Form Penugasan RR Imunisasi Covid19 - v2

Nama Puskesmas/Jejaring : Puskesmas Tino
Kabupaten/Kota : Jeneponto
Provinsi : Sulawesi selatan
Nama Penerima Jenis

No No. Registrasi NIK
Vaksin Kelamin
Rika P
3 7304115800797000
Kurniasty Qalby L
16 7304055308820000
Rosdiana M P
17 7304115001900001
H.salamuddin,SKM L
29 7304111508680001
32 7303026009840004 Pusparini P
Yuliati L
34 7304114309880002
Mahyuni P
38 7304086804940003
Rahmi Nurfajri P
39 7305055005950001
Nurmalasari P
40 7303045207960002
Kartini P
43 7304115905830003
45 7304110708880001 Kasmang L
Kasmawati P
47 7304096905880002
49 7303065212840001 Harmawati P
52 7304117006960001 Puji Astuti P
Kurnia agus P
53 7304114101970002
Nurhayana P
55 7304075305870001
Haris L
60
Asdar L
61 9204011905881000
Bora L
62 7304111011480001
Putri P
63 7304115812020002
P
64 7304116002030002 Sumrani
Rani L
65 7304043112760025l
Ramang L
66 7304113112500030
Duda L
67
Mas'ud L
68 7304113117560022
Swandi L
69 7304111208210002
Abd.Rahman L
70 7304112209700001
Ramli.N L
71 7304113112700064
Tika amalia P
72 7304116507000002
Suleman L
73 7304113112770043
Hadawia P
74 7304114505690002
P
75 7304114112990002 Hasmilah
Hading L
76 73041113112640012
Kasmi P
77 730411711840004
Safaruddin L
78 7304110506760001
Muh saleh L
79 7304111202920001
Muhammad L
80 7304113112670021
Nurbaya P
81 7304174303700001
Nurhidaya P
82 73041164039030001
Nur Asri L
83 7304110809950002
Nurul khairunisa P
84 7304116707990001
Nurmi P
85 7304115203830001
Jusman L
86 7304110507840002
Yusril us hendra L
88 7304111911950001
89
90
Keterangan **Komorbid: ***Merek Vaksin

* Pekerjaan dikelompokkan menjadi: 1= Hipertensi 1 = Sinopharm
1 = Petugas Medis dan Non Medis di Fasilitas Pelayan 2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang berhadapan langs 3= Penyakit Jantung 3 = Lainnya (Mohon disebu
3 = Administrator Pemerintahan 4= Penyakit Ginjal
4 = Lainnya 5= Penyakit Paru Kronis
5 = Tidak Bekerja 6=Lainnya
Kelompok Umur:
18-30 38
31-45 33
46-59 14
Total 85
Pekerjaan:
1 59
2 1
3 0
4 26
5 0
Total 86
FORMAT PENCATATAN PELAKSANAAN IMUNISAS
TINGKAT PUSKESMAS/JEJAR
Kepesertaan BPJS (tulis 'Ya'

pada kolom yang sesuai)
Umur
Pekerjaan Kelompok
(18-59 Alamat No. Hp
* Umur
tahun)
BPJS
BPJS PBI
Non PBI
1 23 18-30 Sepe Ya
1 28 18-30 Tino Ya
1 28 18-30 Ujung Ya
1 53 46-59 Balangloe Ya
11 36 31-45 Tino Ya
1 33 31-45 Balbar Ya
1 27 18 Tino Ya
1 26 18-30 Balangloe Ya
1 25 18-30 Bantaeng Ya
1 37 31-45 Balbar Ya
1 33 31-45 Pao Ya
1 33 31-45 Arungkeke Ya
1 36 31-45 Tino Ya
1 25 18-30 Tarowang Ya
1 24 18-30 Tarowang Ya
1 34 Rani Lingrungloe Ya
1 24 18-30 Tino Ya
4 32 31-45 sepe 081344043322
4 72 46-59 Camba lompoa 082346211451
4 18 18-30 Sepe 082347119715
4 18 18-30 Sepe 085342556958
4 44 31-45 bonto manai 082399229798

4 70 46-59 Camba lompoa 085255937863
4 48 46-59 Bonto manai 081340524356
4 54 46-59 Sepe 085342556958
4 49 46-59 bonto manai 082399229798
4 50 46-59 ra'ra 085343993816
4 50 46-59 Camba lompoa 082193613655
4 20 18-30 ra'ra 081241441379
4 43 31-45 bonto masugi 082340141194
4 41 31-45 Bonto manai 082399267268
4 21 18-30 Bonto manai 082399267268
4 56 46-59 Bonto masugi 085255806805
4 36 31-45 Bonto masugi 087346770165
4 44 46-59 Bonto masugi 081330258685
4 29 18-30 Bonto masugi 085395823565
4 53 46-59 Bonto masugi 082336169043
4 41 31-45 Bonto baru 081355476823
4 28 18-30 Camba lompoa 082346704408

2 25 18-30 Camba lompoa 082352029654
4 21 18-30 Camba lompoa 08234807237
4 38 31-45 Bonto masugi 082290252132
4 36 31-45 Bonto masugi 082348449157
4 25 18-30 Bonto masugi 085256194761
**Merek Vaksin
= Sinopharm
= Sinovac
= Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
Kepesertaan BPJS Pekerjaan

BPJS PBI 18 1 59
BPJS Non PB 42 2 1
Non Anggot 0 3 0
Total 60 4 26
Pemberian Dosis 5 0
Dosis 1 73 Total 86
Dosis 2 45 Komorbid
Total 1 0
2 0
3 0
4 0
5 0
6 0
Tidak ada 61
Total 0
AN IMUNISASI COVID-19
ESMAS/JEJARING
an BPJS (tulis 'Ya' Tanggal Pemberian

Komorbid** No. Batch
om yang sesuai) Imunisasi
Merek
Ada Vaksin***
Non (sebutkan Tidak Ada
Dosis I Dosis II Dosis I
Anggota komorbidn (centang)
ya)
v Sinovac
v Sinovac
v Sinovac
v Sinovac 202009009 202009009
v Sinovac 202009009 202009009 2/5/2021

v Sinovac
v Sinovac
v Sinovac
v Sinovac
v Sinovac
v Sinovac 202009009 202009009 2/5/2021
v Sinovac
v Sinovac 202009009 202009009 2/5/2021
v Sinovac 202009009 202009009 2/5/2021
v Sinovac
v Sinovac
v Sinovac 202009009 202009009
v sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
sinovac 24001921 4/27/2021
2-Feb 1 47
3-Feb 23
4
anggal Pemberian
Imunisasi
Keterangan
(Contoh: Ditunda/Dirujuk/….)
Dosis 2
Tunda(3 Bulan Ke depan)
Tunda
Tidak Diberikan Alergi Obat
2/16/2021 Dosis 1 DiPkm Bonto Sunggu Kota
2/20/2021
Tunda 3 bulan kedepan
Tidak Diberikan Reumatik
Tunda Hamil
Tunda Hamil
2/22/2021
Tunda 3 bulan Kedepan
2/19/2021
2/20/2021
Tunda Hamil
Tunda 3 bulan ke depan

11 9
45 14 13
2 org tdk diberikan 47 45
2 org dosis ke 2
10 org tunda
1 org dosis ke 2 sakit flu
15 dosis 2
11 dosis 1
Nama Puskesmas/Jejaring
Kabupaten/Kota
Provinsi
No No. Registrasi NIK
1 7304110107570018
2 7304114111870001
3 7304113112790040
4 7304110411760001
5 7304114505520005
6 7304110203780002
7 73041131128120046
8 7304110102660001
9 7304117112690244
10 7304110101880008
11 7304116112770002
12 7304110107850098
13 7304114206810001
14 7304116509980001
15 7304117112020013
16 7304117112770037
17 7304114107820004
18 7304113112560035
19 7304117112760058
20 7304110107800005
21 7304115312750002
22 7304114107790048
23 7304114107760053
24 7304112205700003
25 7304103112850339
26 7304114707860001
27 7303051610950001
28 7304117112810043
29 7304114912010001
30 7304116005020002
31 7304113012640001
32 7304117112740026
33 7304117112800037
34 7304117112720029
35 7304114306000001
36 7304114503020001
37 7304113112810033
38 7304112102860002
39 7304112211930001
40 7304113112690024
41 7304112311010001
42 7304114202930001
43 7304113112560032
44 7304113112590021
45 7304115607840001
46 7304111104990002
47 7304114107800083
48 7304117112760005
49 7304113112760036
50 7304114107790035
51 7304116211010001
52 7304114506030002
53 7304117112710043
54 7304110506750001
55 7304114505770002
56 730411560684002
57 730411711810052
58 73071103112860117
59 7304031110900002
60 7304086312960004
61 7304114107840020
62 7304112506940001
63 7304110503960002
64 6474012202340002
65 7304114903580002
66 7304110912620001
67 7304112004650001
68 7304115010680001
69 7304114804880001
70 7304117112860041
71 7304116112860002
72 7304115503590001
73 7304115203810001
74 7304117112550044
75 7304116004710001
76 7304116006800001
77 7304110203740003
78 7304116709800001
79 7304117112600049
80 7304115606800001
81 7304117006500001
82 7304115205760002
83 7304114605710001
84 7304113003620002
85 7304115010690001
86 7304117112550024
87 7304110203800002
88 7304117112790038
89 7304115010820003
90 7304116509740003
91 7304113112530018
92 7304111003970002
93 7304111911950001
94 7304110304780002
95 7304115811980002
96 7304117112800038
97 7304117112830031
98 7304114107820010
99 7304117112780036
100 7304113112840032
101 7304113112570005
102 7304115509720000
103 7304110107570010
104 7304114107590008
105 7304116109720002
106 7304114103880004
107 7304115107770001
108 7304115003880001
109 7304116606020005
110 7304110107900061
111 7304115209750001
112 7304111504740002
113 7304111707660002
114 7304114805580001
115 7304116606020001
116 7304117112640020
117 7304113112560033
118 7304117005030001
119 7304114606820002
120 7304114101970002
121 7303016807940001
122 7304047112760274
123 7304113112960024
124 7304035107976004
125 7304117112450018
126 7304115004020001
127 7304114205770002
128 7304110701800001
129 7304111008490001
130 7304040203550001
131 7304117112730031
132 7304114203740001
133 7304115111810002
134 730411420740001
135 7304116312760001
136 7304115510800002
137 7303045207960002
138 7304117112600048
139 7304112802020002
140 7304115210830001
141 7304114505780001
142 7304112109850002
143 7304117105830001
144 7304115511660001
145 7304112112640001
146 7401044404830005
147 7304113112860041
148 7304117112650007
149 7304113112680004
150 7304115405880002
151 7304115412940001
152 7304116512850001
153 7304110107850079
154 7304116509860001
155 7304111201030000
156 7304117112750042
157 7304112603030002
158 7304114107840035
159 7304112606610001
160 7304114303880002
161 7304113112590016
162 7304110112660001
163 7304117112620028
164 7304114210690001
165 7304117112710039
166 7304114107460011
167 7304114511800002
168 7304114305810004
169 7304113112820045
170 7304113112740020
171 7303077112820008
172 7303011210740002
173 7304111712760001
174 7304113101930001
175 7304116011020003
176 7304114811000001
177 7304113112640023
178 7304114506600002
179 671042703850006
180 7304117112620018
181 7304117010980001
182 7304114409980001
183 7304110201030003
184 7304110107600031
185 730411106780001
186 7304114506750004
187 7304115604850001
188 7304117112850041
189 7303086603880002
190 7304116706850002
191 7304117112950016
192 6472061504770003
193 7304112812770002
194 7304106503950001
195 7304117112570020
196 730411711260050
197 7304113004750001
198 7304116202800001
199 7304115301000001
200 7304114203760001
201 7304113112840060
202 7303081605870002
203 7304117112710019
204 7304113112690010
205 7304113112810055
206 7304114701740001
207 7304117112640025
208 7304116707690001
209 7304046505570001
210 7304114508560001
211 7304114107890020
212 730705711262
213 7304114609980002
214 7304113112700032
215 7304110909020002
216 730411010840005
217 7307055707000005
218 7304113112820049
219 7304117112740043
220 73041155110730001
221 7303054710000003
222 7304117112700041
223 7304116403830002
224 7304117112800034
225 7304112105020001
226 7304117112820071
227 7304110507810002
228 7304117112810038
229 7304115509030001
230 7304114404030001
231 7304114607800002
232 7304115205010002
233 7304111505700002
234 7304116312990001
235 7304113112690045
236 7304113112760939
237 7304117112590017
238 7304114107580019
239 7304117112810036
240 7304110202520001
241 7304111012560001
242 7304117112560033
243 7304114107570024
244 7304114102780003
245 7304113112750046
246 7304113112890027
247 7304111610940002
248 7304111411970001
249 7304116507660001
250 7304115501700001
251 7304114501860001
252 7304114102780001
253 7304113112600075
254 7304113112640022
255 7304115102740001
256 7304116004980001
257 7304117112770027
258 7304112203710001
259 7304117112710040
260 7304113112780010
261 7304114100780003
262 731314410442000
263 720407305950003
264 7304111202010002
265 7304110707020002
266 7304116306840001
267 7306104107930105
268 7304117112770019
269 7304114107930028
270 7304113112800046
271 7304116012820001
272 7304110503970001
273 7303080505960003
274 7304113112710040
275 7304110101950001
276 7304110102670001
277 7304117112720030
278 7304112004990004
279 7304111312020001
280 7304113112790003
281 7304110107800060
282 7304113112680019
283 7304110905680001
284 73041170129300001
285 7304111903840001
286 73041171126500039
287 7304114604800003
288 7304114107800089
289 7304114912840001
290 7304115512000001
291 7304111501720001
292 7304116712760002
293 7304110907920001
294 7304113112670035
295 7304115904890001
296 7304113112750051
297 7304115105710001
298 7304110908840001
299 7304114302990001
300 7304112404960002
301 7304115507810002
302 7304110512770001
303 7304115108980001
304 7304114905800001
305 7304115812950001
306 7304114712580001
307 7304116204940001
308 7304113112830034
309 7304110905730001
310 7304113112670037
311 7304117112770023
312 7304117112550015
313 7304113112580015
314 7304113112760038
315 7304115205920002
316 7304116905650001
317 7304044107650022
318 7304110710020001
319 7304045011780001
320 730408508860010
321 7304113112610035
322 730305410790010
323 7304112710990002
324 7304112505030002
325 7304111602010001
326 7304116909970002
327 7304113112830032
328 7304112201920001
329 7304113112550013
330 7304045211840001
331 7304113112810036
332 7304115707980001
333 7304044107780002
334 7304117112790027
335 7304041506730002
336 7304044501810001
337 7304117112840012
338 7304111503820003
339 7304117012610001
340 7304114107030001
341 7304117112600070
342 7304111504760001
343 7304114708500001
344 7304116007600001
345 730411410160003
346 7304114507780004
347 2102050807700001
348 7304110303990004
349 7304110408790001
350 7304117007010001
351 7304110610020001
352 7304114204820001
353 7304117108670001
354 7304115707020002
355 7304111109760002
356 7304110105950001
357 7304117004020002
358 73040410760018
359 7304113112840065
360 7304110107590006
361 7304117112860066
362 31720305018300223
363 7304113112820030
364 7304117112840019
365 7304117112780033
366 7304113112790029
367 7304114912920001
368 7304113112610046
369 7304111305870001
370 7308084101700004
371 7304114107720028
372 7304110107970037
373 7304114809670001
374 7304040701780001
375 73041127020330002
376 7304114306890002
377 7304113112700061
378 7304114107720035
379 7304110606800001
380 7304114107450023
381 7304113012530001
382 7308080103600001
383 7304031003010003
384 7304110205730002
385 7304111005910001
386 7304112604860002
387 73070054202020007
388 6402131706520001
389 7304115110730004
390 6472051809790005
391 7304040107090003
392 7304116909020004
393 7303016412940004
394 7304114506820001
395 7303080701850004
396 7303087105900002
397 7304116408990001
398 7304115708800002
399 7304113112650028
400 7304114511950001
401 7304115210810001
402 7304110107790060
403 7304117112570019
404 7304114107870003
405 7304116808790001
406 7371077112740096
407 7304114106760004
408 7304110502690001
409 7304114111690001
410 7304117007720001
411 7304110304980001
412 7304114107790037
413 7304110107760018
414 7304110107830042
415 7304115109800001
416 7304111507830002
417 3604101107900328
418 7304117112860037
419 7371064505780006
420 7304114107880048
421 7304117112820046
422 7304117112820045
423 7304115802800002
424 7303054107820559
425 7303053112850089
426 6402130811900002
427 7304115010950005
428 7303014404760004
429 7304113112700060
430 7304112401860001
431 7304115504710002
432 7304117101870001
433 7304114102750005
434 7304114107760032
435 7304115802000002
436 7304116712990001
437 7304040501760004
438 73041147112830027
439 7303054203870006
440 7304113112840048
441 7304110802840001
442 7304115007870007
443 7304080501930001
444 7304114102720001
445 7304110107380002
446 7304114402860002
447 7304114107920028
448 7304116510910002
449 7304116310770002
450 7304113112750050
451 7304116011730001
452 7304116308010001
453 7304111209720001
454 7304117112820057
455 7304117112020008
456 7304117112820047
457 7304111903770002
458 7304114711840002
459 7304030509750002
460 7471045007900003
461 7304114205750001
462 7304114107880037
463 7304111001890001
464 7304114102880006
465 7304113112790035
466 7304111212730002
467 7304117112830032
468 7304115306990002
469 7304110107830028
470 7304117112800039
471 7304114107840036
472 7304113112790031
473 7303026307010004
474 7303025804710003
475 7304111908810001
476 7304111512020001
477 7304116001770001
478 7304110509740001
479 7304110303710006
480 7304114107790009
481 7304116909760003
482 7304117112700042
483 7304113112720035
484 7304113112570009
485 7304113112610047
486 7304117112590021
487 7303017112520020
488 7304114411000001
489 7304117112660022
490 7304114712680001
491 7304110107790061
492 7304115502890002
493 7304110504770005
494 7304114304690001
495 7304114107930034
496 7304114502810004
497 7304116810850002
498 6406021611710001
499 6406024612790001
500 7304116505930001
501 7304044102850008
502 7304114705980002
503 7304110107600055
504 7304113010840002
505 7371012101700002
506 7304115803850001
507 7304110102770004
508 7304113005910001
509 7304112202750001
510 7304114805840002
511 7304110506740001
512 7304111204010001
513 7304110704990001
514 7304110102640003
515 7304111203850002
516 7304114107870043
517 7304114804910001
518 7304113112840068
519 7304117112830027
520 7304115405950001
521
522 7304115211910001
523 7304111803870002
524 7304115601690001
525 7304113112640008
526 7304117112640009
527 7304110308020005
528 7304115107990003
529 7304110107790032
530 7304110107760040
531 7304114107710015
532 7304114107990004
533 7304110107900060
534 7304110909590002
535 7303044501800003
536 7304114407970006
537 7304116809980001
538 7303017112020009
539 7304116706800005
540 7304115801010002
541 7304115509830001
542 7304114704040002
543 7304116303040002
544 7372031708810002
545 7304114107850001
546 7304113112750041
547 73041140405970001
548 7304112806030002
549 7304113003620002
550 7371111806800008
551 7304111112010001
552 7304116006950001
553 7304112002990001
554 7304116310820001
555 7304040704910001
556 7304110805000002
557 7304114402860001
558 7304117112840037
559 7304112505850001
560 7304112204950001
561 7304114402860001
562 7304114107700052
563 7304116915290001
564 7304110106860001
565 7304111507700001
566 7304115005020001
567 7303084711830001
568 7303014107820356
569 7304114107890027
570 7304115507990001
571 7304113001990001
572 7304114203700003
573 7304052210950001
574 73041100707970002
575 7304114309990001
576 7304110107790006
577 7304115802860001
578 7304111704700001
579 7304034106860004
580 7304115902020002
581 7304112209700001
582 7304111708500002
583 7304115405880002
584 7304115304950001
585 7304116412746002
586 7304112302600002
587 730403420360003
588 7304117107400005
589 7304116707790002
590 7304114112990003
591 7304110810700001
592 7304110107820005
593 7304116106820002
594 7304116404770001
595 7304091905900003
596 7304114107860009
597 730411450780003
598 7171085603820002
599 7304116811280001
600 7304114305950001
601 7304117112880024
602 7304117112730052
603 730411206700001
604 73720335003760005
605 7304113112820059
606 7304117112850046
607 7304116003730001
608 7304115009900002
609 7304112412830001
610 7304111107890001
611 7304114802020001
612 7304115002750004
613 7171082403080001
614 7304110101580002
615 7304113112800049
616 7304110107970028
617 7304043112790350
618 7304114107780042
619 7304114107890004
620 7304114508750001
621 7304117112830017
622 7304114107800084
623 7304114107800087
624 7304117112920002
625 7304116105830005
626 7304115506800001
627 7304054503920001
628 7304114506820003
629 7304114107600010
630 7304112007950002
631 7304113112650006
632 7304114709880001
633 7303054312970001
634 7304112110660001
635 76060166069770001
636 7304111010820002
637 7304114305840001
638 7304110610020002
639 7302084704950002
640 7304111708750004
641 7304110205000001
642 730411170750001
643 7304111302040001
644 7304115502770001
645 7304115102010001
646 7304115708930001
647 7304115002930002
648 7303012205900001
649 7304117112780030
650 7304116607030002
651 730411650480001
652 7304113112800068
653 7304114507990003
654 7304115101980001
655 7304114705860005
656 7304111511960002
657 7304117112800013
658 7304112501940003
659 7304111212950002
660 7311024101960004
661 7304117112870035
662 7304116006980002
663 7304115004750001
664 7304113112900030
665 7304115003890003
666 7304114704880001
667 7304112504940003
668 7304110107720017
669 7304114712990001
670 7304115210590001
671 7304115705900001
672 7304111303800001
673 7303015504870002
674 7304110909850001
675 7304112012940001
676 7304113006930001
677 730411230900002
678 7304116506010002
679 7304115612940001
680 7304110107710005
681 7304111012890003
682 7304117112890028
683 7304114107950030
684 7304116606960002
685 7271042906670001
686 7303010203000004
687 7304112307950001
688 7304114906010001
689 7304111707540001
690 7304111304770001
691 7602010210740001
692 7304113112920023
693 730411250600002
694 5316017112850007
695 7304116611810001
696 7304115412890002
697 7304115808990001
698 7304114512950001
699 7304115205870002
700 7304117112800010
701 7304117112690215
702 7304116511990003
703 7304116201010001
704 7304117112800008
705 7304114505740001
706 7304111102040002
707 7372030507690004
708 7304115401030001
709 7304113112670025
710 7304115206980002
711 7304041110970001
712 7306074104790006
713 7304115809730001
714 7304114107500030
715 7304114507710002
716 7304110809680001
717 7304111006680001
718 7304043112630014
719 7304110506790003
720 7304114107550024
721 7304115008600003
722 7304111002920001
723 7304042905020001
724 7304110308020004
725 7304117112650018
726 7304114107760037
727 7304113112470016
728 7304114508710001
729 7304110805580001
730 7304114112900003
731 7304115503890003
732 7302016311840002
733 7304115803860001
734 7304110107730024
735 7304114107900004
736 7304114501820001
737 7304117101020001
738 6402046001880002
739 7304112612030001
740 7304110510940002
741 7304044109030003
742 7304111602790002
743 7304114702700001
744 7304116205770001
745 7304090303950001
746 7304110101880003
747 7304114703750001
748 7304116904980001
749 7304110112700001
750 7304114403850001
751 7304115802770001
752 7304111509780001
753 7303012102870002
754 7303011904950001
755 7304111404770001
756 7306070711710004
757 7304115504750002
758 7303013006660001
759 7304116703950001
760 7304112002040002
761 7304071912960001
762 7304110108010002
763 7304111603000001
764 7304113112650029
765 7304110512540002
766 7304113112730031
767 7304111011750001
768 73040402125500
769 7306086610980002
770 7304114202830001
771 7305076401790001
772 7304114107780029
773 7304111605830001
774 7304114303860002
775 7304116201830001
776 7304115504040001
777 7304114301850001
778 7304117112720013
779 7304117112920011
780 7304117004010001
781 7304115111010002
782 7304117112940030
783 7304117112870014
784 7304116507850001
785 7304115806820002
786 7304112003800001
787 7304110107660018
788 7304112806810002
789 5206074102031008
790 5206074208011002
791 7304113101560002
792 7304117112810067
793 7304116410000001
794 7304114204790001
795 7304116805720001
796 7304115005790004
797 7304110605820001
798 7304114107760039
799 7304112003860002
800 7304116507000003
801 7304116010920002
802 7304043112810028
803 6471021004830005
804 7304043112630009
805 7304115004840001
806 7304116002710001
807 7304114511940003
808 7304115106860001
809 7304115105820001
810 7304111205920001
811 7304115008820002
812 7304111203870001
813 7304114107690026
814 7304116503880002
815 7305011010780002
816 7304112510010001
817 7304116610740001
818 7303010405890003
819 7304117112000007
820 7304114601800001
821 7304040110910001
822 7304110205820001
823 7304112512730002
824 7304114502730001
825 7304110510850001
826 7304114606860003
827 73041142027440001
828 7304115108930001
829 7304114202930001
830 7304111707660002
831 7304113112590021
832 6405011704780001
833 6405014302780002
834 7304115605730002
835 7304110107570010
836 7304114107590008
837 6474012202340002
838 7304114107840020
839 7304113112690024
840 7304112203710001
841 7304113112760939
842 7304112506940001
843 7304113112560032
844 7304117112810043
845 7304114506030002
846 6471042703850006
847 7304117112830031
848 7304114107820010
849 7304110107600031
850 7304116007600001
851 7304112311010001
852 7304113112530018
853 7304117112550024
854 7304114107800083
855 7304111411970001
856 7304115412940001
857 7304113012640001
858 7304113112560030
859 7304117006500001
860 7304114107790035
861 7304115111780001
862 7304114505520001
863 7304110201030003
864 7304114409980001
865 7304117005030001
866 7304117112780036
867 7304115811980002
868 7304106503950001
869 7304117112860041
870 7304114107890029
871 7304111003970002
872 7304117112800038
873 73040468079970001
874 7304114604800003
875 7307057112620266
876 7307055707000005
877 730411410746001
878 7304116011020003
879 7304115004020001
880 7304040203550001
881 7304114101970002
882 7304113112690010
883 7304116312990001
884 7304114305810004
885 7371103112860117
886 7304114903580002
887 730411620280001
888 6405020701680002
889 7304110202520001
890 7304117112570020
891 7304110909020001
892 7304114508560001
893 7304114203500002
894 7304110405970003
895 7304113112790030
896 7304115410700001
897 7304111505750003
898 7304112802700001
899 7304114107800103
900 7304115608020003
901 7304113112640009
902 7304112105730001
903 7304114211990001
904 7304114208780001
905 730411441170002
906 7304114304550002
907 7304110101530002
908 7303054107970304
909 7304115010030001
910 7303013112840008
911 7304114112890001
912 7304114411050001
913 7304115805020001
914 7304110105030002
915 7304110107570017
916 7304111505030003
917 7304112312920001
918 7304110404950002
919 7304110107700003
920 730313112700056
921 7304110909590001
922 7304117112610035
923 7304116101870001
924 7304110102780003
925 7304116211010001
926 7304117112800037
927
928
Keterangan
* Pekerjaan dikelompokkan menjadi:
1 = Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan
2 = Petugas pelayanan publik yang berhadapan langsung dengan m
3 = Administrator Pemerintahan
4 = Lainnya
5 = Tidak Bekerja
Kelompok Umur:
18-30
31-45
46-59
Total
Pekerjaan:
1
2
3
4
5
Total
FORMAT PENCAT
: Puskesmas Tino
: Jeneponto
: Sulawesi Selatan
Jenis Umur Kelompok

Nama Penerima Vaksin Pekerjaan*
Kelamin (18-59 tahun) Umur
MUH SALEH MONCONG L 63 0

