869 J-0****B8W EMO LISANO RUMBAY 351611******0001 0822*****271 04/10/2021 Sesi 1 08.00 - 10.00
2870 J-0****DNE ATIKA SAFITRI NUGRAHANI 351508******0011 0878*****099 04/10/2021 Sesi 1 08.00 - 10.00
2871 J-0****FMH AHMAD MIFTAKHUSSUHRI 357303******0006 0895*****3066 04/10/2021 Sesi 1 08.00 - 10.00
2872 J-0****ZLR DWI HARI SRIMULYANI 357305******0001 0853*****698 04/10/2021 Sesi 1 08.00 - 10.00
2873 J-0****5OV YOSRIDHA PRISTIANI FARAKH 330302******0001 0859*****177 04/10/2021 Sesi 1 08.00 - 10.00
2874 J-0****9LK SHEYLA SAFITRI 350517******0003 0821*****872 04/10/2021 Sesi 1 08.00 - 10.00
2875 J-0****C6N ERWIND RIZKA RAHMADANI 351409******0001 0857*****661 04/10/2021 Sesi 1 08.00 - 10.00
2876 J-0****GRT LAILA SAFIRA 350704******0002 0857*****705 04/10/2021 Sesi 1 08.00 - 10.00
2877 J-0****HQ9 HERMAN MAULANA EFENDI 352703******4928 0821*****294 04/10/2021 Sesi 1 08.00 - 10.00
2878 J-0****ILY JANGGUL LAILI ANISA 350724******0006 0858*****505 04/10/2021 Sesi 1 08.00 - 10.00
2879 J-0****LHI TERAS ALANG 620505******0003 0858*****716 04/10/2021 Sesi 1 08.00 - 10.00
2880 J-0****LXB SILVIANA IBAU 640603******0002 0812*****324 04/10/2021 Sesi 1 08.00 - 10.00
2881 J-0****M2E SEVINA MAITUTON MAJAZI 351508******0004 0812*****011 04/10/2021 Sesi 1 08.00 - 10.00
2882 J-0****M2L VIVIN VIDIA NURDIANSYAH 357305******0003 0857*****011 04/10/2021 Sesi 1 08.00 - 10.00
2883 J-0****QKN FENI AFRI FIANI 351411******0003 0858*****097 04/10/2021 Sesi 1 08.00 - 10.00
2884 J-0****ZGZ ANISA RIZQI SAQINAH 357304******0002 0812*****660 04/10/2021 Sesi 1 08.00 - 10.00
2885 J-0****1CO RIZALDY ANDRA PRASETYO 527106******0004 0823*****225 04/10/2021 Sesi 1 08.00 - 10.00
2886 J-0****1ZA MUHAMMAD FAJRUL FALAH 351518******0010 0812*****182 04/10/2021 Sesi 1 08.00 - 10.00
2887 J-0****2A1 MOHAMMAD AQMARUL HILMI 357304******0005 0852*****697 04/10/2021 Sesi 1 08.00 - 10.00
2888 J-0****2BU MUHAMMAD DZAKY ABDURRAHMAN 647105******0002 0838*****228 04/10/2021 Sesi 1 08.00 - 10.00
2889 J-0****2J0 ILHAM ISDIANSYAH 367108******0004 0895*****1749 04/10/2021 Sesi 1 08.00 - 10.00
2890 J-0****2P7 DAFFA ADRISTI FIRAYNE 350724******0005 0878*****452 04/10/2021 Sesi 1 08.00 - 10.00
2891 J-0****2YV ADI SUWANDONO 180701******0001 0812*****269 04/10/2021 Sesi 1 08.00 - 10.00
2892 J-0****338 SAWADE SHANIA ZECILIA 357301******0002 0896*****125 04/10/2021 Sesi 1 08.00 - 10.00
2893 J-0****36B PENGGALIH FIRMANDIKA SUBEKTI 350731******0001 0858*****751 04/10/2021 Sesi 1 08.00 - 10.00
2894 J-0****3AI HARITS GHOZI MUZAKI SARTONO 327330******0005 0812*****22 04/10/2021 Sesi 1 08.00 - 10.00
2895 J-0****3KY ANIS TRIMARSELA 351602******0001 0813*****669 04/10/2021 Sesi 1 08.00 - 10.00

Page 69 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2896 J-0****3PD DEWANGGA FAJAR ROCHMANA 331410******0001 0857*****880 04/10/2021 Sesi 1 08.00 - 10.00
2897 J-0****3Q6 NAHDIAH HILMI NUR FATIN 357305******0001 0857*****767 04/10/2021 Sesi 1 08.00 - 10.00
2898 J-0****3W2 ACHMAD RAMADHONA CHOIR 357304******0001 0812*****380 04/10/2021 Sesi 1 08.00 - 10.00
2899 J-0****420 NABILLAH ANISSA 357602******0002 0812*****022 04/10/2021 Sesi 1 08.00 - 10.00
2900 J-0****47G HERFANDI LAMDO 187113******0001 0821*****808 04/10/2021 Sesi 1 08.00 - 10.00
2901 J-0****47W ANGGITA SASMITA FERNANDA 357301******0013 0896*****243 04/10/2021 Sesi 1 08.00 - 10.00
2902 J-0****498 PANCA BASUKI RAHMAT 910901******0004 0822*****974 04/10/2021 Sesi 1 08.00 - 10.00
2903 J-0****4BB SYLVIA NOOR HARDIYANTI 357304******0006 0896*****275 04/10/2021 Sesi 1 08.00 - 10.00
2904 J-0****4HJ SHOFI AYU SAFITRI 351608******0001 0857*****189 04/10/2021 Sesi 1 08.00 - 10.00
2905 J-0****4PL EKA FARAH ANNISA 351708******0010 0821*****834 04/10/2021 Sesi 1 08.00 - 10.00
2906 J-0****4UL NURHALIMAH 127112******0005 0821*****039 04/10/2021 Sesi 1 08.00 - 10.00
2907 J-0****50R MUHAMMAD HASBIANTO 327503******0020 0857*****701 04/10/2021 Sesi 1 08.00 - 10.00
2908 J-0****53V SONNIA SYAFIRRA 350722******0002 0852*****020 04/10/2021 Sesi 1 08.00 - 10.00
2909 J-0****5LG M. W. BINTANG KAKIAY 180310******0001 0812*****779 04/10/2021 Sesi 1 08.00 - 10.00
2910 J-0****5LP FAIRUZ IKBAR FARANDY 327511******0005 0859*****464 04/10/2021 Sesi 1 08.00 - 10.00
2911 J-0****5OV WILDANA TSANI 367407******0003 0813*****583 04/10/2021 Sesi 1 08.00 - 10.00
2912 J-0****5VA GANDUNG ORIE INDRAWAN 180217******0004 0896*****758 04/10/2021 Sesi 1 08.00 - 10.00
2913 J-0****6Y9 DEDI SUPRIONO 357305******0014 0813*****312 04/10/2021 Sesi 1 08.00 - 10.00
2914 J-0****70N FRIZKY RIA SUSANTO 360323******0002 0882*****175 04/10/2021 Sesi 1 08.00 - 10.00
2915 J-0****7HC DESTIA REGITA AYUNDA ANANG 357503******0004 0815*****000 04/10/2021 Sesi 1 08.00 - 10.00
2916 J-0****7S2 ANANDA MAGHFIRA AJENG MENTARI 331309******0001 0812*****921 04/10/2021 Sesi 1 08.00 - 10.00
2917 J-0****7TZ ELSA NURSAFITRI 517101******0001 0857*****033 04/10/2021 Sesi 1 08.00 - 10.00
2918 J-0****7VX M. SALIM SUPRIATNA 140204******0008 0813*****115 04/10/2021 Sesi 1 08.00 - 10.00
2919 J-0****7W8 JIHAD PRAKOSO 327104******0007 0857*****959 04/10/2021 Sesi 1 08.00 - 10.00
2920 J-0****7YF AZIS ARIEF ANGGARA 331102******0002 0822*****738 04/10/2021 Sesi 1 08.00 - 10.00
2921 J-0****87B LATIFAH WINDA HAMIDAH 350724******0001 0877*****326 04/10/2021 Sesi 1 08.00 - 10.00
2922 J-0****8FT RAHULFAJRI ASH-SHAFFAN YAHYA 350921******0004 0851*****411 04/10/2021 Sesi 1 08.00 - 10.00
2923 J-0****8JP GABRIELA KARINA KAAWOAN 710212******0001 0813*****565 04/10/2021 Sesi 1 08.00 - 10.00
2924 J-0****8JR DANI ZAKIYUDDIN 351006******0001 0822*****576 04/10/2021 Sesi 1 08.00 - 10.00
2925 J-0****8NG DINDA PUSPA MUSTIKA 350722******0001 0858*****774 04/10/2021 Sesi 1 08.00 - 10.00
2926 J-0****8UN MUHAMMAD FAISHAL FARRAS 331810******0002 0821*****098 04/10/2021 Sesi 1 08.00 - 10.00
2927 J-0****98E FIKA SHALSABILLA ADDISHA PUTRI 327327******0002 0812*****533 04/10/2021 Sesi 1 08.00 - 10.00
2928 J-0****9D9 DANIAR RISTYA FADIA 360404******0001 0816*****3 04/10/2021 Sesi 1 08.00 - 10.00
2929 J-0****9EW M. AINUN NAIM 640206******0005 0821*****756 04/10/2021 Sesi 1 08.00 - 10.00
2930 J-0****9G0 RANI KHARISMA NISA' 357304******0001 0822*****990 04/10/2021 Sesi 1 08.00 - 10.00
2931 J-0****9LI FATKURROHIM 827103******0002 0813*****753 04/10/2021 Sesi 1 08.00 - 10.00
2932 J-0****9PX RIYANDA SATRIYO WICAKSONO 352008******0001 0816*****411 04/10/2021 Sesi 1 08.00 - 10.00
2933 J-0****9T1 MIRSA AYU 357303******0002 0816*****2 04/10/2021 Sesi 1 08.00 - 10.00
2934 J-0****A45 NASRUL AULIA KALAMULLAH 350719******0001 0895*****4499 04/10/2021 Sesi 1 08.00 - 10.00
2935 J-0****AKC ANDREW RIZKI SUNURAT 351418******0002 0812*****635 04/10/2021 Sesi 1 08.00 - 10.00
2936 J-0****AND SATPUTRI PARINATA ISYWARI 350725******0001 0853*****103 04/10/2021 Sesi 1 08.00 - 10.00
2937 J-0****AQA AYU KARTIKA 357303******0002 0822*****783 04/10/2021 Sesi 1 08.00 - 10.00

Page 70 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2938 J-0****ARJ MUHAMMAD IQBAL PRADHANA 327508******0020 0817*****75 04/10/2021 Sesi 1 08.00 - 10.00
2939 J-0****B4W SILFI VENI SUSANTI 351411******0004 0857*****320 04/10/2021 Sesi 1 08.00 - 10.00
2940 J-0****B58 RETNO AYU WULANDARI 350713******0004 0856*****635 04/10/2021 Sesi 1 08.00 - 10.00
2941 J-0****BE5 RAKA JATINDRA DIWYASTRA 357203******0003 0822*****595 04/10/2021 Sesi 1 08.00 - 10.00
2942 J-0****BIK MUHAMMAD WAHFIUDDIN 357305******0003 0823*****546 04/10/2021 Sesi 1 08.00 - 10.00
2943 J-0****BLR ARNETA DELLAVANI 357305******0007 0812*****516 04/10/2021 Sesi 1 08.00 - 10.00
2944 J-0****BTL KHOLIFATUL IZZA 352426******0001 0857*****211 04/10/2021 Sesi 1 08.00 - 10.00
2945 J-0****C16 ZARO EZZA SYACHNIAR 350418******0003 0857*****828 04/10/2021 Sesi 1 08.00 - 10.00
2946 J-0****C77 AFFAN RAFI' EKO WICAKSONO 321620******0003 0812*****796 04/10/2021 Sesi 1 08.00 - 10.00
2947 J-0****C78 ROJA AMNADAROINI 350731******0001 0858*****611 04/10/2021 Sesi 1 08.00 - 10.00
2948 J-0****CEX DEBORA INDRA SAYEKTI 357305******0001 0831*****785 04/10/2021 Sesi 1 08.00 - 10.00
2949 J-0****CHB LAILATUL IZZAH 350719******0001 0896*****647 04/10/2021 Sesi 1 08.00 - 10.00
2950 J-0****CI2 NELA TASYAFA SALSABELA 352505******0001 0855*****316 04/10/2021 Sesi 1 08.00 - 10.00
2951 J-0****CUM ARIF MUSTOFA 350801******0001 0812*****512 04/10/2021 Sesi 1 08.00 - 10.00
2952 J-0****CWU ARLIS ERLIANA SAVITRI 350723******0001 0813*****639 04/10/2021 Sesi 1 08.00 - 10.00
2953 J-0****DBF WILLY ALVIAN RIVALDO 331217******0001 0838*****149 04/10/2021 Sesi 1 08.00 - 10.00
2954 J-0****DH7 IRSALINA DIAN ARDIANI 321609******0009 0838*****133 04/10/2021 Sesi 1 08.00 - 10.00
2955 J-0****DJN KHAULA FATHIA HUMAIRA 350724******0001 0813*****763 04/10/2021 Sesi 1 08.00 - 10.00
2956 J-0****DK6 PRIMARESTY MILLENDA SUSANTO 357803******0002 0896*****555 04/10/2021 Sesi 1 08.00 - 10.00
2957 J-0****DKF LUTHFIYAH KAMILA AFANDI 357102******0002 0858*****415 04/10/2021 Sesi 1 08.00 - 10.00
2958 J-0****DL7 WIDURAMA TRI BUANA YUHANDANA 352215******0001 0821*****380 04/10/2021 Sesi 1 08.00 - 10.00
2959 J-0****E2L TITA JIWANTY FITRI 351020******0004 0822*****510 04/10/2021 Sesi 1 08.00 - 10.00
2960 J-0****E3K NENENG SEPTIKA DAGIS 630206******0004 0822*****366 04/10/2021 Sesi 1 08.00 - 10.00
2961 J-0****EB5 ISWATUL KHASANAH 350724******0003 0881*****9077 04/10/2021 Sesi 1 08.00 - 10.00
2962 J-0****EV6 RATIH DEVI PUJA FELINA 537102******0008 0819*****678 04/10/2021 Sesi 1 08.00 - 10.00
2963 J-0****F0L CHOLIFATU NADIAH 350725******0001 0814*****964 04/10/2021 Sesi 1 08.00 - 10.00
2964 J-0****F10 CAHYANI APRILIA HIDAYAH 351502******0001 0856*****42 04/10/2021 Sesi 1 08.00 - 10.00
2965 J-0****F5A AZIZAH AL AQSATH 130207******0006 0813*****651 04/10/2021 Sesi 1 08.00 - 10.00
2966 J-0****FAS SALMA NADIA RAHMA 610110******0001 0812*****851 04/10/2021 Sesi 1 08.00 - 10.00
2967 J-0****FKQ SITI KHODIJAH 350902******0002 0821*****507 04/10/2021 Sesi 1 08.00 - 10.00
2968 J-0****FOM MUHAMMAD IFAN ZULFAN NURHAKIM SUSENO 357203******0003 0812*****424 04/10/2021 Sesi 1 08.00 - 10.00
2969 J-0****FPM WAHIDA AMALIN 350711******0005 0812*****208 04/10/2021 Sesi 1 08.00 - 10.00
2970 J-0****FVY FITRI DWI FADIA 350713******0001 0896*****277 04/10/2021 Sesi 1 08.00 - 10.00
2971 J-0****G3G LATIFATUS ZAHROH 350719******0001 0821*****004 04/10/2021 Sesi 1 08.00 - 10.00
2972 J-0****G60 ISDA MAGFIRAH 620205******0003 0822*****368 04/10/2021 Sesi 1 08.00 - 10.00
2973 J-0****G6F TWISTCHA NATHANAEL NUGROHO 147111******0001 0822*****823 04/10/2021 Sesi 1 08.00 - 10.00
2974 J-0****GE9 TEGUH BAMBANG E 350723******0001 0851*****164 04/10/2021 Sesi 1 08.00 - 10.00
2975 J-0****GHJ ENNI ASTUTI 350723******0002 0856*****546 04/10/2021 Sesi 1 08.00 - 10.00
2976 J-0****GK0 FADZIL MISBACHUDIN BUSRO 350718******0001 0815*****742 04/10/2021 Sesi 1 08.00 - 10.00
2977 J-0****GW1 LIPIANA SARAGIH 120807******0001 0813*****011 04/10/2021 Sesi 1 08.00 - 10.00
2978 J-0****H36 FAIZ AMINUL HIKAM 331821******0003 0812*****917 04/10/2021 Sesi 1 08.00 - 10.00
2979 J-0****HBM RESOLITA YULIANI SAMOSIR 121815******0002 0812*****853 04/10/2021 Sesi 1 08.00 - 10.00

Page 71 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
2980 J-0****HXJ GATRA DYAH CHRISTIANTI 910601******0006 0822*****772 04/10/2021 Sesi 1 08.00 - 10.00
2981 J-0****HYR ILHAM PRABOWO GHUTO 647203******0002 0822*****724 04/10/2021 Sesi 1 08.00 - 10.00
2982 J-0****HZ8 MUHAMMAD KHOIRUL ANAM 351105******0002 0823*****230 04/10/2021 Sesi 1 08.00 - 10.00
2983 J-0****I3K RIDHA NURLITA BRILIANA 350722******0004 0823*****813 04/10/2021 Sesi 1 08.00 - 10.00
2984 J-0****IG6 NADILA AZZA NUR PRASETYA 357304******0007 0878*****604 04/10/2021 Sesi 1 08.00 - 10.00
2985 J-0****IHR BRIAN REZKI O. MANALU 121606******0001 0852*****511 04/10/2021 Sesi 1 08.00 - 10.00
2986 J-0****IPP RECHITA DINDA ELISHA 350712******0002 0821*****187 04/10/2021 Sesi 1 08.00 - 10.00
2987 J-0****ISP ADITYA HENDRA PRATAMA 350612******0001 0812*****398 04/10/2021 Sesi 1 08.00 - 10.00
2988 J-0****ITF MOH RIFQI NAWAFI 350404******0002 0858*****419 04/10/2021 Sesi 1 08.00 - 10.00
2989 J-0****IUY ANANDA HANIE ASTYANTI 350723******0001 0812*****218 04/10/2021 Sesi 1 08.00 - 10.00
2990 J-0****IZO ANNISA AURORA KARTIKA 351714******0001 0812*****610 04/10/2021 Sesi 1 08.00 - 10.00
2991 J-0****J3M NINA AMELIA 351502******0004 0857*****420 04/10/2021 Sesi 1 08.00 - 10.00
2992 J-0****JKM ALFI YULIANA MANURUNG 910201******0004 0821*****268 04/10/2021 Sesi 1 08.00 - 10.00
2993 J-0****JY5 MUHAMMAD NAUFAL FIKRI 367104******0005 0896*****805 04/10/2021 Sesi 1 08.00 - 10.00
2994 J-0****K9O LUTFIARI NUR ROHMAH 350510******0002 0857*****407 04/10/2021 Sesi 1 08.00 - 10.00
2995 J-0****KAN ANDREAS DANNISWARA 357302******0005 0858*****034 04/10/2021 Sesi 1 08.00 - 10.00
2996 J-0****KEU KRISNA FAJAR KURNIAWAN 331510******0007 0895*****6763 04/10/2021 Sesi 1 08.00 - 10.00
2997 J-0****KFK DINNY CARRIEN 352006******0002 0895*****4529 04/10/2021 Sesi 1 08.00 - 10.00
2998 J-0****KRI CHECE FEBRIANTI SURYA INANDA 357301******0014 0813*****843 04/10/2021 Sesi 1 08.00 - 10.00
2999 J-0****KV5 PUTRI NIVALDA MARIA KOMBER 917101******0003 0812*****351 04/10/2021 Sesi 1 08.00 - 10.00
3000 J-0****L7X MIA PRASTIKA DEVI 352107******0001 0822*****760 04/10/2021 Sesi 1 08.00 - 10.00
3001 J-0****L8F FIRDA MASRUROH 350308******0005 0817*****996 04/10/2021 Sesi 1 08.00 - 10.00
3002 J-0****LD7 CAHYONO BAGASKORO 350404******0002 0822*****912 04/10/2021 Sesi 1 08.00 - 10.00
3003 J-0****LOZ MUHAMMAD FAWZUL ALIF NUGROHO 720407******0001 0822*****664 04/10/2021 Sesi 1 08.00 - 10.00
3004 J-0****LPB AJI ZULFIKAR 610514******0001 0857*****285 04/10/2021 Sesi 1 08.00 - 10.00
3005 J-0****LPZ MUHAMMAD ICHSAN ASY'ARI 350605******0004 0878*****771 04/10/2021 Sesi 1 08.00 - 10.00
3006 J-0****LRD MOHAMMAD KHAAFI RADJA RIHAN 357301******0003 0815*****060 04/10/2021 Sesi 1 08.00 - 10.00
3007 J-0****LSC ADINDA SAFITRI NUGRAHENY 647205******0003 0851*****722 04/10/2021 Sesi 1 08.00 - 10.00
3008 J-0****M3W BIMA HARY PRASETYA 620210******0002 0857*****944 04/10/2021 Sesi 1 08.00 - 10.00
3009 J-0****MOP NAZHIF UBAIDILLAH 321706******0011 0878*****960 04/10/2021 Sesi 1 08.00 - 10.00
3010 J-0****MQD RIDA ROHMATA INJIYA 351810******0001 0858*****135 04/10/2021 Sesi 1 08.00 - 10.00
3011 J-0****MU2 AMEILYA RAHMA 357305******0005 0857*****480 04/10/2021 Sesi 1 08.00 - 10.00
3012 J-0****MY7 NEVIA AYU ISTIQOMAH 180104******0016 0822*****427 04/10/2021 Sesi 1 08.00 - 10.00
3013 J-0****MYA JAKA MULYA PRATAMA 187103******0006 0812*****29 04/10/2021 Sesi 1 08.00 - 10.00
3014 J-0****NUX SANTRI ANOM BANGUN PAHALA 350411******0003 0877*****087 04/10/2021 Sesi 1 08.00 - 10.00
3015 J-0****OB8 ANNISA MEYLANA IMANIYAR 357304******0009 0896*****399 04/10/2021 Sesi 1 08.00 - 10.00
3016 J-0****OU9 SHAKIRA MUTIARA DZIKRILLAH 320112******0004 0858*****807 04/10/2021 Sesi 1 08.00 - 10.00
3017 J-0****R89 ROFIAN HENIS MUSLIMAH 351909******0002 0857*****473 04/10/2021 Sesi 1 08.00 - 10.00
3018 J-0****RHR M. AMIN MUZAKI 352212******0001 0895*****1112 04/10/2021 Sesi 1 08.00 - 10.00
3019 J-0****UFJ SHINTA ANGGRAINI PUTRI 357305******0002 0852*****020 04/10/2021 Sesi 1 08.00 - 10.00
3020 J-0****W3F INDAH NURFITRIANINGTYAS 350713******0001 0821*****516 04/10/2021 Sesi 1 08.00 - 10.00
3021 J-0****XCF ROHMA ANGELINA MAULANI PUTRI 357304******0001 0896*****639 04/10/2021 Sesi 1 08.00 - 10.00

Page 72 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3022 J-0****Z0N WAHYU ANDIKA SANTOSA 357302******0004 0822*****973 04/10/2021 Sesi 1 08.00 - 10.00
3023 J-0****ZGY WULAN YULIARTI 357801******0002 0878*****085 04/10/2021 Sesi 1 08.00 - 10.00
3024 J-0****ZH2 RIZKI UTAMI 720104******0001 0822*****496 04/10/2021 Sesi 1 08.00 - 10.00
3025 J-0****ZNL YUSTIKA KUSUMA WARDANI 350311******0005 0813*****736 04/10/2021 Sesi 1 08.00 - 10.00
3026 J-0****ZQD INGGRIT PUJI MANGGARANTI 350603******0001 0856*****610 04/10/2021 Sesi 1 08.00 - 10.00
3027 J-0****ZR2 SINDU RETNO WIDIASTUTI 350603******0001 0857*****26 04/10/2021 Sesi 1 08.00 - 10.00
3028 J-0****00O RISTANSYAH ARYA MAULANA 357302******0001 0822*****326 04/10/2021 Sesi 1 08.00 - 10.00
3029 J-0****02A PUTUT PRANITA 340215******0001 0812*****582 04/10/2021 Sesi 1 08.00 - 10.00
3030 J-0****0S3 FARIDA PRIHATININGRUM 357301******0005 0856*****504 04/10/2021 Sesi 1 08.00 - 10.00
3031 J-0****1AT ANIZA FITRIANA 350728******0001 0857*****395 04/10/2021 Sesi 1 08.00 - 10.00
3032 J-0****1GW MUHAMMAD FAUZIL HAQQI 350722******0002 0811*****7 04/10/2021 Sesi 1 08.00 - 10.00
3033 J-0****1OJ CAROLINE ARASYAH PURIWANGI 351413******0001 0822*****802 04/10/2021 Sesi 1 08.00 - 10.00
3034 J-0****1OZ WAHYU UTOMO 331104******0005 0812*****07 04/10/2021 Sesi 1 08.00 - 10.00
3035 J-0****3ZG KENNY ALVIN MARPAUNG 121809******0006 0813*****855 04/10/2021 Sesi 1 08.00 - 10.00
3036 J-0****4PY RISKI AMALIA 187109******0003 0819*****603 04/10/2021 Sesi 1 08.00 - 10.00
3037 J-0****679 ARI SETYO AJI 357901******0004 0856*****860 04/10/2021 Sesi 1 08.00 - 10.00
3038 J-0****6DG NISYA ARUM WAFI SOFWAN 350718******0004 0812*****577 04/10/2021 Sesi 1 08.00 - 10.00
3039 J-0****6G1 REGA APRILIANTO 350721******0004 0895*****7569 04/10/2021 Sesi 1 08.00 - 10.00
3040 J-0****6GC KAMALIN NUR LAILI 350709******0008 0831*****085 04/10/2021 Sesi 1 08.00 - 10.00
3041 J-0****6KL ARIF RAHMAD ADI 350517******0001 0812*****245 04/10/2021 Sesi 1 08.00 - 10.00
3042 J-0****6KQ NABILLA SYAFRIN AISY 350110******0003 0838*****653 04/10/2021 Sesi 1 08.00 - 10.00
3043 J-0****6LM NAKHRISA 350722******0001 0852*****232 04/10/2021 Sesi 1 08.00 - 10.00
3044 J-0****6LU PRIMADYA RACHMAT HIDAYAT 350724******0003 0896*****03 04/10/2021 Sesi 1 08.00 - 10.00
3045 J-0****6MG DAHLIA GLADIOLA RURINA MENUFANDU 920212******0001 0821*****048 04/10/2021 Sesi 1 08.00 - 10.00
3046 J-0****6MT MARIA MAHARANI 350705******0004 0851*****0589 04/10/2021 Sesi 1 08.00 - 10.00
3047 J-0****6N3 AULIA KHAIRANI 327505******0005 0857*****882 04/10/2021 Sesi 1 08.00 - 10.00
3048 J-0****6YD ZAMACHSYARI FATHAH 331807******0001 0813*****201 04/10/2021 Sesi 1 08.00 - 10.00
3049 J-0****6Z3 REZA KUMALASARI 357301******0001 0822*****393 04/10/2021 Sesi 1 08.00 - 10.00
3050 J-0****71M RATNA RUSWIDYA ANWAR 352210******0002 0821*****306 04/10/2021 Sesi 1 08.00 - 10.00
3051 J-0****72O MOCHAMMAD LUTHFY BACHTIAR 357303******0002 0857*****573 04/10/2021 Sesi 1 08.00 - 10.00
3052 J-0****735 WAHYU DWI ALFIANTO 350721******0001 0896*****058 04/10/2021 Sesi 1 08.00 - 10.00
3053 J-0****76P ARIEF JOKO SAPUTRO 320210******0001 0857*****275 04/10/2021 Sesi 1 08.00 - 10.00
3054 J-0****772 DAYU IKHWANIKA PRASETYO 350912******0008 0851*****596 04/10/2021 Sesi 1 08.00 - 10.00
3055 J-0****7BD ANGELINA CHRISTEL PINGKAN WURI 357303******0004 0822*****084 04/10/2021 Sesi 1 08.00 - 10.00
3056 J-0****7DD LANI AYU ARTHAMEVIA 357305******0003 0812*****577 04/10/2021 Sesi 1 08.00 - 10.00
3057 J-0****7DI NINDA SILVIA TRI CAHYANI 357801******0003 0851*****677 04/10/2021 Sesi 1 08.00 - 10.00
3058 J-0****7E2 YULIA ANGGRAINI 357305******0001 0895*****1476 04/10/2021 Sesi 1 08.00 - 10.00
3059 J-0****7FM JESSY ATIKA 351321******0001 0823*****654 04/10/2021 Sesi 1 08.00 - 10.00
3060 J-0****7G7 DYAH ARI KUSUMAH WARDANI 350732******0001 0821*****841 04/10/2021 Sesi 1 08.00 - 10.00
3061 J-0****7JK KEMBANG REGAIN 350717******0001 0813*****030 04/10/2021 Sesi 1 08.00 - 10.00
3062 J-0****7LQ IVAN FADILLA SUYUTI 350617******0001 0895*****2351 04/10/2021 Sesi 1 08.00 - 10.00
3063 J-0****7ML YUSRIL ANANTA 350719******0003 0899*****77 04/10/2021 Sesi 1 08.00 - 10.00

Page 73 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3064 J-0****7OD PUTRI ISMADIANTIKA INDANTI 350724******0002 0838*****725 04/10/2021 Sesi 1 08.00 - 10.00
3065 J-0****7OJ KARINA MENTARI PUTRI SUBAGIO 357303******0001 0812*****231 04/10/2021 Sesi 1 08.00 - 10.00
3066 J-0****7OR HUNTAL DUMOLI NAPITUPULU 121201******0003 0812*****170 04/10/2021 Sesi 1 08.00 - 10.00
3067 J-0****7XL FATIH ANWAR SUSETYO 150607******0001 0851*****827 04/10/2021 Sesi 1 08.00 - 10.00
3068 J-0****7YE HIKMAHTIAR DAVID SYAHPUTRA 352314******0005 0813*****137 04/10/2021 Sesi 1 08.00 - 10.00
3069 J-0****7YU GINA GRISELDA 357301******0001 0813*****146 04/10/2021 Sesi 1 08.00 - 10.00
3070 J-0****7ZF CLARA CARISSA 357301******0002 0823*****171 04/10/2021 Sesi 1 08.00 - 10.00
3071 J-0****82Q KRISTIANI VIRGI KUSUMA PUTRI 350714******0003 0852*****016 04/10/2021 Sesi 1 08.00 - 10.00
3072 J-0****84M ADELINA MUSTIKA NINGRUM 350404******0001 0813*****076 04/10/2021 Sesi 1 08.00 - 10.00
3073 J-0****85K VALENTINO ODE ANUGRAH K 350718******0001 0812*****508 04/10/2021 Sesi 1 08.00 - 10.00
3074 J-0****87Z ANNISA VERA OKTAVIANI 357901******0002 0822*****830 04/10/2021 Sesi 1 08.00 - 10.00
3075 J-0****8BA RAFIDAH KUSUMA WIDADI 350720******0002 0822*****600 04/10/2021 Sesi 1 08.00 - 10.00
3076 J-0****8BJ IRON LEOREIRERA 327610******0003 0813*****001 04/10/2021 Sesi 1 08.00 - 10.00
3077 J-0****8C8 ANDYKA LAWRENCE SITORUS 321606******0029 0812*****868 04/10/2021 Sesi 1 08.00 - 10.00
3078 J-0****8CG NOVELLA HENDIK PRATAMA 350730******0002 0852*****202 04/10/2021 Sesi 1 08.00 - 10.00
3079 J-0****8CZ MUHAMMAD AGUNG RAY 327505******0016 0813*****858 04/10/2021 Sesi 1 08.00 - 10.00
3080 J-0****8JB DEVA NINGTIAS 357903******0005 0858*****955 04/10/2021 Sesi 1 08.00 - 10.00
3081 J-0****8RD MUHAMMAD FATIH SA'DI 357305******0002 0857*****777 04/10/2021 Sesi 1 08.00 - 10.00
3082 J-0****8TS HANDHIKA BAYU EKA FEBRIANTO 740104******0004 0812*****713 04/10/2021 Sesi 1 08.00 - 10.00
3083 J-0****8U8 LIVIA YUSTANTINAH 357305******0004 0819*****739 04/10/2021 Sesi 1 08.00 - 10.00
3084 J-0****8UT AHMAD SHOKHIBUL KHIZZUDIN 350411******0002 0858*****595 04/10/2021 Sesi 1 08.00 - 10.00
3085 J-0****8XE RULITASARI 350724******0001 0831*****112 04/10/2021 Sesi 1 08.00 - 10.00
3086 J-0****90D WAHYU DEWANTARA CANDRA 357302******0003 0896*****824 04/10/2021 Sesi 1 08.00 - 10.00
3087 J-0****921 AMIRULLAH STORY 531215******0002 0813*****397 04/10/2021 Sesi 1 08.00 - 10.00
3088 J-0****92G BILAL MU'TAZ ZUHAIR 357305******0001 0813*****633 04/10/2021 Sesi 1 08.00 - 10.00
3089 J-0****93R RYAN JOFANI PUTRA 357305******0003 0822*****412 04/10/2021 Sesi 1 08.00 - 10.00
3090 J-0****94N HENDERIKUS MESE WEA 530812******0001 0852*****219 04/10/2021 Sesi 1 08.00 - 10.00
3091 J-0****98V VEBRINA DEWI CAHYANI 350731******0001 0822*****205 04/10/2021 Sesi 1 08.00 - 10.00
3092 J-0****9JM PUSPA DWI RAHMAWATI 350724******0002 0821*****792 04/10/2021 Sesi 1 08.00 - 10.00
3093 J-0****9JN WINDA ARMEINITA WULANDARI 520502******0001 0823*****871 04/10/2021 Sesi 1 08.00 - 10.00
3094 J-0****9L9 NADYA PUSPITA SARI 527204******0003 0852*****583 04/10/2021 Sesi 1 08.00 - 10.00
3095 J-0****9OC MARISA DELVIA 351411******0002 0895*****1412 04/10/2021 Sesi 1 08.00 - 10.00
3096 J-0****9T5 ERLINDA FEBRIOLA KURNIASTUTI 350403******0006 0856*****417 04/10/2021 Sesi 1 08.00 - 10.00
3097 J-0****9WA NADIA SABILLA RAMADHANI 350719******0004 0813*****935 04/10/2021 Sesi 1 08.00 - 10.00
3098 J-0****9XO NIRA ASTRID WAHINGSA 350724******0003 0813*****151 04/10/2021 Sesi 1 08.00 - 10.00
3099 J-0****9ZF KHOIRUN NISAK 351412******0003 0856*****640 04/10/2021 Sesi 1 08.00 - 10.00
3100 J-0****A2G RETRICIA CIPTANING CANTITA 357303******0004 0895*****3171 04/10/2021 Sesi 1 08.00 - 10.00
3101 J-0****A3E MOHAMAD IMRON BUKORI 351804******0023 0856*****046 04/10/2021 Sesi 1 08.00 - 10.00
3102 J-0****A6H MOHAMMAD RISAL HABIBULLOH 352503******0001 0895*****3604 04/10/2021 Sesi 1 08.00 - 10.00
3103 J-0****A7E DIMAS KARISMA FEBRIANTO 352008******0001 0857*****639 04/10/2021 Sesi 1 08.00 - 10.00
3104 J-0****AC5 CHUSNA MUTIARA MEILAWATI 352315******0002 0823*****301 04/10/2021 Sesi 1 08.00 - 10.00
3105 J-0****AD0 FAREL JONAS SOPLANIT 910301******0004 0813*****466 04/10/2021 Sesi 1 08.00 - 10.00