ERNAWATI P 33 31-45
RURUNG L 41 31-45
HASAN PANCE L 53 46-59
HASNAH P 68 0
BAKRI L 42 31-45
SAHARUDDIN L 38 31-45
SANE LIWANG L 54 46-59
TIMA P 51 46-59
SUHARDI L 32 31-45
SANNIA P 44 31-45
YUSUF L 36 31-45
RAHMA P 39 31-45
ELVI SUKAESIH P 25 18-30
RAHMAWATI P 25 18-30
MAISA P 43 31-45
YANTI P 39 31-45
MUH DUDA L 66 0
SIA P 44 31-45
YONGKI L 40 31-45
BUNGASIA P 46 46-59
TUNI P 41 31-45
TATI P 44 31-45
RABAINANG P 50 46-59
SUARDI L 36 31-45
MARDIANA P 34 31-45
PANDI L 25 18-30
DARMI P 39 31-45
SRI HARINA P 20 18-30
SRI WAHYUNI P 19 18-30
HAKIM L 56 46-59
SUBAEDA P 46 46-59
SUMIATI P 30 18-30
HAWIAH P 49 46-59
DEWI SINTA P 21 18-30
IRMA P 19 18-30
BAHA L 39 31-45
BAKHTIAR L 34 31-45
FAISAL L 27 18-30
SAKA L 51 46-59
SAHRUL L 20 18-30
ISMAINAR P 27 18-30
SALAMING L 64 0
SARASANG ALLE L 61 0
DADA' P 36 31-45
SAENAL K L 21 18-30
SARI P 30 18-30
NURSIA P 44 31-45
ABD SAMID L 44 31-45
SURIATI P 41 31-45
NURUL MUTMAINNA P 20 18-30
AIRA ALFIRA P 18 18-30
HASNAH P 39 31-45
HAMALI L 45 31-45
MULIATI P 43 31-45
ROMBA P 36 31-45
TURIAH P 39 31-45
SABRIANTO L 34 31-45
DEDY KURNIADI L 30 18-30
ANNISA P 24 18-30
rosmawati P 37 31-45
MUHAMMAD AKRAM L 19 18-30
NASRUN L 46 46-59
TUMBA RAJAB L 87 0
ST MARWAH KR INTANG P 62 0
ILHAM MINDAR L 58 46-59
ALES L 55 46-59
PUJI DG NGAI P 52 46-59
DIANA P 32 31-45
HASNA P 34 31-45
NURLIA P 34 31-45
SAENAB P 62 0
IRNAWATI P 33 31-45
NURBIA P 65 0
SUBAEDA P 50 46-59
AHRIANI P 30 18-30
ANWAR JAYA L 46 46-59
AISYAH P 40 31-45
MITTI P 50 46-59
SAHRA P 30 18-30
LEBONG P 71 0
HASNAWIAH P 45 31-45
IDA SIKKI P 40 31-45
RAMALAN L 57 46-59
JUHRA P 51 46-59
NAHARIA P 65 0
RIDWAN L 37 31-45
ENNIATI P 41 31-45
MARNI P 38 31-45
NURMAH P 46 46-59
BUNGANNIA P 67 0
SAHRUL GUNAWAN L 23 18-30
Yusril Yus hendra L 56 46-59
M SAID L 42 31-45
RISNAWATI P 22 18-30
INTANG P 30 18-30
SANGSI P 37 31-45
ROSTINA P 42 31-45
RAHMAN L 36 31-45
BADO L 63 0
HERAWATI P 47 46-59
ILYAS NAKKU L 63 0
BINARUNG P 61 0
HAMSINA P 48 46-59
NAHARIAH P 33 31-45
KAMI P 43 31-45
YASNI P 33 31-45
KASMIYANTI P 19 18-30
SAMA L 30 18-30
SUMIYATI P 45 31-45
HANAPI L 47 46-59
MUSAKKIR L 54 46-59
KUASA P 63 0
ASMILA SRI WAHYUNI P 19 18-30
ROSMA P 56 46-59
SUTOMO L 64 0
MAULIAH AL AYUMI P 18 18-30
HASNA P 39 31-45
KURNIA AGUS P 23 18-30
YULI FARIDA ISMAR P 27 18-30
NERA P 45 31-45
AMIRUDDIN L 28 18-30
SRI NENGSIH TAWANG P 24 18-30
MONE P 76 0
ROHANI P 19 18-30
HUSNIA P 44 31-45
M AIDIL SIKKI L 40 31-45
SAMPARA GASSING L 72 0
HARIS L 66 0
SYAMSIAH P 49 46-59
SUDARNI P 46 46-59
SURIANI P 39 31-45
SUADA P 47 46-59
HASBIAH P 45 31-45
NURHAYATI P 40 31-45
NURMALASARI P 24 18-30
RAMUNG L 61 0
MUHAMMAD ISHAK L 19 18-30
MULIANI P 37 31-45
RAHMATIA P 39 31-45
SARIFUDDIN L 36 31-45
NURBAYAH P 37 31-45
NABA P 55 46-59
MASSIRI P 56 46-59
ROSMALA P 38 31-45
BAHARUDDIN L 34 31-45
KARE P 65 0
H. YARASA L 63 0
SRI HASTUTI P 33 31-45
BASMA P 26 18-30
RISMA P 35 31-45
JUPRI L 37 31-45
DARWIN L 18 18-30
RABA P 45 31-45
HERLIN P 21 18-30
ROSNIAH P 37 31-45
DONGKO L 60 0
HASNI P 37 31-45
H.SAPPARA L 61 0
AMIR P 45 31-45
SURI P 39 31-45
HANIA P 51 46-59
KEBE P 50 46-59
SAINTANG P 74 0
SAHARI P 41 31-45
IRAWATI P 40 31-45
SANGKALA L 38 31-45
JAPA. B L 47 46-59
HARIANTI P 38 31-45
LALLO D L 47 46-59
EDI L 44 31-45
NURSALAM L 28 18-30
KARMILA P 18 18-30
MURNIATI P 21 18-30
KADERE P 56 46-59
RABATIA P 61 0
SYUKUR P 36 31-45
CORA P 58 46-59
MIFTAHUL JANNAH P 22 18-30
RISKA DEWIYANTI P 23 18-30
ISDAR ARIYANTO S L 18 18-30
ALIMUDDIN L 50 46-59
ABD. WAHID L 42 31-45
NURAENI P 46 46-59
WATI.K P 38 31-45
DARMAWATI P 35 31-45
ISMARIANTI P 33 31-45
LINA P 37 31-45
DARMI P 25 18-30
AHMAD RIYADI L 53 46-59
BAHA. D L 40 31-45
SUMARNI P 26 18-30
NAHARIAH P 65 0
RABI P 51 46-59
MUH. ARSYAD L 46 46-59
MADE DEWI ERNAWATI P 41 31-45
FITRIANI NUR P 20 18-30
SAHARIA P 45 31-45
MULLING L 36 31-45
RAHMAN L 33 31-45
HJ. RABAINTANG P 49 46-59
H. NASIRI L 51 46-59
BAKRI L 40 31-45
SARIMMA P 47 46-59
NIA P 57 46-59
RIA P 42 31-45
HJ. ROSMIAH P 63 0
NURASIYA KR RIMANG P 65 0
HANIA P 31 31-45
MANTANG P 58 46-59
TUTI ALFIANA P 22 18-30
ABD. SALAM L 50 46-59
ASWIN SALAM L 19 18-30
ILYAS L 37 31-45
SELVI P 20 18-30
SATTUANG L 38 31-45
HAWIAH P 46 46-59
SIAMA P 41 31-45
ULYI P 20 18-30
LENTENG P 40 31-45
SURI P 37 31-45
KAMI P 30 18-30
ERWIN L 19 18-30
BACCE P 38 31-45
AMIR L 40 31-45
NURINTANG P 39 31-45
USNA P 19 18-30
NURFAJRIANI PRATIWI P 19 18-30
HADIA P 40 31-45
SALMA P 20 18-30
ABD.HAMID L 51 46-59
NURWAHYUNI P 22 18-30
TAMA' L 51 46-59
SASO L 44 31-45
CAKKA P 61 0
JAWARIAH P 63 0
HJ SUMARNI P 40 31-45
ABDULLAH KR BULU L 69 0
RABANAI L 64 0
SATUA P 64 0
NAHARA P 63 0
NURSIA P 54 46-59
ABDULLAH L 46 46-59
ASIS L 30 18-30
HARIS MUNANDAR L 26 18-30
ACHMAD FADLY ILHAM L 23 18-30
ROSMAWATI P 54 46-59
SAHRIYANI P 51 46-59
HIKMAWATI P 35 31-45
ASSE P 42 31-45
CIDO L 60 0
SUDIRMAN BALA L 54 46-59
NURSIAH P 47 46-59
HASNI P 23 18-30
NORMA P 43 31-45
RAPPUNG L 49 46-59
SARIPUDDIN L 42 31-45
MARIA P 43 31-45
DIA P 79 0
DARMAN SYAGI L 26 18-30
M IKBAL L 20 18-30
RAHUL L 22 18-30
ROHANI L 37 31-45
A MEGAWATI P 27 18-30
SARI P 43 31-45
RAHMA P 28 18-30
KITTA L 30 18-30
MANTANG P 38 31-45
FAISAL L 24 18-30
MALIK W L 24 18-30
PAMA L 49 46-59
IRFAN HAMSAH L 35 31-45
BARAWIAH P 48 46-59
IRSAN L 21 18-30
M. YUSUF L 19 18-30
MARSUKI L 41 31-45
SANO L 40 31-45
H. SANNANG L 52 46-59
ABD HAKIM L 53 46-59
MAWAR P 27 18-30
ISMAIL L 37 31-45
KAMA P 56 46-59
NAHANA P 30 18-30
MEMI P 40 31-45
AHRIANI P 36 31-45
SRI SUCI RAMADAN P 20 18-30
KUMI L 49 46-59
SUNNI P 44 31-45
M YUSUF L 29 18-30
MANSUR L 53 46-59
NURHIDAYAH P 32 31-45
KAHARUDDIN L 45 31-45
NURSIAH P 49 46-59
PATTAHUDDIN L 36 31-45
HASNI HN P 21 18-30
AHMAD SOFYAN L 24 18-30
SUMIATI P 39 31-45
KAMARUDDIN L 43 31-45
NURRAHMA P 22 18-30
SUARNI P 40 31-45
SALMAH P 25 18-30
KAMASIA P 62 0
NURAEDAH P 27 18-30
BAHTIAR L 37 31-45
HATTA L 48 46-59
SALASING L 53 46-59
RUPI P 43 31-45
SAIPA P 54 46-59
RAJA L 53 46-59
SAPO HS L 44 31-45
ROSI P 56 46-59
MURI P 55 46-59
FANI EFENDI L 19 18-30
HASNIAH DG KEBO P 42 31-45
MARLINA SP.DI P 35 31-45
CACING B L 50 46-59
ASSE P 42 31-45
HARIS MUNANDAR L 21 18-30
FIRMANSYAH L 18 18-30
A. DIO IAM L 20 18-30
NUR HARINI P 33 31-45
ISMAIL L 38 31-45
RAHMAT WAHYUDI L 29 18-30
TEPU L 66 0
SUHARTIN P 36 31-45
USMAN TOMPO L 40 31-45
RESKI P 23 18-30
NGAI P 43 31-45
SASSE CAWANG P 51 46-59
ARIF L 44 31-45
SAHARIAH P 40 31-45
PUJI P 21 18-30
MUSTAKIM L 39 31-45
HJ. HERA P 59 46-59
WIWI WIDYA ASTUTI P 18 18-30
RIMA P 61 0
H RADENG L 45 31-45
RABAINTANG P 70 0
HASNAH R P 60 0
RABANIA P 61 0
TRISNAWATI P 42 31-45
SULKIPLI L 51 46-59
MUH. SIDIQ SIJAYA L 22 18-30
M.ADI AL GHIFARI L 41 31-45
RATIH PURNAMA SARI P 19 18-30
NANDA MULIADI RIDWAN P 19 18-30
JUSNIATI P 39 31-45
NURHAYATI P 64 0
SYAMHUJRAH AWALIA SARI P 19 18-30
JASMAN DG SIALA L 44 31-45
SUPRIADI L 26 18-30
SULMIYATI P 19 18-30
RAHMAN M L 61 0
RAHMAN SAID L 62 0
ROSMINI P 34 31-45
IRMAN BASO L 38 31-45
UMAR L 38 31-45
SYAMSIA P 36 31-45
SURI P 42 31-45
H..DUDDIN L 41 31-45
DINA P 28 18-30
SULAEMAN L 60 0
MISDIN L 34 31-45
NURSIA P 51 46-59
SURI P 48 46-59
USMAN L 23 18-30
ST. NUR RAHMAWATI P 53 46-59
IRSAN L 43 31-45
AKBAR L 18 18-30
KAMARIA P 32 31-45
JAFAR L 40 31-45
BANONG P 48 46-59
MANAI L 40 31-45
MARIAMA P 66 0
NURGANTI TOMPO L 67 0
SIDIK L 61 0
MUH. IBRAHIM RAHMAT L 20 18-30
AHMAD SAEDI L 58 46-59
RORIS WIJAYA L 30 18-30
WAWAN L 35 31-45
AYU FEBRIANTI AMALIA P 19 18-30
M SYARIFUDDIN L 69 0
JUNAEDAH P 47 46-59
IRWAN L 41 31-45
RISAL L 16 0
SRI AYU SUCI P 19 18-30
RISMAWATI P 26 18-30
KASMAWATI P 39 31-45
MUSAKKIR L 36 31-45
SANTI P 31 31-45
CITRA SRI HANDAYANI P 21 18-30
MINA P 40 31-45
H.JUMA L 55 46-59
SUTRIANA P 26 18-30
NASIR P 42 31-45
HJ. RABIA P 63 0
SYARMILA P 34 31-45
NURAEDA P 41 31-45
HASNI DG NGINTANG P 46 46-59
HARIATI P 46 46-59
HAPSA P 51 46-59
JAMILA NAZAR P 48 46-59
ABDUL TALIB L 23 18-30
HAJRA P 42 31-45
DIONG L 45 31-45
MADDIN L 38 31-45
HASNA P 41 31-45
BASRI L 38 31-45
ROHMAN L 31 31-45
SYAMSIA P 34 31-45
RIA P 38 31-45
NURAENI P 38 31-45
YATI P 31 31-45
SYAMSIA P 39 31-45
DARWIS JAYA L 35 31-45
AKBAR SAID L 30 18-30
NURAENI P 25 18-30
MARYANI P 45 31-45
JAMALUDDIN L 50 46-59
LUKMAN L 45 31-45
MANAO P 50 46-59
KAMARIA P 34 31-45
ROHANI DG PALE P 46 46-59
RAMLAH P 45 31-45
RENI ANGGRAENI P 20 18-30
JUMRAH P 21 18-30
JAENUDDIN L 54 46-59
MARINJA P 37 31-45
SUMARNI P 34 31-45
NAPI L 36 31-45
SAYUTI L 37 31-45
NURMI P 33 31-45
PARDI L 27 18-30
RAHMATIA P 38 31-45
BACO L 83 0
SANAWIA P 34 31-45
SANTI P 29 18-30
SUNARTI P 30 18-30
ROHANI P 43 31-45
SASO TOMPO L 46 46-59
ROSMINI P 47 46-59
JUMRIANI P 20 18-30
SARIUDDIN L 51 46-59
SAHRIANI P 18 18-30
HASNA P 39 31-45
ARIF L 44 31-45
HASNI P 36 31-45
RUSMIN R L 46 46-59
AYU P 31 31-45
ST SUNARI SANANG P 45 31-45
SUNNIATI P 32 31-45
HERMAN L 31 31-45
ASSE P 32 31-45
ABD. HAMID L 42 31-45
SULAIMAN L 58 46-59
NORMA P 27 18-30
SUKMAWATI P 22 18-30
IBRAHIM L 38 31-45
NEMBONG P 37 31-45
POGE JAI L 49 46-59
NURFHATIRANNISA P 20 18-30
HAWANI P 49 46-59
JAYADI L 39 31-45
IDIL MAHENDRA L 18 18-30
SAHARIA P 44 31-45
NASIR L 46 46-59
MUH. ALI L 50 46-59
H.HASNA P 42 31-45
NIARTI P 44 31-45
SAIMA P 50 46-59
ABD RASYID L 49 46-59
SUNU DG TIKA L 64 0
ALIMUDDIN L 60 0
SURIANI P 61 0
SARIAMBONG P 69 0
MUSDALIFAH P 21 18-30
TUNI DG RANNU P 55 46-59
HAYATI P 53 46-59
ZAENUDDIN L 42 31-45
NORMA P 32 31-45
TAWANG L 55 46-59
HAJARA P 54 46-59
HASANA P 28 18-30
NURSYAMSI P 40 31-45
RAHMI ASIS P 35 31-45
KARIA L 41 31-45
JOHO P 41 31-45
RIANI P 35 31-45
ERNI P 23 18-30
SANGKA L 50 46-59
HARPIN L 36 31-45
SYAMSINAR P 36 31-45
SIRAJUDDIN L 43 31-45
APDAL L 30 18-30
SARO SATTU L 45 31-45
DIANA P 37 31-45
H. ANTO L 46 46-59
IRWAN L 20 18-30
WAHYU L 21 18-30
ARIPUDDIN L 65 0
ABD. RAHIM L 36 31-45
ROSMA P 33 31-45
RABIAH P 30 18-30
SYAMSUDDIN L 36 31-45
SAMSIA P 37 31-45
SRI WAHYUNI P 26 18-30
CACI p 55 46-59
IRMAWATI P 30 18-30
RONI CARITO BOWO L 36 31-45
HAMSINAH P 53 46-59
AGUS SALIM L 57 46-59
HASNIA P 57 46-59
M IKBAL HIDAYAT L 19 18-30
IRMAWATI P 21 18-30
AGUS L 42 31-45
SIMBANG L 54 46-59
SOHO P 50 46-59
NURMINAH P 23 18-30
KAHARUDDIN L 31 31-45
ROHANI P 62 0
MARWAH P 41 31-45
NARWIAH P 24 18-30
MULIATI P 32 31-45
SAPNAWATI P 29 18-30
NURHIKMA P 41 31-45
EKA WULANDARI NENGSIH P 20 18-30
SUMARNI P 38 31-45
RENI ANGRAENI P 17 0
PUTRI P 17 0
ROSMIATI P 40 31-45
NURAENI P 36 31-45
ABD. WAHID L 45 31-45
ZULWAHDI HALIM L 23 18-30
USMAN ALI L 18 18-30
RAMALAN L 59 46-59
ISWADI L 41 31-45
SULKIFLI L 20 18-30
NURUL ALIFAH ASDIAN P 26 18-30
NUR IMIN L 23 18-30
SUARTI P 39 31-45
AHMAD P 30 18-30
AAN JAMAL L 20 18-30
NURJANNAH KR BAJI P 43 31-45
HERLINA P 37 31-45
ABD QADAR L 27 18-30
WAWAN SAHRIR L 18 18-30
ATTI P 51 46-59
ASTIPAH P 62 0
SUDIRMAN L 31 31-45
MUH MUSTAQIM NUR L 51 46-59
AINUN MARDIANA P 19 18-30
SUBAEDAH P 38 31-45
HJ SANNIA P 39 31-45
MERLINA P 32 31-45
NURMIATI P 21 18-30
ALFIAN L 22 18-30
ST HARDIANA P 51 46-59
SYAMSUL L 24 18-30
ASRIANTO L 24 18-30
FINA UYUN FADILLAH P 21 18-30
KAMALUDDIN L 24 18-30
JUMARIA P 35 31-45
SYAMSUDDIN L 41 31-45
HASNAH P 35 31-45
NUR ANNISA SRI FEBRIANI MUCHLI P 19 18-30
JAMAL L 51 46-59
BAKRI DG BELLA L 71 0
SRI HARTUTI P 33 31-45
HERAWATI P 19 18-30
KURNIA P 46 46-59
H ABD KADIR L 61 0
KAMIHA P 58 46-59
NIA P 81 0
HIJRAH P 42 31-45
ULFA P 21 18-30
M SULTAN DG NGIRI L 51 46-59
HIKMAL AKBAR L 26 18-30
ASRIANI P 29 18-30
HAYATI P 54 46-59
RAHMAN L 31 31-45
HAMSINAH P 41 31-45
BUNGA PUTRI P 39 31-45
LISDA P 25 18-30
NORMA P 33 31-45
SITTI P 47 46-59
AHMAD S L 51 46-59
HAFSAH P 45 31-45
RESTINA P 36 31-45
ANRIANI P 39 31-45
MANTANG P 31 31-45
IDRIS L 37 31-45
SALMAN L 32 31-45
SARMILA P 19 18-30
NUR ALAM P 38 31-45
MUH ZAHIRUL NUGRAHA L 13 0
DALLI L 63 0
SARUDDIN L 40 31-45
SALDI L 22 18-30
USMAN L 41 31-45
CINI P 43 31-45
SURIANI P 32 31-45
SUNNIATI P 45 31-45
ERNI P 37 31-45
SANA DG NGASSENG P 40 31-45
YONA DG NGAMONG P 40 31-45
MURNI P 28 18-30
A. NUR LELA S P 38 31-45
NURLIYA P 40 31-45
SUMARNI P 29 18-30
MASITA P 39 31-45
NURJANNI P 61 0
DARWIS L 21 18-30
HASNI P 33 31-45
SRI ERIKA P 24 18-30
SYAMSUDDIN DG NGAWING L 54 46-59
NURANTI P 24 18-30
ANTO DG TOMPO L 38 31-45
SAIMIA DG TE'NE P 37 31-45
ASRIYANTI P 18 18-30
RISKI P 26 18-30
UDIN L 45 31-45
AKBAR L 20 18-30
ASKIM DG SA'RA L 46 46-59
FAJRIN L 17 0
HJ RAHMATIA P 44 31-45
ESTI RAHAYU P 20 18-30
ROSMAWAR P 27 18-30
YUDHA RESKI L 28 18-30
ANTO L 30 18-30
SANNIA P 42 31-45
YUYUNG PUSPITA P 18 18-30
KARIM P 30 18-30
YULI P 22 18-30
FITRI HANDAYANI P 23 18-30
SUMARNI DG NA'NA P 35 31-45
MUTAKHIRIN FATWA L 24 18-30
MUSTAKIM NUR L 27 18-30
SUPARMAN L 25 18-30
FITRI WAHDANIYAH P 25 18-30
JAM'A P 34 31-45
SYAMHIJRA P 23 18-30
ASKINA P 46 46-59
SAMSUDDIN RAFID L 30 18-30
RATNA HANDAYANI P 32 31-45
PATIMA P 33 31-45
HIKMAN L 27 18-30
SYAMSUDDIN DG NGALLE L 49 46-59
NURUL FITRAH P 21 18-30
BASSE KR BAU P 61 0
SANTI P 31 31-45
SAHUR H.M L 40 31-45
NORMA P 34 31-45
KHAERUL L 36 31-45
KHAIDIR L 27 18-30
ILHAM FATAHILLAH L 27 18-30
M SHIDIQ AL MUTAWAKKIL L 20 18-30
ULVI WULAN P 20 18-30
SULASTRI DG LANTI P 27 18-30
BASNUR L 50 46-59
MALIK L 31 31-45
SANTI P 31 31-45
NURLINDA P 26 18-30
FAHIRAH P 27 18-30
SYAMSUL ALAM L 54 46-59
MUHAMMAD AKBAR JAHIR L 21 18-30
ANWAR L 25 18-30
RITA NANDA SARI P 20 18-30
KH MUH BAHTIAR HS L 67 0
SAHRIR L 44 31-45
H SUMANENG L 46 46-59
UNTUNG L 28 18-30
RUSLAN L 21 18-30
INDARWATI P 35 31-45
KARMILA P 39 31-45
MURNI DG BAU P 31 31-45
EKA LESTARI ARDI P 21 18-30
HASNIATI P 25 18-30
SARTIKA P 34 31-45
HASBIA P 40 31-45
SALMA P 51 46-59
YUSNAWATI P 21 18-30
TRISNAWATI P 21 18-30
NURSAMSI P 40 31-45
NURAENI AHMAD P 47 46-59
MUHAMMAD AQMAL AHMAD L 17 0
NIPPAS NYITTO DAENG L 52 46-59
SUHARTINI P 17 0
SUDIRMAN L 53 46-59
DILA DIRYA LARASATI P 23 18-30
SUPARDI L 23 18-30
HARLINA P 42 31-45
SALWIAH P 71 0
SUBIATI P 50 46-59
MAPPA L 53 46-59
BAHARUDDIN L 53 46-59
LAKA DG NGERO L 57 46-59
NUKMAN L 42 31-45
SOMPU P 66 0
JOHORA P 60 0
SISDARYANTO L 29 18-30
ASRIANTO L 19 18-30
ASWIN L 18 18-30
MANNENG P 55 46-59
SAMSIA DG LANTI P 45 31-45
SAMSUDDIN LAU L 73 0
BULAN P 49 46-59
LUKMAN L 63 0
KURNIA P 30 18-30
MITHA P 32 31-45
NISMAWATI P 36 31-45
NIPPI L 48 46-59
CITRA P 31 31-45
NURIDA P 39 31-45
FEBRIANA ASTI PRATIWI P 19 18-30
HADANIAH P 33 31-45
MAHMUDDIN L 17 0
ASFAR L 26 18-30
NUR FANI EKA PUTRI P 18 18-30
AMIR L 42 31-45
SYAMSIAH P 51 46-59
SYAMSIAH P 44 31-45
IRFAN SARIF L 26 18-30
IDRIS L 33 31-45
SURIAH P 46 46-59
WINDY EKA PUTRI P 23 18-30
SYARIFUDDIN L 51 46-59
HIKMAWATI P 44 31-45
JUFRIANTO L 43 31-45
HAMZAH HAZ L 34 31-45
KAMAL SYAM L 26 18-30
SAIFUL BAHRI L 44 31-45
SYAMSUL ALAM L 50 46-59
RABIAH P 46 46-59
FAHIR L 55 46-59
IRAWATI P 26 18-30
KHAERIL FADLI L 17 0
IKBAL L 24 18-30
ALBANI NUR L 19 18-30
IDIL ADHA L 21 18-30
MAKKASAU L 65 0
JUMAIN L 77 0
EFENDI L 47 46-59
MUH IDRIS L 45 31-45
MALLOSERANG L 65 0
SELVIANA AMIR P 22 18-30
IDAWATI P 38 31-45
NURLINDA P 42 31-45
SAMSIAH P 43 31-45
FIRMAN J L 38 31-45
SAMSIAH DG NGUGI P 35 31-45
SUMIATI P 38 31-45
SALSABILAH HAERANI P 17 0
JUNAEDA P 36 31-45
MAINNA P 48 46-59
ROSNIATI P 25 18-30
NURLAITA ARIANTO P 20 18-30
NURFIMA RAHMI SYARIF P 20 18-30
PITRI ULAIKA P 19 18-30
SARIBONE P 33 31-45
NURHAYATI SPD P 36 31-45
BIYA P 39 31-45
SARIPUDDIN L 41 31-45
CACO ALLI L 55 46-59
SALEH NYALLANG L 40 31-45
MITA SARI P 18 18-30
MIRNAWATI P 20 18-30
M AMIN L 65 0
MAPPIASSA L 39 31-45
INJI MURI PANANRANGI P 21 18-30
MARWAH P 42 31-45
TATI B P 49 46-59
HASNIATI P 42 31-45
LEDENG L 39 31-45
ROSNIA P 45 31-45
DARWIS L 35 31-45
HERLY P 21 18-30
MARNI P 28 18-30
KIKI SAPUTRA L 39 31-45
RUSMIN L 38 31-45
BADOLLAH L 57 46-59
MURNI P 37 31-45
NUR SYAMSI P 50 46-59
HERLINA P 27 18-30
FITRIANI P 37 31-45
SANTI P 39 31-45
YUDDING L 29 18-30
SAIDAH P 38 31-45
PATTALOLO P 34 31-45
TIMA P 52 46-59
YANI P 33 31-45
S DG NGAGO L 42 31-45
A M MIZWAR R L 19 18-30
SOLIHIN L 32 31-45
WIWI AMELIA P 19 18-30
AYU P 41 31-45
ISRAFIL L 30 18-30
ZULKARNAIN L 39 31-45
HAMKA SEWANG L 47 46-59
NURMI KR MEDI P 48 46-59
YUSUF L 35 31-45
SUPIATI P 35 31-45
HAPSAH DG RIMANG P 47 46-59
ROSMA DG LANTI P 27 18-30
ISMANIAR P 28 18-30
MUSAKKIR L 55 46-59
SARASANG ALLE L 62 0
ADNAN LOLO S.PDI L 43 31-45
HAMSIAH S.PDI P 43 31-45
ILYAS NAKKU L 64 0
BINARUNG P 62 0
JUNIBA RAJAB L 87 0
SAKA L 52 46-59
RAPPUNG L 50 46-59
SASO L 44 31-45
MUHAMMAD AKRAM L 24 18-30
SALAMING L 65 0
DARMI P 39 31-45
AINA ALFIRA P 18 18-30
SYUKUR L 36 31-45
SANGSI P 37 31-45
ALIMUDDIN L 61 0
HASNAH R P 60 0
SAHRUL L 20 18-30
BUNGA NIA P 67 0
NAHARIA P 65 0
SARI P 41 31-45
ACHMAD FADLI ILHAM L 24 18-30
BASMA P 26 18-30
HAKIM L 56 46-59
SUTOMO L 64 0
LEBONG P 71 0
SURIANTI P 42 31-45
SUMIATI P 42 31-45
HASNAH P 69 0
ISDAR IRIANTO SPAUTRA L 18 18-30
RISKA DEWIYANTI P 22 18-30
MAULIAH AL AYUMI P 18 18-30
ROSTINA P 42 31-45
SUMARNI P 26 18-30
HASNA P 34 31-45
HANIA P 32 31-45
SAHRUL GUNAWAN L 24 18-30
INTANG P 40 31-45
SUAEBAH P 26 18-30
NAHARIAH P 41 31-45
MANTANG P 58 46-59
SELVI P 21 18-30
SAINTANG P 75 0
KARMILA P 18 18-30
ROHANI P 19 18-30
HARIS L 68 0
KURNIA AGUS P 24 18-30
H. NASTRI L 51 46-59
NUR WAHYUNI P 21 18-30
IRAWATI P 40 31-45
SABRIANTO L 34 31-45
ST MARWAH KR INTANG P 63 0
MADE DEWI ERNAWATI P 41 31-45
JUNURUDDIN L 53 46-59
ABDULLAH KR BULU L 69 0
NAHARIA P 63 0
ARWIN TALAM L 18 18-30
NUR ASIYA KR RIMANG P 64 0
RAPIA P 70 0
RUDI L 24 18-30
SITUNG L 41 31-45
SYAMSURIAH P 50 46-59
PATTA L 45 31-45
ABDULLAH L 50 46-59
MAWAR P 40 31-45
KHAERA MUFLIHA P 18 18-30
H BANA L 56 46-59
IBRAHIM L 48 46-59
IRNAWATI P 23 18-30
NURSIAH P 42 31-45
SITTIAMANG DG TE'NE P 40 31-45
RAMIAH P 66 0
RAHAKING L 68 0
RISKAWATI P 24 18-30
NURUL FADILLAH P 17 0
RISWAN L 36 31-45
MARLINA P 31 31-45
NURLISA P 15 0
DINI P 19 18-30
NASIR L 18 18-30
RAMLI L 64 0
RAHMAT L 18 18-30
TAJUDDIN L 28 18-30
KURNIAWAN SP L 26 18-30
H RABANAI L 50 46-59
H TAHIR L 50 46-59
H RABALI L 61 0
SANNENG P 59 46-59
RASMIATI P 34 31-45
M YUSUF L 43 31-45
NURUL MUTMAINNA P 19 18-30
SUMIATI P 41 31-45
Nur arini P 27 18-30
Fitri Ayudia salim P 20 18-30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
**Komorbid: ***Merek Vaksin
1= Hipertensi 1 = Sinopharm
2= Diabetes 2 = Sinovac
3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
4= Penyakit Ginjal
5= Penyakit Paru Kronis
6=Lainnya
Kelompok Umur: Kepesertaan BPJS

261 BPJS PBI 0
374 BPJS Non PBI 0
181 Non Anggota 0
816 Total 0
Pekerjaan: Pemberian Dosis
0 Dosis 1 641
0 Dosis 2 29
0 Total
0
0
0
RMAT PENCATATAN PELAKSANAAN IMUNISASI COVID-19
TINGKAT PUSKESMAS/JEJARING
Kepesertaan BPJS (tulis 'Ya'

pada kolom yang sesuai)
Alamat No. Hp
BPJS Non
BPJS PBI
Non PBI Anggota
kanang kanang
kanang kanang
kanang kanang
kanang kanang
paccinongan
kanang kanang
kanang kanang
TINO
kanang kanang
PARANGSIALLA
kanang kanang
kanang kanang
PARANGSIALLA
kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
Kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
PACCINONGAN
BONTO LANGGA
BONTO LANGGA
BONTO LANGGA
paccinongan
paccinongan
paccinongan
kanang kanang
kanang kanang
kanang kanang
paccinongan
BONTO LANGGA
paccinongan
kanang kanang
kanang kanang
TINO
kanang kanang
kanang kanang
kanang kanang
paccinongan
kanang kanang
paccinongan
TINO
TINO
TINO
kanang kanang
kanang kanang
kanang kanang
kanang kanang
kanang kanang
TAROWANG
GANRANG BATU
GANRANG BATU
PACCINONGAN 085255173701
BONTO RITA 081387816481
BONTO LANGGA 082192681986
Tino 085332621676
KANANG KANANG 085242363239
TINO 082347700117
TINO 082290200142
TINO 085248424482
TINO 085345710287
TINO 085345220685
TINO 085345220685
TINO 082337175668
TINO 085395073456
TINO 085871092792
TINO 082346737602
BT MASUGI 082347931042
TINO 082198582068
TINO 085251817427
TINO 085340168826
PARANGSIALLA 085242363239
TINO 082353263283
TINO 085340651260
TINO 085394056720
TINO 082192874983
Bonto masugi 085256194711
TINO 085244135262
TINO 085396049832
TINO 085396049832
TINO 085396049832
BT LANGGA 081524280626
TINO 085395829587
TANGGAKANA 081563705296
TINO 085256776736
PURO'RO 085285295439
BONTO UJUNG 081253378213
TINO 082349991871
TINO TOA 081350505005
BABULU BARAT 085242028343

TINO 081354503324
TINO 082151945020
TINO 085341376109
TINO 082151945020
BALTAR 085387584471
BALANGLOE 085387584471
ASPOL JLN MANGGIS085342598227
PANOANG 085240548630
TINO 082393084725
TINO 085345220685
BUNGENG 085348035467
KALOKO 085240647750
KALOKO 085334869542
BUNGUNG KONCI 082347119060
JL. ATIEK SUTEDJA 08578113614
KALOKO 082287394168
KALOKO 082287394168
BONTOWA 081342421206
BONTORAPPO 085242701004
JL MELODI TUGU 081212094333
TINO 085348428288
TINO 085348428288
JL. TEMBAKAU 082271532192
BULO BULO TIMUR 085343788371
BUNGUN CAMBA 082159759317
BUNGUN CAMBA 085347361078
CEMPAJA UTARA KALT 082150567416
RA'RA 085342198438
RA'RA 085240021835
RA'RA 085656362718
JL NAJA DG NAI 085757591711
RA'RA 085247949076
KASSI KASSI 083133914917
RA'RA 085395414572
RA'RA 085240280977
RA'RA 082188386048
BONTOMANAI 081350198461
BONTOMANAI 082286665852
TINO 085242036803
BONTO MASUGI 082347141501
PACCINONGAN
TAWINDE 081241216698
BALANG BARU 085343759520
BONTOLANGGA 082395340300
TINO 082352162527
LENGKE LENGKE 082350648764
KANANG KANANG '082346105830
CAMBA LOMPOA 085298704610
KANANG-KANANG 085256313057
KP GALUNG TAROWAN 081354766623
KP GALUNG TAROWAN 082350943993
TINO 082346772351
MABINAU HULU 085393658951
MABINAU HULU 085393658951
TINO 082346772351
TINO 082292471311
KAMP BERU 085241742283
PARANG 082193301730
KAMP BERU 085241742283
PACCINONGAN
PACCINONGAN
PACCINONGAN
TEPOSUA 082231857046
BUNGUNG BOMBONG 082231857046
RA'RA 085255164535
RA'RA 085247001646
RA'RA 085299624872
BALANG BARU 085240270971
KP BENDI 085399925559
JL. SUMUR JODOH 085243474447
KP BERU 082353039390
KP BENDI 085255398420
KALOKO 085348708908
UJUNG BARAT 085823162808
BONTOWA 082152177567
UJUNG 085823162808
UJUNG 081347351207
UJUNG 082122966340
UJUNG 085342598755
UJUNG 085811483628
UJUNG TIMUR 085279277145
RA'RA 082393514903
TOMPOK KELARA 082190013153
TIKALA BARU 082393081688
UJUNG 082395350394
UJUNG 085394226741
UJUNG BUNDU 085394226741
UJUNG 085256870451
ASPOL PANIKI 085255274774
BONTO KATANGKA 082259520170
JL KARAKASIA 082349605808
MANADO 085255274774
KP LAMBOCCA 082197127128
BATULANG 082293597120
UJUNG 085395823584
ANRIHUA 082158775738
UJUNG 085250151430
BTN MINASA UPA 085299290808
UJUNG 087786249645
UJUNG 085807465383
UJUNG 081522663758
UJUNG 085824715221
MATTIROWALIE 081343693383
UJUNG 081242494456
UJUNG 085249517519
TANAKEKE 085283841669
UJUNG 085
UJUNG 087841143031
UJUNG 085393841826
UJUNG 085398327750
TINO TOA 085651240337
BALBAR 085256486425
BALBAR 085352711477
BALBAR 085352711477
UJUNG 085251505518
BONTOWA 085299198276
SEPE 085656800634
JL KEBUN SAYUR 082394842804
BONTOWA 082395358240
BONTOWA 082395358240
DUSUN PELABUHAN 083132893987
BONTOWA 082396677546
BALTAR 082312524417
TONROWA 081243419389
BALTAR 082312524417
RA'RA 082347955686
KP BERU 082150215943
BALANGLOE 0887436327335
KP BERU 085348955899
BONTOWA 085223042042
KP BERU 085348955899
TINO TOA 085242868975
TINO 085342030908
BALANG BERU 082393514903
NGGARA RANDI 085238739054
DUSUN LEWI 085253402345
BALTAR 082312524417
BONTOWA 082337178738
BALTAR 085298873348
KAYANGAN 081944605036
BALTAR 085240620629
BALTAR 085394461438
KP BERU 085348955899
KP BERU 085348955899
BALTAR 082352138535
JL KIHAJAR DEWANTAR085348870344
LAPRI 085246271650
BALANG LOE 085397158831
TINO 085340168827
TINO 082151945020
TINO 081387816481
TINO TOA 081350505005
JL KAKATUA ASKOL 082393208378
BATULU BARAT 085242028343
TINO 085396049832
TANGGAKANG 081563705296
TINO 081354503324
TAROWANG 085342296655
KALOKO 082347382598
KALOKO 082347382598
PARANG LABBUA 085341124459
TANAKEKE 085342013582
PACCINONGAN
PACCINONGAN
ma Puskesmas/Faskes)
Pekerjaan
1 0
2 0
3 0
4 0
5 0
Total 0
Komorbid
1 0
2 0
3 0
4 0
5 0
6 0
Tidak ada 22
Total 0
ASI COVID-19
ARING
Tanggal Pemberian
Imunisasi
Merek
Vaksin***
Ada (sebutkan Tidak Ada
Dosis I Dosis II Dosis I
komorbidnya) (centang)
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021

coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021

coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24003721 6/28/2021
coronovac 24001121 24003721 3/31/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021

coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721
coronovac 24003721
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/29/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021

coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021

coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 6/30/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 7/1/2021
coronovac 24003721 01/07/2021
coronovac 24003722 01/07/2022
coronovac 24003723 01/07/2023
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac \ 24003721
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
coronovac 24003721 7/3/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
v Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24003721 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 06/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121 07/07/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 08/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121
Coronovac 24200121 14/07/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121
Coronovac
Coronovac 24200121
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 7/14/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 14/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
v Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121 7/15/2021
Coronovac 24200121
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121 15/07/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121 7/17/2021
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
Coronovac 24200121
anggal Pemberian
Imunisasi
Keterangan
Dosis 2
6/28/2021
6/29/2021
6/29/2021
24003721
7/3/2021
7/3/2021
07/072021
7/7/2021
7/7/2021
7/7/2021
7/7/2021
7/7/2021
7/7/2021
7/7/2021
7/7/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/14/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/15/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
7/17/2021
FORMAT PENCATATAN PELAKSANAAN IMUNISASI COVID-19

Tanggal : 28 Juni 2021
Kepesertaan BPJS (tulis

'Ya' pada kolom yang Komorbid**
sesuai)
Jenis Peke Umur Kelomp
Nama Penerima Merek
NoNo. Registrasi NIK Kelami rjaan (18-59 ok Alamat No. Hp
Vaksin Vaksin***
n * tahun) Umur
BPJS BPJS Non Ada (sebutkan Tidak Ada
PBI Non PBI Anggota komorbidnya) (centang)
1 7304110107570018 MUH SALEH MONCO L 1 63 0 kanang kanang Ya v Sinovac
2 7304114111870001 ERNAWATI P 1 33 31-45 kanang kanang Ya v Sinovac
3 7304113112790040 RURUNG L 1 41 31-45 kanang kanang Ya v Sinovac
4 7304110411760001 HASAN PANCE L 1 53 46-59 kanang kanang Ya v Sinovac
5 7304114505520005 HASNAH P 1 68 0 paccinongan Ya v Sinovac
6 7304110203780002 BAKRI L 1 42 31-45 kanang kanang Ya v Sinovac
7 73041131128120046 SAHARUDDIN L 1 38 31-45 kanang kanang Ya v Sinovac

8 7304110102660001 SANE LIWANG L 1 54 46-59 TINO Ya v Sinovac
9 7304117112690244 TIMA P 1 51 46-59 kanang kanang Ya v Sinovac
10 7304110101880008 SUHARDI L 1 32 31-45 PARANGSIALLA Ya v Sinovac
11 7304116112770002 SANNIA P 1 44 31-45 kanang kanang Ya v Sinovac
12 7304110107850098 YUSUF L 1 36 31-45 kanang kanang Ya v Sinovac
13 7304114206810001 RAHMA P 1 39 31-45 PARANGSIALLA Ya v Sinovac
14 7304116509980001 ELVI SUKAESIH P 1 25 18-30 kanang kanang Ya v Sinovac
15 7304117112020013 RAHMAWATI P 1 25 18-30 kanang kanang Ya v Sinovac
16 7304117112770037 MAISA P 1 43 31-45 kanang kanang Ya v Sinovac
17 7304114107820004 YANTI P 1 39 31-45 kanang kanang Ya v Sinovac
18 7304113112560035 MUH DUDA L 4 66 0 kanang kanang v sinovac
19 7304117112760058 SIA P 4 44 31-45 Kanang kanang sinovac
20 7304110107800005 YONGKI L 4 40 31-45 kanang kanang sinovac
21 7304115312750002 BUNGASIA P 4 46 46-59 kanang kanang sinovac
22 7304114107790048 TUNI P 4 41 31-45 kanang kanang sinovac
23 7304114107760053 TATI P 4 44 31-45 kanang kanang sinovac
24 7304112205700003 RABAINANG P 4 50 46-59 kanang kanang sinovac
25 7304103112850339 SUARDI L 4 36 31-45 kanang kanang sinovac
26 7304114707860001 MARDIANA P 4 34 31-45 kanang kanang sinovac
27 7303051610950001 PANDI L 4 25 18-30 kanang kanang sinovac
28 7304117112810043 DARMI P 4 39 31-45 PACCINONGAN sinovac
29 7304114912010001 SRI HARINA P 4 20 18-30 BONTO LANGGA sinovac
30 7304116005020002 SRI WAHYUNI P 4 19 18-30 BONTO LANGGA sinovac
31 7304113012640001 HAKIM L 4 56 46-59 BONTO LANGGA sinovac
32 7304117112740026 SUBAEDA P 4 46 46-59 paccinongan sinovac

33 7304117112800037 SUMIATI P 4 30 18-30 paccinongan sinovac
34 7304117112720029 HAWIAH P 4 49 46-59 paccinongan sinovac
35 7304114306000001 DEWI SINTA P 4 21 18-30 kanang kanang sinovac
36 7304114503020001 IRMA P 4 19 18-30 kanang kanang sinovac
37 7304113112810033 BAHA L 4 39 31-45 kanang kanang sinovac
38 7304112102860002 BAKHTIAR L 4 34 31-45 paccinongan sinovac
39 7304112211930001 FAISAL L 4 27 18-30 BONTO LANGGA sinovac
40 7304113112690024 SAKA L 2 51 46-59 paccinongan sinovac
41 7304112311010001 SAHRUL L 4 20 18-30 kanang kanang sinovac
42 7304114202930001 ISMAINAR P 4 27 18-30 kanang kanang sinovac
43 7304113112560032 SALAMING L 4 64 0 TINO sinovac
44 7304113112590021 SARASANG ALLE L 4 61 0 kanang kanang sinovac
45 7304115607840001 DADA' P 36 31-45 kanang kanang sinovac
46 7304111104990002 SAENAL K L 21 18-30 kanang kanang sinovac
47 7304114107800083 SARI P 30 18-30 paccinongan sinovac
48 7304117112760005 NURSIA P 44 31-45 kanang kanang sinovac
49 7304113112760036 ABD SAMID L 44 31-45 paccinongan sinovac
50 7304114107790035 SURIATI P 41 31-45 TINO sinovac
51 7304116211010001 NURUL MUTMAINNA P 20 18-30 TINO sinovac
52 7304114506030002 AIRA ALFIRA P 18 18-30 TINO sinovac
53 7304117112710043 HASNAH P 39 31-45 kanang kanang sinovac
54 7304110506750001 HAMALI L 45 31-45 kanang kanang sinovac
55 7304114505770002 MULIATI P 43 31-45 kanang kanang sinovac
56 730411560684002 ROMBA P 36 31-45 kanang kanang sinovac
57 730411711810052 TURIAH P 39 31-45 kanang kanang sinovac

58 73071103112860117 SABRIANTO L 34 31-45 TAROWANG sinovac
59 7304031110900002 DEDY KURNIADI L 30 18-30 GANRANG BATU sinovac
60 7304086312960004 ANNISA P 24 18-30 GANRANG BATU sinovac
61 7304117112790047 hajra p 41 kanang kanang
62 7304114103550001 beda p 66 kanang kanang
63 7304117112580026 harapa p 62 kanang kanang
64 7304110707510001 sangkala l 70 paccinongan
65 7304114311530001 sada p 67 paccinongan
66 7304110101770005 sila l 43 BONTO LANGGA
67 7304114710830001 ramla p 37 BONTO LANGGA
68 7304114505810003 yuni p 39 kanang kanang
69 7304117112840023 yati p 36 kanang kanang
70 7304117112790037 goa p 41 kanang kanang
71 7304117112550015 saipa p 74 BONTO LANGGA
72 7304113112550013 tepu l 65 paccinongan
73 7304117112790035 lenteng p 41 kanang kanang
74 7304114506600002 rabatia p 50 PARANGSIALLA
75 7304113112580015 raja l 53 BONTO LANGGA
76 7304114112600001 sitti p 50 kanang kanang

1 = Petugas Medis dan Non Medis di Fasili 2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang berhad 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
Kelompok Umur: Kepesertaan BPJS Pekerjaan
18-30 38 BPJS 18 1 59
31-45 33 BPJS N 42 2 1
46-59 14 Non An 0 3 0
Total 85 Total 60 4 26
Pekerjaan: Pemberian Dosis 5 0
1 59 Dosis 73 Total 86
2 1 Dosis 45 Komorbid
3 0 Total 1 0
4 26 2 0
5 0 3 0
Total 86 4 0
5 0
6 0
Tidak ada 61
Total 0
Tanggal Pemberian
No. Batch
Imunisasi
Keterangan
(Contoh:
Ditunda/Dirujuk/….
)
Dosis I Dosis II Dosis I Dosis 2
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021 \
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021 11 9
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021
24003721 6/28/2021 11 9
24003721 6/28/2021 14 13
24003721 6/28/2021 47 45
Sakit kepala pusing
Sakit kepala pusing
Sakit kepala pusing
Sakit kepala pusing
Sakit kepala pusing
Sakit kepala pusing
Sakit kepala pusing
Sakit kepala
DM
Pusing alergi obat
pusing
HT
DM
HT
Sakit kepala
Sakit kepala
2-Feb 1 47 45
3-Feb 23 2 org tdk diberikan
4 2 org dosis ke 2
10 org tunda
15 dosis 2
11 dosis 1
FORMAT PENC

Tanggal 29-06-2021
Jenis Umur
Nama Penerima Pekerja
NoNo. Registrasi NIK Kelami (18-59
Vaksin an*
n tahun)
1 7304114107840020 rosmawati P 4 37
23 7304114605710001 IDA SIKKI P 4 40
33 7304111911950001 Yusril Yus hendra L 4 56

1 = Petugas Medis dan Non Medis di F2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang b 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin ya
Kelompok Umur: Kepesertaan BPJS

18-30 37 BPJS PBI 13
31-45 30 BPJS Non 30
46-59 18 Non Angg 0
Total 85 Total 43
Pekerjaan: Pemberian Dosis
1 43 Dosis 1 84
2 4 Dosis 2 41
3 0 Total
4 38
5 0
Total 85

sesuai)
Kelomp Ada
Tidak
ok Alamat No. Hp BPJS Non (sebutk
BPJS Ada
Umur Non Anggot an
PBI (centan
PBI a komorb
g)
idnya)
31-40 PACCINONGAN 085255173701 v

31-40 BT MASUGI 082347931042
51-60 Bonto masugi 085256194711
disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

Pekerjaan
1 43
2 4
3 0
4 39
5 0
Total 86
Komorbid
1 0
2 0
3 0
4 0
5 0
6 0
Tidak ada 64
Total 0
Tanggal Pemberian
No. Batch
Imunisasi
Keterangan
Merek
(Contoh:
Vaksin*
Dosis I Dosis II Dosis I Dosis 2 Ditunda/Diruju
**
k/….)
Sinovac 24003721 6/29/2021

sinovac 24003721 6/29/2021
sinovac 24003721 6/29/2021
2-Feb 1 47 45
3-Feb 23 2 org tdk diberikan
4 2 org dosis ke 2
10 org tunda
15 dosis 2
11 dosis 1
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
Nama Puskesmas/Fasyankes/Pos : Tino

Provinsi : sulawesi selatan
PKM Tino 6/30/2021 Kepesertaan BPJS (tulis

'Ya' pada kolom yang Dosis I Dosis 2
Jenis Umur sesuai) Tanggal Nama/Je Keterangan
Nama Penerima Kelompo
No No. Tiket NIK Kelam
Pekerjaan*(18-59 Alamat No. Hp BPJS BPJS Non Screeni nis/Merek Tanggal No.
Tanggal
No. (Ditunda/Tidak
Vaksin k Umur
in tahun) PBI Non PBI Anggota ng Vaksin*** Pemberian No. Batch Serial
Pemberian No. Batch
Serial Diberikan/Lanjut)
Vaksinasi Vaksinasi
1 7304110107570010 ILYAS NAKKU L 63 0 PACCINONGAN 085340168827 6/30/2021 24003721

2 7304114107590008 BINARUNG P 61 0 PACCINONGAN 085340168827 6/30/2021 24003721
3 7304116109720002 HAMSINA P 48 46-59 KANANG KANANG 085343766944 6/30/2021 24003721
4 7304114103880004 NAHARIAH P 33 31-45 KANANG KANANG 085343766944 6/30/2021 24003721
5 7304115107770001 KAMI P 43 31-45 KANANG KANANG 082346726129 6/30/2021 24003721
6 7304115003880001 YASNI P 33 31-45 KANANG KANANG 082346726129 6/30/2021 24003721
7 7304116606020005 KASMIYANTI P 19 18-30 KANANG KANANG 085891838969 6/30/2021 24003721
8 7304110107900061 SAMA L 30 18-30 KANANG KANANG 085389498947 6/30/2021 24003721
9 7304115209750001 SUMIYATI P 45 31-45 KANANG KANANG 085891838969 6/30/2021 24003721
10 7304111504740002 HANAPI L 47 46-59 KANANG KANANG 085891838969 6/30/2021 24003721
11 7304111707660002 MUSAKKIR L 54 46-59 KANANG KANANG 085259008335 6/30/2021 24003721
12 7304114805580001 KUASA P 63 0 PACCINONGAN 085298141677 6/30/2021 24003721
13 7304116606020001 ASMILA SRI WAHYU P 19 18-30 PACCINONGAN 085342341045 6/30/2021 24003721
14 7304117112640020 ROSMA P 56 46-59 PACCINONGAN 085240622746 6/30/2021 24003721
15 7304113112560033 SUTOMO L 64 0 PACCINONGAN 082332611614 6/30/2021 24003721
16 7304117005030001 MAULIAH AL AYUMI P 18 18-30 PACCINONGAN 081243441756 6/30/2021 24003721
17 7304114606820002 HASNA P 39 31-45 PACCINONGAN 081243441756 6/30/2021 24003721
18 7304114101970002 KURNIA AGUS P 23 18-30 TANGGAKANA 081563705296 6/30/2021 24003721
19 7303016807940001 YULI FARIDA ISMAR P 27 18-30 PACCINONGAN 082399237215 6/30/2021 24003721
20 7304047112760274 NERA P 45 31-45 PACCINONGAN 082395336562 6/30/2021 24003721
21 7304113112960024 AMIRUDDIN L 28 18-30 PACCINONGAN 082311605019 6/30/2021 24003721
22 7304035107976004 SRI NENGSIH TAW P 24 18-30 PACCINONGAN 082311605019 6/30/2021 24003721
23 7304117112450018 MONE P 76 0 PACCINONGAN 081347452036 6/30/2021 24003721
24 7304115004020001 ROHANI P 19 18-30 PACCINONGAN 081241441201 6/30/2021 24003721
25 7304114205770002 HUSNIA P 44 31-45 PACCINONGAN 085398066321 6/30/2021 24003721
26 7304110701800001 M AIDIL SIKKI L 40 31-45 KANANG KANANG 082240632685 6/30/2021 24003721
27 7304111008490001 SAMPARA GASSING L 72 0 KANANG KANANG 085256469379 6/30/2021 24003721
28 7304040203550001 HARIS L 66 0 TINO 085256776736 6/30/2021 24003721
29 7304117112730031 SYAMSIAH P 49 46-59 PACCINONGAN 085343997527 6/30/2021 24003721
30 7304114203740001 SUDARNI P 46 46-59 PACCINONGAN 085242698284 6/30/2021 24003721
31 7304115111810002 SURIANI P 39 31-45 PACCINONGAN 081241905559 6/30/2021 24003721
32 730411420740001 SUADA P 47 46-59 PACCINONGAN 085242698284 6/30/2021 24003721
33 7304116312760001 HASBIAH P 45 31-45 PACCINONGAN 085395221139 6/30/2021 24003721
34 7304115510800002 NURHAYATI P 40 31-45 PACCINONGAN 082393064117 6/30/2021 24003721
35 7303045207960002 NURMALASARI P 24 18-30 PURO'RO 085285295439 6/30/2021 24003721
36 7304117112600048 RAMUNG L 61 0 PACCINONGAN 08884348335 6/30/2021 24003721
37 7304112802020002 MUHAMMAD ISHAK L 19 18-30 PACCINONGAN 085394754151 6/30/2021 24003721
38 7304115210830001 MULIANI P 37 31-45 KANANG KANANG 085292344457 6/30/2021 24003721
39 7304114505780001 RAHMATIA P 39 31-45 KANANG KANANG 082190914606 6/30/2021 24003721
40 7304112109850002 SARIFUDDIN L 36 31-45 KANANG KANANG 085299768321 6/30/2021 24003721
41 7304117105830001 NURBAYAH P 37 31-45 KANANG KANANG 085299768321 6/30/2021 24003721
42 7304115511660001 NABA P 55 46-59 KANANG KANANG 085299768321 6/30/2021 24003721
43 7304112112640001 MASSIRI P 56 46-59 KANANG KANANG 085295768321 6/30/2021 24003721
44 7401044404830005 ROSMALA P 38 31-45 PACCINONGAN 085241111567 6/30/2021 24003721
45 7304113112860041 BAHARUDDIN L 34 31-45 KANANG KANANG 082398857503 6/30/2021 24003721
46 7304117112650007 KARE P 65 0 KANANG KANANG 082398857503 6/30/2021 24003721
47 7304113112680004 H. YARASA L 63 0 KANANG KANANG 082398857503 6/30/2021 24003721
48 7304115405880002 SRI HASTUTI P 33 31-45 BONTO UJUNG 081253378213 6/30/2021 24003721
49 7304115412940001 BASMA P 26 18-30 BONTO LANGGA 085348613230 6/30/2021 24003721
50 7304116512850001 RISMA P 35 31-45 PACCINONGAN 085256470520 6/30/2021 24003721
51 7304110107850079 SAHARUDDIN L 35 31-45 PACCINONGAN 085241111567 6/30/2021 24003721
52 7304116509860001 JUPRI L 37 31-45 KANANG KANANG 085255947687 6/30/2021 24003721
53 7304111201030000 DARWIN L 18 18-30 PACCINONGAN 081342798479 6/30/2021 24003721
54 7304117112750042 RABA P 45 31-45 PACCINONGAN 081342798479 6/30/2021 24003721
55 7304112603030002 HERLIN P 21 18-30 KANANG KANANG 085255947687 6/30/2021 24003721
56 7304114107840035 ROSNIAH P 37 31-45 PACCINONGAN 085241111567 6/30/2021 24003721
57 7304112606610001 DONGKO L 60 0 KANANG KANANG 082393548902 6/30/2021 24003721
58 7304114303880002 HASNI P 37 31-45 PACCINONGAN 085298964903 6/30/2021 24003721
59 7304113112590016 H.SAPPARA L 61 0 KANANG KANANG 082395350550 6/30/2021 24003721
60 7304110112660001 AMIR P 45 31-45 PACCINONGAN 085242864569 6/30/2021 24003721
61 7304117112620028 SURI P 39 31-45 KANANG KANANG 085343962591 6/30/2021 24003721
62 7304114210690001 HANIA P 51 46-59 PACCINONGAN 085242864569 6/30/2021 24003721
63 7304117112710039 KEBE P 50 46-59 KANANG KANANG 085343962591 6/30/2021 24003721
64 7304114107460011 SAINTANG P 74 0 PACCINONGAN 085256469981 6/30/2021 24003721
65 7304114511800002 SAHARI P 41 31-45 TINO 082349991871 6/30/2021 24003721
66 7304114305810004 IRAWATI P 40 31-45 PACCINONGAN 085248169248 6/30/2021 24003721
67 7304113112820045 SANGKALA L 38 31-45 KANANG KANANG 085348113284 6/30/2021 24003721
68 7304113112740020 JAPA. B L 47 46-59 KANANG KANANG 085348113284 6/30/2021 24003721
69 7303077112820008 HARIANTI P 38 31-45 PACCINONGAN 085397348965 6/30/2021 24003721
70 7303011210740002 LALLO D L 47 46-59 PACCINONGAN 085241111567 6/30/2021 24003721
71 7304111712760001 EDI L 44 31-45 KANANG KANANG 085255375557 6/30/2021 24003721
72 7304113101930001 NURSALAM L 28 18-30 PACCINONGAN 085394260494 6/30/2021 24003721
73 7304116011020003 KARMILA P 18 18-30 PACCINONGAN 085256310474 6/30/2021 24003721
74 7304114811000001 MURNIATI P 21 18-30 PARANGSIALLA 085394593430 6/30/2021 24003721
75 7304113112640023 KADERE P 56 46-59 KANANG KANANG 082398857503 6/30/2021 24003721
76 7304114506600002 RABATIA P 61 0 PARANGSIALLA 085242108958 6/30/2021 24003721
77 671042703850006 SYUKUR P 36 31-45 TINO TOA 081350505005 6/30/2021 24003721
78 7304117112620018 CORA P 58 46-59 PACCINONGAN 082193600712 6/30/2021 24003721
79 7304117010980001 MIFTAHUL JANNAH P 22 18-30 PACCINONGAN 087851667081 6/30/2021 24003721
80 7304114409980001 RISKA DEWIYANTI P 23 18-30 BABULU BARAT 085242028343 6/30/2021 24003721
81 7304110201030003 ISDAR ARIYANTO S L 18 18-30 PACCINONGAN 085242028343 6/30/2021 24003721
82 7304110107600031 ALIMUDDIN L 50 46-59 PACCINONGAN 085240026905 6/30/2021 24003721
83 730411106780001 ABD. WAHID L 42 31-45 PACCINONGAN 082349991871 6/30/2021 24003721
84 7304114506750004 NURAENI P 46 46-59 PACCINONGAN 085256564522 6/30/2021 24003721
85 7304115604850001 WATI.K P 38 31-45 KANANG KANANG 085393785668 6/30/2021 24003721
86 7304117112850041 DARMAWATI P 35 31-45 KANANG KANANG 081351182487 6/30/2021 24003721
87 7303086603880002 ISMARIANTI P 33 31-45 KANANG KANANG 085343785570 6/30/2021 24003721
88 7304116706850002 LINA P 37 31-45 KANANG KANANG 085146287316 6/30/2021 24003721
89 7304117112950016 DARMI P 25 18-30 KANANG KANANG 081351182487 6/30/2021 24003721
90 6472061504770003 AHMAD RIYADI L 53 46-59 KANANG KANANG 081351182487 6/30/2021 24003721
91 7304112812770002 BAHA. D L 40 31-45 KANANG KANANG 082393548902 6/30/2021 24003721
92 7304106503950001 SUMARNI P 26 18-30 PACCINONGAN 085241208729 6/30/2021 24003721
93 7304117112570020 NAHARIAH P 65 0 PACCINONGAN 085241208729 6/30/2021 24003721
94 730411711260050 RABI P 51 46-59 PACCINONGAN 085241208729 6/30/2021 24003721
95 7304113004750001 MUH. ARSYAD L 46 46-59 PACCINONGAN 0887436934095 6/30/2021 24003721
96 7304116202800001 MADE DEWI ERNAW P 41 31-45 PACCINONGAN 082197080471 6/30/2021 24003721
97 7304115301000001 FITRIANI NUR P 20 18-30 PACCINONGAN 087861644230 6/30/2021 24003721
98 7304114203760001 SAHARIA P 45 31-45 PACCINONGAN 0887436934095 6/30/2021 24003721
99 7304113112840060 MULLING L 36 31-45 BONTO LANGGA 085738430437 6/30/2021 24003721
100 7303081605870002 RAHMAN L 33 31-45 6/30/2021 24003721
101 7304117112710019 HJ. RABAINTANG P 49 46-59 KANANG KANANG 082399523269 6/30/2021 24003721
102 7304113112690010 H. NASIRI L 51 46-59 KANANG KANANG 082399523269 6/30/2021 24003721
103 7304113112810055 BAKRI L 40 31-45 PACCINONGAN 082332538771 6/30/2021 24003721
104 7304114701740001 SARIMMA P 47 46-59 KANANG KANANG 085397912864 6/30/2021 24003721
105 7304117112640025 NIA P 57 46-59 KANANG KANANG 081351182487 6/30/2021 24003721
106 7304116707690001 RIA P 42 31-45 KANANG KANANG 085343781833 6/30/2021 24003721
107 7304046505570001 HJ. ROSMIAH P 63 0 KANANG KANANG 085255365531 6/30/2021 24003721
108 7304114508560001 NURASIYA KR RIM P 65 0 PACCINONGAN 085256146780 6/30/2021 24003721
109 7304114107890020 HANIA P 31 31-45 PACCINONGAN 085396773724 6/30/2021 24003721
110 730705711262 MANTANG P 58 46-59 PACCINONGAN 085265908025 6/30/2021 24003721
111 7304114609980002 TUTI ALFIANA P 22 18-30 PACCINONGAN 085341782451 6/30/2021 24003721
112 7304113112700032 ABD. SALAM L 50 46-59 PACCINONGAN 082187694300 6/30/2021 24003721
113 7304110909020002 ASWIN SALAM L 19 18-30 PACCINONGAN 082187694300 6/30/2021 24003721
114 730411010840005 ILYAS L 37 31-45 PARANGSIALLA 082334643081 6/30/2021 24003721
115 7307055707000005 SELVI P 20 18-30 PACCINONGAN 081524484819 6/30/2021 24003721
116 7304113112820049 SATTUANG L 38 31-45 PACCINONGAN 085231505781 6/30/2021 24003721
117 7304117112740043 HAWIAH P 46 46-59 KANANG KANANG 085242359515 6/30/2021 24003721
118 73041155110730001 SIAMA P 41 31-45 KANANG KANANG 082250799719 6/30/2021 24003721
119 7303054710000003 ULYI P 20 18-30 KANANG KANANG 085395220986 6/30/2021 24003721
120 7304117112700041 LENTENG P 40 31-45 PACCINONGAN 082346769031 6/30/2021 24003721
121 7304116403830002 SURI P 37 31-45 KANANG KANANG 082343729959 6/30/2021 24003721
122 7304117112800034 KAMI P 30 18-30 KANANG KANANG 082346824689 6/30/2021 24003721
123 7304112105020001 ERWIN L 19 18-30 KANANG KANANG 082019638133 6/30/2021 24003721
124 7304117112820071 BACCE P 38 31-45 KANANG KANANG 085696525538 6/30/2021 24003721
125 7304110507810002 AMIR L 40 31-45 KANANG KANANG 085391938588 6/30/2021 24003721
126 7304117112810038 NURINTANG P 39 31-45 PACCINONGAN 085387034491 6/30/2021 24003721
127 7304115509030001 USNA P 19 18-30 PARANGSIALLA 081524914638 6/30/2021 24003721
128 7304114404030001 NURFAJRIANI PRAT P 19 18-30 PACCINONGAN 082348407317 6/30/2021 24003721
129 7304114607800002 HADIA P 40 31-45 KANANG KANANG 082393083099 6/30/2021 24003721
130 7304115205010002 SALMA P 20 18-30 KANANG KANANG 085393519198 6/30/2021 24003721
131 7304111505700002 ABD.HAMID L 51 46-59 KANANG KANANG 082250799719 6/30/2021 24003721
132 7304116312990001 NURWAHYUNI P 22 18-30 TINO 081354503324 6/30/2021 24003721
133 7304113112690045 TAMA' L 51 46-59 KANANG KANANG 085241217582 6/30/2021 24003721
134 7304113112760939 SASO L 44 31-45 PACCINONGAN 085242145919 6/30/2021 24003721
135 7304114310810001 SURIANI P 40 31-45 PACCINONGAN 082337182409 TUNDA:LEMAS
136 7304114109740001 BASMAWATI P 46 46-59 PACCINONGAN 082347649838 TUNDA:SAKIT KEPALA
137 7304116909020004 SRI AYU SUCI P 19 18-30 PACCINONGAN 085398787453 TUNDA: SAKIT KEPALA
138 7304117112790027 SASSE CAWANG P 51 46-59 KANANG KANANG 085255656493 TUNDA:SAKIT KEPALA
139 7304114107790009 H. HASNA P 42 31-45 KANANG KANANG 085256313057 TUNDA: LEMAS
140 7304115507940001 SYAMSIA P 26 18-30 KANANG KANANG 085823404575 TUNDA: SAKIT KEPALA
141 7304115606640001 HANAPA P 56 46-59 KANANG KANANG 085823404575 TUNDA:KOLESTEROL TINGGI
142 7304117112890012 PUJI P 21 18-30 KANANG KANANG 085299838598 TUNDA:SAKIT PERUT
143 7304115407710001 HALAWIAH P 49 46-59 PACCINONGAN 085251505518 TUNDA:ISPA
144 7304114107880037 SUNNIATI P 32 31-45 PACCINONGAN 0887436934095 TUNDA: SAKIT KEPALA
145 7304117112590021 SURIANI P 61 0 PACCINONGAN 0887436934095 TUNDA: PUSING
146 7304117112700042 SAIMA P 50 46-59 PACCINONGAN 085242145919 TUNDA:ISPA
147 7304110107560026 DG GILING L 64 0 BONTOWA 085242698284 TUNDA:SAKIT KEPALA
148 7304113112620024 BALI L 58 46-59 PARANGSIALLA 082348028566 TUNDA: BATUK FLU
149 7304114101600004 SINJA P 61 0 PARANGSIALLA 085256352751 TUNDA:DM TIPE II
150 7304116212530001 SANNIA P 67 0 KANANG KANANG 082349745684 TUNDA:SAKIT PINGGANG
151 7304117112650058 NURHAYATI P 55 46-59 PARANGSIALLA 085255806795 TUNDA:SAKIT KEPALA
152 7304110307990003 IRWAN L 21 18-30 KANANG KANANG 085348113284 TUNDA:MUNTAH DARAH
153 7304117012610001 HJ.HERA P 59 46-59 KANANG KANANG 082399281823 TUNDA:FLU
154 7304111507660001 SYAMSUDDIN L 54 46-59 KANANG KANANG 082351439559 TUNDA : KOLESTROL TINGGI
155 7304114107680028 SANNERA P 53 46-59 PACCINONGAN 085398066321 TUNDA : JANTUNG
156 7304110107590016 JAPA L 62 0 KANANG KANANG 082240632685 TUNDA :HT
157 7304115709750001 RANNU P 45 31-45 KANANG KANANG 082346726129 TUNDA : FLU BERAT
Keterangan ***Merek Vaksin

* Pekerjaan dikelompokkan menjadi: A = Sinovac
A = Petugas Medis dan Non Medis di FasiB = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
C = Administrator Pemerintahan
D = Lainnya
E = Tidak Bekerja

18-30 37 BPJS P 0 A 0
31-45 59 BPJS No 0 B 0
46-59 39 Non Ang 0 C 0
Total 135 Total 0 D 0
Pekerjaan: Pemberian Dosis E 0
A 0 Dosis 1 132 Total 0
B 0 Dosis 2 1
C 0 Total
D 0
E 0
Total 0


'Ya' pada kolom yang Nama/ Dosis I Dosis 2
Jenis Umur Kelomp sesuai) Tanggal Jenis/ Keterangan
Nama Penerima BPJS Non Screenin Merek Tanggal Tanggal
No No. Tiket NIK KelamiPekerjaan*(18-59 ok Alamat No. Hp BPJS No. No. (Ditunda/Tidak
Vaksin Non Anggot Pemberian No. Batch Pemberian No. Batch
n tahun) Umur PBI g Vaksin Serial Serial Diberikan/Lanjut)
PBI a *** Vaksinasi Vaksinasi
1 7304117112590017 CAKKA P 61 0 PACCINONGAN 085240023539 sinovac 7/1/2021 24003721

2 7304114107580019 JAWARIAH P 63 0 PACCINONGAN 085396312616 sinovac 7/1/2021 24003721
3 7304117112810036 HJ SUMARNI P 40 31-45 KANANG KANANG 082334643085 sinovac 7/1/2021 24003721
4 7304110202520001 ABDULLAH KR BULU L 69 0 PACCINONGAN 085342053850 sinovac 7/1/2021 24003721
5 7304111012560001 RABANAI L 64 0 PACCINONGAN 085254625742 sinovac 7/1/2021 24003721
6 7304117112560033 SATUA P 64 0 KANANG KANANG 085395744783 sinovac 7/1/2021 24003721
7 7304114107570024 NAHARA P 63 0 BONTO LANGGA 081341963393 sinovac 7/1/2021 24003721
8 7304114102780003 NURSIA P 54 46-59 BONTO LANGGA 085398328318 sinovac 7/1/2021 24003721
9 7304113112750046 ABDULLAH L 46 46-59 PACCINONGAN 081255179017 sinovac 7/1/2021 24003721
10 7304113112890027 ASIS L 30 18-30 BONTO LANGGA 085348613230 sinovac 7/1/2021 24003721
11 7304111610940002 HARIS MUNANDAR L 26 18-30 PACCINONGAN 085396312616 sinovac 7/1/2021 24003721
12 7304111411970001 ACHMAD FADLY ILHAM L 23 18-30 PACCINONGAN 085241115115 sinovac 7/1/2021 24003721
13 7304116507660001 ROSMAWATI P 54 46-59 PACCINONGAN 085256715525 sinovac 7/1/2021 24003721
14 7304115501700001 SAHRIYANI P 51 46-59 PACCINONGAN 085394226772 sinovac 7/1/2021 24003721
15 7304114501860001 HIKMAWATI P 35 31-45 PACCINONGAN 082345888456 sinovac 7/1/2021 24003721
16 7304114102780001 ASSE P 42 31-45 BONTO LANGGA 082347964900 sinovac 7/1/2021 24003721
17 7304113112600075 CIDO L 60 0 KANANG KANANG 082346824654 sinovac 7/1/2021 24003721
18 7304113112640022 SUDIRMAN BALA L 54 46-59 KANANG KANANG 085243352436 sinovac 7/1/2021 24003721
19 7304115102740001 NURSIAH P 47 46-59 PACCINONGAN 085343962560 sinovac 7/1/2021 24003721
20 7304116004980001 HASNI P 23 18-30 PACCINONGAN 085343962560 sinovac 7/1/2021 24003721
21 7304117112770027 NORMA P 43 31-45 PACCINONGAN 085213227180 sinovac 7/1/2021 24003721
22 7304112203710001 RAPPUNG L 49 46-59 TINO 082151945020 sinovac 7/1/2021 24003721
23 7304117112710040 NURHAYATI P 49 46-59 KANANG KANANG 085242352436 sinovac 7/1/2021 24003721
24 7304113112780010 SARIPUDDIN L 42 31-45 KANANG KANANG 085395370030 sinovac 7/1/2021 24003721
25 7304114100780003 MARIA P 43 31-45 KANANG KANANG 0887435057899 sinovac 7/1/2021 24003721
26 731314410442000 DIA P 79 0 TINO 085341376109 sinovac 7/1/2021 24003721
27 720407305950003 DARMAN SYAGI L 26 18-30 PACCINONGAN 085245465451 sinovac 7/1/2021 24003721
28 7304111202010002 M IKBAL L 20 18-30 TINO 082151945020 sinovac 7/1/2021 24003721
29 7304110707020002 RAHUL L 22 18-30 KANANG KANANG 085342766944 sinovac 7/1/2021 24003721
30 7304116306840001 ROHANI L 37 31-45 PACCINONGAN 082399278195 sinovac 7/1/2021 24003721
31 7306104107930105 A MEGAWATI P 27 18-30 PACCINONGAN 082396085609 sinovac 7/1/2021 24003721
32 7304117112770019 SARI P 43 31-45 PACCINONGAN 085240023539 sinovac 7/1/2021 24003721
33 7304114107930028 RAHMA P 28 18-30 PACCINONGAN 085242198439 sinovac 7/1/2021 24003721
34 7304113112800046 KITTA L 30 18-30 KANANG KANANG 082347964900 sinovac 7/1/2021 24003721
35 7304116012820001 MANTANG P 38 31-45 KANANG KANANG 082347964900 sinovac 7/1/2021 24003721
36 7304110503970001 FAISAL L 24 18-30 BONTO LANGGA 085398328318 sinovac 7/1/2021 24003721
37 7303080505960003 MALIK W L 24 18-30 KANANG KANANG 085299990836 sinovac 7/1/2021 24003721
38 7304113112710040 PAMA L 49 46-59 KANANG KANANG 082226404004 sinovac 7/1/2021 24003721
39 7304110101950001 IRFAN HAMSAH L 35 31-45 PACCINONGAN 085396312616 sinovac 7/1/2021 24003721
40 7304110102670001 SAHARUDDIN L 53 46-59 BONTO LANGGA 085298062955 sinovac 7/1/2021 24003721
41 7304117112720030 BARAWIAH P 48 46-59 PACCINONGAN 085342033305 sinovac 7/1/2021 24003721
42 7304112004990004 IRSAN L 21 18-30 BALTAR 085387584471 sinovac 7/1/2021 24003721
43 7304111312020001 M. YUSUF L 19 18-30 BALANGLOE 085387584471 sinovac 7/1/2021 24003721
44 7304113112790003 MARSUKI L 41 31-45 BALANGLOE 085387584471 sinovac 7/1/2021 24003721
45 7304110107800060 SANO L 40 31-45 BALANGLOE 085387584471 sinovac 7/1/2021 24003721
46 7304113112680019 H. SANNANG L 52 46-59 KANANG KANANG 082334643085 sinovac 7/1/2021 24003721
47 7304110905680001 ABD HAKIM L 53 46-59 PACCINONGAN 085343962560 sinovac 7/1/2021 24003721
48 73041170129300001 MAWAR P 27 18-30 KANANG KANANG 082399281823 sinovac 7/1/2021 24003721
49 7304111903840001 ISMAIL L 37 31-45 KANANG KANANG 082399281823 sinovac 7/1/2021 24003721
50 73041171126500039 KAMA P 56 46-59 KANANG KANANG 085343788065 sinovac 7/1/2021 24003721
51 7304114604800003 NAHANA P 30 18-30 PACCINONGAN 085348321109 sinovac 7/1/2021 24003721
52 7304114107800089 MEMI P 40 31-45 KANANG KANANG 082340841037 sinovac 7/1/2021 24003721
53 7304114912840001 AHRIANI P 36 31-45 PACCINONGAN 082347983703 sinovac 7/1/2021 24003721
54 7304115512000001 SRI SUCI RAMADAN P 20 18-30 PACCINONGAN 085342902225 sinovac 7/1/2021 24003721
55 7304111501720001 KUMI L 49 46-59 KANANG KANANG 082340841037 sinovac 7/1/2021 24003721
56 7304116712760002 SUNNI P 44 31-45 KANANG KANANG 085255109202 sinovac 7/1/2021 24003721
57 7304110907920001 M YUSUF L 29 18-30 PACCINONGAN 081250885963 sinovac 7/1/2021 24003721
58 7304113112670035 MANSUR L 53 46-59 KANANG KANANG 081342225732 sinovac 7/1/2021 24003721
59 7304115904890001 NURHIDAYAH P 32 31-45 PACCINONGAN 085299985185 sinovac 7/1/2021 24003721
60 7304113112750051 KAHARUDDIN L 45 31-45 PACCINONGAN 085343764741 sinovac 7/1/2021 24003721
61 7304115105710001 NURSIAH P 49 46-59 PACCINONGAN 082347129804 sinovac 7/1/2021 24003721
62 7304110908840001 PATTAHUDDIN L 36 31-45 PACCINONGAN 081355690796 sinovac 7/1/2021 24003721
63 7304114302990001 HASNI HN P 21 18-30 PACCINONGAN 082328668195 sinovac 7/1/2021 24003721
64 7304112404960002 AHMAD SOFYAN L 24 18-30 KANANG KANANG 081243339112 sinovac 7/1/2021 24003721
65 7304115507810002 SUMIATI P 39 31-45 PACCINONGAN 085340043277 sinovac 7/1/2021 24003721
66 7304110512770001 KAMARUDDIN L 43 31-45 PACCINONGAN 082344962633 sinovac 7/1/2021 24003721
67 7304115108980001 NURRAHMA P 22 18-30 ASPOL JLN MANGGI085342598227 sinovac 7/1/2021 24003721
68 7304114905800001 SUARNI P 40 31-45 PACCINONGAN 085341935848 sinovac 7/1/2021 24003721
69 7304115812950001 SALMAH P 25 18-30 PACCINONGAN 085387673382 sinovac 7/1/2021 24003721
70 7304114712580001 KAMASIA P 62 0 KANANG KANANG 082346206226 sinovac 7/1/2021 24003721
71 7304116204940001 NURAEDAH P 27 18-30 KANANG KANANG 082395350460 sinovac 7/1/2021 24003721
72 7304113112830034 BAHTIAR L 37 31-45 KANANG KANANG 085252610214 sinovac 7/1/2021 24003721
73 7304110905730001 HATTA L 48 46-59 KANANG KANANG 082336060303 sinovac 7/1/2021 24003721
74 7304113112670037 SALASING L 53 46-59 KANANG KANANG 085341376109 sinovac 7/1/2021 24003721
75 7304117112770023 RUPI P 43 31-45 KANANG KANANG 082352165936 sinovac 7/1/2021 24003721
76 7304117112550015 SAIPA P 54 46-59 BONTO LANGGA 082191747882 sinovac 7/1/2021 24003721
77 7304113112580015 RAJA L 53 46-59 KANANG KANANG 082191747882 sinovac 7/1/2021 24003721
78 7304113112760038 SAPO HS L 44 31-45 KANANG KANANG 082352165936 sinovac 7/1/2021 24003721
79 7304115205920002 ROSMAWATI P 29 18-30 KANANG KANANG 082352156936 sinovac 7/1/2021 24003721
80 7304116905650001 ROSI P 56 46-59 KANANG KANANG 081288549262 sinovac 7/1/2021 24003721
81 7304044107650022 MURI P 55 46-59 PACCINONGAN 085394460530 sinovac 7/1/2021 24003721
82 7304110710020001 FANI EFENDI L 19 18-30 PACCINONGAN 085647583462 sinovac 7/1/2021 24003721
83 7304045011780001 HASNIAH DG KEBO P 42 31-45 PACCINONGAN 082155698722 sinovac 7/1/2021 24003721
84 730408508860010 MARLINA SP.DI P 35 31-45 PACCINONGAN 085247607960 sinovac 7/1/2021 24003721
85 7304113112610035 CACING B L 50 46-59 KANANG KANANG 085240548630 sinovac 7/1/2021 24003721
86 730305410790010 ASSE P 42 31-45 PANOANG 085240548630 sinovac 7/1/2021 24003721
87 7304112710990002 HARIS MUNANDAR L 21 18-30 PACCINONGAN 085256819106 sinovac 7/1/2021 24003721
88 7304112505030002 FIRMANSYAH L 18 18-30 TINO 082393084725 sinovac 7/1/2021 24003721
89 7304111602010001 A. DIO IAM L 20 18-30 TINO 085345220685 sinovac 7/1/2021 24003721
90 7304116909970002 NUR HARINI P 33 31-45 PACCINONGAN 083847688127 sinovac 01/07/2021 24003721
91 7304113112830032 ISMAIL L 38 31-45 PACCINONGAN 082343652560 sinovac 01/07/2022 24003722
92 7304112201920001 RAHMAT WAHYUDI L 29 18-30 PACCINONGAN 085256146780 sinovac 01/07/2023 24003723