Page 74 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3106 J-0****AFD WIWIT MAKHMUDAH 350723******0003 0857*****136 04/10/2021 Sesi 1 08.00 - 10.00
3107 J-0****AJA FIRMAN NUR WAHYU 351416******0006 0896*****783 04/10/2021 Sesi 1 08.00 - 10.00
3108 J-0****ALD VIANNEY EVIKA JEMADU 537104******0004 0821*****367 04/10/2021 Sesi 1 08.00 - 10.00
3109 J-0****AM9 SHEVA MEHDAHAVIA 350725******0002 0896*****953 04/10/2021 Sesi 1 08.00 - 10.00
3110 J-0****AWN PUTRI REGINA APRELIA 357902******0003 0896*****211 04/10/2021 Sesi 1 08.00 - 10.00
3111 J-0****AY4 RIRIES DWI AMBARWATI 352514******0002 0812*****971 04/10/2021 Sesi 1 08.00 - 10.00
3112 J-0****B07 CHARIS ANDI PAMUNGKAS 351508******0005 0819*****706 04/10/2021 Sesi 1 08.00 - 10.00
3113 J-0****BER AWALLUDZIN KUSUMA N 350725******0004 0822*****689 04/10/2021 Sesi 1 08.00 - 10.00
3114 J-0****BFW WUWUN MILANSARI 350722******0001 0821*****449 04/10/2021 Sesi 1 08.00 - 10.00
3115 J-0****BMS GALEH SETYOWATI 352213******0002 0858*****939 04/10/2021 Sesi 1 08.00 - 10.00
3116 J-0****BSF ELING SHIDQI ASWIDISUKMA 350920******0010 0822*****299 04/10/2021 Sesi 1 08.00 - 10.00
3117 J-0****BWU YENI KRISDIANA 350731******0001 0812*****003 04/10/2021 Sesi 1 08.00 - 10.00
3118 J-0****BZ6 ELFANI IKHWAN NURI 352102******0002 0856*****216 04/10/2021 Sesi 1 08.00 - 10.00
3119 J-0****BZI ADISHA AUDI NABILLA 357803******0002 0895*****8506 04/10/2021 Sesi 1 08.00 - 10.00
3120 J-0****CAY WAHYUDI REKSO SANTOSO 350731******0005 0812*****003 04/10/2021 Sesi 1 08.00 - 10.00
3121 J-0****CCY VIVI APRILIA RAHMAWATI 357302******0001 0877*****961 04/10/2021 Sesi 1 08.00 - 10.00
3122 J-0****CDU MOCHAMAD JUNAEDI 357301******0007 0888*****668 04/10/2021 Sesi 1 08.00 - 10.00
3123 J-0****CIT BALQIS MUTIARIN 357302******0002 0823*****094 04/10/2021 Sesi 1 08.00 - 10.00
3124 J-0****CIZ SABRINA VANEZZA PUTRI 351814******0003 0896*****658 04/10/2021 Sesi 1 08.00 - 10.00
3125 J-0****CKV AGUS SALIM 350606******0004 0812*****087 04/10/2021 Sesi 1 08.00 - 10.00
3126 J-0****CNR ADITYO JOHAN WIRAWAN 350724******0003 0819*****287 04/10/2021 Sesi 1 08.00 - 10.00
3127 J-0****CPO PAULUS RISAN FUNAN LALONG 537101******0003 0852*****381 04/10/2021 Sesi 1 08.00 - 10.00
3128 J-0****CTC LIA NURUL FITRI 357304******0006 0896*****045 04/10/2021 Sesi 1 08.00 - 10.00
3129 J-0****CW4 MUCHAMMAD JA'FAR SHIDDIK 357302******0001 0838*****844 04/10/2021 Sesi 1 08.00 - 10.00
3130 J-0****D0O RIDHO AQLI EFENDI 130819******0001 0852*****554 04/10/2021 Sesi 1 08.00 - 10.00
3131 J-0****D6W DIKI PURNAMA PUTRA 352018******0002 0856*****62 04/10/2021 Sesi 1 08.00 - 10.00
3132 J-0****DCF DINDA MALEMA ERZYKA KENCANA AYU 352221******0001 0821*****313 04/10/2021 Sesi 1 08.00 - 10.00
3133 J-0****DHG AHMAD FARHAN AL HAMID 350720******0003 0822*****950 04/10/2021 Sesi 1 08.00 - 10.00
3134 J-0****DK2 BELGIS NURSELA IRFENDI 350810******0002 0859*****693 04/10/2021 Sesi 1 08.00 - 10.00
3135 J-0****DKX HJ. RAHMAH FITRIANA. S.SOS, M.SI 737103******0001 0821*****515 04/10/2021 Sesi 1 08.00 - 10.00
3136 J-0****DVB SAMUEL DOMADE SITORUS 120209******0001 0812*****375 04/10/2021 Sesi 1 08.00 - 10.00
3137 J-0****E09 ARSYI FAJRI 130817******0001 0852*****655 04/10/2021 Sesi 1 08.00 - 10.00
3138 J-0****E2V NAJIB FERISAL RZ. 350513******0002 0821*****880 04/10/2021 Sesi 1 08.00 - 10.00
3139 J-0****EBA SARETTA NATHANIATASHA PRAWINDRIJO, S.ST 357806******0006 0819*****393 04/10/2021 Sesi 1 08.00 - 10.00
3140 J-0****ERZ ADITYA NURPRATAMA 520501******0002 0852*****733 04/10/2021 Sesi 1 08.00 - 10.00
3141 J-0****F94 LOLITA DWI LARASWATI 357303******0003 0856*****559 04/10/2021 Sesi 1 08.00 - 10.00
3142 J-0****FIP ZYDAN ACHMAD ROBBANI 351402******0002 0857*****7561 04/10/2021 Sesi 1 08.00 - 10.00
3143 J-0****FKU NAURAH FAUZIAH ALZAEND 357304******0003 0812*****484 04/10/2021 Sesi 1 08.00 - 10.00
3144 J-0****FMN FASYA YAHYA 357601******0001 0857*****370 04/10/2021 Sesi 1 08.00 - 10.00
3145 J-0****FNM MUHAMMAD SYUKRAN NI'MATULLAH 747110******0002 0821*****644 04/10/2021 Sesi 1 08.00 - 10.00
3146 J-0****FP0 WAHFI ADITYA TRYAS PUTRA 127701******0002 0831*****624 04/10/2021 Sesi 1 08.00 - 10.00
3147 J-0****FVB ABDAN SYAKURA 350626******0001 0821*****724 04/10/2021 Sesi 1 08.00 - 10.00

Page 75 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3148 J-0****FWK PLASIDIA DINFLORA MEGAWISTA 530710******0001 0823*****325 04/10/2021 Sesi 1 08.00 - 10.00
3149 J-0****FZ7 MUCHAMMAD ABDURROCHMAN 352405******0003 0895*****1209 04/10/2021 Sesi 1 08.00 - 10.00
3150 J-0****G1Y SYAIFUL ANAM 352813******0003 0822*****282 04/10/2021 Sesi 1 08.00 - 10.00
3151 J-0****GAK DEWI SA'ADHATUL MASRUROH 357301******0002 0821*****676 04/10/2021 Sesi 1 08.00 - 10.00
3152 J-0****GDD RIZKA GITTA ALMAIDA 337411******0006 0812*****501 04/10/2021 Sesi 1 08.00 - 10.00
3153 J-0****GNO TITIN DWI SANTHI 350411******0001 0877*****489 04/10/2021 Sesi 1 08.00 - 10.00
3154 J-0****GOS HIKMAH KARIMATUL MAGHFIROH 350709******0004 0858*****083 04/10/2021 Sesi 1 08.00 - 10.00
3155 J-0****GVC DIAN MIRA PUSPITASARI 357305******0002 0895*****1195 04/10/2021 Sesi 1 08.00 - 10.00
3156 J-0****H2E MOCH HISYAM FARCHAN A 350709******0003 0856*****745 04/10/2021 Sesi 1 08.00 - 10.00
3157 J-0****H3D NUNANG KUMI HARJITO 357303******0005 0881*****287 04/10/2021 Sesi 1 08.00 - 10.00
3158 J-0****H4Q RIA MAHARANI RIDHWAN 357304******0009 0821*****499 04/10/2021 Sesi 1 08.00 - 10.00
3159 J-0****H54 SRI AYU 730806******0002 0815*****175 04/10/2021 Sesi 1 08.00 - 10.00
3160 J-0****HB6 APKWINT MARIANO RAJAGUKGUK 120915******0001 0882*****779 04/10/2021 Sesi 1 08.00 - 10.00
3161 J-0****HEW DEWI PERMANASARI 350724******0002 0821*****949 04/10/2021 Sesi 1 08.00 - 10.00
3162 J-0****HRA GALIH FAJAR ANTASARI 640502******0001 0821*****614 04/10/2021 Sesi 1 08.00 - 10.00
3163 J-0****HVE DIAN YUSTIKA INTARTI 351411******0001 0823*****861 04/10/2021 Sesi 1 08.00 - 10.00
3164 J-0****HVW WITRA FARI NING RIZKIE 327602******0010 0813*****698 04/10/2021 Sesi 1 08.00 - 10.00
3165 J-0****I15 AGUS ANUGRAH SATRIA 357302******0009 0881*****40 04/10/2021 Sesi 1 08.00 - 10.00
3166 J-0****I9M AGUNG SULAKSONO 350724******0003 0813*****151 04/10/2021 Sesi 1 08.00 - 10.00
3167 J-0****IIJ ABRAM MANALU 120723******0002 0852*****473 04/10/2021 Sesi 1 08.00 - 10.00
3168 J-0****IN8 RISA ANDRIAN EKA PUTRA 352901******0006 0822*****208 04/10/2021 Sesi 1 08.00 - 10.00
3169 J-0****IPR RAYYAN ASHADIN ABJAR 352414******0003 0812*****889 04/10/2021 Sesi 1 08.00 - 10.00
3170 J-0****IR6 PUTRI KARTIKA SARI 357203******0008 0822*****383 04/10/2021 Sesi 1 08.00 - 10.00
3171 J-0****IRP MUHAMMAD TAJUL BARI 357802******0002 0853*****020 04/10/2021 Sesi 1 08.00 - 10.00
3172 J-0****ISE MIFTA AHMAD FARID 350102******0005 0851*****020 04/10/2021 Sesi 1 08.00 - 10.00
3173 J-0****IU3 ERNI YULIATI NUR 350721******0003 0812*****110 04/10/2021 Sesi 1 08.00 - 10.00
3174 J-0****IVQ LELI ULIANA RIANTI SIMANJUNTAK 910901******0002 0852*****665 04/10/2021 Sesi 1 08.00 - 10.00
3175 J-0****IWI NAZA AMIRUL ASMI HIDAYAT 357305******0004 0858*****636 04/10/2021 Sesi 1 08.00 - 10.00
3176 J-0****IWW SELFI DEWI AKMAL NURHIKMAH 350520******0001 0858*****301 04/10/2021 Sesi 1 08.00 - 10.00
3177 J-0****IYA KHALISA SALMA KAMILA 357305******0001 0811*****35 04/10/2021 Sesi 1 08.00 - 10.00
3178 J-0****IZW YUNI LESTARI 350716******0003 0858*****559 04/10/2021 Sesi 1 08.00 - 10.00
3179 J-0****J09 VICKA MEY ARDHINA 357903******0001 0858*****063 04/10/2021 Sesi 1 08.00 - 10.00
3180 J-0****J29 ANFA SYAIFUL ISLAM 357301******0010 0896*****923 04/10/2021 Sesi 1 08.00 - 10.00
3181 J-0****J2X FARHAN AL FARISI 357301******0011 0822*****740 04/10/2021 Sesi 1 08.00 - 10.00
3182 J-0****J4C VIVI ARNISYIATUL AULIA 350514******0003 0813*****919 04/10/2021 Sesi 1 08.00 - 10.00
3183 J-0****JB5 MUHAMMAD RYAN FABEANZA PUTRA 351410******0001 0813*****252 04/10/2021 Sesi 1 08.00 - 10.00
3184 J-0****JCQ MUHAMMAD RIYAN ATHARIQ 351518******0010 0821*****058 04/10/2021 Sesi 1 08.00 - 10.00
3185 J-0****JI8 ARVIN WAHYU NOR IMAM 332303******0001 0857*****038 04/10/2021 Sesi 1 08.00 - 10.00
3186 J-0****JRA SAPTARINA RESTUNINGRUM 357305******0004 0851*****113 04/10/2021 Sesi 1 08.00 - 10.00
3187 J-0****JSN DUKUT HERMANTO 357903******0002 0857*****489 04/10/2021 Sesi 1 08.00 - 10.00
3188 J-0****JTJ SRI WAHYUNI 357903******0001 0816*****908 04/10/2021 Sesi 1 08.00 - 10.00
3189 J-0****JUI REVIAN FIRZA FERDIAN 357301******0004 0812*****789 04/10/2021 Sesi 1 08.00 - 10.00

Page 76 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3190 J-0****JUS MUHAMAD ILHAM FERIYANTO 357101******0002 0895*****280 04/10/2021 Sesi 1 08.00 - 10.00
3191 J-0****JXE RENI ANGGRAENI 352317******0002 0856*****580 04/10/2021 Sesi 1 08.00 - 10.00
3192 J-0****JYQ AMELIA JUNIETHA ANGGELA 320920******0005 0896*****363 04/10/2021 Sesi 1 08.00 - 10.00
3193 J-0****JZF M. FAHRUDI HARTANTO 352105******0003 0857*****166 04/10/2021 Sesi 1 08.00 - 10.00
3194 J-0****K05 RISKA WAHDALINA 630904******0002 0853*****180 04/10/2021 Sesi 1 08.00 - 10.00
3195 J-0****K0Y RIA FITRIA, SH 367108******0005 0823*****688 04/10/2021 Sesi 1 08.00 - 10.00
3196 J-0****K0Z DENI KURNIAWAN 351705******0003 0813*****459 04/10/2021 Sesi 1 08.00 - 10.00
3197 J-0****K24 BRAMA POSA CANDRA PRAKASA 357304******0005 0858*****425 04/10/2021 Sesi 1 08.00 - 10.00
3198 J-0****K2B WIRAWAN MOHAMAD AL SALAM 647403******0002 0821*****109 04/10/2021 Sesi 1 08.00 - 10.00
3199 J-0****K2I DEVANTI WULAN SUCI 351411******0001 0858*****170 04/10/2021 Sesi 1 08.00 - 10.00
3200 J-0****K2J AFRINDA EREN NETA 350724******0001 0838*****388 04/10/2021 Sesi 1 08.00 - 10.00
3201 J-0****K2M SHAILA WIDA RAHARJA 350725******0002 0813*****420 04/10/2021 Sesi 1 08.00 - 10.00
3202 J-0****K2U ARIF FADJAR WAHYUDIN 357305******0001 0815*****457 04/10/2021 Sesi 1 08.00 - 10.00
3203 J-0****K4Y ANANDA FEBRIANSYAH 351402******0002 0896*****395 04/10/2021 Sesi 1 08.00 - 10.00
3204 J-0****K5O ANUGRAH NELA CAHYA 352318******0002 0882*****838 04/10/2021 Sesi 1 08.00 - 10.00
3205 J-0****K63 SHOFIA DZIHNY 147107******0061 0811*****77 04/10/2021 Sesi 1 08.00 - 10.00
3206 J-0****K69 ADE HARVEY FILEMON 327601******0013 0857*****210 04/10/2021 Sesi 1 08.00 - 10.00
3207 J-0****K78 MOCH QOHARUDIN 357302******0004 0813*****736 04/10/2021 Sesi 1 08.00 - 10.00
3208 J-0****KAS DAYINTA HINDRADINI 357303******0010 0857*****413 04/10/2021 Sesi 1 08.00 - 10.00
3209 J-0****KAT DIAGO FERNANDA 352422******0001 0813*****790 04/10/2021 Sesi 1 08.00 - 10.00
3210 J-0****KC2 DEWI KUSUMMANINGSIH 357302******0003 0838*****468 04/10/2021 Sesi 1 08.00 - 10.00
3211 J-0****KGG REGGI REZZA MONICA 351913******0001 0838*****136 04/10/2021 Sesi 1 08.00 - 10.00
3212 J-0****KI9 TIFANY ARIFIA INSANI 351509******0002 0895*****5175 04/10/2021 Sesi 1 08.00 - 10.00
3213 J-0****KIB SALSABILA NARA CANTIKA PUTRI 351408******0003 0813*****954 04/10/2021 Sesi 1 08.00 - 10.00
3214 J-0****KM1 SOFIA AULIA HIDAYAT 351408******0001 0857*****541 04/10/2021 Sesi 1 08.00 - 10.00
3215 J-0****KN4 MUHAMMAD RIZKY 817103******0003 0812*****025 04/10/2021 Sesi 1 08.00 - 10.00
3216 J-0****KOO DEDI KURNIAWAN 350728******0001 0812*****558 04/10/2021 Sesi 1 08.00 - 10.00
3217 J-0****KP2 ALFI FADHIIL ABU ZAHIR 350726******0001 0812*****946 04/10/2021 Sesi 1 08.00 - 10.00
3218 J-0****KPI CALLISTA HASSYA ALODIA 357901******0003 0813*****529 04/10/2021 Sesi 1 08.00 - 10.00
3219 J-0****KPU FRANSISCA PUJI ASTUTI 357901******0003 0857*****704 04/10/2021 Sesi 1 08.00 - 10.00
3220 J-0****KUQ NABILA INTAN MILANIA 350719******0001 0821*****896 04/10/2021 Sesi 1 08.00 - 10.00
3221 J-0****KVM BRILIANA AULIA RAHMA 721001******0006 0822*****514 04/10/2021 Sesi 1 08.00 - 10.00
3222 J-0****KZD LULUK OKTAVIANA 350618******0002 0896*****871 04/10/2021 Sesi 1 08.00 - 10.00
3223 J-0****L57 FIKARTIKA 350722******0003 0852*****968 04/10/2021 Sesi 1 08.00 - 10.00
3224 J-0****LDC LILIS SETIYOWATI 351410******0002 0838*****215 04/10/2021 Sesi 1 08.00 - 10.00
3225 J-0****LDR AFRIZHAL HASWIN PRADANA 350104******0002 0822*****119 04/10/2021 Sesi 1 08.00 - 10.00
3226 J-0****LGJ DONY RAHARDI ARYA PUTRA 357305******0003 0822*****728 04/10/2021 Sesi 1 08.00 - 10.00
3227 J-0****LGP ARDHIA PRAMITHA DIWA SEKARWANGI 350722******0001 0895*****376 04/10/2021 Sesi 1 08.00 - 10.00
3228 J-0****LHN DODY WICAHYO YUDY HANDARU S 350722******0003 0852*****299 04/10/2021 Sesi 1 08.00 - 10.00
3229 J-0****LI1 ABDUL HAMID 331706******0003 0815*****76 04/10/2021 Sesi 1 08.00 - 10.00
3230 J-0****LMD SAFA NAURA RIYANDA 357304******0009 0822*****733 04/10/2021 Sesi 1 08.00 - 10.00
3231 J-0****LMF MOHAMMAD FARHAD HATIFY 351413******0002 0878*****666 04/10/2021 Sesi 1 08.00 - 10.00

Page 77 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3232 J-0****LNZ ALVIANTA DWI PUTRA 350722******0003 0811*****14 04/10/2021 Sesi 1 08.00 - 10.00
3233 J-0****LV0 YAHYA NAHNUL SAPUTRA 351409******0003 0858*****758 04/10/2021 Sesi 1 08.00 - 10.00
3234 J-0****LWJ VIRA TRIYANISHA 351412******0004 0838*****792 04/10/2021 Sesi 1 08.00 - 10.00
3235 J-0****M05 DIA KUMALASARI 350702******0001 0812*****390 04/10/2021 Sesi 1 08.00 - 10.00
3236 J-0****M1H FESA WAHYU KURNIAWAN 350733******0002 0838*****214 04/10/2021 Sesi 1 08.00 - 10.00
3237 J-0****M2Z HADIRA THUMANINAH JIBRIL 737114******0002 0823*****265 04/10/2021 Sesi 1 08.00 - 10.00
3238 J-0****M54 FITRIANING RAHAYU 357305******0003 0821*****520 04/10/2021 Sesi 1 08.00 - 10.00
3239 J-0****M55 FILIPUS DARMADI SANTOSO 350721******0003 0812*****700 04/10/2021 Sesi 1 08.00 - 10.00
3240 J-0****M5L KHAIRA ANNISA YOSKAR 137109******0001 0821*****845 04/10/2021 Sesi 1 08.00 - 10.00
3241 J-0****M9K RIHHADADATUL AISY SITOMPUL 121009******0003 0821*****704 04/10/2021 Sesi 1 08.00 - 10.00
3242 J-0****MBZ DINDA SHOLICHAH 350724******0004 0858*****207 04/10/2021 Sesi 1 08.00 - 10.00
3243 J-0****MC3 NENY APRILIANI 321405******0001 0858*****894 04/10/2021 Sesi 1 08.00 - 10.00
3244 J-0****MDK MITHA AYU DIAH SAFITRI 510101******0005 0877*****222 04/10/2021 Sesi 1 08.00 - 10.00
3245 J-0****MEZ PACHO ADWITIYA BHAGASKARA 357303******0008 0817*****268 04/10/2021 Sesi 1 08.00 - 10.00
3246 J-0****MJ2 SHELA FEBRI ANGGRAINI 350307******0002 0857*****493 04/10/2021 Sesi 1 08.00 - 10.00
3247 J-0****MJM ANDIKA JAYA AKBARUDDIN 357304******0002 0853*****454 04/10/2021 Sesi 1 08.00 - 10.00
3248 J-0****MO0 MAYANG AGSIH 350718******0003 0822*****906 04/10/2021 Sesi 1 08.00 - 10.00
3249 J-0****MOA MUHAMMAD IKBAL 520112******0001 0878*****866 04/10/2021 Sesi 1 08.00 - 10.00
3250 J-0****MPH ARKANY JULIVIAN DIAS 637103******0014 0813*****168 04/10/2021 Sesi 1 08.00 - 10.00
3251 J-0****MQL AMALIYA AKHSANI 350517******0001 0877*****986 04/10/2021 Sesi 1 08.00 - 10.00
3252 J-0****MRR VEIGANATA WISNU PRADANA 357304******0003 0859*****173 04/10/2021 Sesi 1 08.00 - 10.00
3253 J-0****MRS ACHMAD FAUZI 357502******0002 0816*****26 04/10/2021 Sesi 1 08.00 - 10.00
3254 J-0****MU3 DIAN NOVITA SARI 351616******0001 0855*****01 04/10/2021 Sesi 1 08.00 - 10.00
3255 J-0****MUO RAHMA AGSIHASA 350718******0005 0882*****044 04/10/2021 Sesi 1 08.00 - 10.00
3256 J-0****MWZ IQBAL KAHFI YUSUF 357305******0003 0897*****94 04/10/2021 Sesi 1 08.00 - 10.00
3257 J-0****MZ5 EKO NUR WAHYUDI 357901******0002 0822*****399 04/10/2021 Sesi 1 08.00 - 10.00
3258 J-0****N22 DINDA NADIRA 111603******0001 0896*****300 04/10/2021 Sesi 1 08.00 - 10.00
3259 J-0****N30 YANNETTA LEONORA P 350722******0001 0819*****016 04/10/2021 Sesi 1 08.00 - 10.00
3260 J-0****N35 TARI RAHMITHA 111603******0001 0812*****154 04/10/2021 Sesi 1 08.00 - 10.00
3261 J-0****N6F RACHMA NADILA ZALMA 350725******0004 0813*****367 04/10/2021 Sesi 1 08.00 - 10.00
3262 J-0****N6I WESTERN FERDINAND WATTIMENA 350705******0002 0812*****182 04/10/2021 Sesi 1 08.00 - 10.00
3263 J-0****N8R BERLIANA ALIFTIA IFADA 317103******0009 0856*****096 04/10/2021 Sesi 1 08.00 - 10.00
3264 J-0****NC8 FEBRILIAN DANY CHRISTIANTO 350724******0001 0813*****677 04/10/2021 Sesi 1 08.00 - 10.00
3265 J-0****NDH HENDRA HAFID RISALBI 357303******0001 0896*****244 04/10/2021 Sesi 1 08.00 - 10.00
3266 J-0****NET SUCI KRESNAWATI 350722******0001 0812*****881 04/10/2021 Sesi 1 08.00 - 10.00
3267 J-0****NF6 MEDIANA ROFIKA YUNIAR 357822******0001 0819*****688 04/10/2021 Sesi 1 08.00 - 10.00
3268 J-0****NFY SRI MARTA ISNAINIK MUSTIKARANI 350703******0003 0813*****707 04/10/2021 Sesi 1 08.00 - 10.00
3269 J-0****NGI RIZKY ASA NURLITA 357806******0004 0822*****889 04/10/2021 Sesi 1 08.00 - 10.00
3270 J-0****NJF FITRATUL RIZQI AMALIA 351305******0002 0823*****979 04/10/2021 Sesi 1 08.00 - 10.00
3271 J-0****NJW BACHTIAR ARIFIN 647401******0002 0897*****21 04/10/2021 Sesi 1 08.00 - 10.00
3272 J-0****NO2 AGUSTINA SIHOMBING 127104******0004 0822*****148 04/10/2021 Sesi 1 08.00 - 10.00
3273 J-0****NOR NOER AINI 357301******0009 0838*****988 04/10/2021 Sesi 1 08.00 - 10.00

Page 78 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3274 J-0****NPY ARIK SUSANTO 357305******0002 0851*****592 04/10/2021 Sesi 1 08.00 - 10.00
3275 J-0****NQB ARIE PRIMADANI 327503******0019 0811*****90 04/10/2021 Sesi 1 08.00 - 10.00
3276 J-0****NQK NADYA NEYZA SHALSHABILLA 357301******0013 0813*****941 04/10/2021 Sesi 1 08.00 - 10.00
3277 J-0****NR4 CINDERA MAYGHOFTA SALSABILLA 352219******0001 0822*****419 04/10/2021 Sesi 1 08.00 - 10.00
3278 J-0****NSS YUNI IRIANINGTYAS 357302******0002 0856*****507 04/10/2021 Sesi 1 08.00 - 10.00
3279 J-0****NUG NOPI PRABOWO 327501******0046 0858*****027 04/10/2021 Sesi 1 08.00 - 10.00
3280 J-0****NZX DOMAS GALIH PATRIA 350605******0001 0853*****307 04/10/2021 Sesi 1 08.00 - 10.00
3281 J-0****O19 ENGGAR OKTADIA KOSNAWATI 357302******0001 0821*****628 04/10/2021 Sesi 1 08.00 - 10.00
3282 J-0****O26 CHATARINA IVONNEDA SILVIANA 357305******0005 0831*****096 04/10/2021 Sesi 1 08.00 - 10.00
3283 J-0****O27 FATIMAH KARIM 357305******0003 0821*****780 04/10/2021 Sesi 1 08.00 - 10.00
3284 J-0****O3Y SITI MASRUROH 352210******0002 0858*****729 04/10/2021 Sesi 1 08.00 - 10.00
3285 J-0****O42 MOCHAMMAD ITTAQIE TAFUZIE 351504******0003 0822*****042 04/10/2021 Sesi 1 08.00 - 10.00
3286 J-0****O46 GEMA ANGGUN PALUPI 351409******0003 0895*****183 04/10/2021 Sesi 1 08.00 - 10.00
3287 J-0****O5Y RIZKI FITRIA RAHMA DINA 352425******0001 0853*****296 04/10/2021 Sesi 1 08.00 - 10.00
3288 J-0****O6T GANAR WASKITO JATI 327405******0008 0821*****232 04/10/2021 Sesi 1 08.00 - 10.00
3289 J-0****O71 ANGGI RENIKA 160710******0002 0851*****021 04/10/2021 Sesi 1 08.00 - 10.00
3290 J-0****O74 RIFDILLAH ZULAFA 351507******0002 0821*****031 04/10/2021 Sesi 1 08.00 - 10.00
3291 J-0****O8O MUHAMMAD BARIDS FADJAR 351517******0003 0821*****564 04/10/2021 Sesi 1 08.00 - 10.00
3292 J-0****O97 UMAR ABDUL MUNTOLIB 357815******0001 0852*****336 04/10/2021 Sesi 1 08.00 - 10.00
3293 J-0****OD2 SAMUDI 357301******0003 0813*****189 04/10/2021 Sesi 1 08.00 - 10.00
3294 J-0****OFU HANIATUL ISNANIAH 350723******0001 0898*****35 04/10/2021 Sesi 1 08.00 - 10.00
3295 J-0****OGA IFAN SUSANTO 357304******0008 0813*****086 04/10/2021 Sesi 1 08.00 - 10.00
3296 J-0****OI7 SITI UMAYAH 357301******0088 0813*****189 04/10/2021 Sesi 1 08.00 - 10.00
3297 J-0****OIJ JUSTI ANDI 210203******0004 0813*****031 04/10/2021 Sesi 1 08.00 - 10.00
3298 J-0****OIO JOKO NUGROHO 350608******0001 0819*****524 04/10/2021 Sesi 1 08.00 - 10.00
3299 J-0****OJ9 HANIFA RASDA RACHMA 357822******0001 0856*****929 04/10/2021 Sesi 1 08.00 - 10.00
3300 J-0****OKL IMA ISNAWATI 357304******0008 0852*****141 04/10/2021 Sesi 1 08.00 - 10.00
3301 J-0****OME SUGITA NINGSIH CAHYA 357903******0004 0858*****075 04/10/2021 Sesi 1 08.00 - 10.00
3302 J-0****OOL RIFKY AMALIA ANNISA 352504******0003 0812*****282 04/10/2021 Sesi 1 08.00 - 10.00
3303 J-0****OQB SOALOON HASIHOLAN TAMBUNAN 357822******0002 0877*****744 04/10/2021 Sesi 1 08.00 - 10.00
3304 J-0****OQM PANCA AGHNIAA RUUHU ALFAIEN 367403******0003 0896*****119 04/10/2021 Sesi 1 08.00 - 10.00
3305 J-0****OU2 NEYSA AUGIE NURANICA 357303******0007 0812*****850 04/10/2021 Sesi 1 08.00 - 10.00
3306 J-0****OU3 FAIS AMANULLAH YUNG 331513******0001 0812*****691 04/10/2021 Sesi 1 08.00 - 10.00
3307 J-0****OWO SATIO ARDIANSYAH 350707******0001 0823*****564 04/10/2021 Sesi 1 08.00 - 10.00
3308 J-0****OZE AHMAD SIGIT KURNIAWAN 357304******0003 0877*****631 04/10/2021 Sesi 1 08.00 - 10.00
3309 J-0****OZK ANNISA NUR FADHILAH 351511******0002 0813*****445 04/10/2021 Sesi 1 08.00 - 10.00
3310 J-0****OZM MARGARETHA ESTERLINA 327504******0029 0812*****958 04/10/2021 Sesi 1 08.00 - 10.00
3311 J-0****P0D RIZKY YONATHAN CRISTIANTO 350722******0001 0813*****889 04/10/2021 Sesi 1 08.00 - 10.00
3312 J-0****P1N TASYA AYU SYIFA 350217******0002 0812*****971 04/10/2021 Sesi 1 08.00 - 10.00
3313 J-0****P1P WAHYU ADI SETYAWAN 357303******0006 0813*****339 04/10/2021 Sesi 1 08.00 - 10.00
3314 J-0****P30 FELIX RAFIANSYAH AFFANDI 357301******0006 0811*****88 04/10/2021 Sesi 1 08.00 - 10.00
3315 J-0****P3L DIYA KHOIRUN NISA 351013******0005 0823*****642 04/10/2021 Sesi 1 08.00 - 10.00