* Pekerjaan dikelompokkan menjadi: A = Sinovac 14 TUNDA
A = Petugas Medis dan Non Medis di Fasil B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
D = Lainnya
E = Tidak Bekerja

18-30 29 BPJS PBI 0 A 0
31-45 30 BPJS Non 0 B 0
46-59 24 Non Angg 0 C 0
B 0 Dosis 2 0
C 0 Total
D 0
E 0
Total 0


'Ya' pada kolom yang Dosis I Dosis 2
sesuai) Keterangan
Umur Kelomp Nama/Jenis/
Nama Penerima Jenis Pekerja Tanggal Tanggal Tanggal (Ditunda/Tidak
No No. Tiket NIK (18-59 ok Alamat No. Hp BPJS BPJS Non Merek No. No. Diberikan/Lanju
Vaksin Kelamin an* Screening
tahun) Umur PBI Non PBI Anggota Vaksin*** Pemberian No. Batch Serial Pemberian No. Batch Serial
Vaksinasi Vaksinasi t)
1 7304113112550013 TEPU L 66 0 PACCINONGAN 082353013728 coronovac 7/3/2021 24003721

2 7304045211840001 SUHARTIN P 36 31-45 BUNGENG 085348035467 coronovac 7/3/2021 24003721
3 7304113112810036 USMAN TOMPO L 40 31-45 PACCINONGAN 085259218740 coronovac 7/3/2021 24003721
4 7304115707980001 RESKI P 23 18-30 PARANGSIALLA 082343459217 coronovac 7/3/2021 24003721
5 7304044107780002 NGAI P 43 31-45 KANANG KANANG 085895383204 coronovac 7/3/2021 24003721
6 7304117112790027 SASSE CAWANG P 51 46-59 KANANG KANANG 085255656493 coronovac 7/3/2021 24003721
7 7304041506730002 ARIF L 44 31-45 KALOKO 085240647750 coronovac 7/3/2021 24003721
8 7304044501810001 SAHARIAH P 40 31-45 KALOKO 085334869542 coronovac 7/3/2021 24003721
9 7304117112840012 PUJI P 21 18-30 KANANG KANANG 085299838598 coronovac 7/3/2021 24003721
10 7304111503820003 MUSTAKIM L 39 31-45 PACCINONGAN 085234964561 coronovac 7/3/2021 24003721
11 7304117012610001 HJ. HERA P 59 46-59 KANANG KANANG 082399281823 coronovac 7/3/2021 24003721
12 7304114107030001 WIWI WIDYA ASTUTI P 18 18-30 BUNGUNG KONCI 082347119060 coronovac 7/3/2021 24003721
13 7304117112600070 RIMA P 61 0 JL. ATIEK SUTEDJA 08578113614 coronovac 7/3/2021 24003721
14 7304111504760001 H RADENG L 45 31-45 KANANG KANANG 085145663988 coronovac 7/3/2021 24003721
15 7304114708500001 RABAINTANG P 70 0 PACCINONGAN 081355868282 coronovac 7/3/2021 24003721
16 7304116007600001 HASNAH R P 60 0 PACCINONGAN 085340880880 coronovac 7/3/2021 24003721
17 730411410160003 RABANIA P 61 0 BONTO LANGGA 082343459217 coronovac 7/3/2021 24003721
18 7304114507780004 TRISNAWATI P 42 31-45 KALOKO 082287394168 coronovac 7/3/2021 24003721
19 2102050807700001 SULKIPLI L 51 46-59 KALOKO 082287394168 coronovac 7/3/2021 24003721
20 7304110303990004 MUH. SIDIQ SIJAYA L 22 18-30 PACCINONGAN 087846774562 coronovac 7/3/2021 24003721
21 7304110408790001 M.ADI AL GHIFARI L 41 31-45 PACCINONGAN 085340515477 coronovac 7/3/2021 24003721
22 7304117007010001 RATIH PURNAMA SARI P 19 18-30 PARANGSIALLA 082393096525 coronovac 7/3/2021 24003721
23 7304110610020001 NANDA MULIADI RIDW P 19 18-30 BONTO LANGGA 081242083303 coronovac 7/3/2021 24003721
24 7304114204820001 JUSNIATI P 39 31-45 KANANG KANANG 085393096525 coronovac 7/3/2021 24003721
25 7304117108670001 NURHAYATI P 64 0 BONTOWA 081342421206 coronovac \ 7/3/2021 24003721
26 7304115707020002 SYAMHUJRAH AWALIA P 19 18-30 PACCINONGAN 081347179660 coronovac 7/3/2021 24003721
27 7304111109760002 JASMAN DG SIALA L 44 31-45 PACCINONGAN 081355280285 coronovac 7/3/2021 24003721
28 7304110105950001 SUPRIADI L 26 18-30 BONTORAPPO 085242701004 coronovac 7/3/2021 24003721
29 7304117004020002 SULMIYATI P 19 18-30 KANANG KANANG 085772129277 coronovac 7/3/2021 24003721
30 73040410760018 RAHMAN M L 61 0 PACCINONGAN 085394460530 coronovac 7/3/2021 24003721
31 7304113112840065 SAHARUDDIN L 36 31-45 KANANG KANANG 082346439244 coronovac 7/3/2021 24003721
32 7304110107590006 RAHMAN SAID L 62 0 PACCINONGAN 085341782451 coronovac 7/3/2021 24003721
33 7304117112860066 ROSMINI P 34 31-45 KANANG KANANG 082346439244 coronovac 7/3/2021 24003721
34 31720305018300223 IRMAN BASO L 38 31-45 JL MELODI TUGU 081212094333 coronovac 7/3/2021 24003721
35 7304113112820030 UMAR L 38 31-45 KANANG KANANG 082346439244 coronovac 7/3/2021 24003721
36 7304117112840019 SYAMSIA P 36 31-45 KANANG KANANG 082346439244 coronovac 7/3/2021 24003721
37 7304117112780033 SURI P 42 31-45 KANANG KANANG 082326668195 coronovac 7/3/2021 24003721
38 7304113112790029 H..DUDDIN L 41 31-45 KANANG KANANG 082346824689 coronovac 7/3/2021 24003721
39 7304114912920001 DINA P 28 18-30 PACCINONGAN 085251505493 coronovac 7/3/2021 24003721
40 7304113112610046 SULAEMAN L 60 0 PACCINONGAN 085348428288 coronovac 7/3/2021 24003721
41 7304111305870001 MISDIN L 34 31-45 PACCINONGAN 082346052997 coronovac 7/3/2021 24003721
42 7308084101700004 NURSIA P 51 46-59 TINO 085348428288 coronovac 7/3/2021 24003721
43 7304114107720028 SURI P 48 46-59 KANANG KANANG 085395744783 coronovac 7/3/2021 24003721
44 7304110107970037 USMAN L 23 18-30 BONTO LANGGA 082292250233 coronovac 7/3/2021 24003721
45 7304114809670001 ST. NUR RAHMAWATI P 53 46-59 KANANG KANANG 085299698570 coronovac 7/3/2021 24003721
46 7304040701780001 IRSAN L 43 31-45 PACCINONGAN 085340229639 coronovac 7/3/2021 24003721
47 73041127020330002 AKBAR L 18 18-30 PACCINONGAN 081342578147 coronovac 7/3/2021 24003721
48 7304114306890002 KAMARIA P 32 31-45 PACCINONGAN 082320153834 coronovac 7/3/2021 24003721
49 7304113112700061 JAFAR L 40 31-45 PACCINONGAN 085256903182 coronovac 7/3/2021 24003721
50 7304114107720035 BANONG P 48 46-59 KANANG KANANG 085349797751 coronovac 7/3/2021 24003721
51 7304110606800001 MANAI L 40 31-45 PACCINONGAN 085397895267 coronovac 7/3/2021 24003721
52 7304114107450023 MARIAMA P 66 0 PACCINONGAN 082399278195 coronovac 7/3/2021 24003721
53 7304113012530001 NURGANTI TOMPO L 67 0 BONTO LANGGA 082393344949 coronovac 7/3/2021 24003721
54 7308080103600001 SIDIK L 61 0 TINO 085348428288 coronovac 7/3/2021 24003721
55

* Pekerjaan dikelompokkan menjadi: A = Sinovac TUNDA
A = Petugas Medis dan Non Medis di FasB = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
D = Lainnya
E = Tidak Bekerja

18-30 12 BPJS PBI 0 A 0
31-45 23 BPJS Non 0 B 0
46-59 7 Non Anggo 0 C 0
B 0 Dosis 2 2
C 0 Total
D 0
E 0
Total 0

Tanggal 6-07-2021
Tanggal Pemberian
'Ya' pada kolom yang Komorbid** No. Batch
Imunisasi
sesuai)
Ada Keterangan
Jenis Umur Kelomp Tidak
Nama Penerima Pekerj BPJS Non (sebutk Merek (Contoh:
NoNo. Registrasi NIK Kela (18-59 ok Alamat No. Hp BPJS Ada
Vaksin aan* Non Anggot an Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dirujuk/
min tahun) Umur PBI (centan
PBI a komorb ….)
g)
idnya)
1 7304031003010003 MUH. IBRAHIM RAHMAT L 4 20 18-30 JL. TEMBAKAU 082271532192 v Coronovac 24003721 06/07/2021
2 7304110205730002 AHMAD SAEDI L 4 58 46-59 PACCINONGAN 085212526285 v Coronovac 24003721 06/07/2021
3 7304111005910001 RORIS WIJAYA L 2 30 18-30 BALANGLOE 081222511156 v Coronovac 24003721 06/07/2021
4 7304112604860002 WAWAN L 4 35 31-45 PACCINONGAN 085340168827 v Coronovac 24003721 06/07/2021
5 73070054202020007 AYU FEBRIANTI AMALIA P 4 19 18-30 BULO BULO TIMUR 085343788371 v Coronovac 24003721 06/07/2021
6 6402131706520001 M SYARIFUDDIN L 2 69 0 BUNGUN CAMBA 082159759317 v Coronovac 24003721 06/07/2021
7 7304115110730004 JUNAEDAH P 4 47 46-59 BUNGUN CAMBA 085347361078 v Coronovac 24003721 06/07/2021
8 6472051809790005 IRWAN L 4 41 31-45 CEMPAJA UTARA KA082150567416 v Coronovac 24003721 06/07/2021
9 7304040107090003 RISAL L 4 16 0 PACCINONGAN 0895635098233 v Coronovac 24003721 06/07/2021
10 7304116909020004 SRI AYU SUCI P 4 19 18-30 PACCINONGAN 085398787453 v Coronovac 24003721 06/07/2021
11 7303016412940004 RISMAWATI P 4 26 18-30 BONTO LANGGA 085248564064 v Coronovac 24003721 06/07/2021
12 7304114506820001 KASMAWATI P 4 39 31-45 BONTO LANGGA 082195038147 v Coronovac 24003721 06/07/2021
13 7303080701850004 MUSAKKIR L 4 36 31-45 KANANG KANANG 085833078605 v Coronovac 24003721 06/07/2021
14 7303087105900002 SANTI P 4 31 31-45 KANANG KANANG 085823078605 v Coronovac 24003721 06/07/2021
15 7304116408990001 CITRA SRI HANDAYANI P 4 21 18-30 PACCINONGAN 081524357040 v Coronovac 24003721 06/07/2021
16 7304115708800002 MINA P 4 40 31-45 KANANG KANANG 085321579183 v Coronovac 24003721 06/07/2021
17 7304113112650028 H.JUMA L 2 55 46-59 KANANG KANANG 085348610577 v Coronovac 24003721 06/07/2021
18 7304114511950001 SUTRIANA P 4 26 18-30 RA'RA 085342198438 v Coronovac 24003721 06/07/2021
19 7304115210810001 KASMAWATI P 4 39 31-45 KANANG KANANG 085225962821 v Coronovac 24003721 06/07/2021
20 7304110107790060 NASIR P 4 42 31-45 KANANG KANANG 085225962821 v Coronovac 24003721 06/07/2021
21 7304117112570019 HJ. RABIA P 4 63 0 KANANG KANANG 085348610577 v Coronovac 24003721 06/07/2021
22 7304114107870003 SYARMILA P 34 31-45 RA'RA 085240021835 Coronovac 24003721 06/07/2021
23 7304116808790001 NURAEDA P 4 41 31-45 RA'RA 085656362718 Coronovac 24003721 06/07/2021
24 7371077112740096 HASNI DG NGINTANG P 4 46 46-59 JL NAJA DG NAI 085757591711 Coronovac 24003721 06/07/2021
25 7304114106760004 HARIATI P 4 46 46-59 RA'RA 085247949076 Coronovac 24003721 06/07/2021
26 7304110502690001 SAHARUDDIN L 4 51 46-59 KASSI KASSI 083133914917 Coronovac 24003721 06/07/2021
27 7304114111690001 HAPSA P 4 51 46-59 RA'RA 085395414572 Coronovac 24003721 06/07/2021
28 7304117007720001 JAMILA NAZAR P 4 48 46-59 RA'RA 085240280977 Coronovac 24003721 06/07/2021
29 7304110304980001 ABDUL TALIB L 4 23 18-30 PACCINONGAN 085298702407 Coronovac 24003721 06/07/2021
30 7304114107790037 HAJRA P 4 42 31-45 PACCINONGAN 085298702407 Coronovac 24003721 06/07/2021
31 7304110107760018 DIONG L 4 45 31-45 PACCINONGAN 085298702407 Coronovac 24003721 06/07/2021
32 7304110107830042 MADDIN L 4 38 31-45 KANANG KANANG 082328236937 Coronovac 24003721 06/07/2021
33 7304115109800001 HASNA P 4 41 31-45 KANANG KANANG 082328236937 Coronovac 24003721 06/07/2021
34 7304111507830002 BASRI L 4 38 31-45 KANANG KANANG 085342030963 Coronovac 24003721 06/07/2021
35 3604101107900328 ROHMAN L 4 31 31-45 PACCINONGAN 081217888184 Coronovac 24003721 06/07/2021
36 7304117112860037 SYAMSIA P 4 34 31-45 PACCINONGAN 082398235825 Coronovac 24003721 06/07/2021
37 7371064505780006 NURHAYATI P 4 43 31-45 PACCINONGAN 082346506595 Coronovac 24003721 06/07/2021
38 7304114107880048 DARMAWATI P 4 33 31-45 PACCINONGAN 082346506595 Coronovac 24003721 06/07/2021
39 7304117112820046 RIA P 4 38 31-45 PACCINONGAN 085394066488 Coronovac 24003721 06/07/2021
40 7304117112820045 NURAENI P 4 38 31-45 PACCINONGAN 082346742678 Coronovac 24003721 06/07/2021
41 7304115802800002 YATI P 31 31-45 RA'RA 082188386048 Coronovac 24003721 06/07/2021
42 7303054107820559 SYAMSIA P 39 31-45 KANANG KANANG 085395594839 Coronovac 24003721 06/07/2021
43 7303053112850089 DARWIS JAYA L 2 35 31-45 KANANG KANANG 085395594839 Coronovac 24003721 06/07/2021
44 6402130811900002 AKBAR SAID L 4 30 18-30 BONTOMANAI 081350198461 Coronovac 24003721 06/07/2021
45 7304115010950005 NURAENI P 4 25 18-30 BONTOMANAI 082286665852 Coronovac 24200121 06/07/2021
46 7303014404760004 MARYANI P 4 45 31-45 TINO 085242036803 Coronovac 24200121 06/07/2021
47 7304113112700060 JAMALUDDIN L 50 46-59 PACCINONGAN 085299641667 Coronovac 24200121 06/07/2021
48 7304112401860001 LUKMAN L 45 31-45 BONTO MASUGI 082347141501 Coronovac 24200121 06/07/2021
49 7304115504710002 MANAO P 50 46-59 BONTO LANGGA 085395540063 Coronovac 24200121 06/07/2021
50 7304117101870001 KAMARIA P 34 31-45 PACCINONGAN Coronovac 24200121 06/07/2021
51 7304114102750005 ROHANI DG PALE P 46 46-59 BONTO LANGGA 082187066060 Coronovac 24200121 06/07/2021
52 7304114107760032 RAMLAH P 45 31-45 PACCINONGAN 082311309377 Coronovac 24200121 06/07/2021
53 7304115802000002 RENI ANGGRAENI P 20 18-30 PACCINONGAN 085241126556 Coronovac 24200121 06/07/2021
54 7304116712990001 JUMRAH P 21 18-30 KANANG KANANG 085241126556 Coronovac 24200121 06/07/2021
55 7304040501760004 JAENUDDIN L 54 46-59 PACCINONGAN 082155698722 Coronovac 24200121 06/07/2021
56 73041147112830027 MARINJA P 37 31-45 TAWINDE 081241216698 Coronovac 24200121 06/07/2021
57 7303054203870006 SUMARNI P 34 31-45 BALANG BARU 085343759520 Coronovac 24200121 06/07/2021
58 7304113112840048 NAPI L 36 31-45 KANANG KANANG 082395340300 Coronovac 24200121 06/07/2021
59 7304110802840001 SAYUTI L 37 31-45 KANANG KANANG 082395340300 Coronovac 24200121 06/07/2021
60 7304115007870007 NURMI P 33 31-45 KANANG KANANG 082395340300 Coronovac 24200121 06/07/2021
61 7304080501930001 PARDI L 27 18-30 PACCINONGAN 081257325567 Coronovac 24200121 06/07/2021
62 7304114102720001 RAHMATIA P 38 31-45 BONTOLANGGA 082395340300 Coronovac 24200121 06/07/2021
63 7304110107380002 BACO L 83 0 PACCINONGAN 085256469981 Coronovac 24200121 06/07/2021
64 7304114402860002 SANAWIA P 34 31-45 PACCINONGAN 085252376051 Coronovac 24200121 06/07/2021
65 7304114107920028 SANTI P 29 18-30 PACCINONGAN 085256466833 Coronovac 24200121 06/07/2021
66 7304116510910002 SUNARTI P 30 18-30 PACCINONGAN 085298287931 Coronovac 24200121 06/07/2021
67 7304116310770002 ROHANI P 43 31-45 BONTO LANGGA 082346355219 Coronovac 24200121 06/07/2021
68 7304113112750050 SASO TOMPO L 46 46-59 PACCINONGAN 085213227180 Coronovac 24200121 06/07/2021
69 7304116011730001 ROSMINI P 47 46-59 PACCINONGAN 08875221501 Coronovac 24200121 06/07/2021
70 7304116308010001 JUMRIANI P 20 18-30 PACCINONGAN 082393095820 Coronovac 24200121 06/07/2021
71 7304111209720001 SARIUDDIN L 51 46-59 PACCINONGAN 0853411782451 Coronovac 24200121 06/07/2021
72 7304117112820057 KASMAWATI P 38 31-45 PACCINONGAN 085396049832 Coronovac 24200121 06/07/2021
73 7304117112020008 SAHRIANI P 18 18-30 TINO 082352162527 Coronovac 24200121 06/07/2021
74 7304117112820047 HASNA P 39 31-45 PACCINONGAN 088246873842 Coronovac 24200121 06/07/2021
75 7304111903770002 ARIF L 44 31-45 KASSI KASSI 082337171398 Coronovac 24200121 06/07/2021
76 7304114711840002 HASNI P 36 31-45 PACCINONGAN 085340445943 Coronovac 24200121 06/07/2021
77 7304030509750002 RUSMIN R L 46 46-59 LENGKE LENGKE 082350648764 Coronovac 24200121 06/07/2021
78 7471045007900003 AYU P 31 31-45 BONTO LANGGA 081245229228 Coronovac 24200121 06/07/2021
79 7304114205750001 ST SUNARI SANANG P 45 31-45 PACCINONGAN 081288536225 Coronovac 24200121 06/07/2021
80 7304114107880037 SUNNIATI P 32 31-45 PACCINONGAN 0887436934095 Coronovac 24200121 06/07/2021
81 7304111001890001 HERMAN L 31 31-45 KANANG KANANG '082346105830 Coronovac 24200121 06/07/2021
82 7304114102880006 ASSE P 32 31-45 BONTO LANGGA 082187066060 Coronovac 24200121 06/07/2021
83 7304113112790035 ABD. HAMID L 42 31-45 PACCINONGAN 082193600712 Coronovac 24200121 06/07/2021
84 7304111212730002 SULAIMAN L 58 46-59 PACCINONGAN 082197080086 Coronovac 24200121 06/07/2021
85 7304117112830032 NORMA P 27 18-30 PACCINONGAN 081342722232 Coronovac 24200121 06/07/2021
86 7304115306990002 SUKMAWATI P 22 18-30 PACCINONGAN 085757001116 Coronovac 24200121 06/07/2021
87 7304110107830028 IBRAHIM L 38 31-45 PACCINONGAN 085396773724 Coronovac 24200121 06/07/2021
88 7304117112800039 ROSMAWATI P 40 31-45 PACCINONGAN 085242036803 Coronovac 24200121 06/07/2021
89 7304114107840036 NEMBONG P 37 31-45 KANANG KANANG 085342030963 Coronovac 24200121 06/07/2021
90 7304113112790031 POGE JAI L 49 46-59 KANANG KANANG 082393075604 Coronovac 24200121 06/07/2021
91 7303026307010004 NURFHATIRANNISA P 20 18-30 PACCINONGAN 082347859300 Coronovac 24200121 06/07/2021
92 7303025804710003 HAWANI P 49 46-59 PACCINONGAN 085399875407 Coronovac 24200121 06/07/2021
93 7304111908810001 JAYADI L 39 31-45 PACCINONGAN 085398163123 Coronovac 24200121 06/07/2021
94 7304111512020001 IDIL MAHENDRA L 18 18-30 KANANG KANANG 085656321840 Coronovac 24200121 06/07/2021
95 7304116001770001 SAHARIA P 44 31-45 KASSI KASSI 082337171398 Coronovac 24200121 06/07/2021
96 7304110509740001 NASIR L 46 46-59 CAMBA LOMPOA 085298704610 Coronovac 24200121 06/07/2021
97 7304110303710006 MUH. ALI L 50 46-59 CAMBA LOMPOA 085256732113 Coronovac 24200121 06/07/2021
98 7304114107790009 H.HASNA P 42 31-45 KANANG-KANANG 085256313057 Coronovac 24200121 06/07/2021
99 7304116909760003 NIARTI P 44 31-45 CAMBA LOMPOA 085242226158 Coronovac 24200121 06/07/2021
100 7304117112700042 SAIMA P 50 46-59 PACCINONGAN 085242145919 Coronovac 24200121 06/07/2021

1 = Petugas Medis dan Non Medis di Fa2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang be 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

18-30 37 BPJS PB 13 1 43
31-45 30 BPJS No 30 2 4
46-59 18 Non Ang 0 3 0
1 43 Dosis 1 84 Total 86
2 4 Dosis 2 41 Komorbid
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0

Tanggal 07-07-2021
Kepesertaan BPJS
Tanggal Pemberian
(tulis 'Ya' pada kolom Komorbid** No. Batch
Imunisasi
yang sesuai)
Ada Keterangan
Jenis Umur Kelomp (sebut Tidak
Nama Penerima Pekerja BPJS Non Merek (Contoh:
No No. Registrasi NIK Kelami (18-59 ok Alamat No. Hp BPJS kan Ada
Vaksin an* Non Anggo Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Diruju
n tahun) Umur PBI komor (centan
PBI ta k/….)
bidnya g)
)
1 7304113112720035 ABD RASYID L 4 49 46-59 PACCINONGAN 085756577780 v Coronovac 24200121 07/07/2021

2 7304113112570009 SUNU DG TIKA L 4 64 0 CAMBA LOMPOA 082393570937 v Coronovac 24200121 07/07/2021
3 7304113112610047 ALIMUDDIN L 2 60 0 PACCINONGAN 083151151859 v Coronovac 24200121 07/07/2021
4 7304117112590021 SURIANI P 4 61 0 PACCINONGAN 0887436934095 v Coronovac 24200121 07/07/2021
5 7303017112520020 SARIAMBONG P 4 69 0 PACCINONGAN 085255826559 v Coronovac 24200121 07/072021
6 7304114411000001 MUSDALIFAH P 2 21 18-30 PACCINONGAN 085348855351 v Coronovac 24200121 07/07/2021
7 7304117112660022 TUNI DG RANNU P 4 55 46-59 KP GALUNG TAROWANG 081354766623 v Coronovac 24200121 07/07/2021
8 7304114712680001 HAYATI P 4 53 46-59 KP GALUNG TAROWANG 082350943993 v Coronovac 24200121 07/07/2021
9 7304110107790061 ZAENUDDIN L 4 42 31-45 PACCINONGAN 085298556586 v Coronovac 24200121 07/07/2021
10 7304115502890002 NORMA P 4 32 31-45 KANANG-KANANG 085255533566 v Coronovac 24200121 07/07/2021
11 7304110504770005 TAWANG L 4 55 46-59 TINO 082346772351 v Coronovac 24200121 07/07/2021
12 7304114304690001 HAJARA P 4 54 46-59 PACCINONGAN 085241348698 v Coronovac 24200121 07/07/2021
13 7304114107930034 HASANA P 4 28 18-30 PACCINONGAN 082394446313 v Coronovac 24200121 07/07/2021
14 7304114502810004 NURSYAMSI P 4 40 31-45 PACCINONGAN 085340157200 v Coronovac 24200121 07/07/2021
15 7304116810850002 RAHMI ASIS P 4 35 31-45 PACCINONGAN 085298172531 v Coronovac 24200121 7/7/2021
16 6406021611710001 KARIA L 4 41 31-45 MABINAU HULU 085393658951 v Coronovac 24200121 07/07/2021
17 6406024612790001 JOHO P 2 41 31-45 MABINAU HULU 085393658951 v Coronovac 24200121 07/07/2021
18 7304116505930001 RISNAWATI P 4 26 18-30 PACCINONGAN 081354502236 v Coronovac 24200121 07/07/2021
19 7304044102850008 RIANI P 4 35 31-45 TINO 082346772351 v Coronovac 24200121 07/07/2021
20 7304114705980002 ERNI P 4 23 18-30 BONTO LANGGA 082311014012 v Coronovac 24200121 07/07/2021
21 7304110107600055 SANGKA L 4 50 46-59 PACCINONGAN 082192425386 v Coronovac 24200121 07/07/2021
22 7304113010840002 HARPIN L 36 31-45 PACCINONGAN 085398333345 Coronovac 24200121 07/07/2021
23 7371012101700002 SAHARUDDIN L 4 51 46-59 PACCINONGAN 082399442649 Coronovac 24200121 07/07/2021
24 7304115803850001 SYAMSINAR P 4 36 31-45 TINO 082292471311 Coronovac 24200121 7/7/2021
25 7304110102770004 SIRAJUDDIN L 4 43 31-45 BONTO LANGGA 081242374826 Coronovac 24200121 07/07/2021
26 7304113005910001 APDAL L 4 30 18-30 PACCINONGAN 085394275687 Coronovac 24200121 07/07/2021
27 7304112202750001 SARO SATTU L 4 45 31-45 PACCINONGAN 085298787809 Coronovac 24200121 07/07/2021
28 7304114805840002 DIANA P 4 37 31-45 PACCINONGAN 0853955807703 Coronovac 24200121 07/07/2021
29 7304110506740001 H. ANTO L 4 46 46-59 PACCINONGAN 082180780093 Coronovac 24200121 07/07/2021
30 7304111204010001 IRWAN L 4 20 18-30 PACCINONGAN 085391980225 Coronovac 24200121 07/07/2021
31 7304110704990001 WAHYU L 4 21 18-30 BONTO UJUNG 085391980225 Coronovac 24200121 07/07/2021
32 7304110102640003 ARIPUDDIN L 4 65 0 BONTO LANGGA 085240501104 Coronovac 24200121 07/07/2021
33 7304111203850002 ABD. RAHIM L 36 31-45 PACCINONGAN 085295165545 Coronovac 24200121 07/07/2021
34 7304114107870043 ROSMA P 33 31-45 KAMP BERU 085241742283 Coronovac 24200121 07/07/2021
35 7304114804910001 RABIAH P 30 18-30 PACCINONGAN 082351447557 Coronovac 24200121 07/07/2021
36 7304113112840068 SYAMSUDDIN L 36 31-45 PARANG 082193301730 Coronovac 24200121 07/07/2021
37 7304117112830027 SAMSIA P 37 31-45 KAMP BERU 085241742283 Coronovac 24200121 07/07/2021
38 7304115405950001 SRI WAHYUNI P 26 18-30 PACCINONGAN 085256477985 Coronovac 24200121 07/07/2021
39 CACI p 55 46-59 PACCINONGAN Coronovac 24200121 07/07/2021
40 7304115211910001 IRMAWATI P 30 18-30 PACCINONGAN 085396312616 Coronovac 24200121 7/7/2021
41 7304111803870002 RONI CARITO BOWO L 36 31-45 PACCINONGAN 085215859953 Coronovac 24200121 7/7/2021
42 7304115601690001 HAMSINAH P 53 46-59 PACCINONGAN 085396312616 Coronovac 24200121 7/7/2021
43 7304113112640008 AGUS SALIM L 57 46-59 PACCINONGAN Coronovac 24200121 7/7/2021
44 7304117112640009 HASNIA P 2 57 46-59 PACCINONGAN Coronovac 24200121 7/7/2021
45 7304110308020005 M IKBAL HIDAYAT L 4 19 18-30 PACCINONGAN 082347582358 Coronovac 24200121 7/7/2021

1 = Petugas Medis dan Non Medis di Fasi2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang berh 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

18-30 37 BPJS PBI 13 1 43
31-45 30 BPJS Non 30 2 4
46-59 18 Non Angg 0 3 0
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0

Tanggal 08-07-2021
Tanggal Pemberian
Imunisasi Keteran
sesuai)
gan
Jenis Umur Kelomp Ada (Contoh
Nama Penerima Pekerja Tidak Merek
NoNo. Registrasi NIK Kelami (18-59 ok Alamat No. Hp BPJS Non (sebutk :
Vaksin an* BPJS Ada Vaksin***
n tahun) Umur Non Anggot an Dosis I Dosis II Dosis I Dosis 2 Ditunda
PBI (centan
PBI a komorb /Dirujuk
g)
idnya) /….)
1 7304115107990003 IRMAWATI P 4 21 18-30 PACCINONGAN 081382584601 v Coronovac 24200121 08/07/2021

2 7304110107790032 AGUS L 4 42 31-45 PACCINONGAN 081382584601 v Coronovac 24200121 08/07/2021
3 7304110107760040 SIMBANG L 2 54 46-59 KANANG-KANANG 085823078605 v Coronovac 24200121 08/07/2021
4 7304114107710015 SOHO P 4 50 46-59 PACCINONGAN 085394460494 v Coronovac 24200121 08/07/2021
5 7304114107990004 NURMINAH P 4 23 18-30 PACCINONGAN 085394460494 v Coronovac 24200121 08/07/2021
6 7304110107900060 KAHARUDDIN L 2 31 31-45 PACCINONGAN 081382584601 v Coronovac 24200121 08/07/2021
7 7304110909590002 ROHANI P 4 62 0 PACCINONGAN 088744921756 v Coronovac 24200121 08/07/2021
8 7303044501800003 MARWAH P 4 41 31-45 PACCINONGAN 082192670372 v Coronovac 24200121 08/07/2021
9 7304114407970006 NARWIAH P 4 24 18-30 TEPOSUA 082231857046 v Coronovac 24200121 08/07/2021
10 7304116809980001 MULIATI P 4 32 31-45 PACCINONGAN 085254594309 v Coronovac 24200121 08/07/2021
11 7303017112020009 SAPNAWATI P 4 29 18-30 BUNGUNG BOMBONG 082231857046 v Coronovac 24200121 08/07/2021
12 7304116706800005 NURHIKMA P 4 41 31-45 RA'RA 085255164535 v Coronovac 24200121 08/07/2021
13 7304115801010002 EKA WULANDARI NENGSIH P 4 20 18-30 RA'RA 085247001646 v Coronovac 24200121 08/07/2021
14 7304115509830001 SUMARNI P 4 38 31-45 RA'RA 085299624872 v Coronovac 24200121 08/07/2021
15 7304114704040002 RENI ANGRAENI P 4 17 0 PACCINONGAN 085256470520 v Coronovac 24200121 08/07/2021
16 7304116303040002 PUTRI P 4 17 0 PACCINONGAN 085256440520 v Coronovac 24200121 08/07/2021
17 7372031708810002 ROSMIATI P 2 40 31-45 BALANG BARU 085240270971 v Coronovac 24200121 08/07/2021
18 7304114107850001 NURAENI P 4 36 31-45 PACCINONGAN 085251679141 v Coronovac 24200121 08/07/2021
19 7304113112750041 ABD. WAHID L 4 45 31-45 PACCINONGAN 082231857046 v Coronovac 24200121 08/07/2021
20 73041140405970001 ZULWAHDI HALIM L 23 18-30 KP BENDI 085399925559 v Coronovac 24200121 08/07/2021
21 7304114306890002 KAMARIA P 32 31-45 PACCINONGAN 082320153834 coronovac 24200121 08/07/2021
22 7304113112700061 JAFAR L 40 31-45 PACCINONGAN 085256903182 coronovac 24200121 08/07/2021

1 = Petugas Medis dan Non Medis di Fasil 2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang berha 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

18-30 37 BPJS PBI 13 1 43
31-45 30 BPJS Non 30 2 4
46-59 18 Non Angg 0 3 0
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0

DESA BONTO UJUNG Tanggal 14-07-2021
Tanggal Pemberian
Imunisasi
sesuai)
Ada Keterangan
No. Jenis Umur Kelomp Tidak
Nama Penerima Pekerja BPJS Non (sebutk Merek (Contoh:
No Registra NIK Kelami (18-59 ok Alamat No. Hp BPJS Ada
Vaksin an* Non Anggot an Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dir
si n tahun) Umur PBI (centan
PBI a komorb ujuk/….)
g)
idnya)
1 7304112806030002 USMAN ALI L 4 18 18-30 PACCINONGAN 085323535636 v Coronovac 24200121 14/07/2021

2 7304113003620002 RAMALAN L 4 59 46-59 PACCINONGAN 082198582068 v Coronovac 24200121 14/07/2021
3 7371111806800008 ISWADI L 2 41 31-45 JL. SUMUR JODOH085243474447 v Coronovac 24200121 14/07/2021
4 7304111112010001 SULKIFLI L 4 20 18-30 KP BERU 082353039390 v Coronovac 24200121 14/07/2021
5 7304116006950001 NURUL ALIFAH ASDIAN P 4 26 18-30 KP BENDI 085255398420 v Coronovac 24200121 14/07/2021
6 7304112002990001 NUR IMIN L 2 23 18-30 KALOKO 085348708908 v Coronovac 24200121 14/07/2021
7 7304116310820001 SUARTI P 4 39 31-45 UJUNG BARAT 085823162808 v Coronovac 24200121 14/07/2021
8 7304040704910001 AHMAD P 4 30 18-30 BONTOWA 082152177567 v Coronovac 24200121 14/07/2021
9 7304110805000002 AAN JAMAL L 4 20 18-30 UJUNG BARAT 085343997572 v Coronovac 24200121 7/14/2021
10 7304114402860001 NURJANNAH KR BAJI P 4 43 31-45 UJUNG 085823162808 v Coronovac 24200121 14/07/2021
11 7304117112840037 HERLINA P 4 37 31-45 UJUNG BARAT 081347351207 v Coronovac 24200121 7/14/2021
12 7304112505850001 JAMALUDDIN L 4 47 46-59 UJUNG 081347351207 v Coronovac 24200121 7/14/2021
13 7304112204950001 ABD QADAR L 4 27 18-30 UJUNG 082122966340 v Coronovac 24200121 7/14/2021
14 7304114402860001 WAWAN SAHRIR L 4 18 18-30 CAMBA LOMPOA 085256516037 v Coronovac 24200121 14/07/2021
15 7304114107700052 ATTI P 4 51 46-59 UJUNG 085342598755 v Coronovac 24200121 14/07/2021
16 7304116915290001 ASTIPAH P 4 62 0 UJUNG 085811483628 v Coronovac 24200121 14/07/2021
17 7304110106860001 SUDIRMAN L 2 31 31-45 BONTO UJUNG 081354352357 v Coronovac 24200121 14/07/2021
18 7304111507700001 MUH MUSTAQIM NUR L 4 51 46-59 UJUNG TIMUR 085279277145 v Coronovac 24200121 7/14/2021
19 7304115005020001 AINUN MARDIANA P 4 19 18-30 UJUNG TIMUR 082197256019 v Coronovac 24200121 7/14/2021
20 7303084711830001 SUBAEDAH P 38 31-45 KANANG-KANANG 085823645291 Coronovac 24200121 7/14/2021
21 7303014107820356 HJ SANNIA P 39 31-45 KANANG-KANANG 085321579183 Coronovac 24200121 7/14/2021
22 7304114107890027 MERLINA P 32 31-45 PACCINONGAN 085394460497 Coronovac 24200121 7/14/2021
23 7304115507990001 NURMIATI P 21 18-30 BONTO UJUNG 085242115460 Coronovac 24200121 7/14/2021
24 7304113001990001 ALFIAN L 22 18-30 BUNGUNG KONCI 087840123387 Coronovac 24200121 7/14/2021
25 7304114203700003 ST HARDIANA P 51 46-59 RA'RA 082393514903 Coronovac 24200121 7/14/2021
26 7304052210950001 SYAMSUL L 24 18-30 TOMPOK KELARA 082190013153 Coronovac 24200121 7/14/2021
27 73041100707970002 ASRIANTO L 24 18-30 BONTO LANGGA 085219749774 Coronovac 24200121 7/14/2021
28 7304114309990001 FINA UYUN FADILLAH P 21 18-30 TIKALA BARU 082393081688 Coronovac 24200121 7/14/2021
29 7304110107790006 KAMALUDDIN L 24 18-30 KANANG-KANANG 085219749773 Coronovac 24200121 7/14/2021
30 7304115802860001 JUMARIA P 35 31-45 BONTO UJUNG 082347706401 Coronovac 24200121 7/14/2021
31 7304111704700001 SYAMSUDDIN L 41 31-45 BONTO UJUNG 082396085617 Coronovac 24200121 7/14/2021
32 7304034106860004 HASNAH P 35 31-45 UJUNG BARAT 085349301591 Coronovac 24200121 7/14/2021
33 7304115902020002 NUR ANNISA SRI FEBRIA P 19 18-30 BONTO UJUNG 085757269726 Coronovac 24200121 7/14/2021
34 7304112209700001 JAMAL L 51 46-59 BONTO UJUNG 082346540996 Coronovac 24200121 7/14/2021
35 7304111708500002 BAKRI DG BELLA L 71 0 UJUNG BARAT 085394465348 Coronovac 24200121 7/14/2021
36 7304115405880002 SRI HARTUTI P 33 31-45 BONTO UJUNG 081253378213 Coronovac 24200121 7/14/2021
37 7304115304950001 HERAWATI P 19 18-30 UJUNG 082395350394 Coronovac 24200121 7/14/2021
38 7304116412746002 KURNIA P 46 46-59 UJUNG BARAT 082393081688 Coronovac 24200121 7/14/2021
39 7304112302600002 H ABD KADIR L 61 0 UJUNG 085394226741 Coronovac 24200121 7/14/2021
40 730403420360003 KAMIHA P 58 46-59 UJUNG BUNDU 085394226741 Coronovac 24200121 7/14/2021
41 7304117107400005 NIA P 81 0 KANANG-KANANG 085732250750 Coronovac 24200121 7/14/2021
42 7304116707790002 HIJRAH P 42 31-45 KANANG-KANANG 085692862648 Coronovac 24200121 7/14/2021
43 7304114112990003 ULFA P 21 18-30 UJUNG 085256870451 Coronovac 24200121 7/14/2021
44 7304110810700001 M SULTAN DG NGIRI L 51 46-59 UJUNG BARAT 082290174819 Coronovac 24200121 7/14/2021
45 7304110107820005 HIKMAL AKBAR L 26 18-30 KANANG-KANANG 082398635136 Coronovac 24200121 7/14/2021
46 7304116106820002 ASRIANI P 29 18-30 UJUNG BARAT 085397608650 v Coronovac 24200121 14/07/2021
47 7304116404770001 HAYATI P 54 46-59 BONTO UJUNG 085343790024 Coronovac 24200121 14/07/2021
48 7304091905900003 RAHMAN L 31 31-45 KANANG-KANANG 085325734171 Coronovac 24200121 14/07/2021
49 7304114107860009 RAHMAWATI P 35 31-45 BONTO UJUNG 085242721367 Coronovac 24200121 14/07/2021
50 730411450780003 HAMSINAH P 41 31-45 UJUNG BARAT 082192877468 Coronovac 24200121 14/07/2021
51 7171085603820002 BUNGA PUTRI P 39 31-45 ASPOL PANIKI 085255274774 Coronovac 24200121 14/07/2021
52 7304116811280001 NURHAYATI P 40 31-45 BONTO UJUNG 085343790024 Coronovac 24200121 14/07/2021
53 7304114305950001 LISDA P 25 18-30 BONTO KATANGKA082259520170 Coronovac 24200121 7/14/2021
54 7304117112880024 NORMA P 33 31-45 BONTO UJUNG 081247920033 Coronovac 24200121 14/07/2021
55 7304117112730052 SITTI P 47 46-59 BUNGUNG KONCI 085824094963 Coronovac 24200121 14/07/2021
56 730411206700001 AHMAD S L 51 46-59 UJUNG TIMUR 085242616087 Coronovac 24200121 14/07/2021
57 73720335003760005 HAFSAH P 45 31-45 PACCINONGAN 082228683045 Coronovac 24200121 14/07/2021
58 7304113112820059 JAMALUDDIN L 38 31-45 PACCINONGAN 082228683045 Coronovac 24200121 14/07/2021
59 7304117112850046 RESTINA P 36 31-45 PACCINONGAN 082228683045 Coronovac 24200121 14/07/2021
60 7304116003730001 ANRIANI P 39 31-45 BONTO LANGGA 085394465341 Coronovac 24200121 7/14/2021
61 7304115009900002 MANTANG P 31 31-45 BONTO LANGGA 082393060159 Coronovac 24200121 7/14/2021
62 7304112412830001 IDRIS L 37 31-45 UJUNG BARAT 085341176258 Coronovac 24200121 7/14/2021
63 7304111107890001 SALMAN L 32 31-45 JL KARAKASIA 082349605808 Coronovac 24200121 7/14/2021
64 7304114802020001 SARMILA P 19 18-30 BUNGUNG KONCI 082399136042 Coronovac 24200121 7/14/2021
65 7304115002750004 NUR ALAM P 38 31-45 BONTO UJUNG 083856624629 Coronovac 24200121 7/14/2021
66 7171082403080001 MUH ZAHIRUL NUGRAHA L 13 0 MANADO 085255274774 Coronovac 24200121 7/14/2021
67 7304110101580002 DALLI L 63 0 BONTO UJUNG 085346192136 Coronovac 24200121 7/14/2021
68 7304113112800049 SARUDDIN L 40 31-45 KANANG-KANANG 085394273881 Coronovac 24200121 7/14/2021
69 7304110107970028 SALDI L 22 18-30 BONTO UJUNG 085750200208 Coronovac 24200121 7/14/2021
70 7304043112790350 USMAN L 41 31-45 BONTO UJUNG 085343997259 Coronovac 24200121 7/14/2021
71 7304114107780042 CINI P 43 31-45 UJUNG TIMUR 085340262761 Coronovac 24200121 7/14/2021
72 7304114107890004 SURIANI P 32 31-45 UJUNG TIMUR 085340262761 Coronovac 24200121 7/14/2021
73 7304114508750001 SUNNIATI P 45 31-45 UJUNG TIMUR 082345444404 Coronovac 24200121 7/14/2021
74 7304117112830017 ERNI P 37 31-45 UJUNG TIMUR 085397934891 Coronovac 24200121 7/14/2021
75 7304114107800084 SANA DG NGASSENG P 40 31-45 UJUNG TIMUR 085256251145 Coronovac 24200121 7/14/2021
76 7304114107800087 YONA DG NGAMONG P 40 31-45 UJUNG TIMUR 085256251145 Coronovac 24200121 7/14/2021
77 7304117112920002 MURNI P 28 18-30 UJUNG TIMUR 085256251145 Coronovac 24200121 7/14/2021
78 7304116105830005 A. NUR LELA S P 38 31-45 UJUNG TIMUR 085363723265 Coronovac 24200121 7/14/2021
79 7304115506800001 NURLIYA P 40 31-45 UJUNG TIMUR 085256251145 Coronovac 24200121 7/14/2021
80 7304054503920001 SUMARNI P 29 18-30 UJUNG TIMUR 082346454673 Coronovac 24200121 7/14/2021
81 7304114506820003 MASITA P 39 31-45 UJUNG TIMUR 085363723265 Coronovac 24200121 7/14/2021
82 7304114107600010 NURJANNI P 61 0 BONTO UJUNG 085858110137 Coronovac 24200121 7/14/2021
83 7304112007950002 DARWIS L 21 18-30 UJUNG BARAT 082346412184 Coronovac 24200121 7/14/2021
84 7304113112650006 JAMALUDDIN L 55 46-59 BUNGUNG KONCI 082399136042 Coronovac 24200121 7/14/2021
85 7304114709880001 HASNI P 33 31-45 UJUNG TIMUR 085256251145 Coronovac 24200121 7/14/2021
86 7303054312970001 SRI ERIKA P 24 18-30 KP LAMBOCCA 082197127128 Coronovac 24200121 7/14/2021
87 7304112110660001 SYAMSUDDIN DG NGAW L 54 46-59 UJUNG TIMUR 085242097422 Coronovac 24200121 7/14/2021
88 76060166069770001 NURANTI P 24 18-30 BATULANG 082293597120 Coronovac 24200121 7/14/2021
89 7304111010820002 ANTO DG TOMPO L 38 31-45 UJUNG 085395823584 Coronovac 24200121 7/14/2021
90 7304114305840001 SAIMIA DG TE'NE P 37 31-45 BONTO UJUNG 085395823584 Coronovac 24200121 7/14/2021
91 7304110610020002 ASRIYANTI P 18 18-30 UJUNG BUNDU 085824568809 Coronovac 24200121 7/14/2021
92 7302084704950002 RISKI P 26 18-30 ANRIHUA 082158775738 Coronovac 24200121 7/14/2021
93 7304111708750004 UDIN L 45 31-45 KANANG-KANANG 085394273881 Coronovac 24200121 7/14/2021
94 7304110205000001 AKBAR L 20 18-30 UJUNG TIMUR 085397934891 Coronovac 24200121 7/14/2021
95 730411170750001 ASKIM DG SA'RA L 46 46-59 UJUNG 085250151430 Coronovac 24200121 7/14/2021
96 7304111302040001 FAJRIN L 17 0 UJUNG TIMUR 082395347842 Coronovac 24200121 7/14/2021
97 7304115502770001 HJ RAHMATIA P 44 31-45 BONTO UJUNG 085311540305 Coronovac 24200121 7/14/2021
98 7304115102010001 ESTI RAHAYU P 20 18-30 BONTO UJUNG 085340935966 Coronovac 24200121 7/14/2021
99 7304115708930001 ROSMAWAR P 27 18-30 BTN MINASA UPA 085299290808 Coronovac 24200121 7/14/2021
100 7304115002930002 YUDHA RESKI L 28 18-30 UJUNG 087786249645 Coronovac 24200121 7/14/2021
101 7303012205900001 ANTO L 30 18-30 UJUNG TIMUR 085256251145 Coronovac 24200121 7/14/2021
102 7304117112780030 SANNIA P 42 31-45 UJUNG 085807465383 Coronovac 24200121 7/14/2021
103 7304116607030002 YUYUNG PUSPITA P 18 18-30 UJUNG TIMUR 085807465383 Coronovac 24200121 7/14/2021
104 730411650480001 NURHAYATI P 31 31-45 UJUNG TIMUR 082394842562 Coronovac 24200121 7/14/2021
105 7304113112800068 KARIM P 30 18-30 UJUNG 081522663758 Coronovac 24200121 7/14/2021
106 7304114507990003 YULI P 22 18-30 UJUNG TIMUR 082393131195 Coronovac 24200121 7/14/2021
107 7304115101980001 FITRI HANDAYANI P 23 18-30 UJUNG 085824715221 Coronovac 24200121 7/14/2021
108 7304114705860005 SUMARNI DG NA'NA P 35 31-45 BONTO UJUNG 085256251145 Coronovac 24200121 7/14/2021
109 7304111511960002 MUTAKHIRIN FATWA L 24 18-30 UJUNG TIMUR 085299232973 Coronovac 24200121 7/14/2021
110 7304117112800013 KASMAWATI P 41 31-45 UJUNG BARAT 082348034589 Coronovac 24200121 7/14/2021
111 7304112501940003 MUSTAKIM NUR L 27 18-30 UJUNG TIMUR 082344644298 Coronovac 24200121 14/07/2021
112 7304111212950002 SUPARMAN L 25 18-30 UJUNG BUNDU 085342616027 Coronovac 24200121 14/07/2021
113 7311024101960004 FITRI WAHDANIYAH P 25 18-30 MATTIROWALIE 081343693383 Coronovac 24200121 14/07/2021
114 7304117112870035 JAM'A P 34 31-45 UJUNG TIMUR 085340964304 Coronovac 24200121 14/07/2021
115 7304116006980002 SYAMHIJRA P 23 18-30 UJUNG TIMUR 085395434371 Coronovac 24200121 14/07/2021
116 7304115004750001 ASKINA P 46 46-59 UJUNG TIMUR 085299232973 Coronovac 24200121 14/07/2021
117 7304113112900030 SAMSUDDIN RAFID L 30 18-30 UJUNG TIMUR 085340964304 Coronovac 24200121 14/07/2021
118 7304115003890003 RATNA HANDAYANI P 32 31-45 UJUNG 081242494456 Coronovac 24200121 14/07/2021
119 7304114704880001 PATIMA P 33 31-45 UJUNG 085249517519 Coronovac 24200121 14/07/2021
120 7304112504940003 HIKMAN L 27 18-30 TANAKEKE 085283841669 Coronovac 24200121 14/07/2021
121 7304110107720017 SYAMSUDDIN DG NGALL L 49 46-59 UJUNG 085 Coronovac 24200121 14/07/2021
122 7304114712990001 NURUL FITRAH P 21 18-30 UJUNG BARAT 082344002188 Coronovac 24200121 14/07/2021
123 7304115210590001 BASSE KR BAU P 61 0 UJUNG 087841143031 Coronovac 24200121 14/07/2021
124 7304115705900001 SANTI P 31 31-45 UJUNG 085393841826 Coronovac 24200121 14/07/2021
125 7304111303800001 SAHUR H.M L 40 31-45 BONTO UJUNG 085341360196 Coronovac 24200121 14/07/2021
126 7303015504870002 NORMA P 34 31-45 UJUNG BARAT 085210193586 Coronovac 24200121 14/07/2021
127 7304110909850001 KHAERUL L 36 31-45 BONTO UJUNG 082238838815 Coronovac 24200121 14/07/2021
128 7304112012940001 KHAIDIR L 27 18-30 UJUNG BARAT 082395862654 Coronovac 24200121 14/07/2021
129 7304113006930001 ILHAM FATAHILLAH L 27 18-30 UJUNG TIMUR 085242192017 Coronovac 24200121 14/07/2021
130 730411230900002 M SHIDIQ AL MUTAWAKK L 20 18-30 UJUNG BARAT 085342392329 Coronovac 24200121 14/07/2021
131 7304116506010002 ULVI WULAN P 20 18-30 BONTO UJUNG 085363723265 Coronovac 24200121 14/07/2021
132 7304115612940001 SULASTRI DG LANTI P 27 18-30 UJUNG 085398327750 Coronovac 24200121 14/07/2021
133 7304110107710005 BASNUR L 50 46-59 CAMBA LOMPOA 085146416281 Coronovac 24200121 14/07/2021
1 = Petugas Medis dan Non Medis di Fasi2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang berh 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

18-30 37 BPJS PBI 13 1 43
31-45 30 BPJS Non 30 2 4
46-59 18 Non Angg 0 3 0
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0

DESA BALTAR Tanggal 15-07-2021
Tanggal Pemberian
Imunisasi
sesuai) Keterangan
No. Umur Kelomp Ada
Jenis Pekerja Tidak Merek (Contoh:
No Registras NIK Nama Penerima Vaksin (18-59 ok Alamat No. Hp (sebutka
Kelamin an* BPJS BPJS Non Ada Vaksin*** Ditunda/Dir
i tahun) Umur n Dosis I Dosis II Dosis I Dosis 2
PBI Non PBI Anggota (centang ujuk/….)
komorbi
)
dnya)
1 7304111012890003 MALIK L 4 31 31-45 KANANG-KANANG 085236161909 v Coronovac 24200121 15/07/2021

2 7304117112890028 SANTI P 4 31 31-45 KANANG-KANANG 085236161909 v Coronovac 24200121 15/07/2021
3 7304114107950030 NURLINDA P 2 26 18-30 KANANG-KANANG 082311148232 v Coronovac 24200121 15/07/2021
4 7304116606960002 FAHIRAH P 4 27 18-30 BONTO KATANGKA 085245404421 v Coronovac 24200121 15/07/2021
5 7271042906670001 SYAMSUL ALAM L 4 54 46-59 UJUNG TIMUR 082151495059 v Coronovac 24200121 15/07/2021
6 7303010203000004 MUHAMMAD AKBAR JAHI L 2 21 18-30 TINO TOA 085651240337 v Coronovac 24200121 15/07/2021
7 7304112307950001 ANWAR L 4 25 18-30 BALBAR 085256486425 v Coronovac 24200121 15/07/2021
8 7304114906010001 RITA NANDA SARI P 4 20 18-30 BALBAR 085352711477 v Coronovac 24200121 15/07/2021
9 7304111707540001 KH MUH BAHTIAR HS L 4 67 0 CAMBA LOMPOA 085299341221 v Coronovac 24200121 15/07/2021
10 7304111304770001 SAHRIR L 4 44 31-45 BALBAR 085352711477 v Coronovac 24200121 15/07/2021
11 7602010210740001 H SUMANENG L 4 46 46-59 KANANG-KANANG 082195495555 v Coronovac 24200121 15/07/2021
12 7304113112920023 UNTUNG L 4 28 18-30 KANANG-KANANG 085342031483 v Coronovac 24200121 15/07/2021
13 730411250600002 RUSLAN L 4 21 18-30 UJUNG 085251505518 v Coronovac 24200121 15/07/2021
14 5316017112850007 INDARWATI P 4 35 31-45 UJUNG TIMUR 085341964119 v Coronovac 24200121 15/07/2021
15 7304116611810001 KARMILA P 4 39 31-45 UJUNG BARAT 085242594225 v Coronovac 24200121 15/07/2021
16 7304115412890002 MURNI DG BAU P 4 31 31-45 UJUNG BARAT 085242594225 v Coronovac 24200121 15/07/2021
17 7304115808990001 EKA LESTARI ARDI P 2 21 18-30 UJUNG TIMUR 085242199259 v Coronovac 24200121 15/07/2021
18 7304114512950001 HASNIATI P 4 25 18-30 BUNGUNG KONCI 081354902466 v Coronovac 24200121 15/07/2021
19 7304115205870002 SARTIKA P 4 34 31-45 BALANGLOE 085342275454 v Coronovac 24200121 15/07/2021
20 7304117112800010 HASBIA P 40 31-45 BALANGLOE 085343788061 Coronovac 24200121 15/07/2021
21 7304117112690215 SALMA P 51 46-59 BONTOWA 085299198276 Coronovac 24200121 15/07/2021
22 7304116511990003 YUSNAWATI P 21 18-30 SEPE 085656800634 Coronovac 24200121 15/07/2021
23 7304116201010001 TRISNAWATI P 21 18-30 BALANGLOE 082394449198 Coronovac 24200121 15/07/2021
24 7304117112800008 NURSAMSI P 40 31-45 BALANGLOE 082394449198 Coronovac 24200121 15/07/2021
25 7304114505740001 NURAENI AHMAD P 47 46-59 BALANGLOE 085346192776 Coronovac 24200121 15/07/2021
26 7304111102040002 MUHAMMAD AQMAL AHM L 17 0 UJUNG TIMUR 081286990544 Coronovac 24200121 15/07/2021
27 7372030507690004 NIPPAS NYITTO DAENG L 52 46-59 JL KEBUN SAYUR 082394842804 Coronovac 24200121 15/07/2021
28 7304115401030001 SUHARTINI P 17 0 BONTOWA 082395358240 Coronovac 24200121 15/07/2021
29 7304113112670025 SUDIRMAN L 53 46-59 BONTOWA 082395358240 Coronovac 24200121 15/07/2021
30 7304115206980002 DILA DIRYA LARASATI P 23 18-30 BALANGLOE 085398887612 Coronovac 24200121 15/07/2021
31 7304041110970001 SUPARDI L 23 18-30 DUSUN PELABUHAN083132893987 Coronovac 24200121 15/07/2021
32 7306074104790006 HARLINA P 42 31-45 BONTOWA 082396677546 Coronovac 24200121 15/07/2021
33 7304115809730001 DARMAWATI P 47 46-59 BALANGLOE 085347884692 Coronovac 24200121 15/07/2021
34 7304114107500030 SALWIAH P 71 0 BALANGLOE 085347884692 Coronovac 24200121 15/07/2021
35 7304114507710002 SUBIATI P 50 46-59 BALANGLOE 085347884692 Coronovac 24200121 15/07/2021
36 7304110809680001 MAPPA L 53 46-59 BALANGLOE 08884555162 Coronovac 24200121 15/07/2021
37 7304111006680001 BAHARUDDIN L 53 46-59 BALANGLOE 085391549952 Coronovac 24200121 15/07/2021
38 7304043112630014 LAKA DG NGERO L 57 46-59 BALANGLOE 087840331760 Coronovac 24200121 15/07/2021
39 7304110506790003 NUKMAN L 42 31-45 BALANGLOE 081254654545 Coronovac 24200121 15/07/2021
40 7304114107550024 SOMPU P 66 0 BALTAR 082312524417 Coronovac 24200121 15/07/2021
41 7304115008600003 JOHORA P 60 0 BALANGLOE 085343996623 Coronovac 24200121 15/07/2021
42 7304111002920001 SISDARYANTO L 29 18-30 UJUNG BARAT 085245560744 Coronovac 24200121 15/07/2021
43 7304042905020001 ASRIANTO L 19 18-30 TONROWA 081243419389 Coronovac 24200121 15/07/2021
44 7304110308020004 ASWIN L 18 18-30 UJUNG TIMUR 0882019189545 Coronovac 24200121 15/07/2021
45 7304117112650018 MANNENG P 55 46-59 BALANGLOE 087840331760 Coronovac 24200121 15/07/2021
46 7304114107760037 SAMSIA DG LANTI P 45 31-45 BALANGLOE 082296399929 v Coronovac 24200121 15/07/2021
47 7304113112470016 SAMSUDDIN LAU L 73 0 BALANGLOE 085299198276 Coronovac 24200121 15/07/2021
48 7304114508710001 BULAN P 49 46-59 BALANGLOE 082395913440 Coronovac 24200121 15/07/2021
49 7304110805580001 LUKMAN L 63 0 BALANGLOE 085347884699 Coronovac 24200121 15/07/2021
50 7304114112900003 KURNIA P 30 18-30 BALANGLOE 085399859077 Coronovac 24200121 15/07/2021
51 7304115503890003 MITHA P 32 31-45 BALANGLOE 082399229667 Coronovac 24200121 15/07/2021
52 7302016311840002 NISMAWATI P 36 31-45 UJUNG BARAT 085245560144 Coronovac 24200121 15/07/2021
53 7304115803860001 NURHAYATI P 35 31-45 BALANGLOE 082399229667 Coronovac 24200121 15/07/2021
54 7304110107730024 NIPPI L 48 46-59 BALANGLOE 082189144443 Coronovac 24200121 15/07/2021
55 7304114107900004 CITRA P 31 31-45 BALANGLOE 085240556882 Coronovac 24200121 15/07/2021
56 7304114501820001 NURIDA P 39 31-45 BALANGLOE 082346726052 Coronovac 24200121 15/07/2021
57 7304117101020001 FEBRIANA ASTI PRATIWI P 19 18-30 BONTO LANGGA 082349720923 Coronovac 24200121 15/07/2021
58 6402046001880002 HADANIAH P 33 31-45 KASSI KASSI 081248759620 Coronovac 24200121 15/07/2021
59 7304112612030001 MAHMUDDIN L 17 0 BONTO UJUNG 0887436934101 Coronovac 24200121 15/07/2021
60 7304110510940002 ASFAR L 26 18-30 CAMBA LOMPOA 082347509766 Coronovac 24200121 15/07/2021
61 7304044109030003 NUR FANI EKA PUTRI P 18 18-30 BALTAR 082312524417 Coronovac 24200121 15/07/2021
62 7304111602790002 AMIR L 42 31-45 BALANGLOE 082346726052 Coronovac 24200121 15/07/2021
63 7304114702700001 SYAMSIAH P 51 46-59 KASSI KASSI 081248759620 Coronovac 24200121 15/07/2021
64 7304116205770001 SYAMSIAH P 44 31-45 RA'RA 082347955686 Coronovac 24200121 15/07/2021
65 7304090303950001 IRFAN SARIF L 26 18-30 BALANGLOE 085348673712 Coronovac 24200121 15/07/2021
66 7304110101880003 IDRIS L 33 31-45 BALANGLOE 085298491500 Coronovac 24200121 7/15/2021
67 7304114703750001 SURIAH P 46 46-59 KP BERU 082150215943 Coronovac 24200121 7/15/2021
68 7304116904980001 WINDY EKA PUTRI P 23 18-30 BALANGLOE 085340025417 Coronovac 24200121 7/15/2021
69 7304110112700001 SYARIFUDDIN L 51 46-59 CAMBA LOMPOA 085242152711 Coronovac 24200121 7/15/2021
70 7304114403850001 DARMAWATI P 41 31-45 BONTO UJUNG 085343785409 Coronovac 24200121 7/15/2021
71 7304115802770001 HIKMAWATI P 44 31-45 CAMBA LOMPOA 085346191797 Coronovac 24200121 7/15/2021
72 7304111509780001 JUFRIANTO L 43 31-45 CAMBA LOMPOA 085346191799 Coronovac 24200121 7/15/2021
73 7303012102870002 HAMZAH HAZ L 34 31-45 BALANGLOE 085347884692 Coronovac 24200121 7/15/2021
74 7303011904950001 KAMAL SYAM L 26 18-30 BALANGLOE 0887436327335 Coronovac 24200121 7/15/2021
75 7304111404770001 SAIFUL BAHRI L 44 31-45 KP BERU 085348955899 Coronovac 24200121 7/15/2021
76 7306070711710004 SYAMSUL ALAM L 50 46-59 BONTOWA 085223042042 Coronovac 24200121 7/15/2021
77 7304115504750002 RABIAH P 46 46-59 KP BERU 085348955899 Coronovac 24200121 7/15/2021
78 7303013006660001 FAHIR L 55 46-59 TINO TOA 085242868975 Coronovac 24200121 7/15/2021
79 7304116703950001 IRAWATI P 26 18-30 BALANGLOE 082189542610 Coronovac 24200121 7/15/2021
80 7304112002040002 KHAERIL FADLI L 17 0 TINO 085342030908 Coronovac 24200121 7/15/2021
81 7304071912960001 IKBAL L 24 18-30 UJUNG TIMUR 085395221487 Coronovac 24200121 7/15/2021
82 7304110108010002 ALBANI NUR L 19 18-30 PACCINONGAN 085242199301 Coronovac 24200121 7/15/2021
83 7304111603000001 IDIL ADHA L 21 18-30 BALANGLOE 085298140094 Coronovac 24200121 7/15/2021
84 7304113112650029 MAKKASAU L 65 0 BALANGLOE 082291786075 Coronovac 24200121 7/15/2021
85 7304110512540002 JUMAIN L 77 0 BALANGLOE 085397158831 Coronovac 24200121 7/15/2021
86 7304113112730031 EFENDI L 47 46-59 BALANGLOE 085298140094 Coronovac 24200121 7/15/2021
87 7304111011750001 MUH IDRIS L 45 31-45 UJUNG BARAT 085299566418 Coronovac 24200121 7/15/2021
88 73040402125500 MALLOSERANG L 65 0 UJUNG TIMUR 081253662430 Coronovac 24200121 7/15/2021
89 7306086610980002 SELVIANA AMIR P 22 18-30 UJUNG TIMUR 085395221487 Coronovac 24200121 7/15/2021
90 7304114202830001 IDAWATI P 38 31-45 BALANGLOE 085242242071 Coronovac 24200121 7/15/2021
91 7305076401790001 NURLINDA P 42 31-45 BALANGLOE 082189144443 Coronovac 24200121 7/15/2021
92 7304114107780029 SAMSIAH P 43 31-45 BALANGLOE 085341171600 Coronovac 24200121 7/15/2021
93 7304111605830001 FIRMAN J L 38 31-45 BALANGLOE 082346747039 Coronovac 24200121 7/15/2021
94 7304114303860002 SAMSIAH DG NGUGI P 35 31-45 BALANGLOE 082346747039 Coronovac 24200121 7/15/2021
95 7304116201830001 SUMIATI P 38 31-45 BALANGLOE 081243595705 Coronovac 24200121 7/15/2021
96 7304115504040001 SALSABILAH HAERANI P 17 0 BALANG BERU 082393514903 Coronovac 24200121 7/15/2021
97 7304114301850001 JUNAEDA P 36 31-45 BALANGLOE 081254154545 Coronovac 24200121 7/15/2021
98 7304117112720013 MAINNA P 48 46-59 CAMBA LOMPOA 081242152711 Coronovac 24200121 7/15/2021
99 7304117112920011 ROSNIATI P 25 18-30 BALANGLOE 082396123932 Coronovac 24200121 7/15/2021
100 7304117004010001 NURLAITA ARIANTO P 20 18-30 CAMBA LOMPOA 082393096239 Coronovac 24200121 7/15/2021
101 7304115111010002 NURFIMA RAHMI SYARIF P 20 18-30 CAMBA LOMPOA 085242152711 Coronovac 24200121 7/15/2021
102 7304117112940030 PITRI ULAIKA P 19 18-30 BALANGLOE 085299232937 Coronovac 24200121 7/15/2021
103 7304117112870014 SARIBONE P 33 31-45 CAMBA LOMPOA 085242152711 Coronovac 24200121 7/15/2021
104 7304116507850001 NURHAYATI SPD P 36 31-45 UJUNG TIMUR 085772129337 Coronovac 24200121 7/15/2021
105 7304115806820002 BIYA P 39 31-45 BUNGUNG KONCI 082347397127 Coronovac 24200121 7/15/2021
106 7304112003800001 SARIPUDDIN L 41 31-45 BUNGUNG KONCI 082347397127 Coronovac 24200121 7/15/2021
107 7304110107660018 CACO ALLI L 55 46-59 BALANGLOE 082347579161 Coronovac 24200121 7/15/2021
108 7304112806810002 SALEH NYALLANG L 40 31-45 BALANGLOE 085256802918 Coronovac 24200121 7/15/2021
109 5206074102031008 MITA SARI P 18 18-30 NGGARA RANDI 085238739054 Coronovac 24200121 7/15/2021
110 5206074208011002 MIRNAWATI P 20 18-30 DUSUN LEWI 085253402345 Coronovac 24200121 7/15/2021
111 7304113101560002 M AMIN L 65 0 BALANGLOE 085347884692 Coronovac 24200121 7/15/2021
112 7304117112810067 MAPPIASSA L 39 31-45 BALANGLOE 085772618728 Coronovac 24200121 7/15/2021
113 7304116410000001 INJI MURI PANANRANGI P 21 18-30 BALANGLOE 085394385937 Coronovac 24200121 7/15/2021
114 7304114204790001 MARWAH P 42 31-45 BALANGLOE 085730746362 Coronovac 24200121 7/15/2021
115 7304116805720001 TATI B P 49 46-59 BALANGLOE 085394385932 Coronovac 24200121 7/15/2021
116 7304115005790004 HASNIATI P 42 31-45 BALANGLOE 085397692529 Coronovac 24200121 7/15/2021
117 7304110605820001 LEDENG L 39 31-45 BALANGLOE 085343639307 Coronovac 24200121 7/15/2021
118 7304114107760039 ROSNIA P 45 31-45 BALANGLOE 082189542753 Coronovac 24200121 7/15/2021
119 7304112003860002 DARWIS L 35 31-45 BALANGLOE 085397158839 Coronovac 24200121 7/15/2021
120 7304116507000003 HERLY P 21 18-30 BALANGLOE 081242567022 Coronovac 24200121 7/15/2021
121 7304116010920002 MARNI P 28 18-30 BALANGLOE 081242567022 Coronovac 24200121 7/15/2021
122 7304043112810028 KIKI SAPUTRA L 39 31-45 BALTAR 082312524417 Coronovac 24200121 7/15/2021
123 6471021004830005 RUSMIN L 38 31-45 BALANGLOE 081349038071 Coronovac 24200121 7/15/2021
124 7304043112630009 BADOLLAH L 57 46-59 BALANGLOE 085233539485 Coronovac 24200121 7/15/2021
125 7304115004840001 MURNI P 37 31-45 BALANGLOE 082396123932 Coronovac 24200121 7/15/2021
126 7304116002710001 NUR SYAMSI P 50 46-59 BALANGLOE 085715504926 Coronovac 24200121 7/15/2021
127 7304114511940003 HERLINA P 27 18-30 BALANGLOE 085245560806 Coronovac 24200121 7/15/2021
128 7304115106860001 FITRIANI P 37 31-45 BALANGLOE 085397158831 Coronovac 24200121 7/15/2021
129 7304115105820001 SANTI P 39 31-45 BALANGLOE 085387582214 Coronovac 24200121 15/07/2021
130 7304111205920001 YUDDING L 29 18-30 BALANGLOE 082346470756 Coronovac 24200121 15/07/2021
131 7304115008820002 SAIDAH P 38 31-45 BONTOWA 082337178738 Coronovac 24200121 15/07/2021
132 7304111203870001 PATTALOLO P 34 31-45 BALANGLOE 085211117696 Coronovac 24200121 15/07/2021
133 7304114107690026 TIMA P 52 46-59 BALANGLOE 085348956357 Coronovac 24200121 15/07/2021
134 7304116503880002 YANI P 33 31-45 BALANGLOE 085298140079 Coronovac 24200121 15/07/2021
135 7305011010780002 S DG NGAGO L 42 31-45 BALANGLOE 085394712895 Coronovac 24200121 15/07/2021
136 7304112510010001 A M MIZWAR R L 19 18-30 BALANGLOE 085715504926 Coronovac 24200121 15/07/2021
137 7304116610740001 NURHAYATI P 46 46-59 BALTAR 085298873348 Coronovac 24200121 15/07/2021
138 7303010405890003 SOLIHIN L 32 31-45 KAYANGAN 081944605036 Coronovac 24200121 15/07/2021
139 7304117112000007 WIWI AMELIA P 19 18-30 BALANGLOE 081242750024 Coronovac 24200121 15/07/2021
140 7304114601800001 AYU P 41 31-45 BALANGLOE 082344824092 Coronovac 24200121 15/07/2021
141 7304040110910001 ISRAFIL L 30 18-30 BALANGLOE 085233539485 Coronovac 24200121 15/07/2021
142 7304110205820001 ZULKARNAIN L 39 31-45 BALTAR 085240620629 Coronovac 24200121 15/07/2021
143 7304112512730002 HAMKA SEWANG L 47 46-59 BALTAR 085394461438 Coronovac 24200121 15/07/2021
144 7304114502730001 NURMI KR MEDI P 48 46-59 BALANGLOE 082394461438 Coronovac 24200121 15/07/2021
145 7304110510850001 YUSUF L 35 31-45 KP BERU 085348955899 Coronovac 24200121 15/07/2021
146 7304114606860003 SUPIATI P 35 31-45 KP BERU 085348955899 Coronovac 24200121 15/07/2021
147 73041142027440001 HAPSAH DG RIMANG P 47 46-59 BALANGLOE 085725694126 Coronovac 24200121 15/07/2021
148 7304115108930001 ROSMA DG LANTI P 27 18-30 BALTAR 082352138535 Coronovac 24200121 15/07/2021

1 = Petugas Medis dan Non Medis di Fasilita 2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik yang berhadap 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

18-30 37 BPJS PBI 13 1 43
31-45 30 BPJS Non 30 2 4
46-59 18 Non Angg 0 3 0
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0
Nama Puskesmas/Jejarin: Puskesmas Tino