Page 79 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3316 J-0****P47 RHENATA NOVITA SAING 121103******0002 0822*****469 04/10/2021 Sesi 1 08.00 - 10.00
3317 J-0****P5M ANANINGSIH 357502******0001 0851*****703 04/10/2021 Sesi 1 08.00 - 10.00
3318 J-0****P5P MUHAMAD SATRIO B 327502******0020 0812*****365 04/10/2021 Sesi 1 08.00 - 10.00
3319 J-0****P7F KUKUH MUHAMAD AZHAR 357502******0002 0851*****703 04/10/2021 Sesi 1 08.00 - 10.00
3320 J-0****P9Y YUANIKA CALLISTA MARSHA 357303******0009 0822*****175 04/10/2021 Sesi 1 08.00 - 10.00
3321 J-0****PBH CHURIYAH AD-DURIYATUN NAFISAH 357811******0001 0877*****653 04/10/2021 Sesi 1 08.00 - 10.00
3322 J-0****PBZ RIZQI ZIDNI HIDAYATI 351414******0001 0857*****737 04/10/2021 Sesi 1 08.00 - 10.00
3323 J-0****PCI ERMA ERFIANA 350720******0001 0813*****391 04/10/2021 Sesi 1 08.00 - 10.00
3324 J-0****PD4 PUTRI ANGELINA KOBA 350718******0006 0838*****475 04/10/2021 Sesi 1 08.00 - 10.00
3325 J-0****PDD ANDIKA SANDY MAULANA 350720******0004 0813*****867 04/10/2021 Sesi 1 08.00 - 10.00
3326 J-0****PDI EL VASYA LINGGA SAPUTRA 351023******0001 0818*****579 04/10/2021 Sesi 1 08.00 - 10.00
3327 J-0****PDM ROSHIN SYIMA MAULIDY 350708******0001 0812*****325 04/10/2021 Sesi 1 08.00 - 10.00
3328 J-0****PE5 HENDI TJAHYADI 357302******0001 0821*****761 04/10/2021 Sesi 1 08.00 - 10.00
3329 J-0****PFY MENTARI MUTIARI SARI 350724******0002 0881*****66 04/10/2021 Sesi 1 08.00 - 10.00
3330 J-0****PG9 OKKY DWI RAMA PUTRA 357304******0001 0812*****327 04/10/2021 Sesi 1 08.00 - 10.00
3331 J-0****PGT KUWAT HARIANTO 350731******0002 0856*****643 04/10/2021 Sesi 1 08.00 - 10.00
3332 J-0****PGU FANDHI IRAWAN 357305******0007 0857*****337 04/10/2021 Sesi 1 08.00 - 10.00
3333 J-0****PHX WAHIDAH ARIYANI 180202******0005 0831*****065 04/10/2021 Sesi 1 08.00 - 10.00
3334 J-0****PJD GETA WAHYU KINANTI 357304******0006 0895*****7010 04/10/2021 Sesi 1 08.00 - 10.00
3335 J-0****PKS IWAN TRIYANTO 350714******0001 0858*****507 04/10/2021 Sesi 1 08.00 - 10.00
3336 J-0****PL7 ABRAHAM AVISENA SANTOSO 330210******0002 0812*****791 04/10/2021 Sesi 1 08.00 - 10.00
3337 J-0****PL9 DAUD KRISTIANTO 357302******0004 0858*****075 04/10/2021 Sesi 1 08.00 - 10.00
3338 J-0****PLY DAFA MAULANA HAMBALI 351518******0007 0877*****040 04/10/2021 Sesi 1 08.00 - 10.00
3339 J-0****POK ZHAFIRAH CATUR SETYANI 360328******0002 0857*****959 04/10/2021 Sesi 1 08.00 - 10.00
3340 J-0****PRY PUSVITA SUSILOWATI 350724******0001 0822*****538 04/10/2021 Sesi 1 08.00 - 10.00
3341 J-0****PY1 JOICE FEBRIANTY SINAGA 127203******0001 0812*****008 04/10/2021 Sesi 1 08.00 - 10.00
3342 J-0****PYK SALSABILA NUR AZIZAH 357901******0005 0819*****832 04/10/2021 Sesi 1 08.00 - 10.00
3343 J-0****PYZ DIDIK SETYA PRABOWO 350725******0002 0895*****677 04/10/2021 Sesi 1 08.00 - 10.00
3344 J-0****Q4N GUGUS KRISTALIANTO 357302******0004 0812*****501 04/10/2021 Sesi 1 08.00 - 10.00
3345 J-0****Q50 FRIDA WAHYU KRISMADANI 352018******0003 0856*****342 04/10/2021 Sesi 1 08.00 - 10.00
3346 J-0****Q55 AKMAL TRIYAS ADHIPRASTHA 321401******0007 0815*****184 04/10/2021 Sesi 1 08.00 - 10.00
3347 J-0****Q5C A SAYYIDATINA AATHIRAH 367404******0001 0859*****423 04/10/2021 Sesi 1 08.00 - 10.00
3348 J-0****Q7H RACMAD JIBRIL AL KAUTSAR 350722******0001 0819*****703 04/10/2021 Sesi 1 08.00 - 10.00
3349 J-0****Q89 CATUR MAULINA NILAM FATMASARI 357109******0005 0856*****262 04/10/2021 Sesi 1 08.00 - 10.00
3350 J-0****Q8R KURNIAWATI 357302******0006 0812*****501 04/10/2021 Sesi 1 08.00 - 10.00
3351 J-0****QAJ SAFITRI DIAHAYU ARIANI 350722******0003 0859*****015 04/10/2021 Sesi 1 08.00 - 10.00
3352 J-0****QAN ALFIAN FAHRI NABIL 320101******0001 0895*****260 04/10/2021 Sesi 1 08.00 - 10.00
3353 J-0****QAP AMIRAH NUR FARZANA 350402******0005 0813*****801 04/10/2021 Sesi 1 08.00 - 10.00
3354 J-0****QAQ FARAH CHANDRA PUSPITA 357302******0003 0812*****010 04/10/2021 Sesi 1 08.00 - 10.00
3355 J-0****QB7 NUR AZMI ANNASTASYA RAMDHANI 647204******0002 0858*****595 04/10/2021 Sesi 1 08.00 - 10.00
3356 J-0****QEW ACHMAD HANIF NAUFAL 357804******0003 0813*****076 04/10/2021 Sesi 1 08.00 - 10.00
3357 J-0****QF9 DWI JAYANTI 647302******0007 0851*****963 04/10/2021 Sesi 1 08.00 - 10.00

Page 80 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3358 J-0****QIO BINTANG ANDA HARTONO PUTRA 640305******0003 0812*****863 04/10/2021 Sesi 1 08.00 - 10.00
3359 J-0****QJ7 HERU NUR CAHYO 352513******0002 0823*****090 04/10/2021 Sesi 1 08.00 - 10.00
3360 J-0****QKG NOVIA DWI RAHAYU 350617******0003 0823*****013 04/10/2021 Sesi 1 08.00 - 10.00
3361 J-0****QLP ACHMAD FAKHRI 350723******0004 0813*****745 04/10/2021 Sesi 1 08.00 - 10.00
3362 J-0****QMZ OKKY DILLA KARINA 357903******0002 0852*****501 04/10/2021 Sesi 1 08.00 - 10.00
3363 J-0****QOD DUROTUL MAHNUNIN 350417******0003 0814*****125 04/10/2021 Sesi 1 08.00 - 10.00
3364 J-0****QOX ALIFFI MAJIID 351507******0002 0895*****951 04/10/2021 Sesi 1 08.00 - 10.00
3365 J-0****QP1 ANTOK SUTRISNO 351414******0003 0818*****584 04/10/2021 Sesi 1 08.00 - 10.00
3366 J-0****QPZ NAFILAH 351414******0001 0817*****55 04/10/2021 Sesi 1 08.00 - 10.00
3367 J-0****QQ1 MUHAMAD MUCHLIS 357703******0002 0813*****452 04/10/2021 Sesi 1 08.00 - 10.00
3368 J-0****QQP DIVA ANGELINE SINTA INGGRITASARI SIHASALE 357303******0003 0812*****212 04/10/2021 Sesi 1 08.00 - 10.00
3369 J-0****QQW ROSAN FAUZUN NATSIR 327322******0004 0813*****065 04/10/2021 Sesi 1 08.00 - 10.00
3370 J-0****QRJ YADI MALDA 520414******0002 0821*****349 04/10/2021 Sesi 1 08.00 - 10.00
3371 J-0****QRW SANG NORMA LINTANG ASMARA 357304******0009 0857*****301 04/10/2021 Sesi 1 08.00 - 10.00
3372 J-0****QSD JOHAN RAMADHAN 517103******0003 0822*****961 04/10/2021 Sesi 1 08.00 - 10.00
3373 J-0****QT3 CHUSNUL IKA JULINIHMA 351508******0001 0813*****587 04/10/2021 Sesi 1 08.00 - 10.00
3374 J-0****QTF MEY ULLIA AINUR RIZKI 351411******0002 0856*****026 04/10/2021 Sesi 1 08.00 - 10.00
3375 J-0****QTR SYAFIRA KINTAN MAHARANI 367105******0001 0813*****371 04/10/2021 Sesi 1 08.00 - 10.00
3376 J-0****QVQ DENI HARDENI 367405******0007 0817*****8 04/10/2021 Sesi 1 08.00 - 10.00
3377 J-0****QWX AGUS FITRIANUS 357301******0001 0822*****031 04/10/2021 Sesi 1 08.00 - 10.00
3378 J-0****QX6 RIA KUSRINI 367405******0011 0878*****655 04/10/2021 Sesi 1 08.00 - 10.00
3379 J-0****QZV ERMA MAHALLI LASWANTO 357802******0002 0859*****5510 04/10/2021 Sesi 1 08.00 - 10.00
3380 J-0****R04 SRI ASTUTIK 357903******0001 0852*****6885 04/10/2021 Sesi 1 08.00 - 10.00
3381 J-0****R1N NASIHUL ABIDIN 350714******0005 0813*****147 04/10/2021 Sesi 1 08.00 - 10.00
3382 J-0****R1Q BUDI WINARNO 357301******0001 0882*****844 04/10/2021 Sesi 1 08.00 - 10.00
3383 J-0****R2D CAVILLA ANGGIE FALLJACK 167102******0009 0895*****946 04/10/2021 Sesi 1 08.00 - 10.00
3384 J-0****R2E AHMAD ZAINUDIN 350713******0003 0823*****137 04/10/2021 Sesi 1 08.00 - 10.00
3385 J-0****R2Q SURYANSYAH SUCIONO 351015******0002 0822*****724 04/10/2021 Sesi 1 08.00 - 10.00
3386 J-0****R3M ANISAH RAHMAN FITRIANI 350724******0006 0881*****98 04/10/2021 Sesi 1 08.00 - 10.00
3387 J-0****R3T BAGUS IMAM BINTORO 367406******0004 0877*****720 04/10/2021 Sesi 1 08.00 - 10.00
3388 J-0****R3Y KEVIN SURYA WIDJAYA 357305******0004 0895*****0619 04/10/2021 Sesi 1 08.00 - 10.00
3389 J-0****R4I HANZAIS FIRMAN AL BAASITHU 357802******0002 0859*****465 04/10/2021 Sesi 1 08.00 - 10.00
3390 J-0****R4K MUHAMMAD ILHAM ADITIYA 351809******0001 0838*****010 04/10/2021 Sesi 1 08.00 - 10.00
3391 J-0****R53 IWANG JATI PRAYOGO 357303******0007 0812*****680 04/10/2021 Sesi 1 08.00 - 10.00
3392 J-0****R5X JHESY MURIKO DENO 127107******0003 0822*****562 04/10/2021 Sesi 1 08.00 - 10.00
3393 J-0****R68 THARIQ AHMAD AL GASYA 327509******0006 0813*****016 04/10/2021 Sesi 1 08.00 - 10.00
3394 J-0****R6S MOH. ZAIROFI AFNANI 640706******0001 0822*****832 04/10/2021 Sesi 1 08.00 - 10.00
3395 J-0****R76 SAVINKA SALSABIELA IRIANA MACHFUD 327602******0011 0881*****0703 04/10/2021 Sesi 1 08.00 - 10.00
3396 J-0****R7C MUHAMMAD JISMIS SALIM 617102******0002 0858*****496 04/10/2021 Sesi 1 08.00 - 10.00
3397 J-0****R7M NINDY SYAFIRA 331710******0001 0838*****399 04/10/2021 Sesi 1 08.00 - 10.00
3398 J-0****R7O RETTA WAHYU DWI FANY 357301******0003 0838*****348 04/10/2021 Sesi 1 08.00 - 10.00
3399 J-0****R82 DEWI KUSUMAH 352206******0004 0858*****963 04/10/2021 Sesi 1 08.00 - 10.00

Page 81 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3400 J-0****R8W FRENDY JAYA KUSUMA 350705******0003 0822*****845 04/10/2021 Sesi 1 08.00 - 10.00
3401 J-0****R93 MEI LUSI AMBARWATI 351901******0003 0813*****440 04/10/2021 Sesi 1 08.00 - 10.00
3402 J-0****RBK FARIS ATTAMIMI 350709******0001 0812*****710 04/10/2021 Sesi 1 08.00 - 10.00
3403 J-0****RCD HENDY PUTRA PANGESTU 360328******0001 0812*****707 04/10/2021 Sesi 1 08.00 - 10.00
3404 J-0****RE8 NABILLA SYAFA 350724******0008 0813*****484 04/10/2021 Sesi 1 08.00 - 10.00
3405 J-0****RED TANAZZA ZALSABELLA FIRSTY 350510******0001 0856*****323 04/10/2021 Sesi 1 08.00 - 10.00
3406 J-0****REU ARTHANA BUDINTA AZ-ZUHRUFA 350714******0001 0811*****24 04/10/2021 Sesi 1 08.00 - 10.00
3407 J-0****RF3 WIDYA FEBRIYANI 321401******0003 0813*****338 04/10/2021 Sesi 1 08.00 - 10.00
3408 J-0****RF5 GIGIH WAHYU OKTAVIAN 357303******0003 0895*****5012 04/10/2021 Sesi 1 08.00 - 10.00
3409 J-0****RFG ARUM NAHDHIATURRAHMAH 327605******0010 0857*****6401 04/10/2021 Sesi 1 08.00 - 10.00
3410 J-0****RFV MAHINDRA RHAVELL KURNIAWAN 351813******0001 0858*****707 04/10/2021 Sesi 1 08.00 - 10.00
3411 J-0****RFY DINDA ASA RESIANTO 357303******0004 0812*****654 04/10/2021 Sesi 1 08.00 - 10.00
3412 J-0****RG3 ROUDHOTUL JANNATUN NISA` 351413******0006 0821*****580 04/10/2021 Sesi 1 08.00 - 10.00
3413 J-0****RG7 FAHMI RAHMAN ALI SIGIT 357301******0004 0851*****187 04/10/2021 Sesi 1 08.00 - 10.00
3414 J-0****RH6 KHANSA NABILA ROSYADI 357901******0004 0851*****350 04/10/2021 Sesi 1 08.00 - 10.00
3415 J-0****RHV NAUFAL FAKHRIAN 350724******0005 0822*****495 04/10/2021 Sesi 1 08.00 - 10.00
3416 J-0****RIH FIRDAUS PITALOKA 357503******0002 0877*****509 04/10/2021 Sesi 1 08.00 - 10.00
3417 J-0****RIW ARIA ARGANATA 357703******0002 0812*****660 04/10/2021 Sesi 1 08.00 - 10.00
3418 J-0****RJ8 BAIQ PRATIWI 917103******0004 0812*****820 04/10/2021 Sesi 1 08.00 - 10.00
3419 J-0****RJE AZ ZAHRAH NUR AMANI AHMAD 321706******0014 0813*****166 04/10/2021 Sesi 1 08.00 - 10.00
3420 J-0****RJS NURHAYATI ANGELINA 357901******0002 0898*****50 04/10/2021 Sesi 1 08.00 - 10.00
3421 J-0****RJT SHEFIA NIFTA AUDRYNA 357305******0004 0858*****816 04/10/2021 Sesi 1 08.00 - 10.00
3422 J-0****RK4 ILHAM CAHYO RAHARJO 331003******0001 0897*****37 04/10/2021 Sesi 1 08.00 - 10.00
3423 J-0****RK5 NABILA AULIA ARIFIN 350724******0001 0813*****108 04/10/2021 Sesi 1 08.00 - 10.00
3424 J-0****RKQ WIDYA CHRISTINA 357305******0004 0812*****383 04/10/2021 Sesi 1 08.00 - 10.00
3425 J-0****RL4 YENNI RUSIKA 357305******0023 0813*****829 04/10/2021 Sesi 1 08.00 - 10.00
3426 J-0****RL7 ANNA NADIATUS SHOLICHAH 350724******0001 0812*****537 04/10/2021 Sesi 1 08.00 - 10.00
3427 J-0****RLN WIDA ANDREAS 350725******0005 0821*****693 04/10/2021 Sesi 1 08.00 - 10.00
3428 J-0****RMD NAWANG MEINA NABILLA 350719******0001 0896*****890 04/10/2021 Sesi 1 08.00 - 10.00
3429 J-0****RNT YUZZAIN MUHAMMAD SUJUDI 351208******0002 0821*****116 04/10/2021 Sesi 1 08.00 - 10.00
3430 J-0****RNW ADNAN NIBRAS KAUTSAR 367403******0003 0896*****190 04/10/2021 Sesi 1 08.00 - 10.00
3431 J-0****RP5 JA'FAR TSABIT RABBANI 367113******0004 0896*****751 04/10/2021 Sesi 1 08.00 - 10.00
3432 J-0****RPL DHIYA IFTINA LAJUHARDI 150812******0001 0812*****393 04/10/2021 Sesi 1 08.00 - 10.00
3433 J-0****RQI ANNISA ICHA ADELINA 350732******0001 0815*****626 04/10/2021 Sesi 1 08.00 - 10.00
3434 J-0****RRQ NURUL AZIZAH 350701******0002 0856*****695 04/10/2021 Sesi 1 08.00 - 10.00
3435 J-0****RSS PUTRI ADLINA ANGGRAINI 327606******0003 0877*****723 04/10/2021 Sesi 1 08.00 - 10.00
3436 J-0****RTA SYAMSIR NAWAWI 357803******0001 0813*****730 04/10/2021 Sesi 2 10.00 - 12.00
3437 J-0****RUJ MUHAMMAD SALAHUDDIN FERDIAN 640108******0002 0813*****809 04/10/2021 Sesi 2 10.00 - 12.00
3438 J-0****RUP ANIK SUSANTI 357305******0001 0895*****463 04/10/2021 Sesi 2 10.00 - 12.00
3439 J-0****RUV HENRYTA OCTAVIA IMPAL 350714******0003 0812*****286 04/10/2021 Sesi 2 10.00 - 12.00
3440 J-0****RV3 FIRDAUS DEYUSA RAMADHAN 357305******0001 0812*****109 04/10/2021 Sesi 2 10.00 - 12.00
3441 J-0****RV5 NAURAH QAYLA FAYZA 357803******0001 0822*****899 04/10/2021 Sesi 2 10.00 - 12.00

Page 82 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3442 J-0****RVB RIRIS FIFANTORO WIJAYA 350702******0004 0856*****488 04/10/2021 Sesi 2 10.00 - 12.00
3443 J-0****RVN TIKA MININGRUM 357305******0001 0897*****96 04/10/2021 Sesi 2 10.00 - 12.00
3444 J-0****RVZ DALILATUL KHOIRIYAH 357305******0001 0822*****688 04/10/2021 Sesi 2 10.00 - 12.00
3445 J-0****RXP KUSTANIA PROBOSUCI 351507******0001 0856*****20 04/10/2021 Sesi 2 10.00 - 12.00
3446 J-0****RXT GUSNI AMALIA VIANTI 357305******0004 0812*****009 04/10/2021 Sesi 2 10.00 - 12.00
3447 J-0****RXX SHERWINA PUTRI WIDYA NATHANIA 357304******0003 0896*****812 04/10/2021 Sesi 2 10.00 - 12.00
3448 J-0****RXZ FARICHA KHOIRUL UMAMI 350708******0004 0822*****023 04/10/2021 Sesi 2 10.00 - 12.00
3449 J-0****RYK DEWI FARAH ZAIRINA 357903******0002 0878*****241 04/10/2021 Sesi 2 10.00 - 12.00
3450 J-0****RZ3 ATHALA INSYIRA NURJANNAH 351420******0002 0822*****167 04/10/2021 Sesi 2 10.00 - 12.00
3451 J-0****RZL MOHAMMAD FADEL AGAM ISKANDARSYAH 352422******0002 0858*****956 04/10/2021 Sesi 2 10.00 - 12.00
3452 J-0****S00 ARIYA DHIAN NUGRAHA PUTRA 351613******0002 0822*****045 04/10/2021 Sesi 2 10.00 - 12.00
3453 J-0****S01 ABY DEA ADMIR 357301******0001 0881*****48 04/10/2021 Sesi 2 10.00 - 12.00
3454 J-0****S0P ARVA SAKTIA ZULEMITA 352405******0003 0857*****445 04/10/2021 Sesi 2 10.00 - 12.00
3455 J-0****S1S PHILIA PUTRA MAHARDIKA 620206******0002 0822*****146 04/10/2021 Sesi 2 10.00 - 12.00
3456 J-0****S1V LUKY FAHMI 351903******0003 0851*****969 04/10/2021 Sesi 2 10.00 - 12.00
3457 J-0****S1W MUHAMMAD ARIEF SETYAWAN 357302******0001 0895*****8835 04/10/2021 Sesi 2 10.00 - 12.00
3458 J-0****S1Y KHORIYATUN 910111******0001 0852*****051 04/10/2021 Sesi 2 10.00 - 12.00
3459 J-0****S26 SAKAR AZIDAN 352407******0005 0852*****197 04/10/2021 Sesi 2 10.00 - 12.00
3460 J-0****S2I RESTU ARDIAN PRIYOGO 357305******0001 0822*****182 04/10/2021 Sesi 2 10.00 - 12.00
3461 J-0****S3C USEP SAEPUDIN 357102******0006 0858*****899 04/10/2021 Sesi 2 10.00 - 12.00
3462 J-0****S3M FARAH DINA FAUZIAH 357305******0003 0858*****415 04/10/2021 Sesi 2 10.00 - 12.00
3463 J-0****S49 MUHAMMAD RUHIL MIRZA 352603******0005 0852*****065 04/10/2021 Sesi 2 10.00 - 12.00
3464 J-0****S5S MAHARDIKA ANIL HAKIM 357305******0004 0812*****874 04/10/2021 Sesi 2 10.00 - 12.00
3465 J-0****S5W DHELIA AYU PUTRI WULAN DARI 351819******0001 0857*****162 04/10/2021 Sesi 2 10.00 - 12.00
3466 J-0****S6B ANGGI DWI JATI PERMANA 140807******0005 0822*****143 04/10/2021 Sesi 2 10.00 - 12.00
3467 J-0****S86 SUDONA HERLINA 357301******0002 0811*****89 04/10/2021 Sesi 2 10.00 - 12.00
3468 J-0****S8C TALWIYATIN 357303******0007 0823*****472 04/10/2021 Sesi 2 10.00 - 12.00
3469 J-0****S8D NEVI WIDYARETNO 350708******0003 0858*****768 04/10/2021 Sesi 2 10.00 - 12.00
3470 J-0****S9J PUTRI NURMAHMUDAH 352407******0003 0881*****75 04/10/2021 Sesi 2 10.00 - 12.00
3471 J-0****S9L ANGELINA SATYA PUTRI 350721******0002 0823*****895 04/10/2021 Sesi 2 10.00 - 12.00
3472 J-0****SB4 NURUL AVIVAH 351610******0002 0812*****667 04/10/2021 Sesi 2 10.00 - 12.00
3473 J-0****SB6 KRISNA RIFKI ADIPUTRA 640203******0001 0813*****569 04/10/2021 Sesi 2 10.00 - 12.00
3474 J-0****SBX RYONTI MADHANI 350111******0001 0822*****437 04/10/2021 Sesi 2 10.00 - 12.00
3475 J-0****SC8 EMA ZAHRA FIRDAUS 357305******0001 0813*****010 04/10/2021 Sesi 2 10.00 - 12.00
3476 J-0****SCF DIANA WAHYU PRATIWI 350724******0003 0812*****096 04/10/2021 Sesi 2 10.00 - 12.00
3477 J-0****SCG BAGUS DWIANTO 350725******0003 0897*****81 04/10/2021 Sesi 2 10.00 - 12.00
3478 J-0****SCY ELLEN MONICA 331312******0001 0857*****352 04/10/2021 Sesi 2 10.00 - 12.00
3479 J-0****SD2 ALDITYA PUTRI YULINARSARI 350912******0004 0857*****048 04/10/2021 Sesi 2 10.00 - 12.00
3480 J-0****SDL ADITHIA SANDI YOSUA SIMANGUNSONG 321606******0006 0812*****651 04/10/2021 Sesi 2 10.00 - 12.00
3481 J-0****SDM DOMINGGO SINAGA 121709******0001 0821*****172 04/10/2021 Sesi 2 10.00 - 12.00
3482 J-0****SDZ ELVIRA DEWI AJENG 351812******0005 0852*****969 04/10/2021 Sesi 2 10.00 - 12.00
3483 J-0****SE6 JOSUA RIVALDO SIHOMBING 127301******0003 0812*****988 04/10/2021 Sesi 2 10.00 - 12.00

Page 83 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3484 J-0****SE7 ADE NOVIAN SAPUTRA 351414******0001 0813*****221 04/10/2021 Sesi 2 10.00 - 12.00
3485 J-0****SEI KUMARA ARI YUDA NEGARA 357820******0002 0821*****879 04/10/2021 Sesi 2 10.00 - 12.00
3486 J-0****SF2 AISYAH AJI SAHARA 352515******0005 0838*****737 04/10/2021 Sesi 2 10.00 - 12.00
3487 J-0****SFB FAJAR UBAIDILLAH AMIN 350729******0003 0881*****17 04/10/2021 Sesi 2 10.00 - 12.00
3488 J-0****SGV MUHAMMAD SANDRE JULIANSYAH 357304******0008 0896*****581 04/10/2021 Sesi 2 10.00 - 12.00
3489 J-0****SH1 RONA TINGKA HILMI 350417******0002 0823*****817 04/10/2021 Sesi 2 10.00 - 12.00
3490 J-0****SHK NURUL ISTIKHOMAH 350721******0002 0857*****761 04/10/2021 Sesi 2 10.00 - 12.00
3491 J-0****SHW HARTY KRISTI FRIELLA BR SINURAT 120612******0001 0822*****980 04/10/2021 Sesi 2 10.00 - 12.00
3492 J-0****SI1 FARHA SAILANNADA 637206******0001 0812*****106 04/10/2021 Sesi 2 10.00 - 12.00
3493 J-0****SK2 ADINDA MARISKA EKA YANTI 350721******0002 0815*****387 04/10/2021 Sesi 2 10.00 - 12.00
3494 J-0****SKE WAHYU TRIYANTO 331013******0001 0823*****294 04/10/2021 Sesi 2 10.00 - 12.00
3495 J-0****SN3 ZULKIFLI FIRDAUS 357305******0001 0813*****820 04/10/2021 Sesi 2 10.00 - 12.00
3496 J-0****SQ4 AUDINA VERA SINTIA 350419******0001 0857*****337 04/10/2021 Sesi 2 10.00 - 12.00
3497 J-0****SQY ERRA NABILA HARDIYANI PALASTRI 357302******0004 0812*****250 04/10/2021 Sesi 2 10.00 - 12.00
3498 J-0****SS9 JEFRI ILHAM RACHMAWAN 350721******0001 0857*****104 04/10/2021 Sesi 2 10.00 - 12.00
3499 J-0****SSG JIHADUL AMRY 520611******1002 0852*****146 04/10/2021 Sesi 2 10.00 - 12.00
3500 J-0****SSO MUHAMMAD AFTHAN SHIDQI 327509******0011 0856*****000 04/10/2021 Sesi 2 10.00 - 12.00
3501 J-0****SSV MOHAMAD PANDU MANGGASRI 321605******0004 0813*****590 04/10/2021 Sesi 2 10.00 - 12.00
3502 J-0****STB AHMAD FAUZAN ALI SYAHBANA 647103******0002 0822*****183 04/10/2021 Sesi 2 10.00 - 12.00
3503 J-0****STP BUDI SISWOYO 357305******0006 0822*****234 04/10/2021 Sesi 2 10.00 - 12.00
3504 J-0****SU2 ARINA SABILA 350718******0001 0812*****532 04/10/2021 Sesi 2 10.00 - 12.00
3505 J-0****SVW ZALFA GHINA SALSABILA 350718******0002 0896*****550 04/10/2021 Sesi 2 10.00 - 12.00
3506 J-0****SW9 RINDI ARDIKA MELSALASA SAHPUTRI 350722******0001 0812*****712 04/10/2021 Sesi 2 10.00 - 12.00
3507 J-0****SYF ROCHMATUL LAILIYAH 351508******0002 0822*****073 04/10/2021 Sesi 2 10.00 - 12.00
3508 J-0****T0Q NUR PRAMESTHI SETYANINGRUM 350708******0002 0857*****736 04/10/2021 Sesi 2 10.00 - 12.00
3509 J-0****T4N SASONGKO BIRRU ALLAFA HIDAYATTULLOH 350713******0004 0851*****467 04/10/2021 Sesi 2 10.00 - 12.00
3510 J-0****T5Q ELANG WANGKAWA RIZQI KURNIAWAN 327506******0004 0812*****613 04/10/2021 Sesi 2 10.00 - 12.00
3511 J-0****T6X M. ATTALA REZA SYAHPUTRA 357303******0003 0812*****393 04/10/2021 Sesi 2 10.00 - 12.00
3512 J-0****T78 SARAH WIDYATI 320405******0001 0821*****660 04/10/2021 Sesi 2 10.00 - 12.00
3513 J-0****T87 AUFA ALZENA 367106******0005 0813*****457 04/10/2021 Sesi 2 10.00 - 12.00
3514 J-0****T8T EVITA ISNA TANIA 351016******0006 0822*****367 04/10/2021 Sesi 2 10.00 - 12.00
3515 J-0****T92 AHMAD JAKA RAMADHAN 352512******0004 0813*****498 04/10/2021 Sesi 2 10.00 - 12.00
3516 J-0****T98 SELLA RIZKI 327328******0002 0821*****666 04/10/2021 Sesi 2 10.00 - 12.00
3517 J-0****TCG AFIFATUL KHOIRUNNISAK 350709******0002 0857*****725 04/10/2021 Sesi 2 10.00 - 12.00
3518 J-0****TDB SABRINA ALLYSA SYAM 351709******0003 0857*****814 04/10/2021 Sesi 2 10.00 - 12.00
3519 J-0****TEV ADAM DINAR TANJUNG 351409******0002 0895*****0321 04/10/2021 Sesi 2 10.00 - 12.00
3520 J-0****TEW ALIFFIA NURAITA APRIYANI 517101******0004 0812*****199 04/10/2021 Sesi 2 10.00 - 12.00
3521 J-0****TEX ANANDA FEBRI PRATAMA 357404******0004 0857*****337 04/10/2021 Sesi 2 10.00 - 12.00
3522 J-0****TJN AGUS BUDIANTO 350714******0003 0813*****442 04/10/2021 Sesi 2 10.00 - 12.00
3523 J-0****TL4 ATHIYYA KARIMA MAGHFIRA 357305******0001 0857*****574 04/10/2021 Sesi 2 10.00 - 12.00
3524 J-0****TL8 IHSAN AHMAD BADRIANTO 340107******0001 0856*****201 04/10/2021 Sesi 2 10.00 - 12.00
3525 J-0****TLC FEBRYANA ROMA ULI MARPAUNG 127107******0001 0895*****1158 04/10/2021 Sesi 2 10.00 - 12.00