DESA BALBAR Tanggal 21-07-2021
R (tulis 'Ya' Tanggal Pemberian

e No. Batch Keterangan
Umur pada kolom Imunisasi
g Nama Penerima Jenis Pekerjaa Kelompok Merek (Contoh:
No NIK (18-59 Alamat No. Hp
i Vaksin Kelamin n* Umur BPJS PBI Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Diruj
tahun)
s uk/….)
t
1 7304115007000000 DESI RATNASARI P 4 21 18-30 TONROWA 085757475535 Coronovac 24200121 7/21/2021

2 7304110310890002 IRWAN L 4 31 31-45 KARAMPANG PAJA 082399229789 Coronovac 24200121 7/21/2021
3 7304042904890001 FAJAR BAHARI L 2 32 31-45 BORONGLOE 0852568546729 Coronovac 24200121 7/21/2021
4 9171011305750006 ASFAR L 4 46 46-59 KOMP AJENDAM 082397938078 Coronovac 24200121 7/21/2021
5 7304114607950001 DARMAWATI P 4 26 18-30 BONTO KATANGKA 085343667027 Coronovac 24200121 7/21/2021
6 7304114305790003 ERNI ERAWATI P 2 43 31-45 CAMBA LOMPOA 081243728784 Coronovac 24200121 7/21/2021
7 7304111902960002 AKBAR SYARIF L 4 25 18-30 CAMBA LOMPOA 082394423218 Coronovac 24200121 7/21/2021
8 7302095707850001 RAHMATIA L P 4 36 31-45 CAMBA LOMPOA 081245248070 Coronovac 24200121 7/21/2021
9 7304115103950003 RIA SELFIANA P 4 26 18-30 BONTO BARU 082149600556 Coronovac 24200121 7/21/2021
10 7304111905030001 FIKRAN L 4 18 18-30 BONTO BARU 085197550373 Coronovac 24200121 7/21/2021
11 7304114703770001 HIJRAH P 4 44 31-45 BONTO BARU 082149600556 Coronovac 24200121 7/21/2021
12 7304112201000001 RAKHMAT ALFIAN L 4 21 18-30 PACCINONGAN 085341791734 Coronovac 24200121 7/21/2021
13 7304116205000001 NURUL FITRAH HAMKA P 4 20 18-30 BALANGLOE 085259412499 Coronovac 24200121 7/21/2021
14 7304116304010002 ASMILA SYARIF P 4 20 18-30 CAMBA LOMPOA 085657321088 Coronovac 24200121 7/21/2021
15 73041141205730001 HALIM L 4 48 46-59 KP BENDI 081353978871 Coronovac 24200121 7/21/2021
16 7304111405810002 SOFYAN DG LAU L 4 40 31-45 BONTO BARU 085347225476 Coronovac 24200121 7/21/2021
17 7304116612720001 HAJISA P 2 48 46-59 CAMBA LOMPOA 082346206442 Coronovac 24200121 7/21/2021
18 7304110202900002 RAHMAT AL QUDRI L 4 31 31-45 SUSBATER 088744805045 Coronovac 24200121 7/21/2021
19 7304117112870008 HARTINA P 4 33 31-45 BONTOMANAI 085298455700 Coronovac 24200121 7/21/2021
20 7304110807990001 ANDI ILHAM L 22 18-30 KASSI KASSI 082346707684 Coronovac 24200121 7/21/2021
21 7304016506050003 IKA MONIKA TARI P 16 0 PALANTIKANG 082346700151 Coronovac 24200121 7/21/2021
22 7304112507050004 SANDI L 16 0 BONTO MANAI 085240270988 Coronovac 24200121 7/21/2021
23 7304114905960001 ANDI SRI WAHYUNI P 25 18-30 KASSI KASSI 081242138499 Coronovac 24200121 7/21/2021
24 7304112104960002 ASWIN L 25 18-30 RA'RA 082357447567 Coronovac 24200121 7/21/2021
25 7304110404760002 MANSUR L 45 31-45 CAMBA LOMPOA 085242238982 Coronovac 24200121 7/21/2021
26 7306056303000003 SARTIKA DEWI MAHARANI P 21 18-30 KP BERU 088705945457 Coronovac 24200121 7/21/2021
27 7304115106030001 NURFITRAH DINANTI P 19 18-30 BONTO BARU 082347289517 Coronovac 24200121 7/21/2021
28 7304110405630001 RUSTAM L 58 46-59 PACCINONGAN 085242119566 Coronovac 24200121 7/21/2021
29 7304110503930002 KAMARUDDIN L 28 18-30 KP BERU 088705945457 Coronovac 24200121 7/21/2021
30 7304115105770003 RAMLAH P 44 31-45 BALANGLOE 085243468449 Coronovac 24200121 7/21/2021
31 7304011501900001 SARIF ALWI RAHIM SILA Spd L 31 31-45 UJUNG 085242867321 Coronovac 24200121 7/21/2021
32 7304040303900002 ISWAN MAHARDIKA L 31 31-45 TANAKEKE 082153604533 Coronovac 24200121 7/21/2021
33 7304114708830001 KASMAWATI P 37 31-45 BALANGLOE 085211117696 Coronovac 24200121 7/21/2021
34 730411640400000 ALMAIDAH P 21 18-30 SEPE' 085244364540 Coronovac 24200121 7/21/2021
35 7303057112880048 SUSI P 32 31-45 KP BERU 081243246450 Coronovac 24200121 7/21/2021
36 7304110705010003 DANDI L 20 18-30 UJUNG TIMUR 087840862793 Coronovac 24200121 7/21/2021
37 7304110412960001 PRAYUDI ADI UTAMA L 24 18-30 UJUNG BARAT 081543165466 Coronovac 24200121 7/21/2021
38 7304112810000001 DENI CHANDRA L 20 18-30 CAMBA LOMPOA 085824161948 Coronovac 24200121 7/21/2021
39 7306171806960001 ISMAIL L 25 18-30 KORONG BALE 085298613390 Coronovac 24200121 7/21/2021
40 7304110510000002 ACHMAD KURNIAWAN L 20 18-30 CAMBA LOMPOA 085233085868 Coronovac 24200121 7/21/2021
41 7304112307970001 ASRUL L 24 18-30 BONTO BARU 083132928758 Coronovac 24200121 7/21/2021
42 7304111207890002 ASRI L 32 31-45 BONTO BARU 083135065999 Coronovac 24200121 7/21/2021
43 7304040610630002 ADHARUDDIN L 28 18-30 BONTOALA 085256802918 Coronovac 24200121 7/21/2021
44 7304114302670002 MANTANG P 54 46-59 KP BERU 085342338532 Coronovac 24200121 7/21/2021
45 6406024204820002 SUARNI P 39 31-45 JL BANGKUDULIS 085248006705 Coronovac 24200121 7/21/2021
46 6406021501710003 ACHMAD SURO L 50 46-59 JL BANGKUDULIS 085248006705 Coronovac 24200121 7/21/2021
47 6472051809790005 IRWAN L 42 31-45 SEMPAJA UTARA 082394446094 Coronovac 24200121 7/21/2021
48 7304114103000001 NURHIKMA AHRANI PUTRI P 21 18-30 BUNGUNG KONCI 085298908097 Coronovac 24200121 7/21/2021
49 7304116202830001 SUHARTINI K. A.MA P 39 31-45 TAROWANG 085242565331 Coronovac 24200121 7/21/2021
50 7304111506800001 ABD RAHMAN L 41 31-45 CAMBA LOMPOA 085245560639 Coronovac 24200121 7/21/2021
Keterangan
* Pekerjaan dikelompokkan menjadi:
1 = Petugas Medis dan Non Medis di Fasilitas Pelayanan Kesehatan
2 = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
3 = Administrator Pemerintahan
4 = Lainnya
5 = Tidak Bekerja
1= Hipertensi 1 = Sinopharm
2= Diabetes 2 = Sinovac
3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
4= Penyakit Ginjal
5= Penyakit Paru Kronis
6=Lainnya

18-30 37 BPJS PBI 13 1 43
31-45 30 BPJS Non 30 2 4
46-59 18 Non Anggo 0 3 0
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0
Nama Puskesmas/Jejaring: Puskesmas Tino
R 'Ya' Tanggal Pemberian

Umur Komorbid** No. Batch
e pada Imunisasi Keterangan
Jenis (18-
g Kelompok Merek (Contoh:
No NIK Nama Penerima Vaksin Kela Pekerjaan* 59 Alamat No. Hp BPJS Tidak Ada
i Umur Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Diruj
min tahu PBI (centang)
s uk/….)
n)
t
1 7304112505030002 FIRMANSYAH L 4 18 18-30 TINO 082393084725 v Coronovac 24004421 8/5/2021

2 7304111202010002 M IKBAL L 4 19 18-30 TINO 082151945020 v Coronovac 24004421 8/5/2021
3 7304080510890002 RUSLI L 4 31 31-45 BALANGLOE 081343138350 v Coronovac 24004421 8/5/2021
4 7304040401870002 NORMA P 4 37 31-45 PACCINONGAN 081342722232 v Coronovac 24004421 8/5/2021
5 6402131706520001 M SYARIFUDDIN L 4 72 0 BUNGUN CAMBA 082159759317 v Coronovac 24004421 8/5/2021
6 7304110105950001 SUPRIADI L 4 26 18-30 BONTO RAPPO 085242751004 v Coronovac 24004421 8/5/2021
7 7303045207960000 NURMALASARI P 4 24 18-30 BANTAENG 085285295439 v Coronovac 24004421 8/5/2021
8 7303024202830003 FATMA P 4 32 31-45 BUNGUNG BAMBANG 082152461862 v Coronovac 24004421 8/5/2021
9 7304112102860002 BAHTIAR L 4 34 31-45 PACCINONGAN 085341874311 v Coronovac 24004421 8/5/2021
10 7304115110730004 JUNAEDAH P 4 47 46-59 BUNGUNG CAMBA 085347361078 v Coronovac 24004421 8/5/2021
11 730411470850001 RABAINTANG P 4 70 0 PACCINONGAN 08135568282 v Coronovac 24004421 8/5/2021
12 7304110912620001 ILHAM NINDAR L 4 58 46-59 PACCINONGAN 085240880880 v Coronovac 24004421 8/5/2021
13 7304116006800001 AHRIANI P 4 40 31-45 PACCINONGAN 082337175668 v Coronovac 24004421 8/5/2021
14 7304112702030002 AKBAR L 4 18 18-30 TINO 081342578147 v Coronovac 24004421 8/5/2021
15 7304115904890001 NURHIDAYAH P 4 31 31-45 PACCINONGAN 085299985185 v Coronovac 24004421 8/5/2021
16 7304110512770001 KAMARUDDIN P 4 43 31-45 PACCINONGAN 082344962633 v Coronovac 24004421 8/5/2021
17 7304031003010003 MUH. IBRAHIM RAHMAT P 4 19 18-30 JL. TEMBAKAU 082271532192 v Coronovac 24004421 8/5/2021
18 7304114205750001 ST JAWHARI SANNING P 4 45 31-45 TINO 081288536225 v Coronovac 24004421 8/5/2021
19 730312708840001 NURHALIPAH P 4 43 31-45 BUNGUNG BAMBANG 082337250398 v Coronovac 24004421 8/5/2021
20 3604101107900328 ROCHMAN L 4 30 18-30 PACCINONGAN 081217888180 Coronovac 24004421 8/5/2021
21 7304117112860037 SYAMSINA P 4 34 31-45 PACCINONGAN 082398235825 Coronovac 24004421 8/5/2021
22 730411551200001 SRI SUCI RAMADHANI P 4 20 18-30 PACCINONGAN 085342902225 Coronovac 24003121 8/5/2021
23 7304116004980001 HASNI P 4 22 18-30 PACCINONGAN 085343962560 Coronovac 24003121 8/5/2021
24 7304110502690001 SAHARUDDIN,S.HI L 4 51 46-59 KASSI-KASSI 085256205640 Coronovac 24003121 8/5/2021
25 7303015108860000 RAHMATIA P 4 34 31-45 JL TA. GANI 085255803124 Coronovac 24004421 8/5/2021
26 7304112604860000 WAWAN L 4 34 31-45 PACCINONGAN 085340168827 Coronovac 24003121 8/5/2021
27 7304114912840001 AHRIANI P 4 36 31-45 PACCINONGAN 085347983703 Coronovac 24003121 8/5/2021
28 7304111503820000 MUSTAKIM L 4 38 31-45 PACCINONGAN 085234964561 Coronovac 24004421 8/5/2021
29 7304110107800051 SUKARDI L 4 40 31-45 PACCINONGAN 085388300081 Coronovac 24003121 8/5/2021
30 7304111002030001 WAWAN SAHNUR L 4 18 18-30 CAMBA LOMPOA 085256516037 Coronovac 24003121 8/5/2021
31 7304110905680001 ABD HAKIM L 4 52 46-59 PACCINONGAN 085343962560' Coronovac 24003121 8/5/2021
32 7304116507660001 ROSMAWATI P 4 55 46-59 PACCINONGAN 08526715525 Coronovac 24003121 8/5/2021
33 7304111602010001 A. DIO IAM L 4 20 18-30 TINO 085345220685 Coronovac 24003121 8/5/2021 vaksin 1
34 7304113112810055 BAKRI L 4 39 31-45 PACCINONGAN 082332538771 Coronovac 24003121 8/5/2021
35 7306104107930105 A MEGAWATI P 4 26 18-30 PACCINONGAN 085396085609 Coronovac 24003121 8/5/2021
36 730403111090002 DEDI KURNIADI AMRAN L 4 30 18-30 GANGRANG BATU 085299903449 Coronovac 24003121 8/5/2021
37 7304117112550044 NURBIYAH P 4 65 0 PACCINONGAN 082397851187 Coronovac 24003121 8/5/2021
38 7304115010690001 JUHRA P 4 51 46-59 PACCINONGAN 085251817427 Coronovac 24003121 8/5/2021
39 7304112201920001 RAHMAT WAHUDI L 4 29 18-30 JL TOA DAENG 085256146780 Coronovac 24003121 8/5/2021
40 7304115905830003 KARTINI P 2 37 31-45 CAMBA LOMPOA 082399515403 Coronovac 24003121 05/082021
41 7304114312920002 AYULIA P 2 29 18-30 TINO 085394460521 Coronovac 24003121 05/082021
42 9171012505030004 UMAR WIRA HADI ASPAR AMIUL P 2 18 18-30 KOMPLEKS AJENDAM 085244116580 Coronovac 24003121 05/082021
43 7304116002030004 INAYAH QALBI P 2 17 0 TINO 085254741551 Coronovac 24003121 05/082021
Kelompok Umur: 1= Hipertensi 1 = Sinopharm
18-30 2= Diabetes 2 = Sinovac
31-45 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
46-59 4= Penyakit Ginjal
Total 5= Penyakit Paru Kronis
Pekerjaan: 6=Lainnya
1
2
3 Kepesertaan BPJS Pekerjaan
4 37 BPJS PBI 13 1 43
5 30 BPJS Non PBI 30 2 4
Total 18 Non Anggota 0 3 0
85 Total 43 4 39
Pemberian Dosis 5 0
43 Dosis 1 84 Total 86
4 Dosis 2 41 Komorbid
0 Total 1 0
38 2 0
0 3 0
85 4 0
5 0
6 0
Tidak ada 64
Total 0
DESATINO Tanggal 17-07-2021
BPJS (tulis 'Ya' Tanggal Pemberian

pada kolom yang Imunisasi
Um Keteran
No. Jeni ur Ada gan
Pek Kelomp (sebu Tidak Merek
Re Nama Penerima s (18- BPJS Non (Contoh:
No NIK erja ok Alamat No. Hp BPJ tkan Ada Vaksin***
gist Vaksin Kela 59 Non Angg Dosis I Dosis II Dosis I Dosis 2 Ditunda/
an* Umur S PBI komo (cent
rasi min tah PBI ota Dirujuk/
un) rbidn ang) ….)
ya)
1 7304114202930001 ISMANIAR P 4 28 18-30 KANANG-KANANG 085342982353 v Coronovac 24200121 7/17/2021

2 7304111707660002 MUSAKKIR L 4 55 46-59 KANANG-KANANG 085259008335 v Coronovac 24200121 7/17/2021
3 7304113112590021 SARASANG ALLE L 2 62 0 KANANG-KANANG 082394540795 v Coronovac 24200121 7/17/2021
4 6405011704780001 ADNAN LOLO S.PDI L 4 43 31-45 JL KIHAJAR DEWANTA085348870344 v Coronovac 24200121 7/17/2021
5 6405014302780002 HAMSIAH S.PDI P 4 43 31-45 LAPRI 085246271650 v Coronovac 24200121 7/17/2021
6 7304115605730002 ROSMAWATI P 2 48 46-59 BALANG LOE 085397158831 v Coronovac 24200121 7/17/2021
7 7304110107570010 ILYAS NAKKU L 4 64 0 TINO 085340168827 v Coronovac 24200121 7/17/2021
8 7304114107590008 BINARUNG P 4 62 0 PACCINONGAN 085340168827 v Coronovac 24200121 7/17/2021
9 6474012202340002 JUNIBA RAJAB L 4 87 0 PACCINONGAN 082158861215 v Coronovac 24200121 7/17/2021
10 7304114107840020 ROSMAWATI P 4 37 31-45 PACCINONGAN 085255173701 v Coronovac 24200121 7/17/2021
11 7304113112690024 SAKA L 4 52 46-59 PACCINONGAN 082337182409 v Coronovac 24200121 7/17/2021
12 7304112203710001 RAPPUNG L 4 50 46-59 TINO 082151945020 v Coronovac 24200121 7/17/2021
13 7304113112760939 SASO L 4 44 31-45 PACCINONGAN 085242145919 v Coronovac 24200121 7/17/2021
14 7304112506940001 MUHAMMAD AKRAM L 4 24 18-30 TINO 081387816481 v Coronovac 24200121 7/17/2021
15 7304113112560032 SALAMING L 4 65 0 PACCINONGAN 085342548906 v Coronovac 24200121 7/17/2021
16 7304117112810043 DARMI P 4 39 31-45 PACCINONGAN 085240554039 v Coronovac 24200121 7/17/2021
17 7304114506030002 AINA ALFIRA P 2 18 18-30 PACCINONGAN 082393079413 v Coronovac 24200121 7/17/2021
18 6471042703850006 SYUKUR L 4 36 31-45 TINO TOA 081350505005 v Coronovac 24200121 7/17/2021
19 7304117112830031 SANGSI P 4 37 31-45 PACCINONGAN 085242036803 v Coronovac 24200121 7/17/2021
20 7304114107820010 RAHMAWATI P 39 31-45 PACCINONGAN 085242036803 v Coronovac 24200121 7/17/2021
21 7304110107600031 ALIMUDDIN L 61 0 PACCINONGAN 085240026905 v Coronovac 24200121 7/17/2021
22 7304116007600001 HASNAH R P 60 0 PACCINONGAN 085340880880 v Coronovac 24200121 7/17/2021
23 7304112311010001 SAHRUL L 20 18-30 KANANG-KANANG 085259008335 v Coronovac 24200121 7/17/2021
24 7304113112530018 BUNGA NIA P 67 0 PACCINONGAN 085394056720 v Coronovac 24200121 7/17/2021
25 7304117112550024 NAHARIA P 65 0 PACCINONGAN 085340168826 v Coronovac 24200121 7/17/2021
26 7304114107800083 SARI P 41 31-45 PACCINONGAN 085342548906 v Coronovac 24200121 7/17/2021
27 7304111411970001 ACHMAD FADLI ILH L 24 18-30 PACCINONGAN 085241115115 v Coronovac 24200121 7/17/2021
28 7304115412940001 BASMA P 26 18-30 BONTO LANGGA 085348613230 v Coronovac 24200121 7/17/2021
29 7304113012640001 HAKIM L 56 46-59 BONTO LANGGA 085348613230 v Coronovac 24200121 7/17/2021
30 7304113112560030 SUTOMO L 64 0 PACCINONGAN 082332611614 v Coronovac 24200121 7/17/2021
31 7304117006500001 LEBONG P 71 0 PACCINONGAN 082187843957 v Coronovac 24200121 7/17/2021
32 7304114107790035 SURIANTI P 42 31-45 PACCINONGAN 085251505580 v Coronovac 24200121 7/17/2021
33 7304115111780001 SUMIATI P 42 31-45 JL KAKATUA ASKOL 082393208378 v Coronovac 24200121 7/17/2021
34 7304114505520001 HASNAH P 69 0 PACCINONGAN 085242127426 v Coronovac 24200121 7/17/2021
35 7304110201030003 ISDAR IRIANTO SP L 18 18-30 PACCINONGAN 085242020343 v Coronovac 24200121 7/17/2021
36 7304114409980001 RISKA DEWIYANTI P 22 18-30 BATULU BARAT 085242028343 v Coronovac 24200121 7/17/2021
37 7304117005030001 MAULIAH AL AYUMI P 18 18-30 PACCINONGAN 081243441756 v Coronovac 24200121 7/17/2021
38 7304117112780036 ROSTINA P 42 31-45 PACCINONGAN 085396049836 v Coronovac 24200121 7/17/2021
39 7304115811980002 RISNAWATI P 22 18-30 PACCINONGAN 085396049832 v Coronovac 24200121 7/17/2021
40 7304106503950001 SUMARNI P 26 18-30 PACCINONGAN 085241208729 v Coronovac 24200121 7/17/2021
41 7304117112860041 HASNA P 34 31-45 PACCINONGAN 085248424482 v Coronovac 24200121 7/17/2021
42 7304114107890029 HANIA P 32 31-45 PACCINONGAN 085396773724 v Coronovac 24200121 7/17/2021
43 7304111003970002 SAHRUL GUNAWAN L 24 18-30 PACCINONGAN 082192874983 v Coronovac 24200121 7/17/2021
44 7304117112800038 INTANG P 40 31-45 TINO 085396049832 v Coronovac 24200121 7/17/2021
45 73040468079970001SUAEBAH P 26 18-30 PACCINONGAN 085256776736 v Coronovac 24200121 7/17/2021
46 7304114604800003 NAHARIAH P 41 31-45 PACCINONGAN 085348321109 v Coronovac 24200121 7/17/2021
47 7307057112620266 MANTANG P 58 46-59 PACCINONGAN 085265908025 v Coronovac 24200121 7/17/2021
48 7307055707000005 SELVI P 21 18-30 PACCINONGAN 081524484812 v Coronovac 24200121 7/17/2021
49 730411410746001 SAINTANG P 75 0 PACCINONGAN 085256469981 v Coronovac 24200121 7/17/2021
50 7304116011020003 KARMILA P 18 18-30 PACCINONGAN 085256310474 v Coronovac 24200121 7/17/2021
51 7304115004020001 ROHANI P 19 18-30 PACCINONGAN 081241441201 v Coronovac 24200121 7/17/2021
52 7304040203550001 HARIS L 68 0 PACCINONGAN 085256776736 v Coronovac 24200121 7/17/2021
53 7304114101970002 KURNIA AGUS P 24 18-30 TANGGAKANG 081563705296 v Coronovac 24200121 7/17/2021
54 7304113112690010 H. NASTRI L 51 46-59 KANANG-KANANG 082399523269 v Coronovac 24200121 7/17/2021
55 7304116312990001 NUR WAHYUNI P 21 18-30 TINO 081354503324 v Coronovac 24200121 7/17/2021
56 7304114305810004 IRAWATI P 40 31-45 PACCINONGAN 085248169248 v Coronovac 24200121 7/17/2021
57 7371103112860117 SABRIANTO L 34 31-45 TAROWANG 085342296655 v Coronovac 24200121 7/17/2021
58 7304114903580002 ST MARWAH KR IN P 63 0 PACCINONGAN 085332621676 v Coronovac 24200121 7/17/2021
59 730411620280001 MADE DEWI ERNAW P 41 31-45 PACCINONGAN 082197080471 v Coronovac 24200121 7/17/2021
60 6405020701680002 JUNURUDDIN L 53 46-59 BONTO LANGGA 081341963393 v Coronovac 24200121 7/17/2021
61 7304110202520001 ABDULLAH KR BUL L 69 0 PACCINONGAN 085342053850 v Coronovac 24200121 7/17/2021
62 7304117112570020 NAHARIA P 63 0 PACCINONGAN 085241208729 v Coronovac 24200121 7/17/2021
63 7304110909020001 ARWIN TALAM L 18 18-30 PACCINONGAN 082187694300 v Coronovac 24200121 7/17/2021
64 7304114508560001 NUR ASIYA KR RIM P 64 0 PACCINONGAN 085256146780 v Coronovac 24200121 7/17/2021
65 7304114203500002 RAPIA P 70 0 KANANG-KANANG 081342326932 v Coronovac 24200121 7/17/2021
66 7304110405970003 RUDI L 24 18-30 KANANG-KANANG 085827866706 v Coronovac 24200121 7/17/2021
67 7304113112790030 SITUNG L 41 31-45 KANANG-KANANG 085242759939 v Coronovac 24200121 7/17/2021
68 7304115410700001 SYAMSURIAH P 50 46-59 PACCINONGAN 082197080594 v Coronovac 24200121 7/17/2021
69 7304111505750003 PATTA L 45 31-45 KANANG-KANANG 082192874758 v Coronovac 24200121 7/17/2021
70 7304112802700001 ABDULLAH L 50 46-59 KANANG-KANANG 085255109202 v Coronovac 24200121 7/17/2021
71 7304114107800103 MAWAR P 40 31-45 PACCINONGAN 085230822538 v Coronovac 24200121 7/17/2021
72 7304115608020003 KHAERA MUFLIHA P 18 18-30 PACCINONGAN 085230822538 v Coronovac 24200121 7/17/2021
73 7304113112640009 H BANA L 56 46-59 KANANG-KANANG 085341083346 v Coronovac 24200121 7/17/2021
74 7304112105730001 IBRAHIM L 48 46-59 BONTO LANGGA 082393079413 v Coronovac 24200121 7/17/2021
75 7304114211990001 IRNAWATI P 23 18-30 KALOKO 082347382598 v Coronovac 24200121 7/17/2021
76 7304114208780001 NURSIAH P 42 31-45 BONTO LANGGA 082393079413 v Coronovac 24200121 7/17/2021
77 730411441170002 SITTIAMANG DG TE P 40 31-45 KALOKO 082347382598 v Coronovac 24200121 7/17/2021
78 7304114304550002 RAMIAH P 66 0 BONTO LANGGA 082393079413 v Coronovac 24200121 7/17/2021
79 7304110101530002 RAHAKING L 68 0 BONTO LANGGA 082393079413 v Coronovac 24200121 7/17/2021
80 7303054107970304 RISKAWATI P 24 18-30 BONTO LANGGA 085387594124 v Coronovac 24200121 7/17/2021
81 7304115010030001 NURUL FADILLAH P 17 0 PACCINONGAN 081241300799 v Coronovac 24200121 7/17/2021
82 7303013112840008 RISWAN L 36 31-45 PARANG LABBUA 085341124459 v Coronovac 24200121 7/17/2021
83 7304114112890001 MARLINA P 31 31-45 BONTO LANGGA 085395433367 v Coronovac 24200121 7/17/2021
84 7304114411050001 NURLISA P 15 0 KANANG-KANANG 085343789985 v Coronovac 24200121 7/17/2021
85 7304115805020001 DINI P 19 18-30 KANANG-KANANG 082189614977 v Coronovac 24200121 7/17/2021
86 7304110105030002 NASIR L 18 18-30 BONTO LANGGA 082192345802 v Coronovac 24200121 7/17/2021
87 7304110107570017 RAMLI L 64 0 BONTO LANGGA 085256305224 v Coronovac 24200121 7/17/2021
88 7304111505030003 RAHMAT L 18 18-30 KANANG-KANANG 081242894814 v Coronovac 24200121 7/17/2021
89 7304112312920001 TAJUDDIN L 28 18-30 KANANG-KANANG 085240553535 v Coronovac 24200121 7/17/2021
90 7304110404950002 KURNIAWAN SP L 26 18-30 TANAKEKE 085342013582 v Coronovac 24200121 7/17/2021
91 7304110107700003 H RABANAI L 50 46-59 KANANG-KANANG 082336169029 v Coronovac 24200121 7/17/2021
92 730313112700056 H TAHIR L 50 46-59 KANANG-KANANG 082187653817 v Coronovac 24200121 7/17/2021
93 7304110909590001 H RABALI L 61 0 KANANG-KANANG 082187653819 v Coronovac 24200121 7/17/2021
94 7304117112610035 SANNENG P 59 46-59 KANANG-KANANG 0823944540792 v Coronovac 24200121 7/17/2021
95 7304116101870001 RASMIATI P 34 31-45 PACCINONGAN 085340168827 v Coronovac 24200121 7/17/2021
96 7304110102780003 M YUSUF L 43 31-45 BONTO LANGGA 085240005894 v Coronovac 24200121 7/17/2021
97 7304116211010001 NURUL MUTMAINNA P 19 18-30 PACCINONGAN 085251505580 v Coronovac 24200121 7/17/2021
98 7304117112800037 SUMIATI P 41 31-45 PACCINONGAN 085215696080 v Coronovac 24200121 7/17/2021
99 Nur arini P 27 18-30 PACCINONGAN Coronovac 24200121 7/17/2021
100 Fitri Ayudia salim P 20 18-30 PACCINONGAN Coronovac 24200121 7/17/2021

* Pekerjaan dikelompokkan me1= Hipertensi 1 = Sinopharm
1 = Petugas Medis dan Non Med2= Diabetes 2 = Sinovac
2 = Petugas pelayanan publik 3= Penyakit Jantung3 = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)
3 = Administrator Pemerintaha4= Penyakit Ginjal

18-30 37 BPJS 13 1 43
31-45 30 BPJS 30 2 4
46-59 18 Non A 0 3 0
1 43 Dosis 84 Total 86
2 4 Dosis 41 Komorbid
3 0 Total 1 0
4 38 2 0
5 0 3 0
Total 85 4 0
5 0
6 0
Tidak ada 64
Total 0
Nama Puskesmas/Jeja
: Puskesmas Tino
DES Tanggal 07-08-2021
'Ya' Tanggal Pemberian

pada Imunisasi Keterangan
Jenis Peke Umur Ada
Kelompok Merek (Contoh:
No NIK Nama Penerima Vaksin Kelami rjaan (18-59 Alamat No. Hp BPJS (sebutkan Tidak Ada Vaksin***
Umur Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dirujuk/
n * tahun) PBI komorbidny (centang) ….)
a)
1 7304116308010001 JUMRIANI P 4 19 18-30 PACCINONGAN 082393095820 v Coronovac 24004721 8/7/2021

2 7304110102780003 M YUSUF L 4 43 31-45 BONTO LANGGA 085240005894 v Coronovac 24004721 8/7/2021
3 7304112105730001 IBRAHIM L 4 48 46-59 BONTO LANGGA 085399136028 v Coronovac 24004721 8/7/2021
4 7304114304550002 RAMLAH P 4 66 0 BONTO LANGGA 085399136828 v Coronovac 24004721 8/7/2021
5 6402131706520001 M SYARIFUDDIN L 4 72 0 BUNGUN CAMBA LOMPOA 082159759317 v Coronovac 24004721 8/7/2021
6 7304112506200002 RUSLAN L 4 21 18-30 PACCINONGAN 085251505518 v Coronovac 24004721 8/7/2021
7 7304112806030002 USMAN ALI L 4 18 18-30 PACCINONGAN 085323535636 v Coronovac 24004721 8/7/2021
8 7304111304770001 SAHRIR L 4 44 31-45 BALANG BARU 085352711477 v Coronovac 24004721 8/7/2021
9 7304110805580001 LUKMAN L 4 63 0 BALANGLOE 085347854692 v Coronovac 24004721 8/7/2021
10 7304110107730024 NIPPI L 4 48 46-59 BALANGLOE 082189144443 v Coronovac 24004721 8/7/2021
11 7304110101530002 RABAKING L 4 68 0 BONTO LANGGA 085399136828 v Coronovac 24004721 8/7/2021
12 7304115008820002 SAIDAH P 4 38 31-45 BONTOWA 082337178738 v Coronovac 24004721 8/7/2021
13 7304113112730031 EFENDI L 4 47 46-59 BALANGLOE 085298140094 v Coronovac 24004721 8/7/2021
14 7304111603000001 IDIL ADHA L 4 21 18-30 BALANGLOE 085298140094 v Coronovac 24004721 8/7/2021
15 7304110108010002 ALBANI NUR L 4 20 18-30 PACCINONGAN 085242199301 v Coronovac 24004721 8/7/2021
16 7304113101560002 M AMIN L 4 65 0 BALANGLOE 085347884692 v Coronovac 24004721 8/7/2021
17 7303010405890003 SOLIHIN L 4 32 31-45 KAYANGAN 081944605036 v Coronovac 24004721 8/7/2021
18 7304110510940002 ASPAR L 4 26 18-30 CAMBA LOMPOA 082347509766 v Coronovac 24004721 8/7/2021
19 7304114208780001 NURSIAH P 4 43 31-45 BONTO LANGGA 085399136828 v Coronovac 24004721 8/7/2021
20 7304110107570017 RAMLI L 4 64 0 BONTO LANGGA 085256305224 Coronovac 24004721 8/7/2021
21 7304110107660018 CACO ALLI L 4 55 46-59 BALANGLOE 082347579161 Coronovac 24004721 8/7/2021
22 7304115809730001 DARMAWATI P 4 47 46-59 BALANGLOE 085347884692 Coronovac 24004721 8/7/2021
23 7304114107500030 SALWIAH P 4 71 0 BALANGLOE 085347884629 Coronovac 24004721 8/7/2021
24 7304114507710002 SUGIATI P 4 50 46-59 BALANGLOE 085256205640 Coronovac 24004721 8/7/2021
25 7304114508710000 BULAN P 4 50 46-59 BALANGLOE 082395913440 Coronovac 24004721 8/7/2021
26 7304110710020001 FANI EFENDI L 4 18 18-30 PACCINONGAN 085647583462 Coronovac 24004721 8/7/2021
27 7304095005950003 ROSMINA P 4 26 18-30 BONTO LANGGA 085256806488 Coronovac 24004721 8/7/2021
28 7304114509740001 ST MIRA P 4 41 31-45 BONTO LANGGA 082348493134 Coronovac 24004721 8/7/2021
29 7304054710890003 RAMLAH L 4 31 31-45 BONTO LANGGA 082348601725 Coronovac 24004721 8/7/2021
30 6471021004830005 RUSMIN L 4 38 31-45 BALANGLOE 081349038071 Coronovac 24004721 8/7/2021
31 7304114204790001 MARMAH P 4 0 BALANGLOE 085730746362 Coronovac 24004721 8/7/2021
32 7304112002040001 KHAERIL FADLI L 4 17 0 TINO 085342030900 Coronovac 24004721 8/7/2021
33 7304044109030003 NUR IFANI EKA PUTRI P 4 18 18-30 BALTAR 082312524417 Coronovac 24004721 8/7/2021
34 7304117112800000 NURSYAMSI P 4 40 31-45 BALANGLOE 082394449158 Coronovac 24004721 8/7/2021
35 7304116201010001 TRISNAWATI P 4 21 18-30 BALANGLOE 082394449198 Coronovac 24004721 8/7/2021
36 7304113001990001 ALFIAN L 4 22 18-30 BUNGUNG KONCI 087840123387 Coronovac 24004721 8/7/2021
37 7304114205770002 HUSNIA P 4 44 31-45 PACCINONGAN 085398066321 Coronovac 24004721 8/7/2021
38 7304110205730002 AHMAD SAEDI L 4 48 46-59 PACCINONGAN 085212526285 Coronovac 24004721 8/7/2021
39 7304112211930001 FAISAL L 4 27 18-30 BONTO LANGGA 082191949283 Coronovac 24004721 8/7/2021
40 7304110102670001 SAHAUDDIN L 4 54 46-59 BONTO LANGGA 085298062955 Coronovac 24004721 8/7/2021
41 7304115305750001 SALAWATI P 4 46 46-59 TINO 082348212908 Coronovac 24004721 8/7/2021
42 7304114912010001 SRI HARINA P 4 19 18-30 BONTO LANGGA 084343999280 Coronovac 24004721 8/7/2021
43 7304116005020002 SRI WAHYUNI P 4 19 18-30 BONTO LANGGA 085341640067 Coronovac 24004721 8/7/2021
44 7304117112720031 SYAMSIAH P 4 48 46-59 TINO 085343997527 Coronovac 24004721 8/7/2021
45 7304116004710001 SUBAEDA P 4 50 46-59 TINO 085345220685 Coronovac 24004721 8/7/2021
46 730411040970001 RUSDIANTO L 4 24 18-30 BALANGLOE 081934400048 Coronovac 24004721 8/7/2021
47 7304110206000001 HENRA GUSTI RANDA L 4 21 18-30 BATULANG 085240388123 24004721 8/7/2021
48 7304115711020001 FITRI HANDAYANI P 4 19 18-30 TINO 08124190559 24004721 8/7/2021
49 6472025510770004 SAMSIA DG SENGA P 4 44 31-45 JL.P.BANDAHARA 082357833578 24004721 8/7/2021
50 7304113012530001 NURJANI TOMPO L 4 48 46-59 BT LANGGA 082393374949 24004721 8/7/2021
51 7304110405780001 SUKRI L 4 43 31-45 BT BARU 082188844966 24004721 07/0/82021
52 7306110107940128 SAMSUDDIN L 4 27 18-30 BUNGUNG LANTANG 085242604996 24004721 07/0/82021
53 7304111610800001 BAHARUDDIN L 4 40 31-45 BALANGLOE 085395410376 24004721 07/0/82021
54 7304112203870001 SUPRIADI L 4 33 31-45 UJUNG 082396093560 24004721 07/0/82021
55 7304112512730002 HAMKA SEWANG L 4 47 46-59 BALANGLOE 085394461438 24004721 07/0/82021
56 7304116811040001 FERDI L 4 16 0 KASSI-KASSI 082331274233 24004721 07/0/82021
57 7271108690600001 IIN ANJANI NUR P 4 20 18-30 BALANGLOE 081934400048 24004721 07/0/82021
58 7304117112940008 MIRNAWATI L 4 26 18-30 BALANGLOE 085251942301 24004721 07/0/82021
59 7304114305820002 NURMIN L 4 36 31-45 BALANGLOE 085343639307 24004721 8/7/2021
60 7304114510730002 NORMA P 4 47 46-59 PACCINONGAN 085298102456 24004721 8/7/2021
61 7304114107680028 SANNERA P 4 52 46-59 PACCINONGAN 082293322577 24004721 8/7/2021
62 7304111811020001 IMRAN MAULANA L 4 18 18-30 PACCINONGAN 082236169844 24004721 8/7/2021
63 7304114505690002 HADAWIAH P 4 51 46-59 BONTO MANAI 082399267268 24004721 8/7/2021
64 7304110201950001 JUSRIANTI P 4 25 18-30 BONTO LANGGA 082348601725 24004721 8/7/2021
65 SITTI RAMLAH
7304114101040007 P 4 16 0 PACCINONGAN 085396049832 24004721 8/7/2021
66 NURAENI
7304116505760001 P 4 44 31-45 BALANGLOE 085394772895 24004721 8/7/2021
67 H SUDARMAN KASENG
7304111008800001 L 4 40 31-45 PACCINONGAN 085341078878 24004721 8/7/2021
68 TRIMUGENAFAR
7304110509000004 L 4 20 18-30 BALANGLOE 081353177650 24004721 8/7/2021
69 LAHAYA
7304113112610073 L 4 59 46-59 BALANGLOE 085347884692 24004721 8/7/2021
70 7304116808910001 HARIYANTI P 4 29 18-30 BALANGLOE 085256802903 24004721 8/7/2021
71 7304113110960001 ATWAL FATWAL MUHLIS L 4 24 18-30 BONTO UJUNG 085823864472 24004721 8/7/2021
72 7304053112830326 SAMSIU L 4 37 31-45 BONTO LANGGA 082348601725 24004721 8/7/2021
73 7304116706030001 NURUL SASKIA P 4 17 0 CAMBA LOMPOA 081342786036 24004721 8/7/2021
74 7304115912910002 NURHAYATI P 4 29 18-30 PANAIKANG 082394443618 24004721 8/7/2021
75 730404050580001 YONO L 4 40 31-45 KATO'MARA 085256708215 24004721 8/7/2021
76 7304111409990001 HARIS K L 4 21 18-30 TONROA 085397849805 24004721 8/7/2021
77 7304117112820043 SIATI P 4 38 31-45 TINO 085647583462 24004721 8/7/2021
78 7304113112780022 KARIM L 4 42 31-45 PACCINONGAN 085242489631 24004721 8/7/2021
79 7304111606850002 RUSLI M L 4 35 31-45 BALANGLOE 085255827909 24004721 8/7/2021
80 7304110500780001 JUFRI HAMZA L 4 42 31-45 BONTO LANGGA 082348493134 24004721 8/7/2021
81 7304050503850003 RUSLAN L 4 35 31-45 KATO'MARA 085242870060 24004721 8/7/2021
82 7304115005970004 KARTINI P 4 33 31-45 BALANGLOE 081340054024 24004721 8/7/2021
83 7909052712990001 ALWI SIHAK L 4 21 18-30 SARAPPO 081341764509 24004721 8/7/2021
84 ARIFUDDIN GASSING
7304113112530005 L 4 77 0 BALANGLOE 085343639307 24004721 8/7/2021
85 ABD ASIS
7304112805930001 L 4 25 18-30 BALANGLOE 082351618618 24004721 8/7/2021
86 NURDIANA
7304114108870004 P 4 36 31-45 JL.P.BANDAHARA 082100627332 24004721 8/7/2021
87 NURULFADILLAH
7304114108020003 P 4 18 18-30 UJUNG TIMUR 085241586579 24004721 8/7/2021
88 7304110511710001 KAHARUDDIN L 4 49 46-59 JL.P.BANDAHARA 082350045709 24004721 8/7/2021
89 7304114703020001 SUKAENI P 4 22 18-30 BONTO KATANGKA 085352534543 24004721 8/7/2021
90 7371092102010001 M RIAF RASID PAISAL L 4 19 18-30 MAKASSAR 0872826544 24004721 8/7/2021
FORMAT PEN

DES Agustus
No. Jenis Umur Kelomp

Nama Penerima Pekerj
No Registr NIK Kelami (18-59 ok
Vaksin aan*
asi n tahun) Umur
1 7304112505030002 FIRMANSYAH L 4 18 18-30

2 7304111202010002 M IKBAL L 4 19 18-30
3 7304080510890002 RUSLI L 4 31 31-45
4 7304040401870002 NORMA P 4 37 31-45
5 6402131706520001 M SYARIFUDDIN L 4 72 0
6 7304110105950001 SUPRIADI L 4 26 18-30
7 7303045207960000 NURMALASARI P 4 24 18-30
8 7303024202830003 FATMA P 4 32 31-45
9 7304112102860002 BAHTIAR L 4 34 31-45
10 7304115110730004 JUNAEDAH P 4 47 46-59
11 730411470850001 RABAINTANG P 4 70 0
12 7304110912620001 ILHAM NINDAR L 4 58 46-59
13 7304116006800001 AHRIANI P 4 40 31-45
14 7304112702030002 AKBAR L 4 18 18-30
15 7304115904890001 NURHIDAYAH P 4 31 31-45
16 7304110512770001 KAMARUDDIN P 4 43 31-45
17 7304031003010003 MUH. IBRAHIM RAHMAT P 4 19 18-30
18 7304114205750001 ST JAWHARI SANNING P 4 45 31-45
19 730312708840001 NURHALIPAH P 4 43 31-45
20 3604101107900328 ROCHMAN L 4 30 18-30
21 7304117112860037 SYAMSINA P 4 34 31-45
22 730411551200001 SRI SUCI RAMADHANI P 4 20 18-30
23 7304116004980001 HASNI P 4 22 18-30
24 7304110502690001 SAHARUDDIN,S.HI L 4 51 46-59
25 7303015108860000 RAHMATIA P 4 34 31-45
26 7304112604860000 WAWAN L 4 34 31-45
27 7304114912840001 AHRIANI P 4 36 31-45
28 7304111503820000 MUSTAKIM L 4 38 31-45
29 7304110107800051 SUKARDI L 4 40 31-45
30 7304111002030001 WAWAN SAHNUR L 4 18 18-30
31 7304110905680001 ABD HAKIM L 4 52 46-59
32 7304116507660001 ROSMAWATI P 4 55 46-59
33 7304111602010001 A. DIO IAM L 4 20 18-30
34 7304113112810055 BAKRI L 4 39 31-45
35 7306104107930105 A MEGAWATI P 4 26 18-30
36 730403111090002 DEDI KURNIADI AMRAN L 4 30 18-30
37 7304117112550044 NURBIYAH P 4 65 0
38 7304115010690001 JUHRA P 4 51 46-59
39 7304112201920001 RAHMAT WAHUDI L 4 29 18-30
40 7304115905830003 KARTINI P 2 37 31-45
41 7304114312920002 AYULIA P 2 29 18-30
42 9171012505030004 UMAR WIRA HADI ASPAR A P 2 18 18-30
43 7304116002030004 INAYAH QALBI P 2 17 0
44 7304116308010001 JUMRIANI P 4 19 18-30
45 7304110102780003 M YUSUF L 4 43 31-45
46 7304112105730001 IBRAHIM L 4 48 46-59
47 7304114304550002 RAMLAH P 4 66 0
48 6402131706520001 M SYARIFUDDIN L 4 72 0
49 7304112506200002 RUSLAN L 4 21 18-30
50 7304112806030002 USMAN ALI L 4 18 18-30
51 7304111304770001 SAHRIR L 4 44 31-45
52 7304110805580001 LUKMAN L 4 63 0
53 7304110107730024 NIPPI L 4 48 46-59
54 7304110101530002 RABAKING L 4 68 0
55 7304115008820002 SAIDAH P 4 38 31-45
56 7304113112730031 EFENDI L 4 47 46-59
57 7304111603000001 IDIL ADHA L 4 21 18-30
58 7304110108010002 ALBANI NUR L 4 20 18-30
59 7304113101560002 M AMIN L 4 65 0
60 7303010405890003 SOLIHIN L 4 32 31-45
61 7304110510940002 ASPAR L 4 26 18-30
62 7304114208780001 NURSIAH P 4 43 31-45
63 7304043112810028 KIKI SAPUTRA L 4 39 31-45
64 7304116205000001 NURUL FITRA HAMKA P 4 20 18-30
65 7304111902960002 AKBAR SYARIF L 4 25 18-30
66 7304116304010002 ASMILA SYARIF P 4 20 18-30
67 7304110107570017 RAMLI L 4 64 0
68 7304110107660018 CACO ALLI L 4 55 46-59
69 7304115809730001 DARMAWATI P 4 47 46-59
70 7304114107500030 SALWIAH P 4 71 0
71 7304114507710002 SUGIATI P 4 50 46-59
72 7304114508710000 BULAN P 4 50 46-59
73 7304110710020001 FANI EFENDI L 4 18 18-30
74 7304095005950003 ROSMINA P 4 26 18-30
75 7304114509740001 ST MIRA P 4 41 31-45
76 7304054710890003 RAMLAH L 4 31 31-45
77 6471021004830005 RUSMIN L 4 38 31-45
78 7304114204790001 MARMAH P 4 0
79 7304112002040001 KHAERIL FADLI L 4 17 0
80 7304044109030003 NUR IFANI EKA PUTRI P 4 18 18-30
81 7304117112800000 NURSYAMSI P 4 40 31-45
82 7304116201010001 TRISNAWATI P 4 21 18-30
83 7304113001990001 ALFIAN L 4 22 18-30
84 7304114205770002 HUSNIA P 4 44 31-45
85 7304110205730002 AHMAD SAEDI L 4 48 46-59
86 7304112211930001 FAISAL L 4 27 18-30
87 7304110102670001 SAHAUDDIN L 4 54 46-59
88 7304115305750001 SALAWATI P 4 46 46-59
89 7304114912010001 SRI HARINA P 4 19 18-30
90 7304116005020002 SRI WAHYUNI P 4 19 18-30
91 7304117112720031 SYAMSIAH P 4 48 46-59
92 7304116004710001 SUBAEDA P 4 50 46-59
93 730411040970001 RUSDIANTO L 4 24 18-30
94 7304110206000001 HENRA GUSTI RANDA L 4 21 18-30
95 7304115711020001 FITRI HANDAYANI P 4 19 18-30
96 7305076401790001 NURLINDA P 4 42 31-45
97 7304110712940002 RANDY EKO SAPUTRA L 4 27 18-30
98 7304113101930001 NURLINDA P 4 42 31-45
99 7305076401790001 NURLINDA P 4 42 31-45
100 7305076401790001 NURLINDA P 4 42 31-45
97 7304112203870001 SUPRIADI L 4 33 31-45
98 7304112512730002 HAMKA SEWANG L 4 47 46-59
99 7304116811040001 FERDI L 4 16 0
100 7271108690600001 IIN ANJANI NUR P 4 20 18-30
101 7304117112940008 MIRNAWATI L 4 26 18-30
102 7304114305820002 NURMIN L 4 36 31-45
103 7304114510730002 NORMA P 4 47 46-59
104 7304114107680028 SANNERA P 4 52 46-59
105 7304111811020001 IMRAN MAULANA L 4 18 18-30
106 7304114505690002 HADAWIAH P 4 51 46-59
107 7304110201950001 JUSRIANTI P 4 25 18-30
108 7304114101040007 SITTI RAMLAH P 4 16 0
109 7304116505760001 NURAENI P 4 44 31-45
110 7304111008800001 H SUDARMAN KASENG L 4 40 31-45
111 7304110509000004 TRIMUGENAFAR L 4 20 18-30
112 7304113112610073 LAHAYA L 4 59 46-59
113 7304116808910001 HARIYANTI P 4 29 18-30
114 7304113110960001 ATWAL FATWAL MUHLIS L 4 24 18-30
115 7304053112830326 SAMSIU L 4 37 31-45
116 7304116706030001 NURUL SASKIA P 4 17 0
117 7304115912910002 NURHAYATI P 4 29 18-30
118 730404050580001 YONO L 4 40 31-45
119 7304111409990001 HARIS K L 4 21 18-30
120 7304117112820043 SIATI P 4 38 31-45
121 7304113112780022 KARIM L 4 42 31-45
122 7304111606850002 RUSLI M L 4 35 31-45
123 7304110500780001 JUFRI HAMZA L 4 42 31-45
124 7304050503850003 RUSLAN L 4 35 31-45
125 7304115005970004 KARTINI P 4 33 31-45
126 7909052712990001 ALWI SIHAK L 4 21 18-30
127 7304113112530005 ARIFUDDIN GASSING L 4 77 0
128 7304112805930001 ABD ASIS L 4 25 18-30
129 7304114108870004 NURDIANA P 4 36 31-45
130 7304114108020003 NURULFADILLAH P 4 18 18-30
131 7304110511710001 KAHARUDDIN L 4 49 46-59
132 7304114703020001 SUKAENI P 4 22 18-30
133 7371092102010001 M RIAF RASID PAISAL L 4 19 18-30

Kelompok Umur: 1= Hipertensi 1 = Sinopharm
18-30 2= Diabetes 2 = Sinovac
31-45 3= Penyakit Jantung 3 = Lainnya (Mohon disebutkan jenis vaksin yang diterim
46-59 4= Penyakit Ginjal
Total 5= Penyakit Paru Kronis
Pekerjaan: 6=Lainnya
1
2
3 Kepesertaan BPJS
4 37 BPJS PB 13
5 30 BPJS Non 30
Total 18 Non Angg 0
85 Total 43
Pemberian Dosis
43 Dosis 1 84
4 Dosis 2 41
0 Total
38
0
85

sesuai)
Ada
Tidak
Alamat No. Hp BPJS Non (sebutk
BPJS Ada
Non Anggot an
PBI (centan
PBI a komorb
g)
idnya)
TINO 082393084725 v
TINO 082151945020 v
BALANGLOE 081343138350 v
PACCINONGAN 081342722232 v
BUNGUN CAMBA LOM082159759317 v
BONTO RAPPO 085242751004 v
BANTAENG 085285295439 v
BUNGUNG BAMBANG 082152461862 v
BUNGUNG CAMBA 085347361078 v
TINO 081342578147 v
JL. TEMBAKAU 082271532192 v
TINO 081288536225 v
BUNGUNG BAMBANG 082337250398 v
KASSI-KASSI 085256205640 v
JL TA. GANI 085255803124 v
CAMBA LOMPOA 085256516037 v
PACCINONGAN 085343962560' v
TINO 085345220685 v
GANGRANG BATU 085299903449 v
JL TOA DAENG 085256146780 v
TINO 085394460521 v
KOMPLEKS AJENDAM 085244116580 v
TINO 085254741551 v
BONTO LANGGA 085240005894 v
BUNGUN CAMBA LOM082159759317 v
BALANG BARU 085352711477 v
BONTOWA 082337178738 v
KAYANGAN 081944605036 v
TINO 085342030900 v
BALTAR 082312524417 v
BUNGUNG KONCI 087840123387 v
TINO 082348212908 v
TINO 085343997527 v
TINO 085345220685 v
BATULANG 085240388123 v
TINO 08124190559 v
BATU MERAH 082398618928 v
UJUNG 082396093560
KASSI-KASSI 082331274233
BONTO MANAI 082399267268
PANAIKANG 082394443618
KATO'MARA 085256708215
TONROA 085397849805
TINO 085647583462
KATO'MARA 085242870060
SARAPPO 081341764509
JL.P.BANDAHARA 082100627332
JL.P.BANDAHARA 082350045709
MAKASSAR 0872826544
kan jenis vaksin yang diterima Puskesmas/Faskes)

Pekerjaan
1 43
2 4
3 0
4 39
5 0
Total 86
Komorbid
1 0
2 0
3 0
4 0
5 0
6 0
Tidak ada 64
Total 0
Tanggal Pemberian
No. Batch
Imunisasi
Keteranga
n
Merek
(Contoh:
Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dir
ujuk/….)
Coronovac 24004421 8/14/2021

Coronovac 24004421 8/5/2021
Coronovac 24004421 8/14/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24004421 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 24003121 8/5/2021
Coronovac 2.4E+07 05/082021
Coronovac 2.4E+07 05/082021
Coronovac 2.4E+07 05/082021
Coronovac 2.4E+07 05/082021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721
Coronovac
Coronovac
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721
Coronovac
Coronovac 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721
Coronovac 24004721
Coronovac 8/7/2021
Coronovac 8/7/2021
Coronovac 24004721
Coronovac 24004721
Coronovac 24004721 8/7/2021
Coronovac 8/7/2021
Coronovac
Coronovac 24004721
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004721 8/7/2021
Coronovac 24004722 8/8/2021 8/7/2021
Coronovac 24004723 8/9/2021
Coronovac 24004724 8/10/2021
Coronovac 24004725 8/11/2021
24004721
24004721
24004721
24004721
24004721 07/0/82021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
24004721 8/7/2021
Tanggal Pemberian
Imunisasi
Tida Keterangan
Umur
No. Nama Penerima Jenis Pekerjaa Kelomp k Merek (Contoh:
No NIK (18-59 Alamat No. Hp
Registrasi Vaksin Kelamin n* ok Umur Ada Vaksin*** Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dirujuk/
tahun)
(cent ….)
ang)
1 7304045211840001 SUHARTINI P 4 37 31-45 BUNGEN 085248035467 v Coronovac 24004721 8/14/2021

2 7304110107380002 BACO L 4 64 0 TINO 085256469981 v Coronovac 24004721 8/14/2021
3 7311024101960004 FITRI WAHDANIAYAH P 4 25 18-30 TINROWALI 081343693383 v Coronovac 24004721 8/14/2021
4 7304110107590006 RAHMAN SAID P 4 62 0 TINO 085341782451 v Coronovac 24004721 8/14/2021
5 7304116106920002 ASRIANI P 4 29 18-30 UJUNG BARAT 082397608650 v Coronovac 24004721 8/14/2021
6 7304115910700001 SAMSURIATI P 4 42 31-45 PACCINONGAN 082197080594 v Coronovac 24004721 8/14/2021
7 7304113112470016 SAMSUDDIN LAU L 4 64 0 BALANGLOE 085299198276 v Coronovac 24004721 8/14/2021
8 7304117112590017 SALIKA P 4 63 0 PACCINONGAN 085240023539 v Coronovac 24004721 8/14/2021
9 7304113112700032 ABD SALAM L 4 41 31-45 PACCINONGAN 082187694300 v Coronovac 24004721 8/14/2021
10 7303022209010001 KHAERIL AMRI L 4 20 18-30 BONTORAYA 082346710527 v Coronovac 24004721 8/14/2021
11 7304111106780001 ABD WAHID L 4 43 31-45 PACCINONGAN 082349991871 v Coronovac 24004721 8/14/2021
12 7304040701780001 IRSAN L 4 43 31-45 PACCINONGAN 085340229639 v Coronovac 24004721 8/14/2021
13 7271064505780001 NURHAYATI P 4 43 31-45 PACCINONGAN 082346506595 v Coronovac 24004721 8/14/2021
14 7303026307010004 NURFATHIRRANISA P 4 20 18-30 PACCINONGAN 082347859300 v Coronovac 24004721 8/14/2021
15 7304114107760037 SAMSIA DG LANTI P 4 45 31-45 BALANGLOE 082296399929 v Coronovac 24004721 8/14/2021
16 7304114107900004 CITRA P 4 21 18-30 BALANGLOE 085240556882 v Coronovac 24004721 8/14/2021
17 7304117112650018 MANNENG L 4 56 46-59 BALANGLOE 087840331760 v Coronovac 24004721 8/14/2021
18 7304116611810001 KARMILA P 4 40 31-45 UJUNG 085242594225 v Coronovac 24004721 8/14/2021
19 7304117112870014 SARIBAU P 4 31 31-45 CAMBA LOMPOA 085242152711 v Coronovac 24004721 8/14/2021
20 7304115111010002 NURFINA RAHMI SYAR P 4 20 18-30 CAMBA LOMPOA 085242152711 v Coronovac 24004721 8/14/2021
21 7304117112720013 MAINNA P 4 49 46-59 CAMBA LOMPOA 085242152711 v Coronovac 24004721 8/14/2021
22 7304112004650001 ALEX L 4 56 46-59 KANANG2 085242363239 v Coronovac 24004721 8/14/2021
23 7304115004880001 HASNI TANNANG,S.PD P 4 33 31-45 BALANGLOE 085343725844 v Coronovac 24004721 8/14/2021
24 7304111506910002 BUSTAN L 4 20 18-30 KP BERU 085255633546 v Coronovac 24004721 8/14/2021
25 7304114601020001 NESA PIPIAN P 4 19 18-30 PARANNASSANG 082346879675 v Coronovac 24004721 8/14/2021
26 7304111005910001 RORIS WIJOYO L 4 31 31-45 BALANGLOE 081222511156 v Coronovac 24004721 8/14/2021
27 7304117112740026 SUBAEDA P 4 48 46-59 PACCINONGAN 085399957437 v Coronovac 24004721 8/14/2021
28 7304110606800001 MANAI L 4 41 31-45 PACCINONGAN 085397895267 v Coronovac 24004721 8/14/2021
29 7304114107800103 MAWAR P 4 41 31-45 PACCINONGAN 085230822538 v Coronovac 24004721 8/14/2021
30 7304115608020003 KHAERA MUFLIHA P 4 19 18-30 PACCINONGAN 085230822538 v Coronovac 24004721 8/14/2021
31 7304114110900000 HAJRAH P 4 20 18-30 ONTO UJUNG 083856624629 v Coronovac 24004721 8/14/2021
32 7304112003860002 DARWIS L 4 34 31-45 BALANGLOE 085397158831 v Coronovac 24004721 8/14/2021
33 7304114202830001 IDAWATI P 4 37 31-45 BALTAR 085242242071 v Coronovac 24004721 8/14/2021
34 7304045612900001 LISNAWATI P 4 30 18-30 ULUGALUNG 085240564082 v Coronovac 24004721 8/14/2021
35 7304116312760001 HASBIAH P 4 44 31-45 PACCINONGAN 085395221139 v Coronovac 24004721 8/14/2021
36 7304117112770019 SARI P 4 43 31-45 PACCINONGAN 085240023539 v Coronovac 24004721 8/14/2021
37 730411090884001 PATAHUDDIN L 4 36 31-45 PACCINONGAN 081355690746 v Coronovac 24004721 8/14/2021
38 7304110105030002 NASIR L 4 17 0 BONTO LANGGA 082192345802 v Coronovac 24004721 8/14/2021
39 7303015504870002 NORMA P 4 33 31-45 UJUNG ARAT 085210193586 v Coronovac 24004721 8/14/2021
40 7304115008600003 JOHORA P 4 50 46-59 BALANGLOE 085343996623 v Coronovac 24004721 8/14/2021
41 7304116412740002 KURNIA P 4 46 46-59 UJUNG BARAT 082393081688 v Coronovac 24004721 8/14/2021
42 7304114107710015 SOHO P 4 49 46-59 PACCINONGAN 085394460494 v Coronovac 24004721 8/14/2021
43 7304114107990004 NURMINA P 4 22 18-30 PACCINONGAN 085394460494 v Coronovac 24004721 8/14/2021
44 7304110504770001 TAWANG L 4 44 31-45 TINO 082346772351 v Coronovac 24004721 8/14/2021
45 7304112309000002 M SIDIK ALMUTAWAQQ L 4 20 18-30 UJUNG 085342392329 v Coronovac 24004721 8/14/2021
46 7304115412890002 MURNI DG BAU P 4 31 31-45 UJUNG 085342392329 v Coronovac 24004721 8/14/2021
47 7304115509830001 SUMARNI P 4 37 31-45 RA'RA 085299624872 v Coronovac 24004721 8/14/2021
48 7304114107790037 HAJRAH P 4 41 31-45 PACCINONGAN 085298702407 v Coronovac 24004721 8/14/2021
49 7304115801010002 EKAMULANDARI NENG P 4 19 18-30 TINO 085247001646 v Coronovac 24004721 8/14/2021
50 7304052210950001 SAMSUL L 4 25 18-30 KELARA 082190013153 v Coronovac 24004721 8/14/2021
51 7304116101010001 IKAKURNIAWATI P 4 19 18-30 BALTAR 085600166175 v Coronovac 24004721 8/14/2021
52 7304115205870002 SARTIKA P 4 34 31-45 BALANGLOE 085342275454 v Coronovac 24004721 8/14/2021
53 7304114505740001 NURAENI AHMAD P 4 47 46-59 BALANGLOE 085346192776 v Coronovac 24004721 8/14/2021
54 7304043112630014 LAKA DG NGERO L 4 57 46-59 PACCINONGAN 087840331760 v Coronovac 24004721 8/14/2021
55 7304113112750051 KAHARUDDIN L 4 45 31-45 PACCINONGAN 085343764741 v Coronovac 24004721 8/14/2021
56 7304114609980002 TUTI ALFIANA P 4 22 18-30 PACCINONGAN 085341782451 v Coronovac 24004721 8/14/2021
57 7304117112800010 HASBIAH P 4 30 18-30 BALANGLOE 085343788061 v Coronovac 24004721 8/14/2021
58 7304114607950001 DARMAWATI P 4 26 18-30 BONTO KATANGKA 085343667027 v Coronovac 24004721 8/14/2021
59 7304112012940001 KHAIDIR L 4 26 18-30 UJUNG BARAT 082395862654 v Coronovac 24004721 8/14/2021
60 7304111505030003 RAHMAT L 4 18 18-30 KANANG2 081242894814 v Coronovac 24004721 8/14/2021
61 7304110810700001 MUH SULTAN DG NGIR L 4 50 46-59 UJUNG BARAT 082290174819 v Coronovac 24004721 8/14/2021
62 6405020903900004 SAMSUARDI L 4 31 31-45 BONTO KATANGKA 087333199934 v Coronovac 24004721 8/14/2021
63 7304043112810028 KIKI SAPUTRA L 4 39 31-45 BALANGLOE 082312524417 v Coronovac 24004721 8/14/2021
64 7304116205000001 NURUL FITRA HAMKA P 4 20 18-30 BALANGLOE 085259412409 v Coronovac 24004721 8/14/2021
65 7304111902960002 AKBAR SYARIF L 4 25 18-30 CAMBA LOMPOA 082394423218 v Coronovac 24004721 8/14/2021
66 7304116205010001 NURSANTI P 4 19 18-30 PACCINONGAN 085396536945 v Coronovac 24004721 8/14/2021
67 7304110203740003 ANWAR JAYA L 4 47 46-59 PACCINONGAN 085395073456 v Coronovac 24004721 8/14/2021
68 7304116304010002 ASMILA SYARIF P 4 20 18-30 CAMBA LOMPOA 085657321088 v Coronovac 24004721 8/14/2021
69 7304110607890002 ILHAM NUR ALIM L 4 32 31-45 BUNGUNG CAMBA 085256228691 v Coronovac 24004721 8/14/2021
70 7303011512030001 RENDI L 4 17 0 KANANG2 081524246808 v Coronovac 24004721 8/14/2021
71 7304117110040001 MISKA P 4 16 0 BONTO KATANGKA 081286990672 v Coronovac 24004721 8/14/2021
72 7310066303050002 HILWA SALSABILA P 4 16 0 BALANGLOE 088258538424 v Coronovac 24004721 8/14/2021
73 7304041711010001 AAS HARIANTO L 4 19 18-30 DUSUN PELBUHAN 085348311648 v Coronovac 24004721 8/14/2021
74 7304111308960001 MUH FAHRISAL L 4 24 18-30 TANAKEKE 085255807847 v Coronovac 24004721 8/14/2021
75 730411312910001 ILYAS NUR ALIM L 4 29 18-30 LING MARIO PULANA085340284404 v Coronovac 24004721 8/14/2021
76 7304047010790001 NURHAEDA P 4 41 31-45 BONTO LAYA 082193006963 v Coronovac 24004721 8/14/2021
77 7304041203000001 MUH IRFAD ADIL NINR L 4 20 18-30 PAJALAYYA 082189553260 v Coronovac 24004721 8/14/2021
78 7304110107750047 ARIFIN DG GASSING L 4 46 46-59 BALANGLOE 085146108835 v Coronovac 24004721 8/14/2021
79 7304115107020001 ANISA NIAR P 4 19 18-30 BONTO UJUNG 082397608650 v Coronovac 24004721 8/14/2021
80 7304111006960005 KAMARUDDIN L 4 25 18-30 KAMP BERU 085298957664 v Coronovac 24004721 8/14/2021
81 7304046811030003 NAMIRA RAHMADANI A P 4 17 0 PAJALAYYA 082190295865 v Coronovac 24004721 8/14/2021
82 7304114210020001 JURIANI P 4 20 18-30 BONTO KATANGKA 085348365835 v Coronovac 24004721 8/14/2021
83 7304043112000066 YUSRAN L 21 38 31-45 TONROA 083139950962 v Coronovac 24004721 8/14/2021
84 7310042808020002 AGUS SALIM SAPUTRA L 4 18 18-30 BONTO LAYA 082193006963 v Coronovac 24004721 8/14/2021
85 7304114210800001 SAMSIA P 4 40 31-45 KALOKO 082195507499 v Coronovac 24004721 8/14/2021
86 7304110209020001 RENDI SAPUTRA L 4 18 18-30 BALANGLOE 081243888196 v Coronovac 24004721 8/14/2021
87 7304114306810001 DARWMAWATI P 4 40 31-45 KALOKO 082195507499 v Coronovac 24004721 8/14/2021
88 7303011208010002 MUH ANSAR MUJAHIRI L 4 20 18-30 BONTO LANGGA 085298141137 v Coronovac 24004721 8/14/2021
89 7304113012980001 HENDRI HAMZAH L 4 22 18-30 KAMPUNG BERU 082151023451 v Coronovac 24004721 8/14/2021
90 7304117112850027 YATI P 4 35 31-45 BALANGLOE 085343986232 v Coronovac 24004721 8/14/2021
91 7304113004990003 SANDI L 4 22 18-30 BUNGUNG KONCI 085386577804 v Coronovac 24004721 8/14/2021
92 7303011608940004 ERWIN L 4 27 18-30 KAMPUNG BERU 082151023451 v Coronovac 24004721 8/14/2021
93 7371121603830013 PIAN L 4 38 31-45 PACCINONGAN 082154747533 v Coronovac 24004721 8/14/2021
94 7304110607750002 H KAHARUDDIN, SE L 4 46 46-59 BONTO MASUGI 085242194536 v Coronovac 24004721 8/14/2021
95 7304115612030001 NURUL AISYAH AZIS P 4 17 0 CAMBA LOMPOA 082393088375 v Coronovac 24004721 8/14/2021
96 7304114204760001 NURLIA P 4 45 31-45 CAMBA LOMPOA 081232632722 v Coronovac 24004721 8/14/2021
97 7304111410870002 ASWAN, Spd L 4 33 31-45 BALANGLOE 082190380901 v Coronovac 24004721 8/14/2021
98 7305076401790001 NURLINDA P 4 42 31-45 BALANGLOE 082189144443 v Coronovac 24004721 8/14/2021
99 7304110712940002 RANDY EKO SAPUTRA L 4 27 18-30 BATU MERAH 082398618928 v Coronovac 24004722 8/14/2021
100 7304113101930001 NURSALAM L 4 28 18-30 PACCINONGAN 085394260494 v Coronovac 24004723 8/14/2021
101 7304114511030001 RISMAWANA P 4 16 0 PACCINONGAN 085395563020 v Coronovac 24004724 8/14/2021
102 7304113112800045 SAMSIR L 4 40 31-45 PACCINONGAN 085396536945 v Coronovac 24004725 8/14/2021
103 7304115905060000 ST. MARWAH SYAHRIR L 4 15 0 PACCINONGAN 085858022713 v Coronovac 24004726 8/14/2021

Komorbid** No. Batch Tanggal Pemberian Imunisasi
No. Ada
Umur (sebut Tidak Keterangan
Reg Jenis Pekerjaa Kelompok Merek
No NIK Nama Penerima Vaksin
Kelamin n*
(18-59
Umur
Alamat No. Hp kan Ada Vaksin***
(Contoh: Ditunda/Dirujuk/
istr tahun) Dosis I Dosis II Dosis I Dosis 2 ….)
komor (centang
asi bidny )
a)
1 7304110503680004 ANTO L 4 53 46-59 RA'RA 081241441379 v Coronovac 24004721 8/19/2021

2 7304044107650022 MURI P 4 56 46-59 PACCINONGAN 085394460530 v Coronovac 24004721 8/19/2021
3 7304116706800005 NURHIKMAH P 4 41 31-45 RA'RA 085255164535 v Coronovac 24004721 8/19/2021
5 7304112201000001 RAHMAT ALFIAN L 4 21 18-30 PACCINONGAN 085341791734 v Coronovac 24004721 8/19/2021
6 7304117112800039 KASMAWATI P 4 40 31-45 PACCINONGAN 085241830917 v Coronovac 24004721 8/19/2021
7 7304117112820057 KASMA P 4 38 31-45 PACCINONGAN 085396049832 v Coronovac 24004721 8/19/2021
8 6402046001880002 HADANIAH P 4 33 31-45 KASSI-KASSI 081248759620 v Coronovac 24004721 8/19/2021
9 7304110107760018 DIONG L 4 45 31-45 PACCINONGAN 085298702407 v Coronovac 24004721 8/19/2021
10 7304114511800002 SAHARI P 4 40 31-45 PACCINONGAN 082349991871 v Coronovac 24004721 8/19/2021
11 7303016807940001 YULI FARIDA ISMAR P 4 27 18-30 PACCINONGAN 082399237215 v Coronovac 24004721 8/19/2021
12 7303011909790001 MUH ZAINAL ABIDIN L 4 41 31-45 TALA-TALA 082346296026 v Coronovac 24004721 8/19/2021
13 7304040501760004 JAENUDDIN L 4 45 31-45 PACCINONGAN 082155698722 v Coronovac 24004721 8/19/2021
14 7304112104960002 ASWIN L 4 25 18-30 RA'RA 082357447567 v Coronovac 24004721 8/19/2021
15 7304114309880002 YULIATI AMD KEB P 2 33 31-45 CAMBA LOMPOA 085397265396 v Coronovac 24004721 8/19/2021
16 7304116404000001 ALMAIDA P 4 21 18-30 SEPE 085244364540 v Coronovac 24004721 8/19/2021
17 7304115002750004 NUR ALAM L 4 38 31-45 BT UJUNG 083856624629 v Coronovac 24004721 8/19/2021
18 7304110102660005 SARE LIWANG L 4 55 46-59 BATULANG 085211637103 v Coronovac 24004721 8/19/2021
19 7304110907920001 M YUSUF L 4 29 18-30 PACCINONGAN 081250885963 v Coronovac 24004721 8/19/2021
20 7304114502730001 NURMI KR ME'DI P 4 48 46-59 BALANGLOE 082394461438 v Coronovac 24004721 8/19/2021
21 7304115010030001 NURUL FADILLAH P 4 17 0 PACCINONGAN 081241300799 v Coronovac 24004721 8/19/2021
22 73041114107870034 UNI P 4 34 31-45 BALANGLOE 085341667795 v Coronovac 24004721 19/082021
23 7304114607050004 REVALINI EKA WIDYAW P 4 16 0 GA'DEA 085256923215 v Coronovac 24004721 19/082021
24 7304113112850014 HASNUDDIN L 4 35 31-45 PACCINONGAN 085399028806 v Coronovac 24004721 19/082021
25 7304114101790006 NURHAYATI P 4 42 31-45 KASSI-KASSI 085399065097 v Coronovac 24004721 19/082022
26 7304111203830001 MUH ALI L 4 38 31-45 UJUNG BARAT 085242982333 v Coronovac 24004721 19/082023
27 7304052505810002 ANTO L 4 26 18-30 TAIPA CANI 082396311770 v Coronovac 24004721 19/082024
28 6472010101040002 RESPATIAWAN ZULKIF L 4 17 0 JL RENGGANIS 085248424472 v Coronovac 24004721 19/082025
29 7304111009700002 TAJUDDIN DG MASSU L 4 50 46-59 RA'RA 082344416512 v Coronovac 24004721 19/082026
30 7304114208920001 RAMLAH P 4 29 18-30 BONTO LANGGA 081296156813 v Coronovac 24004721 19/082027
DES BALBAR Tanggal 20-08-2021
Tanggal Pemberian
Imunisasi
No. Jeni
Umur Tidak Keterangan
Regi s Peker Kelomp Merek
No NIK Nama Penerima Vaksin (18-59 Alamat No. Hp Ada Vaksin*** (Contoh:
stras Kela jaan* ok Umur Dosis I Dosis II Dosis I Dosis 2
tahun) (centa Ditunda/Dirujuk/….)
i min
ng)
1 7304115105820001 SANTI P 4 39 31-45 BALANGLOE 085387582214 v Coronovac 24004721 8/20/2021