Page 84 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3526 J-0****TPB M WILDAN WICAKSONO 357302******0004 0881*****49 04/10/2021 Sesi 2 10.00 - 12.00
3527 J-0****TPJ RACHEL AZ ZAHRA KURNIAWAN 351021******0003 0858*****848 04/10/2021 Sesi 2 10.00 - 12.00
3528 J-0****TQC M. FEBBY ROMADONNI 350723******0001 0877*****790 04/10/2021 Sesi 2 10.00 - 12.00
3529 J-0****TQN RIZKY DWI PURNOMO 350724******0001 0813*****620 04/10/2021 Sesi 2 10.00 - 12.00
3530 J-0****TQT AHMAD FAUZI RAMDHAN 351613******0001 0896*****833 04/10/2021 Sesi 2 10.00 - 12.00
3531 J-0****TR9 FIRDA ROUUDLOTUL JANNAH 350613******0001 0858*****404 04/10/2021 Sesi 2 10.00 - 12.00
3532 J-0****TSE CHARMELLIA SALSABILA BHAKTI AYUNDA 620301******0002 0822*****699 04/10/2021 Sesi 2 10.00 - 12.00
3533 J-0****TSM RETNO WULANDARI 357302******0002 0812*****648 04/10/2021 Sesi 2 10.00 - 12.00
3534 J-0****TSO DZIYAA 'ANNAUFAL SHOLAAHUDDIN 357602******0005 0878*****550 04/10/2021 Sesi 2 10.00 - 12.00
3535 J-0****TTE BAIQ NANA MARLINA 520313******0003 0823*****017 04/10/2021 Sesi 2 10.00 - 12.00
3536 J-0****TVE IZZATUL AZIZAH 130605******0002 0813*****171 04/10/2021 Sesi 2 10.00 - 12.00
3537 J-0****TVQ HARDI YUDHISTIRA 187112******0013 0812*****305 04/10/2021 Sesi 2 10.00 - 12.00
3538 J-0****TW1 ABDULLOH ISHOM 351511******0001 0896*****440 04/10/2021 Sesi 2 10.00 - 12.00
3539 J-0****TWB NANIN INDANA ZULVA 350111******0004 0838*****910 04/10/2021 Sesi 2 10.00 - 12.00
3540 J-0****U1B ULFATUS SHOBA 351408******0008 0857*****946 04/10/2021 Sesi 2 10.00 - 12.00
3541 J-0****U1G IQBAL BAGUS PRASETYO 327601******0008 0878*****623 04/10/2021 Sesi 2 10.00 - 12.00
3542 J-0****U2F SALMA ATHIYYA 130805******0002 0822*****629 04/10/2021 Sesi 2 10.00 - 12.00
3543 J-0****U2R FITRI FEBRINA RAMADHANI 350617******0003 0859*****463 04/10/2021 Sesi 2 10.00 - 12.00
3544 J-0****U3A GALIH PRATAMA 327506******0010 0821*****295 04/10/2021 Sesi 2 10.00 - 12.00
3545 J-0****U4V M AKIF EKA KARUNIA 350722******0001 0895*****143 04/10/2021 Sesi 2 10.00 - 12.00
3546 J-0****U58 NUR ROCHMAH SEPTIA AMANDA 330612******0001 0812*****541 04/10/2021 Sesi 2 10.00 - 12.00
3547 J-0****U6Y MAUHIBATUL ADAWIYAH 351514******0005 0856*****601 04/10/2021 Sesi 2 10.00 - 12.00
3548 J-0****U9N SINTA RAHMA FANDINI 350725******0001 0852*****237 04/10/2021 Sesi 2 10.00 - 12.00
3549 J-0****UB6 BAGUS ANDRIANTO 350312******0003 0822*****643 04/10/2021 Sesi 2 10.00 - 12.00
3550 J-0****UBZ KEN THANIA CHANDRA KASIH 350724******0001 0812*****101 04/10/2021 Sesi 2 10.00 - 12.00
3551 J-0****UG8 ARLINE OCTAVIA PINESTA 357303******0004 0821*****823 04/10/2021 Sesi 2 10.00 - 12.00
3552 J-0****UGV MUHAMMAD AL FURQAN HAKIM 351408******0002 0857*****943 04/10/2021 Sesi 2 10.00 - 12.00
3553 J-0****UI2 ACHMAD BUDI PRASETYO 357201******0002 0815*****502 04/10/2021 Sesi 2 10.00 - 12.00
3554 J-0****UJ1 AKMAL ABIL GHIFFARI 321606******0021 0857*****361 04/10/2021 Sesi 2 10.00 - 12.00
3555 J-0****UJ8 RORO AYU PRAMESTI MAHARANI 357902******0001 0822*****786 04/10/2021 Sesi 2 10.00 - 12.00
3556 J-0****UJG NANIK WINARSIH 350712******0004 0812*****124 04/10/2021 Sesi 2 10.00 - 12.00
3557 J-0****ULA GADIS GHANATIKA 357304******0003 0812*****101 04/10/2021 Sesi 2 10.00 - 12.00
3558 J-0****UOF NGURAH PRADIPTA SURYA MANDALA 510809******0002 0851*****601 04/10/2021 Sesi 2 10.00 - 12.00
3559 J-0****UPE PATRICK LEON CARLO RAKAPUTRA EMOR 327508******0002 0811*****9 04/10/2021 Sesi 2 10.00 - 12.00
3560 J-0****UPI NAUFALDY GHALY ALANA 350725******0001 0895*****5875 04/10/2021 Sesi 2 10.00 - 12.00
3561 J-0****URF IRWANTO NABABAN 320809******0002 0813*****489 04/10/2021 Sesi 2 10.00 - 12.00
3562 J-0****URJ FIKRI NUR HERDIANSYAH 357902******0001 0812*****767 04/10/2021 Sesi 2 10.00 - 12.00
3563 J-0****URM MIRANDA SEKAR LESTARI 357303******0008 0877*****407 04/10/2021 Sesi 2 10.00 - 12.00
3564 J-0****URU SOFIA ADIRA 351516******0003 0851*****833 04/10/2021 Sesi 2 10.00 - 12.00
3565 J-0****UT4 JESSICA DAYANG PANDAN WANGI 357902******0001 0895*****4195 04/10/2021 Sesi 2 10.00 - 12.00
3566 J-0****UTO NUR KHASANAH 351408******0002 0856*****43 04/10/2021 Sesi 2 10.00 - 12.00
3567 J-0****UUE SANIATUL FADILAH 357304******0004 0896*****094 04/10/2021 Sesi 2 10.00 - 12.00

Page 85 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3568 J-0****UVC JUMADIL WAHID 910201******0002 0821*****593 04/10/2021 Sesi 2 10.00 - 12.00
3569 J-0****UVQ SUNTARI NUR CAHYANI 331714******0001 0859*****6515 04/10/2021 Sesi 2 10.00 - 12.00
3570 J-0****UWI ARINI ROBBIL IZZATI ULINNUHA 350606******0001 0815*****896 04/10/2021 Sesi 2 10.00 - 12.00
3571 J-0****UXC HAFIYYAN DAFFA MUHAMMAD 357807******0001 0812*****096 04/10/2021 Sesi 2 10.00 - 12.00
3572 J-0****UXM ANDRIEO CAHYO PRATOMO 640804******0002 0878*****789 04/10/2021 Sesi 2 10.00 - 12.00
3573 J-0****UXP IBNU SULAIMAN 520206******0004 0877*****433 04/10/2021 Sesi 2 10.00 - 12.00
3574 J-0****UY7 MOHAMMAD EKA SAPUTRA 351002******0002 0822*****110 04/10/2021 Sesi 2 10.00 - 12.00
3575 J-0****UYB RAHMA AJI SANTOSO 352603******0002 0838*****914 04/10/2021 Sesi 2 10.00 - 12.00
3576 J-0****UYC RISKA NIAR MAULIDA 117301******0001 0813*****852 04/10/2021 Sesi 2 10.00 - 12.00
3577 J-0****UYE RIFAT SYAHROFI 147101******0041 0812*****074 04/10/2021 Sesi 2 10.00 - 12.00
3578 J-0****UYW RIZKY MAULANA 350714******0003 0838*****891 04/10/2021 Sesi 2 10.00 - 12.00
3579 J-0****V0P RIA YUNITA LASMANA 170105******0004 0821*****796 04/10/2021 Sesi 2 10.00 - 12.00
3580 J-0****V24 FARAHDILLA HANA AZARIA 357901******0001 0823*****390 04/10/2021 Sesi 2 10.00 - 12.00
3581 J-0****V25 JOVIDIANTO SOESILODEWO 327504******0019 0812*****715 04/10/2021 Sesi 2 10.00 - 12.00
3582 J-0****V2F PANCA WIDI ARIESTA 350724******0001 0853*****512 04/10/2021 Sesi 2 10.00 - 12.00
3583 J-0****V30 RIZKA NUR RAHMA 350725******0001 0878*****058 04/10/2021 Sesi 2 10.00 - 12.00
3584 J-0****V4F RIZMA NOVITA SARI 350724******0006 0877*****535 04/10/2021 Sesi 2 10.00 - 12.00
3585 J-0****V5B RAFI ARMAN SANJAYA 647401******0001 0823*****225 04/10/2021 Sesi 2 10.00 - 12.00
3586 J-0****V5M ADHYAN AGUNG ELANG NURRAMADHANY 357305******0002 0823*****785 04/10/2021 Sesi 2 10.00 - 12.00
3587 J-0****V64 ISNAN NURDIANSYAH 357902******0004 0856*****041 04/10/2021 Sesi 2 10.00 - 12.00
3588 J-0****V6S MATHILDA IVANA TAMPUBOLON 121101******0003 0813*****511 04/10/2021 Sesi 2 10.00 - 12.00
3589 J-0****V72 ALMA SAQUILLE RASHAD 357304******0002 0895*****053 04/10/2021 Sesi 2 10.00 - 12.00
3590 J-0****V74 WAHYU KRISTIANINGSIH 350721******0001 0822*****298 04/10/2021 Sesi 2 10.00 - 12.00
3591 J-0****V75 ANGIE VIA RESTY KIMBAL 710111******0001 0853*****247 04/10/2021 Sesi 2 10.00 - 12.00
3592 J-0****V7K NAUFAL HERNADIPUTRA 351513******0003 0877*****300 04/10/2021 Sesi 2 10.00 - 12.00
3593 J-0****V8C DHEA KURNIA AMALIA 357302******0006 0858*****726 04/10/2021 Sesi 2 10.00 - 12.00
3594 J-0****V8L DISTI MILSANDI 120723******0005 0852*****416 04/10/2021 Sesi 2 10.00 - 12.00
3595 J-0****V8Y ABDULLAH ZAKEY MULTAZAM 352908******0001 0818*****772 04/10/2021 Sesi 2 10.00 - 12.00
3596 J-0****V92 DHEKA SAPTI ISKANDAR 350708******0003 0899*****53 04/10/2021 Sesi 2 10.00 - 12.00
3597 J-0****V9H AYU RIZKI SOVINOVITA 351016******0005 0813*****867 04/10/2021 Sesi 2 10.00 - 12.00
3598 J-0****V9P DELIANA NURDIANTHI 320213******0002 0857*****428 04/10/2021 Sesi 2 10.00 - 12.00
3599 J-0****VA3 DEVI OKTADIANI 167104******0005 0858*****976 04/10/2021 Sesi 2 10.00 - 12.00
3600 J-0****VA6 RADEN YUSUF SINAGA 122008******0003 0822*****970 04/10/2021 Sesi 2 10.00 - 12.00
3601 J-0****VAL REGHITA DWI FARIKHAH 357303******0002 0813*****013 04/10/2021 Sesi 2 10.00 - 12.00
3602 J-0****VC4 REZA WAHYU PUTRA PRATAMA 351813******0001 0813*****137 04/10/2021 Sesi 2 10.00 - 12.00
3603 J-0****VCT VENANY NABILLA 351502******0010 0878*****715 04/10/2021 Sesi 2 10.00 - 12.00
3604 J-0****VCY ROSYIDA NUR KAMILA 357305******0003 0823*****752 04/10/2021 Sesi 2 10.00 - 12.00
3605 J-0****VDE NOVI RAHMAWATI SUTOPO 352116******0001 0857*****719 04/10/2021 Sesi 2 10.00 - 12.00
3606 J-0****VEB RAKHA PATRIA INDRASEPTA P 187111******0003 0858*****078 04/10/2021 Sesi 2 10.00 - 12.00
3607 J-0****VEX RIZKY DIAN EKAYANA 357304******0001 0857*****890 04/10/2021 Sesi 2 10.00 - 12.00
3608 J-0****VGO VINA ANGGRAINI PUTRI 350724******0003 0898*****02 04/10/2021 Sesi 2 10.00 - 12.00
3609 J-0****VGV JUNT VANDER NAINGGOLAN 121708******0002 0813*****415 04/10/2021 Sesi 2 10.00 - 12.00

Page 86 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3610 J-0****VJR ZIDNI AJIRUL MUJIB 647203******0003 0822*****866 04/10/2021 Sesi 2 10.00 - 12.00
3611 J-0****VMB FACHRY BUDI HERMAWAN 327501******0018 0813*****447 04/10/2021 Sesi 2 10.00 - 12.00
3612 J-0****VOC MARTHA GRACIA PUTRI SIHOMBING 127202******0002 0895*****2080 04/10/2021 Sesi 2 10.00 - 12.00
3613 J-0****VR7 AMELIA DWI ROCHANI 357303******0002 0815*****752 04/10/2021 Sesi 2 10.00 - 12.00
3614 J-0****VSH MARITZA AYDIN MAULUDIAH 357303******0001 0812*****085 04/10/2021 Sesi 2 10.00 - 12.00
3615 J-0****VT5 RATU BULKIS 630206******0001 0812*****252 04/10/2021 Sesi 2 10.00 - 12.00
3616 J-0****VT9 DHAWY DAMAYUNANTI 350724******0006 0851*****787 04/10/2021 Sesi 2 10.00 - 12.00
3617 J-0****VTT MUHAMMAD FATHAM MUBINA AKBAR 357305******0004 0877*****755 04/10/2021 Sesi 2 10.00 - 12.00
3618 J-0****VUE DZIAUL MUIZ AL ARIF 331409******0005 0857*****167 04/10/2021 Sesi 2 10.00 - 12.00
3619 J-0****VUK EKA PRATIWI TENRIAWARU 737114******0001 0852*****146 04/10/2021 Sesi 2 10.00 - 12.00
3620 J-0****VUP UMMU HANIK FAUZIYAH 351417******0001 0822*****840 04/10/2021 Sesi 2 10.00 - 12.00
3621 J-0****VUR ALFIYATUZ ZAHROH 351423******0001 0858*****403 04/10/2021 Sesi 2 10.00 - 12.00
3622 J-0****VVV SHAFA BERLIANA ARAMINTHA 357305******0004 0822*****199 04/10/2021 Sesi 2 10.00 - 12.00
3623 J-0****VVW PRIMA ARDIANSAH ZUNAEDI 351618******0002 0856*****847 04/10/2021 Sesi 2 10.00 - 12.00
3624 J-0****VXS MITA HERLINA SARI 350714******0001 0857*****055 04/10/2021 Sesi 2 10.00 - 12.00
3625 J-0****VYV GRAITA SUKMA FEBRIANSYAH TRIWILDAN AZMI 350728******0001 0813*****360 04/10/2021 Sesi 2 10.00 - 12.00
3626 J-0****VZ7 SAFIRA NOFAVINA FAJRIHADIN 357303******0007 0821*****633 04/10/2021 Sesi 2 10.00 - 12.00
3627 J-0****VZG MOHAMMAD HISYAM RISYAD 351413******0001 0813*****549 04/10/2021 Sesi 2 10.00 - 12.00
3628 J-0****VZV SALSABILATUL JANNAH 352307******0001 0821*****665 04/10/2021 Sesi 2 10.00 - 12.00
3629 J-0****W1V ADHEWARA AR YUPA 647403******0001 0851*****343 04/10/2021 Sesi 2 10.00 - 12.00
3630 J-0****W3L HENDRO SETYO 350724******0001 0812*****879 04/10/2021 Sesi 2 10.00 - 12.00
3631 J-0****W5K OCTAVIANDRA CHUSNUR RACHMAN 357703******0002 0851*****315 04/10/2021 Sesi 2 10.00 - 12.00
3632 J-0****W5M TRI MULYANINGRUM 357305******0004 0812*****119 04/10/2021 Sesi 2 10.00 - 12.00
3633 J-0****W8U AISYAH AL-FAJR RACHMAN HAKIM 640904******0001 0856*****395 04/10/2021 Sesi 2 10.00 - 12.00
3634 J-0****W9B SINTIYA FEBRIYANA 350719******0006 0857*****473 04/10/2021 Sesi 2 10.00 - 12.00
3635 J-0****WB9 AFRIEALDHI TREZA PUTRA 352315******0002 0821*****758 04/10/2021 Sesi 2 10.00 - 12.00
3636 J-0****WBH MUCHAMAD ARIQ ROSYANDI 357303******0001 0877*****943 04/10/2021 Sesi 2 10.00 - 12.00
3637 J-0****WBU ALIF ATHALLAH QINTHARA 327318******0001 0812*****116 04/10/2021 Sesi 2 10.00 - 12.00
3638 J-0****WC2 TISKA WIDIANTI 350712******0002 0821*****968 04/10/2021 Sesi 2 10.00 - 12.00
3639 J-0****WC3 MUHAMMAD RAFI ZULKARNAEN 331905******0001 0822*****467 04/10/2021 Sesi 2 10.00 - 12.00
3640 J-0****WC4 RIFQI TAUFIQUR ROHMAN Z 350724******0001 0851*****585 04/10/2021 Sesi 2 10.00 - 12.00
3641 J-0****WCN MUHAMMAD RAFIF TAQIYUDIN 357303******0002 0858*****524 04/10/2021 Sesi 2 10.00 - 12.00
3642 J-0****WCO ALIF ALMER MUHAMMAD 360427******0001 0812*****280 04/10/2021 Sesi 2 10.00 - 12.00
3643 J-0****WCP DASA NOVIANTO 327505******0018 0878*****594 04/10/2021 Sesi 2 10.00 - 12.00
3644 J-0****WD2 WILDAN AKHSANUL IMAN 350723******0004 0813*****747 04/10/2021 Sesi 2 10.00 - 12.00
3645 J-0****WD7 AURA SALWA OKTAVIA 350719******0002 0896*****860 04/10/2021 Sesi 2 10.00 - 12.00
3646 J-0****WDS JOSHE TIMOTHY SIREGAR 630906******0001 0822*****170 04/10/2021 Sesi 2 10.00 - 12.00
3647 J-0****WDV PUTRA GANDA SETYAWAN 350719******0004 0896*****714 04/10/2021 Sesi 2 10.00 - 12.00
3648 J-0****WDZ FAJRUL FALLAAH HIDAYATULLOH 357304******0001 0895*****563 04/10/2021 Sesi 2 10.00 - 12.00
3649 J-0****WE4 MOCH MAHFUTH HARUN 350404******0001 0858*****212 04/10/2021 Sesi 2 10.00 - 12.00
3650 J-0****WF8 ARI PRATAMA HIDAYATULLAH 357305******0004 0838*****711 04/10/2021 Sesi 2 10.00 - 12.00
3651 J-0****WGD OSI DIAN SAPUTRA 357305******0002 0881*****0834 04/10/2021 Sesi 2 10.00 - 12.00

Page 87 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3652 J-0****WHS LANGGENG WIDODO 352108******0003 0813*****396 04/10/2021 Sesi 2 10.00 - 12.00
3653 J-0****WIB PRAMITHA SARI WALUYO 351709******0001 0822*****478 04/10/2021 Sesi 2 10.00 - 12.00
3654 J-0****WIE LUTHFIA AYU DHEA 351004******0003 0822*****872 04/10/2021 Sesi 2 10.00 - 12.00
3655 J-0****WKD ANGGIA DEVI RAUDLATUL JANNAH 357302******0005 0838*****148 04/10/2021 Sesi 2 10.00 - 12.00
3656 J-0****WKF NUR SOFYAN 350718******0005 0816*****2 04/10/2021 Sesi 2 10.00 - 12.00
3657 J-0****WL6 MALINNY DEBRA 737110******0011 0812*****460 04/10/2021 Sesi 2 10.00 - 12.00
3658 J-0****WM1 FITRI AL ISTIQOMAH 621106******0002 0857*****097 04/10/2021 Sesi 2 10.00 - 12.00
3659 J-0****WM3 RAFIF TOSANDA 367401******0010 0813*****839 04/10/2021 Sesi 2 10.00 - 12.00
3660 J-0****WMS MUHAMMAD EVAN FAUZAN 357304******0004 0851*****677 04/10/2021 Sesi 2 10.00 - 12.00
3661 J-0****WNR REDITYO ADE MARCELLINO 187107******0008 0898*****93 04/10/2021 Sesi 2 10.00 - 12.00
3662 J-0****WOO SHEILA ALFAROZ 350724******0002 0813*****332 04/10/2021 Sesi 2 10.00 - 12.00
3663 J-0****WOX MOCHAMMAD FAIZ DWI MAULANA 351411******0001 0822*****223 04/10/2021 Sesi 2 10.00 - 12.00
3664 J-0****WPI BAGAS MAHENDRA 351405******0001 0812*****849 04/10/2021 Sesi 2 10.00 - 12.00
3665 J-0****WRR THEZA PUJIAWAN VINANSYAH 520410******0001 0812*****265 04/10/2021 Sesi 2 10.00 - 12.00
3666 J-0****WXN DHIA HISANAH RAMADHANTY 187102******0004 0821*****391 04/10/2021 Sesi 2 10.00 - 12.00
3667 J-0****WZS NUR IFADAH ROHMAH 352413******0001 0852*****781 04/10/2021 Sesi 2 10.00 - 12.00
3668 J-0****X0R QURRATUL AINI 352801******0002 0852*****793 04/10/2021 Sesi 2 10.00 - 12.00
3669 J-0****X1Q ALIFIA DEWI AZZAHRA 187102******0011 0856*****50 04/10/2021 Sesi 2 10.00 - 12.00
3670 J-0****X5B HENDRA HERMAWAN 357304******0001 0813*****689 04/10/2021 Sesi 2 10.00 - 12.00
3671 J-0****X87 JIHAN RANA SAFIRAH 332915******0001 0896*****630 04/10/2021 Sesi 2 10.00 - 12.00
3672 J-0****X8I FANDI RAHMAN 357903******0002 0877*****604 04/10/2021 Sesi 2 10.00 - 12.00
3673 J-0****XA1 MEGAWATI SULISTIO PUTRI 357301******0003 0881*****2714 04/10/2021 Sesi 2 10.00 - 12.00
3674 J-0****XAQ M.FARCHAN FUADI 351418******0003 0813*****261 04/10/2021 Sesi 2 10.00 - 12.00
3675 J-0****XE8 IZZA KARTIKA AMALIA 350724******0001 0895*****6952 04/10/2021 Sesi 2 10.00 - 12.00
3676 J-0****XF4 ICA PURWATININGRUM 350308******0001 0812*****230 04/10/2021 Sesi 2 10.00 - 12.00
3677 J-0****XFA DHEA ALDA RAMADHANI PUTRI SIWI 350803******0001 0877*****160 04/10/2021 Sesi 2 10.00 - 12.00
3678 J-0****XHD YONI SEVI IVONE 357404******0002 0816*****897 04/10/2021 Sesi 2 10.00 - 12.00
3679 J-0****XI7 NOVI KOMALASARI 520205******0002 0821*****273 04/10/2021 Sesi 2 10.00 - 12.00
3680 J-0****XJ4 YELLA PUSPITA RATRI 357302******0002 0838*****707 04/10/2021 Sesi 2 10.00 - 12.00
3681 J-0****XJ6 FATIHA AZZAH 331508******0002 0857*****466 04/10/2021 Sesi 2 10.00 - 12.00
3682 J-0****XJ8 YOLANDA ELDAMAYANTI 357305******0003 0813*****520 04/10/2021 Sesi 2 10.00 - 12.00
3683 J-0****XK8 IRA HESTIANI 350414******0002 0858*****996 04/10/2021 Sesi 2 10.00 - 12.00
3684 J-0****XKP HESTI YULINDA TRI LESTARINI 350713******0002 0895*****4503 04/10/2021 Sesi 2 10.00 - 12.00
3685 J-0****XLE RAFLY NAUFAL KASTARA 327605******0007 0812*****233 04/10/2021 Sesi 2 10.00 - 12.00
3686 J-0****XLV DHEA AURELIE YONIANSYAH 637105******0006 0823*****454 04/10/2021 Sesi 2 10.00 - 12.00
3687 J-0****XMQ MUHAMMAD BIMA SATRIA 357304******0004 0895*****300 04/10/2021 Sesi 2 10.00 - 12.00
3688 J-0****XOL YULIA RACHMAWATI 350713******0005 0812*****168 04/10/2021 Sesi 2 10.00 - 12.00
3689 J-0****XP8 YOANDRA NADYA YONIANSYAH 637105******0010 0812*****689 04/10/2021 Sesi 2 10.00 - 12.00
3690 J-0****XPU AISYAH NINDA BRILIANTI 357901******0003 0822*****303 04/10/2021 Sesi 2 10.00 - 12.00
3691 J-0****XQN CHARISA YACHROTUS SA'ADAH 357301******0002 0838*****36 04/10/2021 Sesi 2 10.00 - 12.00
3692 J-0****XR3 AGUNG PRAYITNO 637103******0002 0812*****76 04/10/2021 Sesi 2 10.00 - 12.00
3693 J-0****XRS KOTIMAH 357305******0001 0823*****525 04/10/2021 Sesi 2 10.00 - 12.00

Page 88 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3694 J-0****XSS SRI KUNTI W S 350713******0001 0813*****031 04/10/2021 Sesi 2 10.00 - 12.00
3695 J-0****XTR ACHMAD LUQMANUL ARSYA ARFANDHY 321206******0003 0853*****510 04/10/2021 Sesi 2 10.00 - 12.00
3696 J-0****XUK RAIHAN AZMI DHIAULHAQ 352217******0002 0882*****095 04/10/2021 Sesi 2 10.00 - 12.00
3697 J-0****XW5 MUHAMMAD ZEIN BAIHAQI 647203******0006 0812*****046 04/10/2021 Sesi 2 10.00 - 12.00
3698 J-0****XWK ANDHIKA FIRDAUS 327105******0003 0813*****198 04/10/2021 Sesi 2 10.00 - 12.00
3699 J-0****XWQ MAYA INDAH SARI 357302******0005 0851*****727 04/10/2021 Sesi 2 10.00 - 12.00
3700 J-0****XX0 KARINA FAIRUZA PRANASTYA 350724******0001 0838*****699 04/10/2021 Sesi 2 10.00 - 12.00
3701 J-0****XXB RIYAN RIYADLUN NAJIH 352414******0001 0895*****3147 04/10/2021 Sesi 2 10.00 - 12.00
3702 J-0****XZ0 FARADIVA DEVINDA SENANDA 350723******0001 0812*****534 04/10/2021 Sesi 2 10.00 - 12.00
3703 J-0****XZD JEREMY KARTIKA SOERYONO 350725******0004 0858*****791 04/10/2021 Sesi 2 10.00 - 12.00
3704 J-0****Y2V FARIS RAMADHANAIL 321606******0009 0857*****951 04/10/2021 Sesi 2 10.00 - 12.00
3705 J-0****Y3Z HERU ISTIAWAN 357303******0003 0878*****355 04/10/2021 Sesi 2 10.00 - 12.00
3706 J-0****Y5G SEKAR ALIFABILINANDA 167104******0008 0821*****338 04/10/2021 Sesi 2 10.00 - 12.00
3707 J-0****Y6B ANANGGA WIDYA PRADIPTA 350809******0002 0857*****359 04/10/2021 Sesi 2 10.00 - 12.00
3708 J-0****Y6T NURCAHYO DWI PRAMONO 352425******0002 0856*****6 04/10/2021 Sesi 2 10.00 - 12.00
3709 J-0****Y6V KHORIDATUL BAHRIYAH 350713******0001 0888*****50 04/10/2021 Sesi 2 10.00 - 12.00
3710 J-0****Y73 ANIS MIFTACHURROCHMAH 350713******0001 0813*****887 04/10/2021 Sesi 2 10.00 - 12.00
3711 J-0****Y74 SATFERISNAN QORIS FIRMAN YASIN 357302******0002 0899*****63 04/10/2021 Sesi 2 10.00 - 12.00
3712 J-0****Y76 RAVEL CAESAR EKA LESMANA 350724******0001 0856*****110 04/10/2021 Sesi 2 10.00 - 12.00
3713 J-0****Y7I IMA KHOTIMAH 350717******0002 0857*****833 04/10/2021 Sesi 2 10.00 - 12.00
3714 J-0****Y7O DWINANDA GALIH HARYUNI PUTRA 350401******0003 0812*****482 04/10/2021 Sesi 2 10.00 - 12.00
3715 J-0****Y7S SAIFUL BAHRI 352807******0002 0821*****234 04/10/2021 Sesi 2 10.00 - 12.00
3716 J-0****Y89 KEVIN HARTONO SITUMORANG 121705******0002 0812*****020 04/10/2021 Sesi 2 10.00 - 12.00
3717 J-0****Y8E LUHUR TRIHARTO 357305******0012 0821*****153 04/10/2021 Sesi 2 10.00 - 12.00
3718 J-0****Y8K SITI DEVIANTI 357901******0003 0877*****798 04/10/2021 Sesi 2 10.00 - 12.00
3719 J-0****Y8M MUHAMMAD HAFIZH PUTRANTO 327505******0013 0813*****909 04/10/2021 Sesi 2 10.00 - 12.00
3720 J-0****Y8R ASANDY DWI SURYOLAKSONO 352414******0001 0888*****202 04/10/2021 Sesi 2 10.00 - 12.00
3721 J-0****Y9F MUHAMMAD FAHMI ANIF 337405******0002 0877*****041 04/10/2021 Sesi 2 10.00 - 12.00
3722 J-0****Y9N HERNANDA TRIANA PUTRILIA 357901******0001 0857*****932 04/10/2021 Sesi 2 10.00 - 12.00
3723 J-0****Y9R RIFQI FERRY AVIANTO 357901******0005 0858*****047 04/10/2021 Sesi 2 10.00 - 12.00
3724 J-0****Y9V MAYA HANDINI 357303******0003 0896*****954 04/10/2021 Sesi 2 10.00 - 12.00
3725 J-0****YB0 FAUZIYYAH DWI DARMA YANTI 180308******0003 0822*****237 04/10/2021 Sesi 2 10.00 - 12.00
3726 J-0****YB6 RAIS SULAIMAN RUSID 327104******0003 0821*****210 04/10/2021 Sesi 2 10.00 - 12.00
3727 J-0****YB7 SEPTIAN ADY PAMUNGKAS 352408******0001 0812*****452 04/10/2021 Sesi 2 10.00 - 12.00
3728 J-0****YBW BAMBANG AL-JABBAR 127701******0003 0852*****894 04/10/2021 Sesi 2 10.00 - 12.00
3729 J-0****YC5 NINDYA RIMADANI 350719******0005 0859*****6192 04/10/2021 Sesi 2 10.00 - 12.00
3730 J-0****YD2 ERIK SUGISTIONO 352811******0002 0819*****756 04/10/2021 Sesi 2 10.00 - 12.00
3731 J-0****YEG SAVIRA ALVIONITA 351019******0001 0812*****690 04/10/2021 Sesi 2 10.00 - 12.00
3732 J-0****YFY YULIATI 350701******0001 0888*****787 04/10/2021 Sesi 2 10.00 - 12.00
3733 J-0****YH5 VARROSS AUSHOV SA'IED EL FAUZY 357305******0003 0881*****08 04/10/2021 Sesi 2 10.00 - 12.00
3734 J-0****YHA NI WAYAN PUTRI RAHAYUNINGRUM 357301******0005 0812*****089 04/10/2021 Sesi 2 10.00 - 12.00
3735 J-0****YHT FATHIA RAHMATUL AZIZAH 352215******0004 0813*****084 04/10/2021 Sesi 2 10.00 - 12.00

Page 89 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3736 J-0****YHV NOVITA BUDIARTI 160802******0001 0857*****722 04/10/2021 Sesi 2 10.00 - 12.00
3737 J-0****YI9 ANGGRAENI PUSPA SARI 357304******0005 0897*****23 04/10/2021 Sesi 2 10.00 - 12.00
3738 J-0****YIR KURNIAWATI HAKIM 520805******0001 0853*****798 04/10/2021 Sesi 2 10.00 - 12.00
3739 J-0****YJ7 MOCH SODIQ 357305******0006 0878*****131 04/10/2021 Sesi 2 10.00 - 12.00
3740 J-0****YJM ALI BISRI AL MUNIRI 352909******0003 0852*****912 04/10/2021 Sesi 2 10.00 - 12.00
3741 J-0****YJX FIFIA PUTRI NABILA 357301******0002 0819*****174 04/10/2021 Sesi 2 10.00 - 12.00
3742 J-0****YKE A RIZAL HERIWIJAYA 357305******0001 0822*****920 04/10/2021 Sesi 2 10.00 - 12.00
3743 J-0****YLA SITI FAUZIAH 160802******0002 0822*****449 04/10/2021 Sesi 2 10.00 - 12.00
3744 J-0****YM1 RAEHAN DAFFA SABILILLAH 350722******0004 0857*****009 04/10/2021 Sesi 2 10.00 - 12.00
3745 J-0****YM7 M. AHMI AL GAZALI 520211******0005 0878*****468 04/10/2021 Sesi 2 10.00 - 12.00
3746 J-0****YMC ALFINSHA WAHYU PRIANTO 350719******0003 0831*****194 04/10/2021 Sesi 2 10.00 - 12.00
3747 J-0****YMO JANE ANGEL BRILIAN NATASYA 350506******0004 0816*****67 04/10/2021 Sesi 2 10.00 - 12.00
3748 J-0****YN8 SRI HERYANTO 160609******0001 0822*****089 04/10/2021 Sesi 2 10.00 - 12.00
3749 J-0****YQ7 SARWINDA 352811******0003 0856*****072 04/10/2021 Sesi 2 10.00 - 12.00
3750 J-0****YRU MOHAMMAD SYAHRIAL HANIF 357101******0003 0858*****595 04/10/2021 Sesi 2 10.00 - 12.00
3751 J-0****YS3 KOMSATUL ISTIKOMAH 350720******0001 0857*****591 04/10/2021 Sesi 2 10.00 - 12.00
3752 J-0****YSO ILYAS RESTU SHIDDIQ 332709******0016 0831*****180 04/10/2021 Sesi 2 10.00 - 12.00
3753 J-0****YUQ NIKEN PUSPITA HAPSARI 352422******0001 0821*****356 04/10/2021 Sesi 2 10.00 - 12.00
3754 J-0****YVA MUHAMMAD AMIR RAZZAK 357305******0004 0853*****733 04/10/2021 Sesi 2 10.00 - 12.00
3755 J-0****Z88 TITO ARIEF LAKSONO 321215******0003 0821*****006 04/10/2021 Sesi 2 10.00 - 12.00
3756 J-0****Z8D FARADIBA ANNISA 351608******0001 0858*****763 04/10/2021 Sesi 2 10.00 - 12.00
3757 J-0****Z93 NIA 357305******0007 0812*****095 04/10/2021 Sesi 2 10.00 - 12.00
3758 J-0****ZD9 AFUWWAN ALMIRA 111302******0003 0822*****824 04/10/2021 Sesi 2 10.00 - 12.00
3759 J-0****ZE5 NIRMA ENDAH MULIA PUTRI 350724******0001 0878*****015 04/10/2021 Sesi 2 10.00 - 12.00
3760 J-0****ZII SRI ASIKAH 357304******0006 0852*****618 04/10/2021 Sesi 2 10.00 - 12.00
3761 J-0****ZNT AGUS WIDODO 357304******0002 0851*****195 04/10/2021 Sesi 2 10.00 - 12.00
3762 J-0****ZOF ANGELIA YOAN LOMPOLIU 710603******0004 0813*****850 04/10/2021 Sesi 2 10.00 - 12.00
3763 J-0****ZZS RAUSHANFIKR BUSHRON 352703******0008 0812*****13 04/10/2021 Sesi 2 10.00 - 12.00
3764 J-0****01M BAGUS SALAM IBRAHIM 351614******0001 0822*****480 04/10/2021 Sesi 2 10.00 - 12.00
3765 J-0****01Z ALDI YULIANTO 351211******0002 0822*****234 04/10/2021 Sesi 2 10.00 - 12.00
3766 J-0****02N WALFAREL O.F. SITORUS 121201******0001 0878*****778 04/10/2021 Sesi 2 10.00 - 12.00
3767 J-0****05S NINDI MAGITA ISTIQOMAH 357301******0001 0858*****004 04/10/2021 Sesi 2 10.00 - 12.00
3768 J-0****05X AUDISYACH EFFENDI PUTRA 352516******0005 0813*****441 04/10/2021 Sesi 2 10.00 - 12.00
3769 J-0****0DK GINI INDARTI 350904******0004 0822*****109 04/10/2021 Sesi 2 10.00 - 12.00
3770 J-0****0GG DESI KRISTIN PUTRI PUSPITO SARI 350617******0001 0812*****899 04/10/2021 Sesi 2 10.00 - 12.00
3771 J-0****0H4 FAIZ RIFQI ALAMSHAH 747101******0001 0813*****795 04/10/2021 Sesi 2 10.00 - 12.00
3772 J-0****0HG MAYA ASMAUL NISA 350713******0001 0895*****4522 04/10/2021 Sesi 2 10.00 - 12.00
3773 J-0****0IJ MALFIN .D. NUGRAHA .P. 732601******0002 0822*****988 04/10/2021 Sesi 2 10.00 - 12.00
3774 J-0****0J9 ULIL ALBAB ABDALLAH 352501******0004 0812*****664 04/10/2021 Sesi 2 10.00 - 12.00
3775 J-0****0JG RADITYABAYU AJIDHARMA WINARTO 350722******0003 0859*****150 04/10/2021 Sesi 2 10.00 - 12.00
3776 J-0****0JN ALYA NURUL HIKMAH 331902******0002 0889*****491 04/10/2021 Sesi 2 10.00 - 12.00
3777 J-0****0KD AHMAD RIFQI SETIAWAN 147108******0021 0851*****411 04/10/2021 Sesi 2 10.00 - 12.00

Page 90 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3778 J-0****0KH BUDRI SUSANTI 327502******0008 0822*****694 04/10/2021 Sesi 2 10.00 - 12.00
3779 J-0****0M2 MUHAMMAD ANWAR NAZIR 350723******0002 0856*****322 04/10/2021 Sesi 2 10.00 - 12.00
3780 J-0****0SB JOKO SETIAWAN 357809******0005 0821*****343 04/10/2021 Sesi 2 10.00 - 12.00
3781 J-0****0TG RINA RATNAWATI 357809******0005 0821*****343 04/10/2021 Sesi 2 10.00 - 12.00
3782 J-0****0VA UTIK TRI WULAN CAHYA 331004******0003 0857*****695 04/10/2021 Sesi 2 10.00 - 12.00
3783 J-0****0WF DIAH AYU NIAWATI 350727******0001 0822*****896 04/10/2021 Sesi 2 10.00 - 12.00
3784 J-0****0WG ZUL AFIATUL KHARISMA 350715******0002 0813*****520 04/10/2021 Sesi 2 10.00 - 12.00
3785 J-0****0X7 IWAN PRASETIYO HAKIKI 351707******0001 0856*****575 04/10/2021 Sesi 2 10.00 - 12.00
3786 J-0****0XU LINDA SANUSI 332103******0005 0831*****147 04/10/2021 Sesi 2 10.00 - 12.00
3787 J-0****0Y2 VENA AULISA MASFUFAH 350721******0001 0896*****462 04/10/2021 Sesi 2 10.00 - 12.00
3788 J-0****0Y6 ABDUL ROZAQ 351019******0002 0822*****823 04/10/2021 Sesi 2 10.00 - 12.00
3789 J-0****0Y8 CECILIA ROISAH AMINIE 352210******0002 0812*****571 04/10/2021 Sesi 2 10.00 - 12.00
3790 J-0****0YF SUGENG SETYO WIDODO 350733******0001 0858*****686 04/10/2021 Sesi 2 10.00 - 12.00
3791 J-0****0YI KAMILA DEWI NURAINI 357303******0004 0896*****830 04/10/2021 Sesi 2 10.00 - 12.00
3792 J-0****0ZD YAHYA FAHMI 350724******0002 0818*****353 04/10/2021 Sesi 2 10.00 - 12.00
3793 J-0****10D ILHANM ZAIDAN 337203******0003 0899*****39 04/10/2021 Sesi 2 10.00 - 12.00
3794 J-0****11B ADAM BAGUS AL MUSAFAR 350726******0003 0813*****326 04/10/2021 Sesi 2 10.00 - 12.00
3795 J-0****11F MUHAMMAD REZZA PRAMADHANA 351411******0001 0856*****511 04/10/2021 Sesi 2 10.00 - 12.00
3796 J-0****12R IKE DIAK HIDAYATULAH 351407******0001 0811*****936 04/10/2021 Sesi 2 10.00 - 12.00
3797 J-0****132 JALALUDDIN AS SUYUTHI 127505******0003 0812*****049 04/10/2021 Sesi 2 10.00 - 12.00
3798 J-0****135 ADINE VERULYZA MAHARANI 357305******0006 0888*****68 04/10/2021 Sesi 2 10.00 - 12.00
3799 J-0****13F M. FAHMI NUR FAIZIN 352219******0004 0813*****728 04/10/2021 Sesi 2 10.00 - 12.00
3800 J-0****13P BRIAN ARNOLD NATANAEL HUTAPEA 320229******0006 0878*****217 04/10/2021 Sesi 2 10.00 - 12.00
3801 J-0****13S WAFIQ NUR MUHAMMAD ARWANI 352410******0003 0812*****01 04/10/2021 Sesi 2 10.00 - 12.00
3802 J-0****13V WISNU WIJAYA 330609******0003 0812*****307 04/10/2021 Sesi 2 10.00 - 12.00
3803 J-0****142 MERRY KRISTINE FELLE 910301******0006 0852*****309 04/10/2021 Sesi 2 10.00 - 12.00
3804 J-0****144 GHEA SUEKMA HUTAMI 357303******0007 0812*****053 04/10/2021 Sesi 2 10.00 - 12.00
3805 J-0****14C NARENDRA MAULANA WIJAYA 351021******0002 0853*****144 04/10/2021 Sesi 2 10.00 - 12.00
3806 J-0****14H ALMIRA FAHRINDA 647105******0007 0856*****94 04/10/2021 Sesi 2 10.00 - 12.00
3807 J-0****14R NISA UL KHOIR 357302******0002 0817*****21 04/10/2021 Sesi 2 10.00 - 12.00
3808 J-0****14T AHMAD ILHAM SANTOSA 351414******0002 0853*****616 04/10/2021 Sesi 2 10.00 - 12.00
3809 J-0****14U ISYRAQY NAPOSO NASUTION 127705******0001 0823*****430 04/10/2021 Sesi 2 10.00 - 12.00
3810 J-0****14X RAHMAT BUDI SATRYA 332218******0003 0822*****346 04/10/2021 Sesi 2 10.00 - 12.00
3811 J-0****159 V. WISNU CHRISTIANTO 352215******0002 0813*****060 04/10/2021 Sesi 2 10.00 - 12.00
3812 J-0****15A SYAHRUL GUNAWAN 350717******0001 0813*****833 04/10/2021 Sesi 2 10.00 - 12.00
3813 J-0****15H DYANA ROSYDA OKTAVIA 350718******0007 0821*****651 04/10/2021 Sesi 2 10.00 - 12.00
3814 J-0****15J WISNU SATRIYO NUGROHO 357301******0001 0877*****077 04/10/2021 Sesi 2 10.00 - 12.00
3815 J-0****15L ABYAN FAKHRUZI GH. 351518******0001 0822*****441 04/10/2021 Sesi 2 10.00 - 12.00
3816 J-0****15O SABRINA FONDA MIRELA 350408******0004 0822*****282 04/10/2021 Sesi 2 10.00 - 12.00
3817 J-0****15S RATIH UTANTI PUTRI 357305******0001 0856*****31 04/10/2021 Sesi 2 10.00 - 12.00
3818 J-0****15T PUTRA PRADEVA LADISA 620205******0001 0821*****758 04/10/2021 Sesi 2 10.00 - 12.00
3819 J-0****15U AQSHA FADHLU PUTRA 357101******0003 0895*****8824 04/10/2021 Sesi 2 10.00 - 12.00

Page 91 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3820 J-0****15W ERNAWATY 350724******0003 0859*****335 04/10/2021 Sesi 2 10.00 - 12.00
3821 J-0****15Z SOFIA ANDRIANA 357302******0001 0895*****808 04/10/2021 Sesi 2 10.00 - 12.00
3822 J-0****160 RIFAN RIFANDY 320510******0002 0822*****250 04/10/2021 Sesi 2 10.00 - 12.00
3823 J-0****166 ESTI NURHALIZA 350724******0002 0899*****37 04/10/2021 Sesi 2 10.00 - 12.00
3824 J-0****167 YUSRIL FATAHILMI 351508******0009 0857*****529 04/10/2021 Sesi 2 10.00 - 12.00
3825 J-0****169 NOVI KRISTANTI 357301******0003 0895*****6130 04/10/2021 Sesi 2 10.00 - 12.00
3826 J-0****16A HAMAL AGUNG PRIYONO 350602******0001 0853*****192 04/10/2021 Sesi 2 10.00 - 12.00
3827 J-0****16B BAMBANG NURUDDIN IMANULLAH 352901******0004 0822*****431 04/10/2021 Sesi 2 10.00 - 12.00
3828 J-0****16G MUHAMMAD REZA MAULANA 350724******0009 0812*****440 04/10/2021 Sesi 2 10.00 - 12.00
3829 J-0****16J NUR IBNU ALWAN 351317******0003 0877*****073 04/10/2021 Sesi 2 10.00 - 12.00
3830 J-0****16K MARITA IZZUL FAUZIAH 350307******0001 0857*****365 04/10/2021 Sesi 2 10.00 - 12.00
3831 J-0****16X DHIMAS SAPUTRA 357903******0001 0857*****600 04/10/2021 Sesi 2 10.00 - 12.00
3832 J-0****16Y NADYA SYAQINA RAHMADANTY 321708******0012 0895*****999 04/10/2021 Sesi 2 10.00 - 12.00
3833 J-0****171 APRI ARY SAPUTRA 640104******0002 0821*****121 04/10/2021 Sesi 2 10.00 - 12.00
3834 J-0****17C FANIN TRI MARGARETHA 351209******0005 0822*****412 04/10/2021 Sesi 2 10.00 - 12.00
3835 J-0****17D TALITHA RACHMA ULFA 357303******0004 0856*****509 04/10/2021 Sesi 2 10.00 - 12.00
3836 J-0****17L GIBRAN SATRIA SAMUDRA 177107******0001 0812*****144 04/10/2021 Sesi 2 10.00 - 12.00
3837 J-0****184 MUMTAZAH JUBAIR 357301******0001 0896*****532 04/10/2021 Sesi 2 10.00 - 12.00
3838 J-0****18A ZILFANA DARA SALSABILA 357903******0003 0812*****004 04/10/2021 Sesi 2 10.00 - 12.00
3839 J-0****18T MUHAMMAD IHYA SIDQI 331017******0001 0812*****502 04/10/2021 Sesi 2 10.00 - 12.00
3840 J-0****190 ERO FATWA SATRIATAMA 350912******0003 0857*****342 04/10/2021 Sesi 2 10.00 - 12.00
3841 J-0****191 MIA AGUSFINA 350607******0001 0822*****703 04/10/2021 Sesi 2 10.00 - 12.00
3842 J-0****19J ERY VIO VERAWATI 350513******0002 0812*****247 04/10/2021 Sesi 2 10.00 - 12.00
3843 J-0****1AB PANJI SUSILO AJI 640903******0003 0813*****700 04/10/2021 Sesi 2 10.00 - 12.00
3844 J-0****1AE KIRANA SARAH ADILLA 351517******0003 0813*****874 04/10/2021 Sesi 2 10.00 - 12.00
3845 J-0****1B1 SRI FARDIYANTI 357302******0003 0813*****320 04/10/2021 Sesi 2 10.00 - 12.00
3846 J-0****1BB ALDI KURNIAWAN 327505******0007 0895*****9491 04/10/2021 Sesi 2 10.00 - 12.00
3847 J-0****1BH ELOK PAIKOH 332916******0001 0858*****243 04/10/2021 Sesi 2 10.00 - 12.00
3848 J-0****1BW RANI BESTARI IRAWATI 350724******0003 0812*****129 04/10/2021 Sesi 2 10.00 - 12.00
3849 J-0****1C9 CHRISTIAN EVERHART BILLY SISWANTO 321401******0001 0822*****431 04/10/2021 Sesi 2 10.00 - 12.00
3850 J-0****1CA GABRIELLA KEVIAS KUSUMA WARDHANI 330306******0001 0813*****033 04/10/2021 Sesi 2 10.00 - 12.00
3851 J-0****1CK AYUDHA PRADHANA 357826******0001 0812*****012 04/10/2021 Sesi 2 10.00 - 12.00
3852 J-0****1D7 YAHYA NUR FAHMI FAUZI 331408******0001 0857*****484 04/10/2021 Sesi 2 10.00 - 12.00
3853 J-0****1DL LUCKY MAYA DEWANTI 350732******0001 0838*****940 04/10/2021 Sesi 2 10.00 - 12.00
3854 J-0****1DM YENI KURNIATI 520604******0001 0852*****858 04/10/2021 Sesi 2 10.00 - 12.00
3855 J-0****1DR MOCHAMMAD WAFA HUSAIN MUJTABA 351507******0004 0813*****381 04/10/2021 Sesi 2 10.00 - 12.00
3856 J-0****1E5 ALFIN ENDRA PRATAMA 317308******1003 0819*****797 04/10/2021 Sesi 2 10.00 - 12.00
3857 J-0****1F1 BELINDA FEBRIAN SUKADI 351711******0001 0822*****529 04/10/2021 Sesi 2 10.00 - 12.00
3858 J-0****1F7 ITHAROTUN NURIYYAH 640104******0003 0812*****950 04/10/2021 Sesi 2 10.00 - 12.00
3859 J-0****1FS DENDY SUDARYONO 332218******0003 0881*****73 04/10/2021 Sesi 2 10.00 - 12.00
3860 J-0****1G4 HEDYA PUTRI VARDINA 357102******0005 0815*****493 04/10/2021 Sesi 2 10.00 - 12.00
3861 J-0****1GM MUTAMATUN NAHARI 352108******0003 0857*****475 04/10/2021 Sesi 2 10.00 - 12.00

Page 92 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3862 J-0****1GN TITIK WIJAYANTI 357502******0004 0812*****01 04/10/2021 Sesi 2 10.00 - 12.00
3863 J-0****1HI NOOR HASANAH 630305******0010 0896*****585 04/10/2021 Sesi 2 10.00 - 12.00
3864 J-0****1I9 SYANIZ ALFARIANKI 350718******0005 0813*****326 04/10/2021 Sesi 2 10.00 - 12.00
3865 J-0****1KK ASMIFATUN NAHDIYAH 350713******0006 0857*****095 04/10/2021 Sesi 2 10.00 - 12.00
3866 J-0****1PP VINA WAHYU M 350723******0003 0896*****646 04/10/2021 Sesi 2 10.00 - 12.00
3867 J-0****1QX TIRTA ADJIE KUSUMABRATA 351514******0003 0838*****491 04/10/2021 Sesi 2 10.00 - 12.00
3868 J-0****1S4 RISKA QOMARIA ROMADONA 357302******0002 0878*****707 04/10/2021 Sesi 2 10.00 - 12.00
3869 J-0****1SK LUNG AYU ASTI WULAN 357303******0005 0812*****228 04/10/2021 Sesi 2 10.00 - 12.00
3870 J-0****1ST ACHMAD RIZKY MAHTUN 351014******0003 0813*****634 04/10/2021 Sesi 2 10.00 - 12.00
3871 J-0****1UE AHMADTUHFAH TAQILLAH FIQLI 350724******0001 0821*****720 04/10/2021 Sesi 2 10.00 - 12.00
3872 J-0****1VI NAVISSA AURELIA RAMANDHA CHANDRA 357305******0001 0813*****004 04/10/2021 Sesi 2 10.00 - 12.00
3873 J-0****1W4 NUR KHOLIQ 127120******0004 0812*****716 04/10/2021 Sesi 2 10.00 - 12.00
3874 J-0****1WJ ZUHAIR PAMUDIA W 350721******0002 0821*****925 04/10/2021 Sesi 2 10.00 - 12.00
3875 J-0****1WU ERFIAN NUGRAHA 357305******0003 0813*****293 04/10/2021 Sesi 2 10.00 - 12.00
3876 J-0****1XI MOCH AFRIZAL SETIAWAN 350719******0003 0813*****112 04/10/2021 Sesi 2 10.00 - 12.00
3877 J-0****1Y8 MUCHAMMAD ANDARU ARDANA 910201******0002 0812*****0001 04/10/2021 Sesi 2 10.00 - 12.00
3878 J-0****20P NUR CHOLIS ALFIYANI 350216******0001 0813*****149 04/10/2021 Sesi 2 10.00 - 12.00
3879 J-0****213 JODI FAISAL MUHAMMAD 367109******0003 0877*****102 04/10/2021 Sesi 2 10.00 - 12.00
3880 J-0****24P SELLY SHEVIA SEPTIANA 350704******0001 0858*****167 04/10/2021 Sesi 2 10.00 - 12.00
3881 J-0****25U MUHAMMAD DANIEL FATIHURRAHMAN 350925******0003 0859*****807 04/10/2021 Sesi 2 10.00 - 12.00
3882 J-0****262 TARISA PUTRI WARDHANI 357303******0003 0895*****5908 04/10/2021 Sesi 2 10.00 - 12.00
3883 J-0****27U KAMARAJENDRA MUHAMAD JAWARA 357305******0002 0823*****100 04/10/2021 Sesi 2 10.00 - 12.00
3884 J-0****288 FANIDYA HIKHMATUS SYIAM 357303******0001 0813*****793 04/10/2021 Sesi 2 10.00 - 12.00
3885 J-0****2B5 SHOLAWAT TAKBIR JAGAD LANANG 332712******0002 0896*****629 04/10/2021 Sesi 2 10.00 - 12.00
3886 J-0****2B6 DEYINTA APENABEL SURYA 350725******0002 0858*****668 04/10/2021 Sesi 2 10.00 - 12.00
3887 J-0****2BR RAFIDAH SALMA MAULIDIA 350725******0002 0822*****893 04/10/2021 Sesi 2 10.00 - 12.00
3888 J-0****2D1 FANISSA DWI ANDRIANANDA 357304******0002 0813*****618 04/10/2021 Sesi 2 10.00 - 12.00
3889 J-0****2G3 FAUZIDAN IQBAL GHIFFARI 611203******0001 0822*****916 04/10/2021 Sesi 2 10.00 - 12.00
3890 J-0****2GL WIGA TEGARMAS SETIAWAN 350609******0001 0816*****287 04/10/2021 Sesi 2 10.00 - 12.00
3891 J-0****2JN RIDHO RAHMAN 357305******0006 0895*****077 04/10/2021 Sesi 2 10.00 - 12.00
3892 J-0****2JV JIZA INTAN NUR CAHYANI 357305******0003 0882*****408 04/10/2021 Sesi 2 10.00 - 12.00
3893 J-0****2K3 YAAFI' PRATAMA NUSANTARA 357301******0002 0813*****247 04/10/2021 Sesi 2 10.00 - 12.00
3894 J-0****2M0 SALMAN ALFARISIH 350711******0005 0813*****440 04/10/2021 Sesi 2 10.00 - 12.00
3895 J-0****2MA PRATIKA ARYA YULIANA 352514******0004 0813*****487 04/10/2021 Sesi 2 10.00 - 12.00
3896 J-0****2ML ENDANG RUMANI 357903******0001 0821*****006 04/10/2021 Sesi 2 10.00 - 12.00
3897 J-0****2SJ RESKY RIANDO SETYAPRATAMA 357903******0003 0821*****068 04/10/2021 Sesi 2 10.00 - 12.00
3898 J-0****2SV INDRA GUNAWAN HUTABARAT 120302******0002 0822*****470 04/10/2021 Sesi 2 10.00 - 12.00
3899 J-0****2U3 FIKRI AKHDAN WIYATA 351513******0002 0812*****634 04/10/2021 Sesi 2 10.00 - 12.00
3900 J-0****2VB YUANITA NUR ARSIANTY 640405******0003 0813*****646 04/10/2021 Sesi 2 10.00 - 12.00
3901 J-0****2WI MUHAMMAD FAHMI HIDAYAT 350733******0003 0813*****497 04/10/2021 Sesi 2 10.00 - 12.00
3902 J-0****2X4 NIKMATUL FAURIAH 351505******0002 0896*****353 04/10/2021 Sesi 2 10.00 - 12.00
3903 J-0****2XA YOGA PRISTIAWAN HARTANTO 150812******0001 0813*****914 04/10/2021 Sesi 2 10.00 - 12.00

Page 93 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3904 J-0****2XT ANNISA JIHAN ARIFIN 357903******0001 0812*****724 04/10/2021 Sesi 2 10.00 - 12.00
3905 J-0****2XV PUTRI RAHMA SAFITRI 350724******0006 0822*****589 04/10/2021 Sesi 2 10.00 - 12.00
3906 J-0****2XY DUROTUN NAFISAH 351513******0003 0856*****55 04/10/2021 Sesi 2 10.00 - 12.00
3907 J-0****2ZN ANASTASIA JOVITA PASKALINA 350405******0001 0858*****782 04/10/2021 Sesi 2 10.00 - 12.00
3908 J-0****2ZZ FANANI DWI KAMALUDIN 352414******0001 0895*****693 04/10/2021 Sesi 2 10.00 - 12.00
3909 J-0****300 ALISIA SHOFIYANI 330512******0002 0812*****095 04/10/2021 Sesi 2 10.00 - 12.00
3910 J-0****315 AINUL FUA'D 647402******0004 0895*****814 04/10/2021 Sesi 2 10.00 - 12.00
3911 J-0****332 DWI YANTO UNGGUL POERWANTO 317507******0011 0878*****275 04/10/2021 Sesi 2 10.00 - 12.00
3912 J-0****34Z YAHYA MULYA ADITYA 357302******0005 0822*****422 04/10/2021 Sesi 2 10.00 - 12.00
3913 J-0****35R MUJIYONO 331212******0002 0852*****201 04/10/2021 Sesi 2 10.00 - 12.00
3914 J-0****36Y AULIFIA REGINA MULYA ANDANI 357301******0005 0822*****191 04/10/2021 Sesi 2 10.00 - 12.00
3915 J-0****37F SAFA AISYAH ACHMAD MADJID 357102******0002 0813*****530 04/10/2021 Sesi 2 10.00 - 12.00
3916 J-0****39N ARDITAMA PUTRA R 350725******0001 0877*****508 04/10/2021 Sesi 2 10.00 - 12.00
3917 J-0****3AD RAHMA MAUL REZA 640804******0003 0822*****648 04/10/2021 Sesi 2 10.00 - 12.00
3918 J-0****3AS RION RIANDO 352005******0001 0896*****911 04/10/2021 Sesi 2 10.00 - 12.00
3919 J-0****3CM MUHAMMAD SADDAM ABDULLAH SLAMET 817104******0001 0822*****572 04/10/2021 Sesi 2 10.00 - 12.00
3920 J-0****3D4 RIZKO KURNIAWAN 352514******0001 0895*****6497 04/10/2021 Sesi 2 10.00 - 12.00
3921 J-0****3DO BIMA AJI PANGESTU 357305******0008 0812*****831 04/10/2021 Sesi 2 10.00 - 12.00
3922 J-0****3EH ZAINUL BAHAR 350614******0001 0813*****099 04/10/2021 Sesi 2 10.00 - 12.00
3923 J-0****3FD MUHAMMAD RIZKY 111608******0003 0811*****00 04/10/2021 Sesi 2 10.00 - 12.00
3924 J-0****3G6 ASEP ABIANTO 357902******0001 0812*****955 04/10/2021 Sesi 2 10.00 - 12.00
3925 J-0****3GO MUHAMMAD FUAD KURNIAWAN 351411******0004 0858*****779 04/10/2021 Sesi 2 10.00 - 12.00
3926 J-0****3GP MUKHLIS MURTADHO 351901******0003 0858*****335 04/10/2021 Sesi 2 10.00 - 12.00
3927 J-0****3HQ FADILLA AYU INDICKA 357305******0006 0812*****500 04/10/2021 Sesi 2 10.00 - 12.00
3928 J-0****3HV WAFIQ BIN NASIR 320230******0009 0856*****68 04/10/2021 Sesi 2 10.00 - 12.00
3929 J-0****3I9 IAN BERNARD SIAHAAN 327505******0007 0878*****955 04/10/2021 Sesi 2 10.00 - 12.00
3930 J-0****3PY FARUQI SATYA PRATAMA 357301******0008 0812*****830 04/10/2021 Sesi 2 10.00 - 12.00
3931 J-0****3UA FALIKHATUN NISA' 351510******0001 0812*****261 04/10/2021 Sesi 2 10.00 - 12.00
3932 J-0****3X1 ELFIAN PANDU PRATAMA 140206******0001 0822*****522 04/10/2021 Sesi 2 10.00 - 12.00
3933 J-0****3Z7 FAJAR IRIANTO 910901******0002 0895*****4010 04/10/2021 Sesi 2 10.00 - 12.00
3934 J-0****40R LUKMANSYAH 357301******0006 0823*****184 04/10/2021 Sesi 2 10.00 - 12.00
3935 J-0****40T RIZAL GAUTAMA ARFINSYAH 350719******0001 0897*****39 04/10/2021 Sesi 2 10.00 - 12.00
3936 J-0****477 JOICE RIWINSYAH PUTRA 350709******0001 0822*****232 04/10/2021 Sesi 2 10.00 - 12.00
3937 J-0****4DA DAMA ANTA REZA 357302******0003 0815*****862 04/10/2021 Sesi 2 10.00 - 12.00
3938 J-0****4EP ADI PRASETYO 357301******0005 0856*****702 04/10/2021 Sesi 2 10.00 - 12.00
3939 J-0****4FG SUGIONO 357304******0001 0853*****499 04/10/2021 Sesi 2 10.00 - 12.00
3940 J-0****4GE CHUSNUL HIDAYAH 357810******0004 0812*****323 04/10/2021 Sesi 2 10.00 - 12.00
3941 J-0****4GM HARYONO 331024******0002 0-***** 04/10/2021 Sesi 2 10.00 - 12.00
3942 J-0****4GU NUR MUHAMMAD FENDHI IRAWAN 351401******0002 0821*****084 04/10/2021 Sesi 2 10.00 - 12.00
3943 J-0****4KZ SUWADAK 350724******0010 0878*****795 04/10/2021 Sesi 2 10.00 - 12.00
3944 J-0****5AJ SURTILAWATI LA MADU 820505******0001 0852*****916 04/10/2021 Sesi 2 10.00 - 12.00
3945 J-0****5CV IKRAM SAHLAN 827104******0001 0821*****710 04/10/2021 Sesi 2 10.00 - 12.00

Page 94 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3946 J-0****5LR ASIH RIKEWARDANI 357302******0001 0812*****495 04/10/2021 Sesi 2 10.00 - 12.00
3947 J-0****5SN ROKHMAD ROMADHONI 350216******0002 0822*****787 04/10/2021 Sesi 2 10.00 - 12.00
3948 J-0****5X8 MARDIANA HASYIM 820402******0001 0821*****623 04/10/2021 Sesi 2 10.00 - 12.00
3949 J-0****665 ABDUL HAFIS 147101******0002 0823*****620 04/10/2021 Sesi 2 10.00 - 12.00
3950 J-0****66V ABDUL HANAN NUGRAHA 320224******0003 0852*****852 04/10/2021 Sesi 2 10.00 - 12.00
3951 J-0****6BJ SCANIA OPELLIA NASTITI 337503******0004 0813*****060 04/10/2021 Sesi 2 10.00 - 12.00
3952 J-0****6KL QUINZY VARIRA TARTUSI 351111******0003 0812*****786 04/10/2021 Sesi 2 10.00 - 12.00
3953 J-0****6M2 MUHAMMAD NUR FAJRI 351111******0001 0857*****453 04/10/2021 Sesi 2 10.00 - 12.00
3954 J-0****6SL TRIMO 357304******0010 0819*****973 04/10/2021 Sesi 2 10.00 - 12.00
3955 L-0****1GQ SUSANTO 357303******0003 0813*****980 04/10/2021 Sesi 2 10.00 - 12.00
3956 N-7****165 BERTILLA WAIDYAWIMALA GUN 357901******0004 0822*****697 04/10/2021 Sesi 2 10.00 - 12.00
3957 N-9****EB8 Annisa Astika Rada 620206******0002 0822*****522 04/10/2021 Sesi 2 10.00 - 12.00
3958 N-D****567 MUHAMMAD BILAL SAIFULHAQ 337407******0001 0838*****883 04/10/2021 Sesi 2 10.00 - 12.00
3959 P-2****EDA WIJIANTO 350712******0001 0857*****833 04/10/2021 Sesi 2 10.00 - 12.00
3960 P-2****UB5 RAFI'USDYAH FAKHIRURAZI 357301******0003 0895*****509 04/10/2021 Sesi 2 10.00 - 12.00
3961 P-2****CFI DEA YUSHINTA 357903******0002 0895*****3755 04/10/2021 Sesi 2 10.00 - 12.00
3962 P-2****FAE EGA GALANG STANSYAH 350723******0003 0896*****112 04/10/2021 Sesi 2 10.00 - 12.00
3963 P-2****S1L ZAINUL AVAN 350715******0001 0882*****284 04/10/2021 Sesi 2 10.00 - 12.00
3964 P-2****9P1 TOTOK SUGENG HARIONO 357304******0010 0821*****026 04/10/2021 Sesi 2 10.00 - 12.00
3965 P-2****TX4 GRACE SASCHIA PUTRI 910201******0001 0812*****460 04/10/2021 Sesi 2 10.00 - 12.00
3966 P-3****LET RACHMAT WIBOWO 350718******0003 0852*****443 04/10/2021 Sesi 2 10.00 - 12.00
3967 P-4****MH2 WAHYU EKA PRAYITNO 357303******0003 0821*****598 04/10/2021 Sesi 2 10.00 - 12.00
3968 P-4****ZQJ GERALDO MARCO TAHIR 357810******0003 0814*****814 04/10/2021 Sesi 2 10.00 - 12.00
3969 P-4****AEB YUNI DWI PANGESTI 350724******0002 0818*****646 04/10/2021 Sesi 2 10.00 - 12.00
3970 P-4****HK2 MALAK SR RABA 205110******0010 0895*****0141 04/10/2021 Sesi 2 10.00 - 12.00
3971 P-4****2NX LISMAYANTI 350724******0001 0857*****420 04/10/2021 Sesi 2 10.00 - 12.00
3972 P-4****EUN MUHAMMAD BINTANG ALY 352210******0001 0822*****719 04/10/2021 Sesi 2 10.00 - 12.00
3973 P-4****0LN SULTAN RAFI R. 320229******0003 0857*****708 04/10/2021 Sesi 2 10.00 - 12.00
3974 P-5****LAR RAHMA MAULIDA 357903******0002 0857*****501 04/10/2021 Sesi 2 10.00 - 12.00
3975 P-5****G67 SUGENG WAHYUDI 510302******0007 0877*****487 04/10/2021 Sesi 2 10.00 - 12.00
3976 P-5****AUK ELVIRANI FERINA 357304******0005 0812*****696 04/10/2021 Sesi 2 10.00 - 12.00
3977 P-5****HAB ZAKARIA BATAMI 350712******0002 0822*****971 04/10/2021 Sesi 2 10.00 - 12.00
3978 P-6****S59 ROMELAH 357305******0002 0838*****466 04/10/2021 Sesi 2 10.00 - 12.00
3979 P-6****ZUI MULYONO 350724******0005 0831*****438 04/10/2021 Sesi 2 10.00 - 12.00
3980 P-6****8LI RIZKA SUHANA 357103******0007 0896*****006 04/10/2021 Sesi 2 10.00 - 12.00
3981 P-6****RJA IIL NURCHOLIDAH 350723******0001 0812*****341 04/10/2021 Sesi 2 10.00 - 12.00
3982 P-6****UR1 SHILVI MULYANI IKRIMA 350724******0005 0889*****453 04/10/2021 Sesi 2 10.00 - 12.00
3983 P-7****APW ACHMAD SUKADI 350720******0001 0838*****593 04/10/2021 Sesi 2 10.00 - 12.00
3984 P-7****YEE M AQIL RUSDI HILMI 352403******0001 0852*****175 04/10/2021 Sesi 2 10.00 - 12.00
3985 P-7****QSI NUR AINU LUTFIYAH 351712******0003 0857*****130 04/10/2021 Sesi 2 10.00 - 12.00
3986 P-7****R4U YOGIE PURNIAWAN 350720******0002 0821*****377 04/10/2021 Sesi 2 10.00 - 12.00
3987 P-7****NOI ARIS ADHI CAHYONO 350729******0001 0813*****925 04/10/2021 Sesi 2 10.00 - 12.00

Page 95 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
3988 P-7****1XH INDRAWATI 357305******0001 0857*****103 04/10/2021 Sesi 2 10.00 - 12.00
3989 P-7****DMB LUKY AKTONIO DWI RAMADHAN 357305******0002 0896*****999 04/10/2021 Sesi 2 10.00 - 12.00
3990 P-7****GBF KEZIA RATIH PUSPANINGRUM 357819******0002 0811*****22 04/10/2021 Sesi 2 10.00 - 12.00
3991 P-8****UC2 STEFANIA SEA 530803******0001 0813*****722 04/10/2021 Sesi 2 10.00 - 12.00
3992 P-9****UK2 MOH ALIEF FIRMAN AL BANNA 352909******0004 0822*****442 04/10/2021 Sesi 2 10.00 - 12.00
3993 P-9****AKI Yeni Rosida 357302******0006 0817*****77 04/10/2021 Sesi 2 10.00 - 12.00
3994 P-9****EHO RENATA WIDIA TANTRI 331409******0006 0815*****016 04/10/2021 Sesi 2 10.00 - 12.00
3995 P-9****MI5 MAHADEVI SATWIKA LIMIJANA 357305******0005 0859*****967 04/10/2021 Sesi 2 10.00 - 12.00
3996 P-A****9FG IRMA MARWITANTI 350724******0001 0896*****666 04/10/2021 Sesi 2 10.00 - 12.00
3997 P-A****MPS RENI USTIATIK 352407******0005 0857*****266 04/10/2021 Sesi 2 10.00 - 12.00
3998 P-A****NEC ILYASA SATRIA ANANDA 350725******0003 0877*****919 04/10/2021 Sesi 2 10.00 - 12.00
3999 P-A****UWL HENI IRAWATI 357305******0008 0895*****5352 04/10/2021 Sesi 2 10.00 - 12.00
4000 P-A****SDV RIZKA DWIKA AMALIA 350724******0007 0895*****6791 04/10/2021 Sesi 2 10.00 - 12.00
4001 P-B****4TM NEVI AFRIA 350730******0002 0852*****110 04/10/2021 Sesi 2 10.00 - 12.00
4002 P-B****EAA ANDRE WIJAYA ABENAR 357301******0003 0859*****329 04/10/2021 Sesi 2 10.00 - 12.00
4003 P-B****GP5 SHANTY KUSUMAWARDHANI 357903******0002 0812*****802 04/10/2021 Sesi 2 10.00 - 12.00
4004 P-B****9EY DILA MEILINDA 320938******0002 0859*****3944 04/10/2021 Sesi 2 10.00 - 12.00
4005 P-B****VRJ AFIF AHMAD MA'RUF 357302******0002 0822*****460 04/10/2021 Sesi 2 10.00 - 12.00
4006 P-B****BW8 RIKKY RADHITYA 357303******0005 0895*****303 04/10/2021 Sesi 2 10.00 - 12.00
4007 P-B****0OH DIAH RAHMANIA 357302******0002 0812*****940 04/10/2021 Sesi 2 10.00 - 12.00
4008 P-C****94F HIJJUL FIQRI IBRAHIM 520206******0001 0819*****277 04/10/2021 Sesi 2 10.00 - 12.00
4009 P-C****DXA BRAMANTI SULISTYO ANGGRAINI 357302******0009 0821*****767 04/10/2021 Sesi 2 10.00 - 12.00
4010 P-C****VWM MARKUS MANGU 530806******0001 0822*****763 04/10/2021 Sesi 2 10.00 - 12.00
4011 P-C****NPO FERDINANDUS BHANGA 530806******0001 0813*****586 04/10/2021 Sesi 2 10.00 - 12.00
4012 P-D****56P YOSEF GMANUEL GUSI 530820******0001 0822*****052 04/10/2021 Sesi 2 10.00 - 12.00
4013 P-D****TC6 TRI SEPTIAN CAHYO 350713******0002 0857*****823 04/10/2021 Sesi 2 10.00 - 12.00
4014 P-D****N53 INTADAROH RAHILA PRAPTYANA 647104******0004 0852*****295 04/10/2021 Sesi 2 10.00 - 12.00
4015 P-D****UDU FIRA AULIA 357301******0006 0818*****952 04/10/2021 Sesi 2 10.00 - 12.00
4016 P-D****PFG PINA AZIZAH 357305******0009 0857*****662 04/10/2021 Sesi 2 10.00 - 12.00
4017 P-D****YSV DIMAS KRISNALENDRA 357304******0002 0857*****588 04/10/2021 Sesi 2 10.00 - 12.00
4018 P-D****GIF ROHADI 357305******0005 0857*****632 04/10/2021 Sesi 2 10.00 - 12.00
4019 P-D****ELI MEDYK ARIANTO 357302******0001 0813*****900 04/10/2021 Sesi 2 10.00 - 12.00
4020 P-D****CFY DIAH FACHRANI 350401******0003 0812*****886 04/10/2021 Sesi 2 10.00 - 12.00
4021 P-E****AAQ SANDIS WAHYU PRASETIYO 350401******0003 0813*****996 04/10/2021 Sesi 2 10.00 - 12.00
4022 P-E****JVJ NUR LAILA RAMADHANA 350724******0007 0813*****164 04/10/2021 Sesi 2 10.00 - 12.00
4023 P-E****ZGH MARIA GORETI SEKARPINKAN 217110******9008 0811*****06 04/10/2021 Sesi 2 10.00 - 12.00
4024 P-F****JPC ROSALINA BILQISTH 910101******0002 0852*****899 04/10/2021 Sesi 2 10.00 - 12.00
4025 P-F****JEN MEY LESTARI SILITONGA 120202******0001 0899*****32 04/10/2021 Sesi 2 10.00 - 12.00
4026 P-F****7MZ IMSYAK ROMADHONA 357303******0006 0822*****933 04/10/2021 Sesi 2 10.00 - 12.00
4027 P-F****MDB YOHANA CHRISTINE TIURMA M 320124******0002 0822*****823 04/10/2021 Sesi 2 10.00 - 12.00
4028 P-F****PM4 SITI NURHIDAYAH 510102******0001 0877*****133 04/10/2021 Sesi 2 10.00 - 12.00
4029 P-G****HV5 LUCKY ROCHMA ICHSANA 357302******0006 0857*****122 04/10/2021 Sesi 2 10.00 - 12.00

Page 96 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4030 P-G****03B GAGUK PRASETYO 357304******0005 0817*****088 04/10/2021 Sesi 2 10.00 - 12.00
4031 P-G****JEB indriana vaninda karin 350722******0001 0896*****774 04/10/2021 Sesi 2 10.00 - 12.00
4032 P-G****SHY NUR DIANA ISTIQOMAH 357304******0002 0813*****828 04/10/2021 Sesi 2 10.00 - 12.00
4033 P-G****I8N MISBAKHUL MUNIR 350722******0002 0896*****805 04/10/2021 Sesi 2 10.00 - 12.00
4034 P-G****4TA NURUL HASAN 351309******0001 0838*****992 04/10/2021 Sesi 2 10.00 - 12.00
4035 P-G****FSB MUHAMMAD DAVVA PRATAMA 367201******0001 0813*****858 04/10/2021 Sesi 2 10.00 - 12.00
4036 P-G****VJD GALIH BAGUS PRASOJO 321606******0016 0823*****253 04/10/2021 Sesi 3 12.00 - 14.00
4037 P-H****PLW ANNISA AULIA TRISULA 357103******0004 0822*****393 04/10/2021 Sesi 3 12.00 - 14.00
4038 P-H****TGK R. Y. MALONDO SITORUS 120209******0001 0823*****697 04/10/2021 Sesi 3 12.00 - 14.00
4039 P-H****AFA KLARA KUMLASARI 357303******0007 0857*****682 04/10/2021 Sesi 3 12.00 - 14.00
4040 P-H****YCB MUH FARIS AL FARUQ 331901******0003 0857*****812 04/10/2021 Sesi 3 12.00 - 14.00
4041 P-H****MNZ LAMRIS SIMARE-MARE 217103******1001 0822*****693 04/10/2021 Sesi 3 12.00 - 14.00
4042 P-H****UUJ EDI WARISNO 140404******0003 0895*****623 04/10/2021 Sesi 3 12.00 - 14.00
4043 P-H****CE2 ROKHMATUL MAULUDIYAH 350724******0002 0896*****453 04/10/2021 Sesi 3 12.00 - 14.00
4044 P-H****MKQ TANIA ALIFYA NURAIDHA 320101******1001 0899*****22 04/10/2021 Sesi 3 12.00 - 14.00
4045 P-H****BZH IKE KUSUMA HIDAYANI 357302******0003 0895*****887 04/10/2021 Sesi 3 12.00 - 14.00
4046 P-H****OM7 ARIF MAHFUDI 351709******0005 0857*****541 04/10/2021 Sesi 3 12.00 - 14.00
4047 P-H****I1L SHALWA J RHEABAKS 520201******0002 0895*****4171 04/10/2021 Sesi 3 12.00 - 14.00
4048 P-H****GBT AULIYA FAZA SEPTIANI 332111******0004 0895*****5296 04/10/2021 Sesi 3 12.00 - 14.00
4049 P-H****PN7 SAHATA JEKICHEN SIHOTANG 121109******0004 0812*****596 04/10/2021 Sesi 3 12.00 - 14.00
4050 P-H****O8K SYAUQI ALBANI EZRA 327504******0015 0813*****910 04/10/2021 Sesi 3 12.00 - 14.00
4051 P-H****VLD TIARA AYU MARWAH 357113******0003 0896*****680 04/10/2021 Sesi 3 12.00 - 14.00
4052 P-H****Z6Z DWI PUTRA PRAYOGA 357304******0008 0895*****8707 04/10/2021 Sesi 3 12.00 - 14.00
4053 P-H****GJB PRADIPTA DEWANGGA 350725******0002 0813*****417 04/10/2021 Sesi 3 12.00 - 14.00
4054 P-H****BVG LYDIA HALIMATUS SA'DIYAH 357304******0004 0821*****298 04/10/2021 Sesi 3 12.00 - 14.00
4055 P-H****QBG YUDA ARIYANA 527105******0001 0822*****552 04/10/2021 Sesi 3 12.00 - 14.00
4056 P-H****ZRW RATYA RATNA AYU 357305******0011 0838*****889 04/10/2021 Sesi 3 12.00 - 14.00
4057 P-H****HXI MAHIRA NUR ALIFAH RIDIZIANWAR 321605******0007 0897*****17 04/10/2021 Sesi 3 12.00 - 14.00
4058 P-H****6QA FEBY INDRIYANI BALQIS 217111******9006 0812*****474 04/10/2021 Sesi 3 12.00 - 14.00
4059 P-H****OSO IFTRIZIAH IFTITAH 350723******0002 0812*****196 04/10/2021 Sesi 3 12.00 - 14.00
4060 P-H****YSK ALDY YOHANES MANUEKE 717107******0001 0812*****927 04/10/2021 Sesi 3 12.00 - 14.00
4061 P-H****QPZ RISKA TRI WARDANI 647402******0004 0821*****565 04/10/2021 Sesi 3 12.00 - 14.00
4062 P-H****1TX AHMAD TAJUDDIN 350313******0002 0819*****282 04/10/2021 Sesi 3 12.00 - 14.00
4063 P-H****PCV AKBAR YUSUF 537101******0004 0813*****825 04/10/2021 Sesi 3 12.00 - 14.00
4064 P-H****GEF RAMAYUDHA IBRA ANUGRAH 352516******0001 0821*****776 04/10/2021 Sesi 3 12.00 - 14.00
4065 P-H****F9F ALECIA BONITO LEORENTINA 351411******0002 0812*****416 04/10/2021 Sesi 3 12.00 - 14.00
4066 P-H****SSO INDAH DWI RAHAYU 647402******0005 0812*****558 04/10/2021 Sesi 3 12.00 - 14.00
4067 P-H****JHO BIBI DAHLIA UMA 350723******0001 0821*****875 04/10/2021 Sesi 3 12.00 - 14.00
4068 P-H****BJZ Restu Puspitasari 357602******0002 0812*****922 04/10/2021 Sesi 3 12.00 - 14.00
4069 P-H****PL3 VANELA CHATRIN LEKATOMPESSY 817101******0001 0822*****683 04/10/2021 Sesi 3 12.00 - 14.00
4070 P-H****URM BINTANG DZAHABIYYAH ATSIL 357301******0002 0878*****702 04/10/2021 Sesi 3 12.00 - 14.00
4071 P-H****P9F KUKUH ADI WALUYO 351803******0005 0877*****726 04/10/2021 Sesi 3 12.00 - 14.00

Page 97 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4072 P-H****IHC IDDO VARIAN 357303******0006 0822*****844 04/10/2021 Sesi 3 12.00 - 14.00
4073 P-H****FHR Koo Tiong Djen 357302******0004 0812*****648 04/10/2021 Sesi 3 12.00 - 14.00
4074 P-H****XBO OKTAVIANUS PUJI RAHARJO 647402******0002 0830*****494 04/10/2021 Sesi 3 12.00 - 14.00
4075 P-H****ZSJ MULYONO 647402******0006 0822*****302 04/10/2021 Sesi 3 12.00 - 14.00
4076 P-H****CHJ PRISKA 357302******0005 0821*****576 04/10/2021 Sesi 3 12.00 - 14.00
4077 P-H****AR4 VONILU FEBIA 350730******0004 0852*****123 04/10/2021 Sesi 3 12.00 - 14.00
4078 P-H****UNO PRAYOGA HUGROHO PANGESTU 351616******0002 0897*****08 04/10/2021 Sesi 3 12.00 - 14.00
4079 P-H****ZDB RIFKA PRATIWI 357305******0006 0856*****557 04/10/2021 Sesi 3 12.00 - 14.00
4080 P-H****OS9 FITRI HARYANTI 331201******0002 0822*****559 04/10/2021 Sesi 3 12.00 - 14.00
4081 P-H****ZKV MUKHAMAD FAHIM 351305******0001 0856*****686 04/10/2021 Sesi 3 12.00 - 14.00
4082 P-H****303 DIVANY NADYA MELATI 357303******0005 0821*****908 04/10/2021 Sesi 3 12.00 - 14.00
4083 P-H****TBI SUYONO 350721******0001 0851*****775 04/10/2021 Sesi 3 12.00 - 14.00
4084 P-H****AF1 IIK ANDRIANI 357304******0001 0878*****504 04/10/2021 Sesi 3 12.00 - 14.00
4085 P-H****YY7 SUWARNO SLAMET 350718******0004 0877*****540 04/10/2021 Sesi 3 12.00 - 14.00
4086 P-H****TQO PUTRI DEWI 357301******0001 0857*****115 04/10/2021 Sesi 3 12.00 - 14.00
4087 P-H****VYQ AZMI FARAH DHIA 357305******0003 0813*****959 04/10/2021 Sesi 3 12.00 - 14.00
4088 P-H****4UF WANDA ANDI ENDANG 357303******0001 0821*****363 04/10/2021 Sesi 3 12.00 - 14.00
4089 P-H****27C MUHAMMAD ALLAUDDIN ALAHADI 331710******0002 0813*****048 04/10/2021 Sesi 3 12.00 - 14.00
4090 P-H****O5X MICHAEL ENRICO NADEAK 350721******0002 0822*****304 04/10/2021 Sesi 3 12.00 - 14.00
4091 P-H****WM7 ABDUL KHODIR JAELANO 350714******0002 0877*****509 04/10/2021 Sesi 3 12.00 - 14.00
4092 P-H****Q13 IMMANUEL ASIATAMA HAMONANGAN PANDIANGAN 187112******0007 0895*****508 04/10/2021 Sesi 3 12.00 - 14.00
4093 P-H****6JT ANITA NURUL AINI 350714******0001 0857*****584 04/10/2021 Sesi 3 12.00 - 14.00
4094 P-H****3TO DHIMAS NURWAHYU GHUFRONI 350719******0002 0895*****4811 04/10/2021 Sesi 3 12.00 - 14.00
4095 P-H****HXF ARICHA MUDZALIFAH 351704******0002 0857*****087 04/10/2021 Sesi 3 12.00 - 14.00
4096 P-H****M0S MUHAMMAD KHAFIDH FAJRIN 630305******0013 0821*****686 04/10/2021 Sesi 3 12.00 - 14.00
4097 P-H****MKV HERU TRI SULISTIAWAN 352422******0002 0813*****503 04/10/2021 Sesi 3 12.00 - 14.00
4098 P-H****D5N MILANA SANTI DEWI 357302******0002 0823*****703 04/10/2021 Sesi 3 12.00 - 14.00
4099 P-H****G7P NITA NOOR AZIZAH 327510******0001 0857*****322 04/10/2021 Sesi 3 12.00 - 14.00
4100 P-H****NT3 MOCHAMAD TEGAR PRASETYA 357302******0004 0853*****072 04/10/2021 Sesi 3 12.00 - 14.00
4101 P-H****17Y SITI KHOLIPAH 350720******0002 0813*****170 04/10/2021 Sesi 3 12.00 - 14.00
4102 P-H****NUF SITI ISMIATUN 357305******0002 0822*****641 04/10/2021 Sesi 3 12.00 - 14.00
4103 P-H****ECC ACHMAD MUSLIMIN 357305******0001 0813*****669 04/10/2021 Sesi 3 12.00 - 14.00
4104 P-H****OOG BILKIS NADIYA 350725******0001 0856*****226 04/10/2021 Sesi 3 12.00 - 14.00
4105 P-H****M9U RAHMAWATI 357301******0006 0822*****892 04/10/2021 Sesi 3 12.00 - 14.00
4106 P-H****3XG MARIO ALEXANDER TANIA 357305******0006 0821*****812 04/10/2021 Sesi 3 12.00 - 14.00
4107 P-H****EKV ACHMAD SOLICHIN 357305******0010 0852*****300 04/10/2021 Sesi 3 12.00 - 14.00
4108 P-H****BIN RAKHMAD NDARU PRATAMA 352510******0005 0857*****387 04/10/2021 Sesi 3 12.00 - 14.00
4109 P-I****UZE AHMAD 'UBAIDILLAH AFANDI 350410******0001 0896*****045 04/10/2021 Sesi 3 12.00 - 14.00
4110 P-I****A55 DONNA MARIA BERLIANA DUNTANA LEWOEMA 530602******0001 0821*****851 04/10/2021 Sesi 3 12.00 - 14.00
4111 P-I****N5H Raminten 350706******0001 0823*****891 04/10/2021 Sesi 3 12.00 - 14.00
4112 P-I****WDP 3573041212020015 357304******0015 0878*****216 04/10/2021 Sesi 3 12.00 - 14.00
4113 P-I****MVR LILIK SUKMANINGSIH 620206******0001 0813*****821 04/10/2021 Sesi 3 12.00 - 14.00

Page 98 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4114 P-I****ZML Arum Drajat Gayatri 647402******0004 0838*****329 04/10/2021 Sesi 3 12.00 - 14.00
4115 P-I****XUL ANDI MUHAMMAD GALIB 730705******0001 0823*****231 04/10/2021 Sesi 3 12.00 - 14.00
4116 P-I****EX1 PUSPARANI KATARI MAYLINDA 520408******0007 0813*****506 04/10/2021 Sesi 3 12.00 - 14.00
4117 P-I****STQ HIMAWAN DWI PUTRA 321118******0007 0823*****373 04/10/2021 Sesi 3 12.00 - 14.00
4118 P-I****BGE MOHAMMAD RIZAL 350723******0004 0895*****9006 04/10/2021 Sesi 3 12.00 - 14.00
4119 P-I****700 GABIELLA HANIF 352313******0001 0855*****820 04/10/2021 Sesi 3 12.00 - 14.00
4120 P-I****YCZ IMRON MAJID 357302******0002 0895*****8769 04/10/2021 Sesi 3 12.00 - 14.00
4121 P-I****7TS farrel verdica putra 357303******0009 0856*****908 04/10/2021 Sesi 3 12.00 - 14.00
4122 P-I****PRM ALIFIAN CAHYONO NUGROHO 357305******0004 0819*****413 04/10/2021 Sesi 3 12.00 - 14.00
4123 P-I****E8J DWI ANGGA PRASETYA 350727******0001 0823*****874 04/10/2021 Sesi 3 12.00 - 14.00
4124 P-I****NH0 UMI SA'ADAH 351901******0001 0857*****682 04/10/2021 Sesi 3 12.00 - 14.00
4125 P-I****BRM SIELAWATI 357901******0003 0823*****888 04/10/2021 Sesi 3 12.00 - 14.00
4126 P-I****YOH MARTINA ADI JAYANTI 350722******0001 0822*****781 04/10/2021 Sesi 3 12.00 - 14.00
4127 P-I****19P KHOFIFA RABANI SAHAMI 920801******0002 0813*****672 04/10/2021 Sesi 3 12.00 - 14.00
4128 P-I****00C Afrendi lubis setyoko 352111******0002 0858*****727 04/10/2021 Sesi 3 12.00 - 14.00
4129 P-I****TLK DURROTUL INAYAH 350724******0006 0857*****226 04/10/2021 Sesi 3 12.00 - 14.00
4130 P-I****P5N DESEMBRINA ADI RAMADANI 350722******0001 0838*****641 04/10/2021 Sesi 3 12.00 - 14.00
4131 P-I****CER ADVIS KARIMA MUTAKAMILA 351005******0006 0822*****961 04/10/2021 Sesi 3 12.00 - 14.00
4132 P-I****77B REZA DRAJAT LAZUARDI 647402******0001 0819*****814 04/10/2021 Sesi 3 12.00 - 14.00
4133 P-I****2F9 SUTADJI 357903******0002 0856*****967 04/10/2021 Sesi 3 12.00 - 14.00
4134 P-I****WGR RIANAH 357305******0003 0895*****8331 04/10/2021 Sesi 3 12.00 - 14.00
4135 P-I****PPJ ALFINA FARAH NABILA 330512******0002 0899*****78 04/10/2021 Sesi 3 12.00 - 14.00
4136 P-I****TCH VICKY FIRMANSYAH 357302******0001 0859*****271 04/10/2021 Sesi 3 12.00 - 14.00
4137 P-I****4TS CHITA WIBOWO 332217******0001 0856*****340 04/10/2021 Sesi 3 12.00 - 14.00
4138 P-I****6S7 EMILIA YULI ASTUTIK 357301******0017 0898*****99 04/10/2021 Sesi 3 12.00 - 14.00
4139 P-I****T01 FARIS REGI RISWANA 320242******0002 0857*****992 04/10/2021 Sesi 3 12.00 - 14.00
4140 P-I****MCQ Fernina Ellen Mahmuda 357903******0002 0822*****212 04/10/2021 Sesi 3 12.00 - 14.00
4141 P-I****SAT Shona Fadhila Waladhisnaeni 357903******0002 0895*****2801 04/10/2021 Sesi 3 12.00 - 14.00
4142 P-I****R5T SRI HIDAYATI 357303******0003 0812*****220 04/10/2021 Sesi 3 12.00 - 14.00
4143 P-I****WP8 RIZQI PRANITA YUSMAYRA 357902******0003 0878*****176 04/10/2021 Sesi 3 12.00 - 14.00
4144 P-I****AE5 ALIYAN ILMAN SOBARI 357304******0005 0811*****64 04/10/2021 Sesi 3 12.00 - 14.00
4145 P-I****UWB CHANDRA AUDDIE 357902******0001 0812*****709 04/10/2021 Sesi 3 12.00 - 14.00
4146 P-I****TQL CAHYANING NOVITA SARI 357902******0004 0822*****533 04/10/2021 Sesi 3 12.00 - 14.00
4147 P-I****KLO HIDAYATUN MUYASYAROH 331819******0001 0821*****135 04/10/2021 Sesi 3 12.00 - 14.00
4148 P-I****TFW HANDIKA DIAN 351911******0001 0822*****015 04/10/2021 Sesi 3 12.00 - 14.00
4149 P-I****L7C SAMSUL MA'ARIF 357902******0003 0877*****022 04/10/2021 Sesi 3 12.00 - 14.00
4150 P-I****HCM ALFAN ALFARISI 350716******0001 0815*****672 04/10/2021 Sesi 3 12.00 - 14.00
4151 P-I****NMT Edi Subawon 357303******0001 0812*****358 04/10/2021 Sesi 3 12.00 - 14.00
4152 P-I****HJO LUTFI RUSDIYANTO 357304******0002 0851*****012 04/10/2021 Sesi 3 12.00 - 14.00
4153 P-I****6EM ATHIF FAUZAN SHAFA'A 357902******0006 0858*****668 04/10/2021 Sesi 3 12.00 - 14.00
4154 P-I****93G SARAH RIZKY APRISANTI 351503******0004 0881*****7484 04/10/2021 Sesi 3 12.00 - 14.00
4155 P-I****NZI SUPRIHATININGSIH 357305******0002 0895*****8592 04/10/2021 Sesi 3 12.00 - 14.00

Page 99 of 111
Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4156 P-I****97R RAHAYU SULISTYORINI 350725******0001 0858*****783 04/10/2021 Sesi 3 12.00 - 14.00
4157 P-I****L1Q MOCH. ABDULLAH 357302******0006 0899*****96 04/10/2021 Sesi 3 12.00 - 14.00
4158 P-I****IA7 RIZA AZWARNA FATHUR 640305******0001 0822*****699 04/10/2021 Sesi 3 12.00 - 14.00
4159 P-I****NJV Abdul Muis 357304******0003 0895*****9558 04/10/2021 Sesi 3 12.00 - 14.00
4160 P-I****J8R SEPBRILIA ROKHMAWATI 350723******0001 0878*****002 04/10/2021 Sesi 3 12.00 - 14.00
4161 P-I****SIV MITA KUROHMA 350722******0005 0877*****588 04/10/2021 Sesi 3 12.00 - 14.00
4162 P-I****WQ4 JOSHUA ARTHA ANUGERAH SITORUS 121209******0001 0821*****025 04/10/2021 Sesi 3 12.00 - 14.00
4163 P-I****ZW7 DIFA MAULANA ARYA BUJANA 647401******0003 0821*****606 04/10/2021 Sesi 3 12.00 - 14.00
4164 P-I****G3L WIDIA WATI 357303******0014 0816*****836 04/10/2021 Sesi 3 12.00 - 14.00
4165 P-I****3X9 AYU PRAMADITA DEWI 357303******0010 0812*****941 04/10/2021 Sesi 3 12.00 - 14.00
4166 P-I****ZVR Muhammad Abdul Hakim 647401******0002 0813*****988 04/10/2021 Sesi 3 12.00 - 14.00
4167 P-I****HZM SURIANTO 357302******0002 0857*****928 04/10/2021 Sesi 3 12.00 - 14.00
4168 P-I****AYF BONAVENTURA DOFITO 350725******0004 0878*****850 04/10/2021 Sesi 3 12.00 - 14.00
4169 P-I****RML Bagus Ardiansyah 350719******0004 0821*****781 04/10/2021 Sesi 3 12.00 - 14.00
4170 P-I****3N2 MARYANI 357303******0003 0851*****319 04/10/2021 Sesi 3 12.00 - 14.00
4171 P-I****BPD AGUS JUNAEDI IMAWAN 350713******0002 0812*****566 04/10/2021 Sesi 3 12.00 - 14.00
4172 P-I****V2H danny arif 357301******0003 0898*****30 04/10/2021 Sesi 3 12.00 - 14.00
4173 P-I****ND0 SUKARNI SEPTIANA 357301******0004 0823*****885 04/10/2021 Sesi 3 12.00 - 14.00
4174 P-I****FEW EKO ANDRIAN 350713******0003 0878*****500 04/10/2021 Sesi 3 12.00 - 14.00
4175 P-I****TF3 FIFI AFIFATUS ZAKIYA 351608******0002 0857*****654 04/10/2021 Sesi 3 12.00 - 14.00
4176 P-I****G5H ARIQ MUDHOFFAR NADHIF 647403******0004 0822*****301 04/10/2021 Sesi 3 12.00 - 14.00
4177 P-I****EG6 CHRISTIN YULIANA 357305******0005 0822*****876 04/10/2021 Sesi 3 12.00 - 14.00
4178 P-I****QAL ILMA NURSOCHIFAH 357302******0002 0895*****0697 04/10/2021 Sesi 3 12.00 - 14.00
4179 P-I****TZG DEVI APRILIANA 357304******0003 0856*****419 04/10/2021 Sesi 3 12.00 - 14.00
4180 P-I****3CB ROCHIM TONI 357304******0001 0815*****469 04/10/2021 Sesi 3 12.00 - 14.00
4181 P-I****VM7 NURAFNI OKTAVIA 350306******0004 0822*****978 04/10/2021 Sesi 3 12.00 - 14.00
4182 P-I****SKW AGUS PRAYITNO KURNIAWAN 350605******0004 0857*****420 04/10/2021 Sesi 3 12.00 - 14.00
4183 P-I****HN3 USWATUN HASANAH 351703******0002 0821*****011 04/10/2021 Sesi 3 12.00 - 14.00
4184 P-I****4KQ YUDHA DWI PARASETYO 350731******0001 0853*****007 04/10/2021 Sesi 3 12.00 - 14.00
4185 P-I****DKN Dea Imelda Putri 357301******0004 0877*****832 04/10/2021 Sesi 3 12.00 - 14.00
4186 P-I****H50 sherlie dwi hapsari 357903******0003 0812*****899 04/10/2021 Sesi 3 12.00 - 14.00
4187 P-I****5O9 MUHAMMAD IQBAL 357303******0002 0815*****312 04/10/2021 Sesi 3 12.00 - 14.00
4188 P-I****732 DEBY MAULIDA 351011******0003 0838*****245 04/10/2021 Sesi 3 12.00 - 14.00
4189 P-I****GYE M. ABDUL AZIZ 350717******0003 0813*****459 04/10/2021 Sesi 3 12.00 - 14.00
4190 P-I****VH9 Tiyas Putri Wardani 350722******0002 0821*****401 04/10/2021 Sesi 3 12.00 - 14.00
4191 P-I****XQZ ADJI HANNA OKTAVIANTI 357301******0004 0838*****386 04/10/2021 Sesi 3 12.00 - 14.00
4192 P-I****39W I MADE GANDHESA YADNYA 357301******0003 0811*****92 04/10/2021 Sesi 3 12.00 - 14.00
4193 P-I****ZUB TITIK SUYATI 357903******0001 0812*****933 04/10/2021 Sesi 3 12.00 - 14.00
4194 P-I****7PQ ARIE CAHYO UTOMO 640309******0002 0815*****46 04/10/2021 Sesi 3 12.00 - 14.00
4195 P-I****CQE I'timaddin Is'ad Athalla Trafiratama 367201******0003 0895*****953 04/10/2021 Sesi 3 12.00 - 14.00
4196 P-I****COA Dwi Hastutik 357302******0002 0813*****727 04/10/2021 Sesi 3 12.00 - 14.00
4197 P-I****Z9J GRACE VANESSA LASMANA 327307******0001 0821*****505 04/10/2021 Sesi 3 12.00 - 14.00

Page 100 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4198 P-I****6MN NI NYOMAN WENNY HANDAYANI 357301******0006 0812*****52 04/10/2021 Sesi 3 12.00 - 14.00
4199 P-I****CZJ ELVIAN ANANTA JAYA 351401******0001 0877*****768 04/10/2021 Sesi 3 12.00 - 14.00
4200 P-I****F3Q WIDITA KUSUMANINGSIH 350722******0002 0822*****001 04/10/2021 Sesi 3 12.00 - 14.00
4201 P-I****XV3 LAILA SEPTI MAHARANI 350719******0001 0878*****277 04/10/2021 Sesi 3 12.00 - 14.00
4202 P-I****UDO UCIK SOFIANA 350719******0001 0857*****412 04/10/2021 Sesi 3 12.00 - 14.00
4203 P-I****C98 SOCHA SALSABILLAH 351907******0001 0858*****037 04/10/2021 Sesi 3 12.00 - 14.00
4204 P-I****CK2 YULISTYANINGSIH 350722******0001 0812*****145 04/10/2021 Sesi 3 12.00 - 14.00
4205 P-I****FQJ MUHAMMAD SAYYID 520103******0004 0812*****58 04/10/2021 Sesi 3 12.00 - 14.00
4206 P-I****3AK ISTI DIAH ANGGRAENI 351907******0001 0821*****547 04/10/2021 Sesi 3 12.00 - 14.00
4207 P-I****UIY DEBRITA BERNIKE YEUSY ISAY 647205******0004 0895*****6444 04/10/2021 Sesi 3 12.00 - 14.00
4208 P-I****0I4 AFSAH INDAH MAULIDAH 352507******0002 0813*****336 04/10/2021 Sesi 3 12.00 - 14.00
4209 P-I****TTV MOCH. RIZAL 357302******0001 0859*****747 04/10/2021 Sesi 3 12.00 - 14.00
4210 P-I****KJR Alex sandra prastya widodo 351414******0002 0856*****790 04/10/2021 Sesi 3 12.00 - 14.00
4211 P-I****BLE BUDI WIYOTO 357304******0003 0813*****033 04/10/2021 Sesi 3 12.00 - 14.00
4212 P-I****OYQ GIGIH WIDIYAWANTORO 350111******0002 0812*****311 04/10/2021 Sesi 3 12.00 - 14.00
4213 P-I****XFJ RADI WIYOKO 357304******0001 0895*****3971 04/10/2021 Sesi 3 12.00 - 14.00
4214 P-I****SKI Dedik indriansa 350723******0003 0896*****288 04/10/2021 Sesi 3 12.00 - 14.00
4215 P-I****GNL CAROLINE VETI KURNIASARI 351409******0004 0855*****563 04/10/2021 Sesi 3 12.00 - 14.00
4216 P-I****84P LEA FIRDAUSI PUTRI 517104******0003 0881*****0818 04/10/2021 Sesi 3 12.00 - 14.00
4217 P-I****2G3 JODY PRAMANA PUTRA 147109******0021 0852*****372 04/10/2021 Sesi 3 12.00 - 14.00
4218 P-I****8AQ SUPRIADI 350718******0001 0821*****858 04/10/2021 Sesi 3 12.00 - 14.00
4219 P-I****G6F ANDY FIRDAUS SANJAYA 350712******0003 0838*****907 04/10/2021 Sesi 3 12.00 - 14.00
4220 P-I****NMA Ahmad Husen Aurelio 327610******0002 0857*****788 04/10/2021 Sesi 3 12.00 - 14.00
4221 P-I****XEV PURI KHOLIFATUSH SHOLIHAH 352310******0002 0812*****990 04/10/2021 Sesi 3 12.00 - 14.00
4222 P-I****C62 NADA MAWARDA RILEK 350808******0003 0812*****387 04/10/2021 Sesi 3 12.00 - 14.00
4223 P-I****TYZ Nanda agus sofi'i 350710******0001 0853*****526 04/10/2021 Sesi 3 12.00 - 14.00
4224 P-I****3V6 ANDI KURNIAWAN DWI SAPUTRO 350818******0004 0852*****851 04/10/2021 Sesi 3 12.00 - 14.00
4225 P-I****2WF Fathor Rahman 357302******0005 0855*****952 04/10/2021 Sesi 3 12.00 - 14.00
4226 P-I****R41 HADI SANTOSO 350720******0001 0813*****056 04/10/2021 Sesi 3 12.00 - 14.00
4227 P-I****TZX RAIHANA PUTRI NABILA 327602******0014 0852*****772 04/10/2021 Sesi 3 12.00 - 14.00
4228 P-I****CGP SEPTIAN DICKY PRADANA 350723******0001 0812*****97 04/10/2021 Sesi 3 12.00 - 14.00
4229 P-I****5VN UFFY LAILYA QOTRUNNADA 350703******0001 0821*****988 04/10/2021 Sesi 3 12.00 - 14.00
4230 P-I****WP0 M. ADHA SAID 647206******0004 0852*****864 04/10/2021 Sesi 3 12.00 - 14.00
4231 P-I****ER5 MUHAMMAD NOOR 357901******0001 0821*****770 04/10/2021 Sesi 3 12.00 - 14.00
4232 P-I****UVC CHOIRUL ANWAR 357304******0001 0857*****343 04/10/2021 Sesi 3 12.00 - 14.00
4233 P-I****FU2 M.MUHYIDIN A.Q.Z 351018******0002 0821*****733 04/10/2021 Sesi 3 12.00 - 14.00
4234 P-I****DXG MAULANA MURSYID 127103******0005 0852*****405 04/10/2021 Sesi 3 12.00 - 14.00
4235 P-I****YPN ISMI NURJANAH 357305******0002 0838*****371 04/10/2021 Sesi 3 12.00 - 14.00
4236 P-I****9I5 KARINA FARKHA DINA 332705******0001 0812*****892 04/10/2021 Sesi 3 12.00 - 14.00
4237 P-I****X7R RIZKI GUSMAWAN 727103******0001 0821*****133 04/10/2021 Sesi 3 12.00 - 14.00
4238 P-I****W47 ARUMI 350723******0005 0858*****237 04/10/2021 Sesi 3 12.00 - 14.00
4239 P-I****CL4 AMANDA NURFAJRI HIKMAWATI 357502******0004 0821*****862 04/10/2021 Sesi 3 12.00 - 14.00

Page 101 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4240 P-I****2OP HENDRA LESTARIANTO 357305******0002 0812*****341 04/10/2021 Sesi 3 12.00 - 14.00
4241 P-I****W4Z BENEDIKTA K. SITANGGANG TANJUNG 121708******0003 0821*****833 04/10/2021 Sesi 3 12.00 - 14.00
4242 P-I****QHA RAHMA ANINDYA PUTRI 351512******0001 0852*****973 04/10/2021 Sesi 3 12.00 - 14.00
4243 P-I****ZZV Lusiati 357304******0001 0895*****2799 04/10/2021 Sesi 3 12.00 - 14.00
4244 P-I****P69 EVI ASTUTI WULANSARI 357301******0004 0895*****4915 04/10/2021 Sesi 3 12.00 - 14.00
4245 P-I****TNK MASNUN FUAILIN H 350724******0002 0895*****1283 04/10/2021 Sesi 3 12.00 - 14.00
4246 P-I****E4K MUHAMMAD AZHAR THIRAFI SAY 350927******0005 0822*****887 04/10/2021 Sesi 3 12.00 - 14.00
4247 P-I****0PU RATNA ARIANDA JUWITA 357305******0001 0812*****004 04/10/2021 Sesi 3 12.00 - 14.00
4248 P-J****UXR MUHAMMAD ANINDHITA CHANDRA 357302******0003 0812*****018 04/10/2021 Sesi 3 12.00 - 14.00
4249 P-J****HI5 Emilia Tiara Cantika Ratri 357302******0004 0895*****9496 04/10/2021 Sesi 3 12.00 - 14.00
4250 P-J****AL9 Fitriyah 357302******0005 0888*****38 04/10/2021 Sesi 3 12.00 - 14.00
4251 P-J****NLV LITA BUDIARTI 527204******0001 0823*****981 04/10/2021 Sesi 3 12.00 - 14.00
4252 P-J****E4N ARLIEZA RIZKI 350413******0002 0821*****558 04/10/2021 Sesi 3 12.00 - 14.00
4253 P-J****Q6E MOCH IMAMUDIN 350718******0003 0821*****036 04/10/2021 Sesi 3 12.00 - 14.00
4254 P-J****VQ6 RIDHO ADIGUNA 350802******0002 0812*****044 04/10/2021 Sesi 3 12.00 - 14.00
4255 P-J****KKT LAMBERTO LABA LANGODAY 357305******0004 0823*****245 04/10/2021 Sesi 3 12.00 - 14.00
4256 P-J****IEH CARINA TRESNANE WILUJENG 350715******0003 0881*****7138 04/10/2021 Sesi 3 12.00 - 14.00
4257 P-J****JSH INDAH MAYASARI BR TAMPUBOLON 127106******0010 0819*****433 04/10/2021 Sesi 3 12.00 - 14.00
4258 P-J****17P Ricky Charisma Waruwu 127116******0001 0813*****180 04/10/2021 Sesi 3 12.00 - 14.00
4259 P-J****D43 Gindo Raja Hamonangan Saragih 120804******0003 0812*****528 04/10/2021 Sesi 3 12.00 - 14.00
4260 P-J****FQD AHMAD NAUFAL MASHABI 352511******0001 0822*****933 04/10/2021 Sesi 3 12.00 - 14.00
4261 P-J****B3H PUTRI DEWI MASITAH 357902******0002 0857*****74 04/10/2021 Sesi 3 12.00 - 14.00
4262 P-J****L7W NIKEN SARA SYANINGPARA HITA 357304******0009 0819*****895 04/10/2021 Sesi 3 12.00 - 14.00
4263 P-J****GPA Alif Rahman 327505******0013 0882*****447 04/10/2021 Sesi 3 12.00 - 14.00
4264 P-J****AHA NI KADEK WIDYA RAHAYU 350724******0005 0812*****601 04/10/2021 Sesi 3 12.00 - 14.00
4265 P-J****WNM Robiatus Sa'diyah 350721******0002 0812*****430 04/10/2021 Sesi 3 12.00 - 14.00
4266 P-J****7CJ Unzila Zhafarina 617106******0001 0851*****863 04/10/2021 Sesi 3 12.00 - 14.00
4267 P-J****UAE SUHARSONO 357301******0001 0831*****018 04/10/2021 Sesi 3 12.00 - 14.00
4268 P-J****G53 MARIANI SINAGA 350724******0007 0821*****819 04/10/2021 Sesi 3 12.00 - 14.00
4269 P-J****UJM Ihda afnan jadug raharja 332413******0004 0821*****811 04/10/2021 Sesi 3 12.00 - 14.00
4270 P-J****QGB FAIQOTUSSYAI'AH 350724******0003 0812*****461 04/10/2021 Sesi 3 12.00 - 14.00
4271 P-J****E2S SRI SUPRIYATIN 357301******0005 0856*****337 04/10/2021 Sesi 3 12.00 - 14.00
4272 P-J****LXP ULI ELISABETH P. 357831******0002 0822*****812 04/10/2021 Sesi 3 12.00 - 14.00
4273 P-J****QT3 KARTIKA INDAH PRATIVI 331104******0005 0858*****774 04/10/2021 Sesi 3 12.00 - 14.00
4274 P-J****BUR Siti Nurohma 350725******0004 0838*****876 04/10/2021 Sesi 3 12.00 - 14.00
4275 P-J****CPN CHRISTIANA AGUSTIEN 357305******0009 0822*****057 04/10/2021 Sesi 3 12.00 - 14.00
4276 P-J****I9W MOHAMAD ALIF BASTONI ALVI 350718******0004 0821*****331 04/10/2021 Sesi 3 12.00 - 14.00
4277 P-J****O46 SAMUEL SERVAS RAJA 530820******0001 0821*****796 04/10/2021 Sesi 3 12.00 - 14.00
4278 P-J****OZS DITA DWI NOVITASARI 357301******0001 0877*****145 04/10/2021 Sesi 3 12.00 - 14.00
4279 P-J****GZV MISKIYAH 357816******0001 0856*****061 04/10/2021 Sesi 3 12.00 - 14.00
4280 P-J****OB7 DIAH MEI DIANA SARI 351909******0005 0821*****516 04/10/2021 Sesi 3 12.00 - 14.00
4281 P-J****6N0 Siti Hamimah 321506******0003 0856*****209 04/10/2021 Sesi 3 12.00 - 14.00

Page 102 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4282 P-J****RA2 RAHAYU KARTIKA DEWI 350712******0002 0821*****247 04/10/2021 Sesi 3 12.00 - 14.00
4283 P-J****MHI TIMBUL RAMADANA 357305******0001 0838*****115 04/10/2021 Sesi 3 12.00 - 14.00
4284 P-J****BW5 Andrean Okta Pratama 350712******0002 0822*****030 04/10/2021 Sesi 3 12.00 - 14.00
4285 P-J****JQU TSABITAH ADDINNI 357305******0003 0819*****940 04/10/2021 Sesi 3 12.00 - 14.00
4286 P-J****NZ7 HANIS SETYAWATI 357301******0005 0812*****595 04/10/2021 Sesi 3 12.00 - 14.00
4287 P-J****I7K MOH SYA'RONI 357302******0006 0895*****023 04/10/2021 Sesi 3 12.00 - 14.00
4288 P-J****JWE MIRZA IRAWAN 357303******0008 0819*****119 04/10/2021 Sesi 3 12.00 - 14.00
4289 P-J****H4Y CHOIRUL ARIFIN 357302******0004 0878*****073 04/10/2021 Sesi 3 12.00 - 14.00
4290 P-J****4U2 DEWI NURYA AMALINA 331902******0004 0852*****760 04/10/2021 Sesi 3 12.00 - 14.00
4291 P-J****LX1 ARIP HIDAYANTO 350709******0001 0852*****385 04/10/2021 Sesi 3 12.00 - 14.00
4292 P-J****AVS UNIK DAMAYANTI RUSDIANA 357901******0001 0812*****666 04/10/2021 Sesi 3 12.00 - 14.00
4293 P-J****3D6 EFIN FAUZI 350703******0001 0813*****581 04/10/2021 Sesi 3 12.00 - 14.00
4294 P-J****BAM GISELA NUR AISYAH PUTRI 357301******0002 0822*****711 04/10/2021 Sesi 3 12.00 - 14.00
4295 P-J****RSX LAMBERTUS KORTANCE 530703******0001 0821*****551 04/10/2021 Sesi 3 12.00 - 14.00
4296 P-J****EMC LUTTFIA IRKAH ROMIZ 350617******0002 0822*****651 04/10/2021 Sesi 3 12.00 - 14.00
4297 P-J****VXT HARIS ARDIANSYAH 357303******0006 0878*****166 04/10/2021 Sesi 3 12.00 - 14.00
4298 P-J****2O2 ENDAH WAHYUNI 357303******0004 0896*****719 04/10/2021 Sesi 3 12.00 - 14.00
4299 P-J****AWC MUJIANTO 357305******0002 0812*****339 04/10/2021 Sesi 3 12.00 - 14.00
4300 P-J****OBX WAHYU EKO PUTRI 357303******0006 0819*****840 04/10/2021 Sesi 3 12.00 - 14.00
4301 P-J****2K0 KHUSNUL KHOTHIMAH 350724******0002 0813*****441 04/10/2021 Sesi 3 12.00 - 14.00
4302 P-J****9G6 SUDARTI 357103******0006 0815*****634 04/10/2021 Sesi 3 12.00 - 14.00
4303 P-J****KXR HANUGRAH RAHADITYO PRASETYO 357305******0006 0812*****684 04/10/2021 Sesi 3 12.00 - 14.00
4304 P-J****ZL0 DELLA AYU PITALOKA 357301******0007 0812*****752 04/10/2021 Sesi 3 12.00 - 14.00
4305 P-J****5OU KAMALUDDIN 350706******0005 0812*****238 04/10/2021 Sesi 3 12.00 - 14.00
4306 P-J****C58 NILA ALIN SANIA 350313******0001 0896*****277 04/10/2021 Sesi 3 12.00 - 14.00
4307 P-J****DI5 ANINDYA CELENA K K 357303******0002 0822*****366 04/10/2021 Sesi 3 12.00 - 14.00
4308 P-J****YM3 DWI ATMUJI 350708******0007 0812*****343 04/10/2021 Sesi 3 12.00 - 14.00
4309 P-J****BYX ITA BUDI LESTARININGSIH 357305******0004 0815*****074 04/10/2021 Sesi 3 12.00 - 14.00
4310 P-J****83J AFUZA AHNAF DZULFIKAR 350216******0001 0823*****748 04/10/2021 Sesi 3 12.00 - 14.00
4311 P-J****X26 FIKAR MUKAMAL 352004******0002 0857*****977 04/10/2021 Sesi 3 12.00 - 14.00
4312 P-J****VT3 ALVIN RIZAL ROMADHAN 357303******0002 0838*****131 04/10/2021 Sesi 3 12.00 - 14.00
4313 P-J****G7L DITA BELLA FEBRIYANTI 351014******0002 0813*****277 04/10/2021 Sesi 3 12.00 - 14.00
4314 P-J****K9H MUGIYONO 357305******0003 0857*****441 04/10/2021 Sesi 3 12.00 - 14.00
4315 P-J****Z4J YENI RAHMAN 350927******0021 0812*****444 04/10/2021 Sesi 3 12.00 - 14.00
4316 P-J****UZB SARY MINDARIATY 350712******0004 0858*****503 04/10/2021 Sesi 3 12.00 - 14.00
4317 P-J****HXC GUNAWAN 357305******0011 0896*****058 04/10/2021 Sesi 3 12.00 - 14.00
4318 P-J****7IG M. IHSAN LUQMAN HAKIM 327506******0020 0877*****766 04/10/2021 Sesi 3 12.00 - 14.00
4319 P-J****QW6 SAJID 332302******0002 0821*****825 04/10/2021 Sesi 3 12.00 - 14.00
4320 P-J****MEG ADELLA FAJAR CAHYANI 350414******0002 0813*****943 04/10/2021 Sesi 3 12.00 - 14.00
4321 P-J****M0Z EI DWI SAPUTRA 332307******0003 0857*****720 04/10/2021 Sesi 3 12.00 - 14.00
4322 P-J****VTD ANSKARIUS MON 530819******0002 0852*****073 04/10/2021 Sesi 3 12.00 - 14.00
4323 P-J****0EP ADAM ADI PRAWIRA 357901******0014 0895*****6000 04/10/2021 Sesi 3 12.00 - 14.00

Page 103 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4324 P-J****7KZ YUDHI SETIAWAN 332302******0001 0896*****678 04/10/2021 Sesi 3 12.00 - 14.00
4325 P-J****K0N MUJIYATI 332302******0001 0812*****275 04/10/2021 Sesi 3 12.00 - 14.00
4326 P-J****P84 MINARSIH 357302******0003 0813*****673 04/10/2021 Sesi 3 12.00 - 14.00
4327 P-J****X5E YUSUF FUAIDI 332302******0001 0858*****907 04/10/2021 Sesi 3 12.00 - 14.00
4328 P-J****C4G NUR HAJIDAH RACHMANNISA 350724******0003 0812*****03 04/10/2021 Sesi 3 12.00 - 14.00
4329 P-J****M2H RIZKI NATASYA SALSABILA 357804******0007 0878*****812 04/10/2021 Sesi 3 12.00 - 14.00
4330 P-J****ZHB SALMA PUSPITA MARDATILA 351412******0001 0823*****950 04/10/2021 Sesi 3 12.00 - 14.00
4331 P-J****XZU UNZILA AINURROHMA HARDANI 352008******0002 0857*****053 04/10/2021 Sesi 3 12.00 - 14.00
4332 P-J****7SF NOFIYANITA 357302******0001 0857*****400 04/10/2021 Sesi 3 12.00 - 14.00
4333 P-J****BEA FAHRUL ROZI 350724******0001 0858*****358 04/10/2021 Sesi 3 12.00 - 14.00
4334 P-J****LTC SUGIANTO 357301******0007 0812*****243 04/10/2021 Sesi 3 12.00 - 14.00
4335 P-J****5DV MOCHAMMAD FAWWAZ ISLAMI 352516******0001 0812*****433 04/10/2021 Sesi 3 12.00 - 14.00
4336 P-J****52S RUDIANTO 357304******0001 0812*****000 04/10/2021 Sesi 3 12.00 - 14.00
4337 P-J****VS7 Moh Amirul M 351312******0007 0857*****766 04/10/2021 Sesi 3 12.00 - 14.00
4338 P-J****VN2 AZRUL ANANDA 352507******0001 0857*****133 04/10/2021 Sesi 3 12.00 - 14.00
4339 P-J****LB4 ALIFIA NOVITA RAHMAH 352317******0002 0888*****705 04/10/2021 Sesi 3 12.00 - 14.00
4340 P-J****JPZ IMAM SANTOSO 351507******0004 0812*****131 04/10/2021 Sesi 3 12.00 - 14.00
4341 P-J****TWB ALI ZAINAL ABIDIN BASRAH 350722******0005 0815*****695 04/10/2021 Sesi 3 12.00 - 14.00
4342 P-J****F9X MUHAMMAD SATRYO WICAKSONO 327202******0011 0857*****024 04/10/2021 Sesi 3 12.00 - 14.00
4343 P-J****IZS JOKO SUNTORO 357302******0002 0895*****0786 04/10/2021 Sesi 3 12.00 - 14.00
4344 P-J****23X ANITA TRISDIANA YUNIARTI 357301******0006 0821*****003 04/10/2021 Sesi 3 12.00 - 14.00
4345 P-J****8GB DJOKO PRIYOHADI 357903******0002 0851*****411 04/10/2021 Sesi 3 12.00 - 14.00
4346 P-J****EPD SAMSIYAH 332815******0002 0882*****7260 04/10/2021 Sesi 3 12.00 - 14.00
4347 P-J****SNT MUHAMMAD ALI BURHANUDDIN 331802******0005 0858*****556 04/10/2021 Sesi 3 12.00 - 14.00
4348 P-K****PJG DERRY AUGI PUTRA 357301******0011 0838*****228 04/10/2021 Sesi 3 12.00 - 14.00
4349 P-K****8VE Kustriani 350607******0003 0852*****424 04/10/2021 Sesi 3 12.00 - 14.00
4350 P-K****I4T WYNDHA EKA LAILA AYU RAHMADYANA 357304******0004 0817*****310 04/10/2021 Sesi 3 12.00 - 14.00
4351 P-K****TLU TEA INDHIE SAHARA 350919******0006 0815*****361 04/10/2021 Sesi 3 12.00 - 14.00
4352 P-K****KH0 YOGA PINASATRIA 351508******0008 0813*****816 04/10/2021 Sesi 3 12.00 - 14.00
4353 P-K****XH5 RETNO CAHYA KURNIASARI 350217******0001 0838*****886 04/10/2021 Sesi 3 12.00 - 14.00
4354 P-K****BOP EMI FEBRIANTI 740606******0001 0812*****721 04/10/2021 Sesi 3 12.00 - 14.00
4355 P-K****PW0 FAWWAZ MUHAMMAD 647105******0001 0813*****570 04/10/2021 Sesi 3 12.00 - 14.00
4356 P-K****558 CHOIRUL DENIS IRVANSYAH 350719******0001 0895*****8797 04/10/2021 Sesi 3 12.00 - 14.00
4357 P-K****RHF KUMARIYANTO 357302******0004 0813*****740 04/10/2021 Sesi 3 12.00 - 14.00
4358 P-K****0XQ HERZA AVICENA 367404******0004 0813*****890 04/10/2021 Sesi 3 12.00 - 14.00
4359 P-K****G19 IIS VIATI 357302******0009 0812*****033 04/10/2021 Sesi 3 12.00 - 14.00
4360 P-K****1I5 SHERINA IZZATY 367404******0003 0812*****519 04/10/2021 Sesi 3 12.00 - 14.00
4361 P-K****RRI DITO ARIEF NURAKHMADI 327606******0010 0812*****809 04/10/2021 Sesi 3 12.00 - 14.00
4362 P-K****U9V Sugihartini 357305******0002 0812*****566 04/10/2021 Sesi 3 12.00 - 14.00
4363 P-K****R5T SRI INDIJASTUTI SOESSETYORINI 357903******0003 0812*****699 04/10/2021 Sesi 3 12.00 - 14.00
4364 P-K****1IO MIRANDA NOVITA SARI SIANIPAR 127601******0002 0852*****122 04/10/2021 Sesi 3 12.00 - 14.00
4365 P-K****XPT REZTI PUJI INAYAH 167107******0007 0812*****743 04/10/2021 Sesi 3 12.00 - 14.00

Page 104 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4366 P-K****KJ9 ELLA GRESIA SIALLAGAN 121709******0001 0813*****416 04/10/2021 Sesi 3 12.00 - 14.00
4367 P-K****5AL Arba'atin Choirunisak 351706******0002 0815*****352 04/10/2021 Sesi 3 12.00 - 14.00
4368 P-K****OUC ATHAYA FADILLA 637104******0005 0811*****4 04/10/2021 Sesi 3 12.00 - 14.00
4369 P-K****5KK WANDI 331206******0001 0857*****935 04/10/2021 Sesi 3 12.00 - 14.00
4370 P-K****F8T NOVITA NUR HIDAYATI 331104******0001 0812*****500 04/10/2021 Sesi 3 12.00 - 14.00
4371 P-K****GUP PUTRI DEA PERMATASARI HENDRIAWAN 357305******0001 0882*****281 04/10/2021 Sesi 3 12.00 - 14.00
4372 P-K****XN0 TJAHYANI INDIASTUTI 357302******0004 0813*****619 04/10/2021 Sesi 3 12.00 - 14.00
4373 P-K****F7N AYYUTAYA PRADNJA SANARI 197101******0002 0878*****178 04/10/2021 Sesi 3 12.00 - 14.00
4374 P-K****9NE DIAN ANGGRAENI HASTUTIK 357305******0009 0852*****896 04/10/2021 Sesi 3 12.00 - 14.00
4375 P-K****GPE JAMILA TAUFIK 357502******0004 0838*****251 04/10/2021 Sesi 3 12.00 - 14.00
4376 P-K****70X RYAN DWI CAHYONO 350509******0001 0813*****268 04/10/2021 Sesi 3 12.00 - 14.00
4377 P-K****9MD ANDRI ASHARINI 351518******0006 0821*****605 04/10/2021 Sesi 3 12.00 - 14.00
4378 P-K****G8E DESY MA'RIFA TUSA'DYAH 517101******0007 0859*****366 04/10/2021 Sesi 3 12.00 - 14.00
4379 P-K****BCG PRIMADANY YUSUF SUCIANTO 350104******0008 0821*****67 04/10/2021 Sesi 3 12.00 - 14.00
4380 P-K****G8H QANITA CAHYA FIRDAUSY 357305******0003 0858*****460 04/10/2021 Sesi 3 12.00 - 14.00
4381 P-K****BM5 EKA IQBAL VIRGIAWAN 367401******0005 0822*****492 04/10/2021 Sesi 3 12.00 - 14.00
4382 P-K****JS5 NUR'AIDAH 520604******0001 0823*****800 04/10/2021 Sesi 3 12.00 - 14.00
4383 P-K****8NS MAULITA HEFTI AFRIANTI 350732******0002 0856*****453 04/10/2021 Sesi 3 12.00 - 14.00
4384 P-K****YUH KURNIA PANGESTU WIBOWO 357301******0002 0819*****746 04/10/2021 Sesi 3 12.00 - 14.00
4385 P-K****FZQ TATIEK ERWIYANDARI 357305******0001 0813*****729 04/10/2021 Sesi 3 12.00 - 14.00
4386 P-K****6JS GURID SUSENO 180201******0002 0899*****49 04/10/2021 Sesi 3 12.00 - 14.00
4387 P-K****7PP SURYAHADI WIJAYADJATI 357305******0003 0813*****729 04/10/2021 Sesi 3 12.00 - 14.00
4388 P-K****S9F RAHMAT OLLONG 920201******0001 0822*****398 04/10/2021 Sesi 3 12.00 - 14.00
4389 P-K****WQV ANDRI TRISNANTO 350211******0002 0858*****369 04/10/2021 Sesi 3 12.00 - 14.00
4390 P-K****SUH IRVINA FIRADILA 350804******0003 0822*****836 04/10/2021 Sesi 3 12.00 - 14.00
4391 P-K****02R YUSRIL DEWANTARA 350626******0001 0858*****024 04/10/2021 Sesi 3 12.00 - 14.00
4392 P-K****2I6 KRISNA MAHENDRA 350719******0001 0858*****603 04/10/2021 Sesi 3 12.00 - 14.00
4393 P-K****FAJ NADYA AYU MAYSITHA 331906******0004 0857*****809 04/10/2021 Sesi 3 12.00 - 14.00
4394 P-K****903 ASHRI LINTANG ALDISAFITRI 357304******0005 0856*****058 04/10/2021 Sesi 3 12.00 - 14.00
4395 P-K****AY4 NIKE ERLIANA 357305******0013 0856*****09 04/10/2021 Sesi 3 12.00 - 14.00
4396 P-K****SAB NIKA RONA SELA 357305******0003 0895*****7758 04/10/2021 Sesi 3 12.00 - 14.00
4397 P-K****GJD AINUDIN ROSYIHAN AKBAR 350714******0003 0813*****810 04/10/2021 Sesi 3 12.00 - 14.00
4398 P-K****3RF KAUTSAR ALDI FERARY 350715******0003 0812*****551 04/10/2021 Sesi 3 12.00 - 14.00
4399 P-K****DGL THERESIA ZABRINA BUDISUWITA 910909******0002 0822*****838 04/10/2021 Sesi 3 12.00 - 14.00
4400 P-K****K6K NIMAS AYU ARGATYA S A 517101******0001 0813*****006 04/10/2021 Sesi 3 12.00 - 14.00
4401 P-K****K1M M. ALI MACHRUS 350724******0003 0897*****67 04/10/2021 Sesi 3 12.00 - 14.00
4402 P-K****AOJ IWAN AFANDI 350709******0008 0812*****910 04/10/2021 Sesi 3 12.00 - 14.00
4403 P-K****CM3 FADILAH DIMAS PRADANA 350721******0002 0896*****377 04/10/2021 Sesi 3 12.00 - 14.00
4404 P-K****G4Y Achmad Yudono 350722******0001 0812*****150 04/10/2021 Sesi 3 12.00 - 14.00
4405 P-K****AE2 TARIZA ANGGUN PUTRI 357903******0001 0881*****16 04/10/2021 Sesi 3 12.00 - 14.00
4406 P-K****EZW DEVI AYUK VERENTIKA 357903******0003 0877*****671 04/10/2021 Sesi 3 12.00 - 14.00
4407 P-K****NCH INTAHA FATA MAHMUDA 350417******0001 0822*****172 04/10/2021 Sesi 3 12.00 - 14.00

Page 105 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4408 P-K****MUI FITRIA KUMALASARI 350718******0003 0888*****37 04/10/2021 Sesi 3 12.00 - 14.00
4409 P-K****EET NIKEN SULISTYORINI 647401******0003 0812*****24 04/10/2021 Sesi 3 12.00 - 14.00
4410 P-K****U10 ADE LARASATI MAULIDA 357304******0002 0819*****702 04/10/2021 Sesi 3 12.00 - 14.00
4411 P-K****5L0 GRESSIANA 927101******0004 0813*****380 04/10/2021 Sesi 3 12.00 - 14.00
4412 P-K****UZR WILDAN PRATAMA 147108******0042 0877*****100 04/10/2021 Sesi 3 12.00 - 14.00
4413 P-K****3ZW HERA PRILANDARI 351506******0002 0819*****221 04/10/2021 Sesi 3 12.00 - 14.00
4414 P-K****I5A DWINDA LUTHFI ARIFAH 647401******0005 0813*****716 04/10/2021 Sesi 3 12.00 - 14.00
4415 P-K****F0V SULASTRI 357305******0001 0823*****646 04/10/2021 Sesi 3 12.00 - 14.00
4416 P-K****UP7 CINDY LAUREN 350511******0004 0851*****966 04/10/2021 Sesi 3 12.00 - 14.00
4417 P-K****WB8 SITI NURHIDAYAH 350301******0005 0822*****197 04/10/2021 Sesi 3 12.00 - 14.00
4418 P-K****0O2 ALIZA NOER LATIFAH 350713******0003 0821*****828 04/10/2021 Sesi 3 12.00 - 14.00
4419 P-K****9VN HANI AYU LESTARI 350723******0003 0857*****210 04/10/2021 Sesi 3 12.00 - 14.00
4420 P-K****IX5 RISWA WAQID MULYO KUSUMA WARDANA 647403******0003 0812*****987 04/10/2021 Sesi 3 12.00 - 14.00
4421 P-K****JI9 MUHAMMAD ZIDNI RIDLO 350313******0002 0821*****077 04/10/2021 Sesi 3 12.00 - 14.00
4422 P-K****4FV DYAN EKA AGUSTIN 352418******0002 0838*****185 04/10/2021 Sesi 3 12.00 - 14.00
4423 P-K****UD0 ZIDAN ALVIN NUHA 352004******0001 0877*****505 04/10/2021 Sesi 3 12.00 - 14.00
4424 P-K****1H9 CHRISMIYATININGTYAS 357303******0005 0819*****723 04/10/2021 Sesi 3 12.00 - 14.00
4425 P-K****UFM AZIZA MAJID OCTAVIKA 647403******0005 0821*****467 04/10/2021 Sesi 3 12.00 - 14.00
4426 P-K****MXX RIZKI RISANDY 352115******0001 0822*****544 04/10/2021 Sesi 3 12.00 - 14.00
4427 P-K****VC1 ANINDA REHANI 351912******0003 0816*****35 04/10/2021 Sesi 3 12.00 - 14.00
4428 P-K****8MX PRASINTA SARI WAHYU SANTI WARDANI 350804******0006 0813*****966 04/10/2021 Sesi 3 12.00 - 14.00
4429 P-K****KI0 FERY IRAWAN 357303******0001 0813*****678 04/10/2021 Sesi 3 12.00 - 14.00
4430 P-K****O1S FERREL NAUFALDY ABRARI D 357304******0009 0895*****4209 04/10/2021 Sesi 3 12.00 - 14.00
4431 P-K****XP4 FATIMA TUZAHRO 357305******0003 0821*****040 04/10/2021 Sesi 3 12.00 - 14.00
4432 P-K****E7K AKHMAD TAUFIK MUNAJAT 330515******0001 0896*****992 04/10/2021 Sesi 3 12.00 - 14.00
4433 P-K****QES TITIK SUMARLIN 350725******0002 0815*****002 04/10/2021 Sesi 3 12.00 - 14.00
4434 P-K****WTH MUHAMMAD YULIZAR PRADANA 350714******0002 0813*****834 04/10/2021 Sesi 3 12.00 - 14.00
4435 P-K****LLO AIDHA RIZMATIKA ZAHIROH 357302******0002 0838*****796 04/10/2021 Sesi 3 12.00 - 14.00
4436 P-K****XYR Azril Febrian 720407******0002 0813*****223 04/10/2021 Sesi 3 12.00 - 14.00
4437 P-K****0NM ZAHRA HILMY NAFI'AH 330513******0001 0857*****751 04/10/2021 Sesi 3 12.00 - 14.00
4438 P-K****PQ5 Oding Alfarifta E 357902******0001 0822*****911 04/10/2021 Sesi 3 12.00 - 14.00
4439 P-K****U12 ANAS IRFANANTO 351414******0002 0851*****658 04/10/2021 Sesi 3 12.00 - 14.00
4440 P-K****JNN AKHMAD FATIHUL UMAM 157107******0061 0821*****520 04/10/2021 Sesi 3 12.00 - 14.00
4441 P-K****F7S RUSLAN YUSUF 520208******0002 0878*****902 04/10/2021 Sesi 3 12.00 - 14.00
4442 P-K****0LU SITI LUTFIA WAHYU NURANI 357901******0003 0823*****271 04/10/2021 Sesi 3 12.00 - 14.00
4443 P-K****0YO AMALIA BIDAYATUS SHOFI 357302******0009 0813*****567 04/10/2021 Sesi 3 12.00 - 14.00
4444 P-K****5Y9 FAUZIA HIDAYATI 351720******0001 0857*****865 04/10/2021 Sesi 3 12.00 - 14.00
4445 P-K****481 VAROTAMA PUTRA RAMADHANA 357901******0001 0822*****331 04/10/2021 Sesi 3 12.00 - 14.00
4446 P-K****A4U IFADATUL KHOIROH 350718******0002 0857*****727 04/10/2021 Sesi 3 12.00 - 14.00
4447 P-K****WGX NAUFAL IZZUDDIN AFNAN 367206******0001 0895*****051 04/10/2021 Sesi 3 12.00 - 14.00
4448 P-K****FMW BAGAS RACHELMA ARMANDO 350726******0003 0895*****2232 04/10/2021 Sesi 3 12.00 - 14.00
4449 P-K****XBK KUSTINI 337204******0005 0877*****789 04/10/2021 Sesi 3 12.00 - 14.00

Page 106 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4450 P-K****NE2 MIR'ATUSYIFA'HAMIDAH 351901******0001 0896*****123 04/10/2021 Sesi 3 12.00 - 14.00
4451 P-K****B2P USWATUN CHASANAH CAHYA NINGRUM 357305******0001 0859*****458 04/10/2021 Sesi 3 12.00 - 14.00
4452 P-K****NDD RAHMAD FIQIH 350810******0002 0822*****721 04/10/2021 Sesi 3 12.00 - 14.00
4453 P-K****WJX AGUS HANDOKO 357305******0003 0812*****989 04/10/2021 Sesi 3 12.00 - 14.00
4454 P-K****S5O LELY WAHYUNINGRUM ROSANTI 357305******0004 0817*****97 04/10/2021 Sesi 3 12.00 - 14.00
4455 P-K****QQI ZALSABILLA DEVANI 357901******0006 0851*****604 04/10/2021 Sesi 3 12.00 - 14.00
4456 P-K****84O Moh Rizki A Karim 827203******0001 0823*****515 04/10/2021 Sesi 3 12.00 - 14.00
4457 P-K****UOB MANGSUR M. NUR MAKIAN BARUMADEHE 820401******0001 0878*****754 04/10/2021 Sesi 3 12.00 - 14.00
4458 P-K****S3D ADI FAISAL WIBISONO 350708******0002 0878*****567 04/10/2021 Sesi 3 12.00 - 14.00
4459 P-K****QBE MELINIA FITRI HAFIZHA YUSIDA 357303******0001 0822*****547 04/10/2021 Sesi 3 12.00 - 14.00
4460 P-K****T5Z HAFIDZ ABDULLAH 360320******0002 0852*****451 04/10/2021 Sesi 3 12.00 - 14.00
4461 P-K****KZD HANDOKO 357305******0006 0851*****738 04/10/2021 Sesi 3 12.00 - 14.00
4462 P-K****UYJ SEPTIA PUTRI ANGGRAENI 357302******0002 0895*****798 04/10/2021 Sesi 3 12.00 - 14.00
4463 P-K****CRR YONATHAN EKA PRASETYA 357305******0001 0896*****386 04/10/2021 Sesi 3 12.00 - 14.00
4464 P-K****IV0 DEMAS NAUFAL HAKIM 510306******0003 0831*****548 04/10/2021 Sesi 3 12.00 - 14.00
4465 P-K****EBP SUPONO 350724******0032 0896*****363 04/10/2021 Sesi 3 12.00 - 14.00
4466 P-K****STO ACHMAD RAGIL MAULANA 357301******0001 0822*****723 04/10/2021 Sesi 3 12.00 - 14.00
4467 P-K****OK7 ANDI MOHAMMAD SUDIBYO 350721******0001 0857*****531 04/10/2021 Sesi 3 12.00 - 14.00
4468 P-K****MRU DARA DAENARA NUR INDAH 352206******0003 0857*****445 04/10/2021 Sesi 3 12.00 - 14.00
4469 P-K****AJ9 ULIL ALBAB 350718******0006 0822*****932 04/10/2021 Sesi 3 12.00 - 14.00
4470 P-K****UUZ AQIL ATALLAH OKTABRI 357304******0001 0895*****566 04/10/2021 Sesi 3 12.00 - 14.00
4471 P-K****ZHM IRFARADS GHANY 357301******0002 0813*****002 04/10/2021 Sesi 3 12.00 - 14.00
4472 P-K****DAK MUHAMAD RIZQI FIRDAUS 350719******0003 0896*****090 04/10/2021 Sesi 3 12.00 - 14.00
4473 P-K****JYR MAMAT SUPRIYONO 357302******0001 0812*****820 04/10/2021 Sesi 3 12.00 - 14.00
4474 P-K****KCA DWIONOTO ISTYO UTOMO 350718******0003 0823*****912 04/10/2021 Sesi 3 12.00 - 14.00
4475 P-K****KNJ LUTFI SAMBUDI 327403******0011 0823*****679 04/10/2021 Sesi 3 12.00 - 14.00
4476 P-K****CPK ALIFIA DYAH PUSPITA AYU 357304******0002 0816*****954 04/10/2021 Sesi 3 12.00 - 14.00
4477 P-K****IHD NURUL HIDA KURNIADEWI 357304******0006 0821*****293 04/10/2021 Sesi 3 12.00 - 14.00
4478 P-K****KRJ IFAN SYARIF HIDAYAT 350717******0003 0838*****217 04/10/2021 Sesi 3 12.00 - 14.00
4479 P-K****N5A WAHONO SATRIYONO 351423******0001 0857*****895 04/10/2021 Sesi 3 12.00 - 14.00
4480 P-K****QSX WULAN KUSUMA SARI SANJAYA 351507******0006 0812*****089 04/10/2021 Sesi 3 12.00 - 14.00
4481 P-K****LXL GUNAWAN 357304******0003 0896*****660 04/10/2021 Sesi 3 12.00 - 14.00
4482 P-K****J6K ARDIK CHRIS PURDIANATA 357301******0005 0813*****188 04/10/2021 Sesi 3 12.00 - 14.00
4483 P-K****H68 MUHAMMAD FERI ROSYADI 357304******0001 0896*****582 04/10/2021 Sesi 3 12.00 - 14.00
4484 P-K****XR7 DWI MARIANI 357301******0007 0812*****599 04/10/2021 Sesi 3 12.00 - 14.00
4485 P-K****NAO GHENTA TIARA PRAMANA 352315******0002 0821*****725 04/10/2021 Sesi 3 12.00 - 14.00
4486 P-K****O3W RIZKHI DANY PRASETYO 357305******0003 0813*****685 04/10/2021 Sesi 3 12.00 - 14.00
4487 P-K****R8O DEASY NUR FAJRIAH 350718******0003 0821*****588 04/10/2021 Sesi 3 12.00 - 14.00
4488 P-K****PHY ISKANDAR HI HASAN 820422******0001 0852*****735 04/10/2021 Sesi 3 12.00 - 14.00
4489 P-K****3H2 APRIAN DWI SANTIKO 357302******0007 0857*****900 04/10/2021 Sesi 3 12.00 - 14.00
4490 P-K****07R PURBA IRAWAN 350218******0001 0857*****847 04/10/2021 Sesi 3 12.00 - 14.00
4491 P-K****2T6 DEVIA AMANDA RENZANIE 357903******0004 0896*****785 04/10/2021 Sesi 3 12.00 - 14.00

Page 107 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4492 P-K****VMN Fahira Samsul Bahri 820403******0001 0822*****832 04/10/2021 Sesi 3 12.00 - 14.00
4493 P-K****PHN NUR ADILLA 320908******0004 0822*****794 04/10/2021 Sesi 3 12.00 - 14.00
4494 P-K****RHE Alfi Syahrin Salviano 357303******0001 0821*****777 04/10/2021 Sesi 3 12.00 - 14.00
4495 P-K****NMY NUKLEON JEFRI NUR RAHMAN 350729******0001 0857*****601 04/10/2021 Sesi 3 12.00 - 14.00
4496 P-K****GBA MASIDA RATULOLI 530610******0001 0821*****391 04/10/2021 Sesi 3 12.00 - 14.00
4497 P-L****R2D MHD NAUFAL E GINTING 327605******0004 0812*****852 04/10/2021 Sesi 3 12.00 - 14.00
4498 P-M****QSV R. RAMDHAN SYAHARDIMAN 352901******0003 0812*****753 04/10/2021 Sesi 3 12.00 - 14.00
4499 P-N****TIY WAHYU SISWO PUTRO ADI 357305******0001 0815*****34 04/10/2021 Sesi 3 12.00 - 14.00
4500 P-P****9EO LAILATUL AGUSTININGSIH 351509******0002 0856*****130 04/10/2021 Sesi 3 12.00 - 14.00
4501 P-Q****V7Z NURUL MURI'AH 640412******0002 0852*****731 04/10/2021 Sesi 3 12.00 - 14.00
4502 P-U****C4F IZZA MACHRUSA SYAHAB 351413******0001 0821*****086 04/10/2021 Sesi 3 12.00 - 14.00
4503 P-U****LXE MoHAMAD SOLEH 351414******0001 0813*****758 04/10/2021 Sesi 3 12.00 - 14.00
4504 P-X****71V FIRA SUKMANISA 357305******0003 0822*****959 04/10/2021 Sesi 3 12.00 - 14.00
4505 Q-0****YLY FITYATUL MILA 350714******0001 0812*****581 04/10/2021 Sesi 3 12.00 - 14.00
4506 Q-0****X4W MOHAMMAD ROBITUL ANWAR HABIBI 350901******0004 0821*****010 04/10/2021 Sesi 3 12.00 - 14.00
4507 Q-0****Z5H EKI REZA RAHMAWAN 647104******0003 0821*****612 04/10/2021 Sesi 3 12.00 - 14.00
4508 Q-3****B3E RAFAELA XAVIERA T 317406******0002 0811*****78 04/10/2021 Sesi 3 12.00 - 14.00
4509 Q-4****02C HAFIZH IMAN NAUFAL 510306******0009 0812*****328 04/10/2021 Sesi 3 12.00 - 14.00
4510 S-0****E85 Handy Kabirul Dawam 357301******0005 0838*****637 04/10/2021 Sesi 3 12.00 - 14.00
4511 S-0****709 KUSNO 350721******0001 0838*****718 04/10/2021 Sesi 3 12.00 - 14.00
4512 S-0****CD8 MEINI SENEWE 917101******0005 0812*****82 04/10/2021 Sesi 3 12.00 - 14.00
4513 S-0****B35 Muhammad Rizky Farizal Alam 351508******0007 0813*****198 04/10/2021 Sesi 3 12.00 - 14.00
4514 S-1****D25 SITI BARORA SINAY 827102******0002 0821*****115 04/10/2021 Sesi 3 12.00 - 14.00
4515 S-1****257 Reza Nanta Tonny Islam 357305******0001 0896*****036 04/10/2021 Sesi 3 12.00 - 14.00
4516 S-1****B59 RUMIYATI 350713******0001 0857*****498 04/10/2021 Sesi 3 12.00 - 14.00
4517 S-2****B8F TUTIEK ADIASIH 350722******0001 0857*****882 04/10/2021 Sesi 3 12.00 - 14.00
4518 S-3****608 ABU BAKAR 357301******0001 0822*****992 04/10/2021 Sesi 3 12.00 - 14.00
4519 S-3****774 AINI LUIZAWATI 357304******0001 0877*****217 04/10/2021 Sesi 3 12.00 - 14.00
4520 S-3****6C5 ENDANG SETYAWATI 357302******0004 0822*****221 04/10/2021 Sesi 3 12.00 - 14.00
4521 S-3****524 IFA FAUZIAH 350717******0003 0858*****007 04/10/2021 Sesi 3 12.00 - 14.00
4522 S-3****EF7 AMIN NURAINI 357302******0001 0812*****94 04/10/2021 Sesi 3 12.00 - 14.00
4523 S-4****552 Supriyono 647401******0002 0812*****24 04/10/2021 Sesi 3 12.00 - 14.00
4524 S-4****C84 DARLINA ROZIAH 647402******0002 0812*****22 04/10/2021 Sesi 3 12.00 - 14.00
4525 S-4****1E1 FAUZI HAJAR 357304******0003 0856*****088 04/10/2021 Sesi 3 12.00 - 14.00
4526 S-4****B94 BOI LOPO MAKSI KASE 530201******0002 0852*****650 04/10/2021 Sesi 3 12.00 - 14.00
4527 S-5****706 Zainal Arifin 357903******0003 0821*****266 04/10/2021 Sesi 3 12.00 - 14.00
4528 S-5****1A6 Robytho Abidin 352423******0001 0857*****366 04/10/2021 Sesi 3 12.00 - 14.00
4529 S-5****185 Farhan Kalyara Attar 327313******0002 0812*****467 04/10/2021 Sesi 3 12.00 - 14.00
4530 S-5****17E SRI HARI UTAMI 357502******0001 0815*****21 04/10/2021 Sesi 3 12.00 - 14.00
4531 S-5****91C HERI MARSUDI 357304******0006 0851*****900 04/10/2021 Sesi 3 12.00 - 14.00
4532 S-6****3FD MILICHEOR RONALD ABANIT ASA 530421******0001 0812*****390 04/10/2021 Sesi 3 12.00 - 14.00
4533 S-6****EE4 Agus Efendi 351202******0004 0852*****855 04/10/2021 Sesi 3 12.00 - 14.00

Page 108 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4534 S-6****08F ANGGORO EDY SUMARSONO 351411******0001 0813*****380 04/10/2021 Sesi 3 12.00 - 14.00
4535 S-7****CC7 MARIANUS MARIO BELAWA KERAF 530705******0007 0821*****585 04/10/2021 Sesi 3 12.00 - 14.00
4536 S-7****5F0 EFFENDY 357305******0001 0813*****446 04/10/2021 Sesi 3 12.00 - 14.00
4537 S-7****B57 WAHYU HIDAYAT 350731******0001 0812*****898 04/10/2021 Sesi 3 12.00 - 14.00
4538 S-7****963 EKA SATRYO LA`LANG 732601******0001 0852*****977 04/10/2021 Sesi 3 12.00 - 14.00
4539 S-7****1D6 UJANG MANSUR 321618******0008 0813*****061 04/10/2021 Sesi 3 12.00 - 14.00
4540 S-7****81E DEBRIYANTI M KASSEH 537102******0001 0821*****390 04/10/2021 Sesi 3 12.00 - 14.00
4541 S-7****A79 JUARIAH 357903******0001 0813*****57 04/10/2021 Sesi 3 12.00 - 14.00
4542 S-9****182 Elsa Amanda 357901******0005 0895*****7901 04/10/2021 Sesi 3 12.00 - 14.00
4543 S-9****B58 NURWAHYUDI 357305******0001 0821*****324 04/10/2021 Sesi 3 12.00 - 14.00
4544 S-9****6E1 Mochamad Soleh 357301******0006 0813*****500 04/10/2021 Sesi 3 12.00 - 14.00
4545 S-9****CCB DAMANHURI 357304******0008 0838*****681 04/10/2021 Sesi 3 12.00 - 14.00
4546 S-9****449 Hafid Manggaraisyah 357305******0004 0882*****184 04/10/2021 Sesi 3 12.00 - 14.00
4547 S-A****1FB LISMIYATI 350709******0004 0851*****391 04/10/2021 Sesi 3 12.00 - 14.00
4548 S-A****166 FRENGKY MONE ADOE KADJI 530412******0003 0812*****699 04/10/2021 Sesi 3 12.00 - 14.00
4549 S-A****FE7 TRI HASTUTI 350722******0001 0821*****122 04/10/2021 Sesi 3 12.00 - 14.00
4550 S-A****DB2 LAILA CHANDRA 357302******0001 0813*****452 04/10/2021 Sesi 3 12.00 - 14.00
4551 S-B****34D Ebti Uji Rahayu SAP 351009******0003 0813*****832 04/10/2021 Sesi 3 12.00 - 14.00
4552 S-B****968 BAMBANG HARTONO 357304******0001 0812*****528 04/10/2021 Sesi 3 12.00 - 14.00
4553 S-B****8E6 PONIK 357302******0002 0899*****63 04/10/2021 Sesi 3 12.00 - 14.00
4554 S-B****4BB Juari 357305******0007 0821*****007 04/10/2021 Sesi 3 12.00 - 14.00
4555 S-C****2A1 TEGUH WIBOWO 350724******0002 0856*****599 04/10/2021 Sesi 3 12.00 - 14.00
4556 S-C****7DA ADI WIJAYANTO DWI SEBSIONO 350722******0001 0822*****057 04/10/2021 Sesi 3 12.00 - 14.00
4557 S-C****5EA MUKHAMAD IMAM SYAFEI 350724******0005 0822*****646 04/10/2021 Sesi 3 12.00 - 14.00
4558 S-D****BF4 ADI TYAWARMAN 357502******0001 0815*****21 04/10/2021 Sesi 3 12.00 - 14.00
4559 S-D****6EB SURYANI 827106******0001 0821*****032 04/10/2021 Sesi 3 12.00 - 14.00
4560 S-D****E92 M NURWAHID 357305******0002 0856*****495 04/10/2021 Sesi 3 12.00 - 14.00
4561 S-E****389 SUMARLIK 357305******0003 0821*****950 04/10/2021 Sesi 3 12.00 - 14.00
4562 S-E****EAC SUMARDI 357305******0002 0857*****563 04/10/2021 Sesi 3 12.00 - 14.00
4563 S-E****A26 MOH DJAMIL 357301******0001 0812*****984 04/10/2021 Sesi 3 12.00 - 14.00
4564 S-F****BB7 Andreas Roni Saputra 357304******0002 0822*****201 04/10/2021 Sesi 3 12.00 - 14.00
4565 S-F****13B Nifa Indah Witriana 351816******0002 0815*****99 04/10/2021 Sesi 3 12.00 - 14.00
4566 S-F****537 Imam Iskak 357301******0003 0822*****552 04/10/2021 Sesi 3 12.00 - 14.00
4567 S-F****7DD DJUWARIJAH 357302******0050 0858*****714 04/10/2021 Sesi 3 12.00 - 14.00
4568 Y-0****FKG WILOPO 357305******0004 0811*****43 04/10/2021 Sesi 3 12.00 - 14.00
4569 Y-0****M1L FEBBRY ADJI PRATAMA 357304******0005 0813*****951 04/10/2021 Sesi 3 12.00 - 14.00
4570 Y-0****03W ARYO PRAKOSO WIBOWO SSos MA 357301******0004 0812*****989 04/10/2021 Sesi 3 12.00 - 14.00
4571 Y-0****QPY MEGARA MUNANDAR 320101******0011 0823*****699 04/10/2021 Sesi 3 12.00 - 14.00
4572 Y-0****NBP WEMPHY ARI PRADHANA 357305******0002 0812*****102 04/10/2021 Sesi 3 12.00 - 14.00
4573 Y-0****ESO WIDI SUNARYANTO 357301******0003 0852*****070 04/10/2021 Sesi 3 12.00 - 14.00
4574 Y-0****LWB M IQBAL BAIHAQI 352211******0002 0813*****469 04/10/2021 Sesi 3 12.00 - 14.00
4575 Y-0****WST DANI ISWIJAYANTO 717202******0002 0821*****980 04/10/2021 Sesi 3 12.00 - 14.00

Page 109 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4576 Y-0****LXE EKSA OKTAVIAN 330302******0003 0822*****171 04/10/2021 Sesi 3 12.00 - 14.00
4577 Y-0****KCK MOCHAMMAD YUSUF EFENDI 351507******0005 0813*****180 04/10/2021 Sesi 3 12.00 - 14.00
4578 Y-0****I2A SAMSUL RUSDIONO 357301******0003 0812*****367 04/10/2021 Sesi 3 12.00 - 14.00
4579 Y-0****DXO HANIF DHIALFAIZ M 320102******0007 0815*****585 04/10/2021 Sesi 3 12.00 - 14.00
4580 Y-0****DC1 Sulistio Wahyudin Noor 357305******0006 0812*****76 04/10/2021 Sesi 3 12.00 - 14.00
4581 Y-0****WYF MUHAMMAD SANDI HUSEIN 317501******0003 0821*****680 04/10/2021 Sesi 3 12.00 - 14.00
4582 Y-0****2AV REYFAL ADITYA PUTRA PERDANA 317306******0014 0817*****53 04/10/2021 Sesi 3 12.00 - 14.00
4583 Y-0****CVS MUHAMMAD FAIZ SYAUQI 317306******0005 0812*****970 04/10/2021 Sesi 3 12.00 - 14.00
4584 Y-0****G4L LIA ARYANI 317301******0012 0857*****525 04/10/2021 Sesi 3 12.00 - 14.00
4585 Y-0****1VO AHMAD DZAKY FALAH 317405******1001 0895*****501 04/10/2021 Sesi 3 12.00 - 14.00
4586 Y-0****5R7 RAIHAN AUFIDHIA ARNAZAYE 317405******0008 0857*****111 04/10/2021 Sesi 3 12.00 - 14.00
4587 Y-0****A51 ALYA ALIVIA ABROR 317306******1001 0878*****103 04/10/2021 Sesi 3 12.00 - 14.00
4588 Y-0****2F2 TEUKU AUGIBRAN GIVARI 317507******0007 0812*****034 04/10/2021 Sesi 3 12.00 - 14.00
4589 Y-0****EB2 FATIH JUNDI ARRAHMAN 317507******0015 0857*****040 04/10/2021 Sesi 3 12.00 - 14.00
4590 Y-0****311 RR AZALIA NUR HARNANDITA S 317103******0001 0858*****417 04/10/2021 Sesi 3 12.00 - 14.00
4591 Y-0****I7F ERSTY GANESTYARA 317502******1002 0878*****893 04/10/2021 Sesi 3 12.00 - 14.00
4592 Y-0****OBX AMMAR HISYAM FAKHRUDIN 317203******0003 0859*****235 04/10/2021 Sesi 3 12.00 - 14.00
4593 Y-0****QIY MUHAMMAD AL FATIH 317104******0001 0812*****505 04/10/2021 Sesi 3 12.00 - 14.00
4594 Y-0****EVG PATRICK GERALDINE BATUBARA 317406******1002 0812*****128 04/10/2021 Sesi 3 12.00 - 14.00
4595 Y-0****H29 DANIO PRIYEL FEBRALDI PANJAITAN 317507******1001 0877*****367 04/10/2021 Sesi 3 12.00 - 14.00
4596 Y-0****U41 ALDINE SHOFWANDANI 317104******0007 0858*****993 04/10/2021 Sesi 3 12.00 - 14.00
4597 Y-0****A61 DIDAN YUSUF RAHMANDA 317503******0004 0852*****433 04/10/2021 Sesi 3 12.00 - 14.00
4598 Y-0****O1X HAIDAR PRATAMA PUTRA NAYOWAN 317103******0001 0812*****949 04/10/2021 Sesi 3 12.00 - 14.00
4599 Y-0****FN5 ARDILA HAMZA 317308******0008 0895*****537 04/10/2021 Sesi 3 12.00 - 14.00
4600 Y-0****79L PUTRI VISTA SARAH NOVITA 317506******1006 0815*****857 04/10/2021 Sesi 3 12.00 - 14.00
4601 Y-0****U7E NILLA DITARIAH 317105******1001 0812*****749 04/10/2021 Sesi 3 12.00 - 14.00
4602 Y-0****KLM RACHMAT FERDINAND SUGIONO 317503******0004 0821*****655 04/10/2021 Sesi 3 12.00 - 14.00
4603 Y-0****D3P SEKAR SERUNI ANINDYASTUTI 317503******1004 0882*****461 04/10/2021 Sesi 3 12.00 - 14.00
4604 Y-0****EUK SYIFA SALSABILA 317503******1001 0896*****660 04/10/2021 Sesi 3 12.00 - 14.00
4605 Y-0****6PF NIKEN PERMATA SARI 317407******0003 0819*****383 04/10/2021 Sesi 3 12.00 - 14.00
4606 Y-0****X0K RIZAL ARISTO FARRELIANSYAH 317508******0003 0812*****875 04/10/2021 Sesi 3 12.00 - 14.00
4607 Y-0****JPS MUHAMMAD RHAFI ALFIKHO 317408******0004 0811*****7 04/10/2021 Sesi 3 12.00 - 14.00
4608 Y-0****D26 RENDY P JALIASMAR 317407******0001 0856*****22 04/10/2021 Sesi 3 12.00 - 14.00
4609 Y-0****M0K M IQBAL MAULANA 317508******0003 0812*****260 04/10/2021 Sesi 3 12.00 - 14.00
4610 Y-0****CC6 PRISCILLA AZAHRA SAFIRA 317503******1001 0812*****986 04/10/2021 Sesi 3 12.00 - 14.00
4611 Y-0****04D SHIFA IKHTIARA PUTRI 317408******0004 0857*****299 04/10/2021 Sesi 3 12.00 - 14.00
4612 Y-0****YCC MUHAMMAD MUSTHOFA AKHYAR 317409******0005 0813*****775 04/10/2021 Sesi 3 12.00 - 14.00
4613 Y-0****EBG SYIFA NAJMI MAHIRA 317107******0002 0878*****088 04/10/2021 Sesi 3 12.00 - 14.00
4614 Y-0****GSZ ERLINE MUTIA CAHYANI 317408******0002 0812*****634 04/10/2021 Sesi 3 12.00 - 14.00
4615 Y-0****QOZ DRWURIANDARU KURNIASIH 317108******0003 0813*****390 04/10/2021 Sesi 3 12.00 - 14.00
4616 Y-0****ZF0 OSAMA YAAFI GHUFRON YUDHAGAMA 317305******0009 0812*****392 04/10/2021 Sesi 3 12.00 - 14.00
4617 Y-0****8V1 ADHA APRILIOSUSWORO 317305******0001 0812*****284 04/10/2021 Sesi 3 12.00 - 14.00

Page 110 of 111


Lokasi: Samantha Krida UB Jenis Vaksin: Aztrazaneca
Pelaksanaan vaksinasi ditutup pukul 13.30 *Gunakan fitur pencarian pada pembaca file untuk mencari data anda
NO TIKET Dosis 1 NAMA LENGKAP NIK No HP TANGGAL SESI JAM
4618 Y-0****6NH PURWITASARI 317505******0005 0857*****958 04/10/2021 Sesi 3 12.00 - 14.00
4619 Y-0****SCG MUFI HUMAIRA 317505******0001 0878*****674 04/10/2021 Sesi 3 12.00 - 14.00
4620 Y-0****N2F RAFLY AL MAHDY 317205******0001 0812*****161 04/10/2021 Sesi 3 12.00 - 14.00
4621 Y-0****0GX ADDO SATYA BASUKESTI 317404******1001 0813*****636 04/10/2021 Sesi 3 12.00 - 14.00
4622 Y-0****0GT ELDIO PUTRA DIVATAMA 317510******0004 0812*****005 04/10/2021 Sesi 3 12.00 - 14.00
4623 Y-0****NIX ALMYRA CHARMALITA 317510******0001 0812*****301 04/10/2021 Sesi 3 12.00 - 14.00
4624 Y-0****UTT MUHAMMAD FADHIL RACHMAN 317410******0002 0856*****850 04/10/2021 Sesi 3 12.00 - 14.00
4625 Y-0****V4G ABI SETIONO 317410******0003 0822*****359 04/10/2021 Sesi 3 12.00 - 14.00
4626 Y-0****ZYG ZEFANYA SATRIYA UTAMA GULTOM 357808******0003 0877*****645 04/10/2021 Sesi 3 12.00 - 14.00
4627 Y-0****XVB ARVENDO RAFFEL SENDY PRATAMA 351709******0002 0858*****256 04/10/2021 Sesi 3 12.00 - 14.00
4628 Y-0****NKM IWANG ADI PRASETYO 352208******0001 0878*****722 04/10/2021 Sesi 3 12.00 - 14.00
4629 Y-0****F6D FERRY SETIYAWAN 351510******0003 0857*****146 04/10/2021 Sesi 3 12.00 - 14.00
4630 Y-0****F08 MASHITA 351508******0008 0813*****821 04/10/2021 Sesi 3 12.00 - 14.00
4631 Y-0****FDZ HILARIUS YOSEF SIKONE 530304******0001 0812*****839 04/10/2021 Sesi 3 12.00 - 14.00
4632 Y-0****4Q7 DWI NUR CAHYONO 352422******0003 0878*****009 04/10/2021 Sesi 3 12.00 - 14.00
4633 Y-0****MRI NIMAS MAYANG SABRINA S 350710******0001 0813*****626 04/10/2021 Sesi 3 12.00 - 14.00
4634 Y-0****BK5 FARIDATUL LAILY 350903******0001 0822*****654 04/10/2021 Sesi 3 12.00 - 14.00
4635 Z-A****978 NOENIEK WIDJI ASTOETI 357301******0001 0813*****151 04/10/2021 Sesi 3 12.00 - 14.00

Jika Bapak/Ibu telah memperoleh vaksinasi dosis 1 pada 6-9 Agustus 2021 di gedung Samantha Krida UB dan belum masuk daftar ini dapat langsung hadir
Mengingat ada kemungkinan kesamaan nama, mohon cek nomor tiket pada tabel ini dan sesuaikan dengan kartu yang telah diterima pada pendaftaran pertama

Peserta Vaksinasi diwajibkan untuk :


1. Membawa KTP atau fotocopy KTP
2. Membawa e-ticket bagi yang memiliki
3. Memakai pakaian longgar dan rapi, makan pagi terlebih dahulu, istirahat yang cukup sebelum pelaksanaan vaksin
4. Tetap menjalankan protokol kesehatan 6M :
- Memakai masker dobel dan tidak membuka masker selama pelaksanaan dan berada di lokasi vaksin
- Mencuci tangan pakai sabun dan air mengalir,
- Menjaga jarak, Menjauhi kerumunan, Menghindari makan minum bersama
- Membatasi mobilisasi dan interaksi; sebelum, selama menunggu dan setelah pemberian vaksin'
5. Membawa surat Rekomendasi Dokter (jika membutuhkan)
6. Khusus untuk peserta dengan hipertensi (tekanan darah tinggi) batas diperbolehkan vaksin 180/100. Peserta akan diperiksa tekanan darah 2x, jika masih tinggi akan kami arahkan tunda vaksinasi dan periksa ke
fasilitas kesehatan sesuai rekomendasi ahli jantung pembuluh darah
Untuk info lebih lanjut kunjungi https://ruvid.ub.ac.id/vaksinasi

Page 111 of 111

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