2 7304115205760002 HASNAWATI L 4 45 31-45 PACCINONGAN 085145969171 v Coronovac 24004721 8/20/2021
3 7304110107830028 IBRAHIM L 4 38 31-45 PACCINONGAN 085396773724 v Coronovac 24004721 8/20/2021
4 7304113112750050 SASO TOMPO L 4 45 31-45 PACCINONGAN 085213227180 v Coronovac 24004721 8/20/2021
5 7304113112790035 ABD HAMID L 4 41 31-45 PACCINONGAN 082193600712 v Coronovac 24004721 8/20/2021
6 7304116112820001 HISMA P 4 38 31-45 PACCINONGAN 082346251714 v Coronovac 24004721 8/20/2021
7 7306084606020009 IRMAWATI P 4 19 18-30 BONTO LANGGA 082259819487 v Coronovac 24004721 8/20/2021
8 920411212720002 AHMAD DAFID L 4 48 46-59 BALANGLOE 082194762892 v Coronovac 24004721 8/20/2021
9 7304116006950001 NURUL ALIFAH ASDIAN L 4 26 18-30 KAMUNG BENDI P085255398420 v Coronovac 24004721 8/20/2021
10 7304115103950003 RIA SELFIANA P 4 26 18-30 BONTO BARU 082149600556 v Coronovac 24004721 8/20/2021
11 7304115503590001 SAENAB P 4 62 0 PACCINONGAN 085342253236 v Coronovac 24004721 8/20/2021
12 7304116511990003 YUSNAWATI P 4 21 18-30 SEPE 085656800634 v Coronovac 24004721 8/20/2021
13 7304115507990001 NURMIATI P 4 21 18-30 BONTO UJUNG 085242115460 v Coronovac 24004721 8/20/2021
14 7304041110970001 SUPARDI L 4 23 18-30 DUSUN PELABUH083132893987 v Coronovac 24004721 8/20/2021
15 7304114905960001 ANDI SRIWAHYUNI P 4 25 18-30 KASSI-KASSI 081242138499 v Coronovac 24004721 8/20/2021
16 7304114303860002 SYAMSIA DG NGUGI P 4 35 31-45 BALANGLOE 082346747039 v Coronovac 24004721 8/20/2021
17 7302084704950002 RISKI P 4 26 18-30 ANRIHUA 082158775738 v Coronovac 24004721 8/20/2021
18 730410610020002 ASRIYANTI P 4 18 18-30 UJUNG BUNDU 085824568809 v Coronovac 24004721 8/20/2021
19 7304114102740001 NURSIAH P 4 47 46-59 PACCINONGAN 085343962560 v Coronovac 24004721 8/20/2021
20 7304116306850001 NURLINDA L P 4 36 31-45 UJUNG BARAT 085242953621 v Coronovac 24004721 8/20/2021
22 7304114303040001 EKA WAHYUNI SARA P 4 17 0 UJUNG BUNDU 085391980233 v Coronovac 24004721 8/20/2021
23 7304110107770049 IMRAN L 4 44 31-45 PACCINONGAN 085230822538 v Coronovac 24004721 8/20/2021
24 7304110305680001 ALIMUDDIN L 4 48 46-59 BONTO LANGGA 082399546721 v Coronovac 24004721 8/20/2021
25 7311007112600281 MANENG P 4 60 0 PACCINONGAN 085394260952 v Coronovac 24004721 8/20/2021
26 7304114310810001 SURIANI P 4 39 31-45 PACCINONGAN 082159167764 v Coronovac 24004721 8/20/2021
27 7304112812750002 YACENG L 4 45 31-45 CAMBA LOMPOA 081232632722 v Coronovac 24004721 8/20/2021
28 7304117112810026 HERLINA P 4 39 31-45 KAPPO DUSUN T 081245825192 v Coronovac 24004721 8/20/2021
29 7371036109850006 MAYAPADA P 4 35 31-45 BARA-BARAYA 085345710326 v Coronovac 24004721 8/20/2021
30 7304114909030004 NUR FADILLAH PUTRI P 4 17 0 BONTOWA 085247634220 v Coronovac 24004721 8/20/2021
31 7306084805730004 SYAMSIA DG KANANG P 4 46 46-59 PACCINONGAN 081340219705 v Coronovac 24004721 8/20/2021
32 7304113112700060 JAMALUDDIN L 51 46-59 PACCINONGAN 085299641667 v Coronovac 24004721 8/20/2021

Tanggal Pemberian
Imunisasi
Jenis Umur Tida Keterangan

Nama Penerima Peker Kelompok k Merek
No NIK Vaksin
Kelam
jaan*
(18-59
Umur
Alamat No. Hp
Vaksin***
(Contoh:
in tahun) Ada Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dirujuk/….)
(cent
ang)
1 7304110202900002 RAHMAT AL QUDRI L 4 31 31-45 SUSATER 088744805045 v Coronovac 24004721 25/08/2021

2 7304117004010001 NURLAILA ARIANTO P 4 20 18-30 CAMA LOMPOA 082399096239 v Coronovac 24004721 25/08/2021
3 7304090303950001 IRFAN SYARIF L 4 26 18-30 BALANGLOE 085348673712 v Coronovac 24004721 25/08/2021
4 7304056004890001 HASDIANA P 4 32 31-45 BUMBUNG LOE 082346824761 v Coronovac 24004721 25/08/2021
5 7304116201830001 SUMIATI P 4 38 31-45 BALANGLOE 081243595705 v Coronovac 24004721 25/08/2021
6 7304040106930002 ADHARUDDIN L 4 28 18-30 BONTOALA 085256802918 v Coronovac 24004721 25/08/2021
7 7304110512540002 JUMAIN L 4 67 0 BALANGLOE 085397158831 v Coronovac 24004721 25/08/2021
8 7304117112690215 SALMA P 4 51 46-59 BONTOAWA 085299198276 Coronovac 24004721 25/08/2021
9 7304116002710001 NURSYAMSI P 4 50 46-59 BALANGLOE 085341920300 v Coronovac 24004721 25/08/2021
10 7304114112900003 KURNIA P 4 31 31-45 085399859077 v Coronovac 24004721 25/08/2021
11 7304115206980002 DILA DIVYA LARASA P 4 23 18-30 BALANGLOE 085398887612 v Coronovac 24004721 25/08/2021
12 7304114708830001 KASMAWATI P 4 38 31-45 BALANGLOE 085211117696 v Coronovac 24004721 25/08/2021
13 7304112003800001 SARIFUDDIN L 4 41 31-45 BUNGUNG KONCI 082347397127 v Coronovac 24004721 25/08/2021
14 7304052608010001 AGUSTRIADI HAMBA L 4 20 18-30 GANTINGA 085343795039 v Coronovac 24004721 25/08/2021
15 7304116805720001 TATI B P 4 49 46-59 BALANGLOE 085394385937 v Coronovac 24004721 25/08/2021
16 7304115108930001 ROSMA DG LANTI P 4 28 18-30 BALANGLOE 082352138535 v Coronovac 24004721 25/08/2021
17 730411311299003 AMIRULLAH L 4 23 18-30 BALANGLOE 085298246582 v Coronovac 24004721 25/08/2021
18 7304112701940001
ERWIN ISPANDI L 4 27 18-30 TOLO TOA 085395410434 v Coronovac 24004721 25/08/2021
19 7304113112010005
ARDIANSYAH L 4 21 18-30 BALANGLOE 085298246582 v Coronovac 24004721 25/08/2021
20 7304117112600013
NIA DG SUNGGU P 4 60 0 BALANGLOE 081245363910 v Coronovac 24004721 25/08/2021
21 7304116110070001
WATIKA NURUMMU P 4 13 0 PACCINONGAN 085255826559 v Coronovac 24004721 25/08/2021
22 7304114205080001
ANDI NUR ELGI SI P 4 13 0 PACCINONGAN 082337172281 v Coronovac 24004721 25/08/2021
23 730404060754001H HASANUDDIN L 4 67 0 BUNGENG 085242103674 v Coronovac 24004721 25/08/2021
24 7304115105070001 ZAHRA ZAHIRA IDR P 4 14 0 PACCINONGAN 085299147132 v Coronovac 24004721 25/08/2021
25 7304113112800023 SUDIRMAN L 4 40 31-45 RA'RA 085321761785 v Coronovac 24004721 25/08/2021
26 7304111008600003 LIMBANG L 4 61 0 BALANGLOE 085391158831 v Coronovac 24004721 25/08/2021
27 7304112101780002 HASAN L 4 43 31-45 BALANGLOE 085749030026 v Coronovac 24004721 25/08/2021
28 7304112510750001 ANSYAR L 4 45 31-45 KAMPUNG BERU 085341667807 v Coronovac 24004721 25/08/2021
29 7304114810950001 ROSMIA P 4 25 18-30 KAMPUNG BERU 081243037166 v Coronovac 24004721 25/08/2021
30 7304113112560050 SAIN SIKKI L 4 64 0 BALANGLOE 085340025417 v Coronovac 24004721 25/08/2021
31 7304117112500008 RAHMA DG BAJI P 4 70 0 BALANGLOE 085211637605 v Coronovac 24004721 25/08/2021
32 7304115412040001 MUTMAINNAH P 4 16 0 BALANGLOE 082347000807 v Coronovac 24004721 25/08/2021
33 ANDI SUTIYOSO
7304112904080001 L 4 13 0 PACCINONGAN 085234953133 v Coronovac 24004721 25/08/2021
34 SRI ARHAEDA
7304114404040001 P 4 17 0 ALLU 085298433750 v Coronovac 24004721 25/08/2021
35 TARAWE DG ROWA
7304113112590003 L 4 61 0 BALANGLOE 081245363910 v Coronovac 24004721 25/08/2021
36 SURIYATI
7304114204540001 P 4 66 0 BALANGLOE 085255659351 v Coronovac 24004721 25/08/2021
37 MU'MINA DG KANA
7304114605600001 P 4 60 0 BALANGLOE 082190559721 v Coronovac 24004721 25/08/2021
38 NURLAELA
7304114503960002 P 4 24 18-30 BALANGLOE 082346741253 v Coronovac 24004721 25/08/2021
39 7304115212970002 MANTARISSA P 4 23 18-30 BALANGLOE 082190267943 v Coronovac 24004721 25/08/2021
40 7304110912960001 DEDI R L 4 24 18-30 KANANG-KANANG 085211627122 v Coronovac 24004721 25/08/2021
41 7304110107010022 PADIL L 4 19 18-30 BALANGLOE 085256802918 v Coronovac 24004721 25/08/2021
42 7304112603000001 IRWAN L 4 21 18-30 KASSI-KASSI 082236172734 v Coronovac 24004721 25/08/2021
43 7304117112820034 INDAR DG BUNGA P 4 39 31-45 BALANGLOE 085298434081 v Coronovac 24004721 25/08/2021
44 7304116306980001 RINA S P 4 20 18-30 KANANG-KANANG 085211627122 v Coronovac 24004721 25/08/2021
45 7304110705750005 AHMAD L 4 46 46-59 BALANGLOE 087787190313 v Coronovac 24004721 25/08/2021
46 7304116503030003 INDARWATI P 4 18 18-30 KASSI-KASSI 087840666657 v Coronovac 24004721 25/08/2021
47 7304116005780001 ROSMAWATI P 4 42 31-45 BALANGLOE 085298323513 v Coronovac 24004721 25/08/2021
48 7304047112660057 ROSDIANA P 4 54 46-59 BALANGLOE 085242192492 v Coronovac 24004721 25/08/2021
49 7304112112900001 HENDRA L 4 30 18-30 BALANGLOE 085256802903 v Coronovac 24004721 25/08/2021
50 7303011508880004 ALIE AL AKBAR ABD L 4 33 31-45 CAMBA LOMPOA 085342198456 v Coronovac 24004721 25/08/2021
51 7304113112990029 AL MUNAWIR L 4 21 18-30 KAMPUNG BERU 082354947221 v Coronovac 24004721 25/08/2021
52 7304115904960001 ANITA P 4 24 18-30 KASSI-KASSI 082393075500 v Coronovac 24004721 25/08/2021
53 7304116001930001 KURNIA P 4 27 18-30 KASSI-KASSI 085240745152 v Coronovac 24004721 25/08/2021
54 7304111403930003 IRWAN L 4 28 18-30 KAMPUNG BERU 085240024900 v Coronovac 24004721 25/08/2021
55 6473046709790003 TANTI IRWANTI P 4 41 31-45 JL P HJ ISKANDAR 081352336429 v Coronovac 24004721 25/08/2021
56 9204012704930001 KAHAR L 4 28 18-30 JL SOEKARNO HAT082199743737 v Coronovac 24004721 25/08/2021
57 7371137108940007 MUTIARA ZELLA P 4 26 18-30 BALANGLOE 085299686684 v Coronovac 24004721 25/08/2021
58 6471011502810005 KAMARUDDIN L 4 40 31-45 BALANGLOE 085256802918 v Coronovac 24004721 25/08/2021
59 JASMAN
7303060906950003 L 4 25 18-30 PALLOLI 085248569748 v Coronovac 24004721 25/08/2021
60 7371077112930024 ROSMAWAR P 4 27 18-30 BATU MERAH 085825467901 v Coronovac 24004721 25/08/2021
61 7304112709970001 M SALAHUDDIN AL L 4 24 18-30 PACCINONGAN 085256146780 v Coronovac 24004721 25/08/2021

DESA Tanggal 27-08-2021
(tulis 'Ya' Tanggal Pemberian

pada Imunisasi
Jenis Umur Tidak Keterangan

Pekerj Kelompok Merek
No NIK Nama Penerima Vaksin Kela
aan*
(18-59
Umur
Alamat No. Hp BPJS Ada Vaksin***
(Contoh:
min tahun) Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dirujuk/….)
PBI (centang
)
1 7304116606960002 FAHIRAH P 4 25 18-30 BONTO KATANGKA 085245404421 v Coronovac 24202221 27/08/2021

2 7304110410050002 RAJALIL PUTRA RANI L 4 15 0 BONTOWA 087871081041 v Coronovac 24202221 27/08/2022
3 7304115109770005 RAMLAH P 4 44 31-45 BALANGLOE 085243468449 v Coronovac 24202221 27/08/2023
4 7304115503890003 MITHA P 4 32 31-45 BALANGLOE 082399229667 v Coronovac 24202221 27/08/2024
5 7304110408790001 M ADI ALGHIFARI L 4 42 31-45 PACCINONGAN 085340515477 v Coronovac 24202221 27/08/2025
6 7304117112990025 FITRI P 4 21 18-30 BALANGLOE 085298383188 v Coronovac 24202221 27/08/2026
7 7304041306930002 RISAL L 4 28 18-30 PAO 081340270121 v Coronovac 24202221 27/08/2027
8 7304117112770027 NORMA P 4 43 31-45 PACCINONGAN 085213227180 v Coronovac 24202221 27/08/2028
9 7304115803860001 NURHAYATI P 4 35 31-45 BALANGLOE 082399229667 v Coronovac 24202221 27/08/2029
10 7304115901000001 USWATUN NUR TSHAT P 4 21 18-30 PACCINONGAN 085246892001 v Coronovac 24202221 27/08/2030
11 7302021309030003 MUH IMAN SHADOQ L 4 17 0 PACCINONGAN 081244665545 v Coronovac 24202221 27/08/2030
12 7304093112550001 SAINUDDIN L 4 65 0 ARUNGKEKE 082187397952 v Coronovac 24202221 27/08/2030
13 7304117112600050 RABI P 4 50 46-59 PACCINONGAN 085241208729 v Coronovac 24202221 27/08/2030
14 7304110304980001 ABDUL TALI L 4 23 18-30 PACCINONGAN 085298702407 v Coronovac 24202221 27/08/2031
15 7304113112610047 ALIMUDDIN L 4 59 46-59 PACCINONGAN 083151151859 v Coronovac 24202221 27/08/2032
16 7304110504030003 ERWING L 4 17 0 PAO 081244330307 v Coronovac 24202221 27/08/2033
17 7304110107820021 KAMARUDDIN L 4 39 31-45 PAO 082347906120 v Coronovac 24202221 27/08/2034
18 7304116507820001 AYU LESTARI P 4 39 31-45 KAMPUNG BERU 082347000807 v Coronovac 24202221 27/08/2035
19 7304114912040001 NURALDA AFDALIA P 4 16 0 PACCINONGAN 082393081371 v Coronovac 24202221 27/08/2036
20 7304114107740027
MINASA P 4 47 46-59 BALANGLOE 082190559721 v Coronovac 24202221 27/08/2037
21 7304112512600001
MUH SALEH DG TANN L 4 60 0 BALANGLOE 085343725844 v Coronovac 24202221 27/08/2038
22 WAHYU SAPUTRA
7304111811050001 L 4 15 0 PACCINONGAN 081289542869 v Coronovac 24202221 27/08/2039
23 DEDI MAULANA
7304112909990002 L 4 18 18-30 PAO 081998211752 v Coronovac 24202221 27/08/2040
24 NURALAN S
'7372034111750002 P 4 45 31-45 BALANGLOE 085399065097 v Coronovac 24202221 27/08/2041
25 NITHA NATALIA
7304114612090002 P 4 17 0 PACCINONGAN 085341791746 v Coronovac 24202221 27/08/2042
26 7304110511790001 GASSING L 4 41 31-45 KAMPUNG BERU 082151429841 v Coronovac 24202221 27/08/2043
27 7304116707830001 NURINTANG P 4 38 31-45 KAMPUNG BERU 082151429841 v Coronovac 24202221 27/08/2044
28 7304113107040001 NUR AZHARI HALIM L 4 17 0 PACCINONGAN 082383081371 v Coronovac 24202221 27/08/2045
29 7373014209050001 RAHMA P 4 15 0 JL KELAPA 081244240066 v Coronovac 24202221 27/08/2045
30 7311041404730001 SARGADI L 4 48 46-59 SUKARJO 085741196395 v Coronovac 24202221 27/08/2045
Nama Puskesmas/Jejari: Puskesmas Tino
Tanggal Pemberian
Imunisasi
Jenis Peke Umur Tidak
Kelompok Merek Keterangan
No NIK Nama Penerima Vaksin Kela rjaan (18-59
Umur
Alamat No. Hp Ada Vaksin*** (Contoh: Ditunda/Dirujuk/….)
min * tahun) Dosis I Dosis II Dosis I Dosis 2
(centan
g)
1 7304117112620018 CORA P 4 58 46-59 PACCINONGAN 082193600712 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
2 7304116306840001 ROHANI P 4 37 31-45 PACCINONGAN 082399278195 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
3 7304110405630001 RUSTAN L 4 58 46-59 PACCINONGAN 085242119566 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
4 7304114107010024 HASMIRA P 4 20 18-30 BONTO UJUNG 085796536232 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
5 7304111905030001 FIKRAM L 4 18 18-30 BONTO BARU/BALBAR 082150629914 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
6 7304110112030001 IRWAN L 4 17 0 PACCINONGAN 085348428288 v Coronovac 24202221 8/31/2021 REMAJA
7 7304111604090001 SYAIFUL MUBARAK L 4 12 0 PACCINONGAN 082394446024 v Coronovac 24202221 8/31/2021 REMAJA
8 7304116109060001 TIARA P 4 14 0 PACCINONGAN 085346105816 v Coronovac 24202221 8/31/2021 REMAJA
9 7304114202050003 SRI WAHYUNI P 4 16 0 PACCINONGAN 085241830917 v Coronovac 24202221 8/31/2021 REMAJA
10 7304115708010003 NIRMALA P 4 20 18-30 UJUNG TIMUR 082344415519 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
11 7304114101060002 NIKE ARDILLA P 4 15 0 UJUNG TIMUR 082347829780 v Coronovac 24202221 8/31/2021 REMAJA
12 7304110405070001 HENDRI L 4 14 0 UJUNG TIMUR 082347829780 v Coronovac 24202221 8/31/2021 REMAJA
13 7304113009940001 MUH IDRUS L 4 25 18-30 BONTO MANAI/BALBAR 082333999394 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
14 7304110405030001 RUSLAN L 4 18 18-30 BONTO MANAI/BALBAR 082333999394 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
15 7304110901030001 RESKI L 4 18 18-30 BONTO MANAI/BALBAR 085389301901 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
16 7304110707790001 ELI L 4 29 18-30 BONTO MANAI/BALBAR 085298239775 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
17 7304114401040001 HERFINA S P 4 17 0 BONTO MASUGI 085289679417 v Coronovac 24202221 8/31/2021 REMAJA
18 7304116909000001 SAUFIKA P 4 21 18-30 BONTO MASUGI 085289679417 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
19 7304110807980001 ALDI ADRIAN SUAGJ L 4 24 18-30 BONTO BARU/BALBAR 085242356262 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
20 7304112007020001 IKBAL SETIAWAN L 4 19 18-30 DUSUN SAPAMAYO 087726667811 v Coronovac 24202221 8/31/2021 MASYARAKAT UMUM
DESA : Tanggal 01-09-2021
Tanggal Pemberian
Imunisasi
Jenis Umur Tidak
Peker Kelompok Merek Keterangan
jaan*
(18-59
Umur
min tahun) Dosis I Dosis II Dosis I Dosis 2
(centan
g)
1 7304110606670001 ABDULLAH L 4 54 46-59 CAMBA LOMPOA 082346211451 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
2 7304114803060001 WIDA WULANDARI P 4 15 0 BONTO MASUGI 085256928256 v Coronovac 24202221 9/1/2021 REMAJA
3 7304113112790041 SULTAN L 4 41 31-45 CAMBA LOMPOA 085299204131 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
4 7304117112750048 ROSMITA P 4 45 31-45 CAMBA LOMPOA 085299204131 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
5 7304115712050002 SUCI DWI RAMADHANI L 4 15 0 CAMBA LOMPOA 085299204131 v Coronovac 24202221 9/1/2021 REMAJA
6 7304111908970001 MUHAMMAD ASWAN L 4 25 18-30 CAMBA LOMPOA 085394518769 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
7 7304115806060002 ELMAWATI P 4 15 0 CAMBA LOMPOA 085240268612 v Coronovac 24202221 9/1/2021 REMAJA
8 7304112610050002 RYAN HIDAYAT L 4 15 0 CAMBA LOMPOA 085394518769 v Coronovac 24202221 9/1/2021 REMAJA
9 7304110211790001 SUHARDI L 4 41 31-45 CAMBA LOMPOA 081254824019 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
10 7304115906740001 AISYAH P 4 47 46-59 CAMBA LOMPOA 082346211451 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
11 7304114107450046 SARI BAU P 4 46 46-59 CAMBA LOMPOA 085341457501 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
12 7304111303050001 PRIA DWI ANUGRAH L 4 16 0 CAMBA LOMPOA 082347849617 v Coronovac 24202221 9/1/2021 REMAJA
13 7304114703960001 NURBAYA P 4 25 18-30 CAMBA LOMPOA 085244995696 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
14 7304119392920004 IDRIS L 4 28 18-30 CAMBA LOMPOA 085244995696 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
15 7304113112770031 SAKKIR L 4 43 31-45 BONTO MASUGI 085256928250 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
16 7304117112770028 JUMRIANI P 4 43 31-45 BONTO MASUGI 085256928250 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
17 7304115209020001 LEONI P 4 18 18-30 CAMBA LOMPOA 085342181932 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
18 7304111608010001 YUSRAN HAERUL L 4 20 18-30 BONTO MASUGI 081340553183 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
19 7304112901010001 HERI SAPUTRA L 4 20 18-30 BONTO MASUGI 082124187049 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
20 7304110108970002 ASRULLAH L 4 24 18-30 CAMBA LOMPOA 082345619525 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
21 7304116505750017 AISYAH P 4 46 46-59 CAMBA LOMPOA 082352029654 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
22 7304110607760001 KAMIRUDDIN L 4 45 31-45 BONTO MASUGI 082253614959 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
23 7304054305890001 ROSMIATI P 4 36 31-45 CAMBA LOMPOA 082180160254 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
24 7304110709990004 RIFALDY ALSYAM L 4 25 18-30 CAMBA LOMPOA 082346211451 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
25 7371107112680127 SYAMSIAH P 4 52 46-59 CAMBA LOMPOA 082346211451 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
26 7304115305000001 SRI AYU NINGSIH P 4 21 18-30 SEPE 082347806029 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
27 6472025404010005 NURHIKMA SARI P 4 19 18-30 JL ABDUL RASYID 081246204762 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
28 7304115505970004 NURAENI P 4 24 18-30 BUNGUNG KONCI 082349572361 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
29 7304112202020002 AKBAR TANJUNG L 4 18 18-30 JL RAYA MANDALA AS081350032086 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
30 7303052011000002 IRFAN L 4 19 18-30 SARROANGING 082329060196 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
31 7304115209720001 SUSYANTI P 4 48 46-59 PARANASSANG 085256713135 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
32 3214131812910001 JENI IRAWAN SAPUTRA L 4 29 18-30 PERUM BTN VALLEY B082394572365 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
33 7304110404760002 MANSUR L 4 45 31-45 CAMBA LOMPOA 085242238982 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
34 7304114605710001 IDA SIKKI P 4 50 46-59 BONTO MASUGI 082347931042 v Coronovac 2021071351 9/1/2021 MASYARAKAT UMUM
35 7304115504040001 SALSAILAH HAERANI P 4 17 0 BALANG BARU 082393514903 v Coronovac 24202221 9/1/2021 REMAJA
36 7304110303710006 M ALI L 4 50 46-59 CAMBA LOMPOA 085342181932 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
37 7304112412830001 IDRIS L 4 37 31-45 UJUNG BARAT 085341176258 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
36 7304110303710006 M ALI L 4 50 46-59 CAMBA LOMPOA 085342181932 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
37 7304112412830001 IDRIS L 4 37 31-45 UJUNG BARAT 085341176258 v Coronovac 24202221 9/1/2021 MASYARAKAT UMUM
JUMLAH G DI VAKSIN : 37 ORG

MASYARAKAT UMUM : 31 ORG
REMAJA : 6 ORG
VAKSIN 1 : 31 ORG BALBAR : 26 ORG REMAJA : 5 ORG
BONTO UJUNG : 1 ORG
LUAR WILAYAH : 5 ORG
VAKSIN 2 : 5 ORG BALBAR : 3 ORG REMAJA : 1 ORG
BONTO UJUNG : 2 ORG
: Puskesmas Tino
Nama Puskesmas/Jejaring
Tanggal Pemberian
Imunisasi
Umur
Jenis (18- Tidak Keterangan
Peker Kelompok Merek
jaan*
59
Umur
Alamat No. Hp Ada Vaksin*** (Contoh: Ditunda/Dirujuk/
min tahu Dosis I Dosis II Dosis I Dosis 2 ….)
(centa
n) ng)
1 7304116104790003 KAMISA P 4 42 31-45 PACCINONGAN 085399875407 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
2 7304117112930015 DARMA P 4 27 18-30 PACCINONGAN 085399875407 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
3 7304114203920001 HASNAWATI P 4 29 18-30 CAMBA LOMPOA 085320090142 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
4 7304110303980001 ALFIAN L 4 24 18-30 PACCINONGAN 0823 99278195 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
5 7304117112560035 SITTI AMINAH P 4 64 0 PACCINONGAN 085252376051 v Coronovac 2021071351 9/2/2021 LANSIA
6 7304114411890003 JUMRA P 4 31 31-45 KASSI-KASSI 082332611614 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
7 7304112707680001 M JAFAR L 4 53 46-59 KASSI-KASSI 082332611614 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
8 7304021508950001 AGUS HARIANTO L 4 26 18-30 BONTOKURA DESA KA082395866026 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
9 7304111707060002 HAFID L 4 15 0 PACCINONGAN 085298702402 v Coronovac 2021071351 9/2/2021 REMAJA
10 7303025804710000 HAWANI P 4 50 46-59 PACCINONGAN 085399875407 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
11 7304110709930001 ARMAWANSYAH SITUJ L 4 27 18-30 BONTO LANGGA 082395188567 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
12 7304111109760002 JASMAN DG SALA L 4 44 31-45 PACCINONGAN 081355280285 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
13 7304114402860002 SANAWIA P 4 35 31-45 PACCINONGAN 085252376051 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
14 7304115707020002 SAMHIJRAH AWALIA SA P 4 19 18-30 PACCINONGAN 085244995696 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
15 7304111908810001 JAYADI L 4 40 31-45 PACCINONGAN 085398163123 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
16 7304110505810003 JUFRI JAFAR L 4 40 31-45 KORAMIL IYES 01 BNM082331274233 v Coronovac 2021071351 9/2/2021 MASYARAKAT UMUM
JUMLAH YANG DI VAKSIN : 16 ORG

VAKSIN 1 TINO : 5 ORG VAKSIN 2 TINO : 6 ORG
VAKSIN 1 BALTAR : 2 ORG VAKSIN 2 LW : 1 ORG
VAKSIN 1 BALBAR : 1 ORG
VAKSIN 1 LW : 1 ORG
DES : Tanggal 03-09-2021
Tanggal Pemberian
Umur Imunisasi
Jenis Peke Keterangan
(18-59 Kelompok Merek
No NIK Nama Penerima Vaksin Kela rjaan
tahun Umur
Alamat No. Hp Tidak Ada Vaksin***
(Contoh:
min * Dosis I Dosis II Dosis I Dosis 2 Ditunda/Dirujuk/….)
) (centang)
1 7303015904980001 SUKARNENGSI P 4 23 18-30 BONTOWA 085343705673 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
2 7304115212880003 MACI P 4 32 31-45 BALANGLOE 085398445244 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
3 7304114107840025 HAWA P 4 37 31-45 BALANGLOE 081340513441 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
4 7304113112540018 JUMAKING L 4 66 0 BALANGLOE 085242103467 Coronovac 2021071351 9/3/2021 LANSIA
5 7304116511990002 ANNISA MARDATILLA P 4 21 18-30 BALANGLOE 085389302095 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
6 7302105212970008 NURANTI P 4 24 18-30 BONTOWA 082199743737 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
7 7304114107690028 SALIH P 4 62 0 BALANGLOE 085394712895 v Coronovac 2021071351 9/3/2021 LANSIA
8 7304113112700006 ANNE L 4 50 46-59 BONTOWA 085245402021 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
9 7304114107630029 RABIAH P 4 58 46-59 BONTOWA 085395410378 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
10 7304114107660018 SAHARIA DG KEBO P 4 55 46-59 BALANGLOE 085256802918 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
11 7304110501650001 HASANUDDIN L 4 56 46-59 BALANGLOE 082395913440 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
12 7304114911650001 NURHAYATI CAHAYA P 4 55 46-59 BALANGLOE 082395913440 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
13 730411060571001 JUMA L 4 50 46-59 BALANGLOE 082346710624 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
14 7304114807580001 LEBONG P 4 63 0 BALANGLOE 085245402248 v Coronovac 2021071351 9/3/2021 LANSIA
15 7304110306730001 BAHARUDDIN L 4 48 46-59 KAMPUNG BERU 082149636438 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
16 7304111909660001 BAHARUDDIN L 4 55 46-59 BONTOWA 082347141523 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
17 7304117112670036 SEHA P 4 53 46-59 KAMPUNG BERU 085348955899 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
18 7304112005750002 JASMAN DG GASSING L 4 46 46-59 BONTOWA 082151968987 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
19 7372031112740007 HASAN L 4 46 46-59 BONTOWA 082347357623 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
20 7304116012950001 IRA NILAWATI P 4 25 18-30 BALANGLOE 085245402248 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
21 7304117006990002 CITRA DEWI P 4 21 18-30 BALANGLOE 081340513441 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
22 7304117112500001 MUNA P 4 70 0 BALANGLOE 081340174340 v Coronovac 2021071351 9/3/2021 LANSIA
23 7304116512790001 SASA P 4 41 31-45 KAMPUNG BERU 082395050630 Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
24 7304117003990001 SENI VERA PUTRI P 4 22 18-30 BALANGLOE 08124260465 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
25 7304111406900001 ALIMUDDIN L 4 31 31-45 BALANGLOE 085242187930 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
26 7304116510760001 BADARIA P 4 44 31-45 KAMPUNG BERU 085396578442 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
27 7304114509720002 SAINTANG P 4 48 46-59 BALANGLOE 085343983658 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
28 7304031810970003 RESKY P 4 23 18-30 KAMPUNG BERU 082338790777 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
29 7304112005930002 IRWAN B L 4 28 18-30 BALANGLOE 085395434231 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
30 7304111708950003 AGUS SALIM L 4 25 18-30 BALANGLOE 082354449837 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
31 7304116105980001 KASMI P 4 23 18-30 KAMPUNG BERU 085272185714 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
32 7304114107800094 KAMASIA P 4 41 31-45 KAMPUNG BERU 085241217825 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
33 7304114707980004 JUMARNI P 4 23 18-30 KAMPUNG BERU 085210191770 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
34 7304110107660028 KARIM SILA L 4 55 46-59 KAMPUNG BERU 081254827703 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
35 7304110610850001 ABD HALIM L 4 35 31-45 BALANGLOE 085389445244 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
36 7304115808630002 R DG TE'NE P 4 58 46-59 KAMPUNG BERU 082347181915 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
37 7304114107800001 AHRIANI P 4 40 31-45 BALANGLOE 081340174340 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
38 7304110107620001 PUDDING DG NGIMANG L 4 59 46-59 KAMPUNG BERU 081254827703 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
39 7304115307860001 NURSIA P 4 35 31-45 BONTOWA 082199743737 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
40 7304110508800002 SAINUDDIN L 4 41 31-45 BALANGLOE 082353124892 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
41 7304117112860026 SYAMSINA P 4 34 31-45 KAMPUNG BERU 085249636524 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
42 7304116810830001 ROSMILA P 4 37 31-45 BALANGLOE 085748585874 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
43 7304117112980036 MANTASIA P 4 22 18-30 KAMPUNG BERU 085243092840 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
44 7304115607030001 MAHRAENI ULVA P 4 18 18-30 KASSI-KASSI 085245560764 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
45 7304114707780001 NURDEWI P 4 43 31-45 KASSI-KASSI 085245560764 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
46 7304114311790001 NURHAYATI P 4 41 31-45 KASSI-KASSI 082346577556 Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
47 7304117112770032 ROSMIATI P 4 43 31-45 BONTOWA 082151968987 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
48 7304117112870017 ASNI P 4 33 31-45 BONTOWA 081244771560 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
49 7304116506770002 NURSYAM P 4 43 31-45 BONTOWA 082151968987 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
50 7304112310940001 SALAM L 4 26 18-30 KAMPUNG BERU 085259487508 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
51 7304117112770031 SAHARIA P 4 43 31-45 BALANGLOE 082396123932 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
52 7304113112840044 JUFRI L 4 36 31-45 BALANGLOE 082343486247 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
53 7304112003770003 RIDWAN L 4 43 31-45 KASSI-KASSI 085395410378 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
54 7304114406880001 HALIJA P 4 33 31-45 KASSI-KASSI 085320509620 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
55 7304114107700040 SAIYA P 4 51 46-59 KASSI-KASSI 085320509620 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
56 7304114907740001 KAMARI P 4 47 46-59 KAMPUNG BERU 081511990850 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
57 7304114808880001
HANARTI P 4 33 31-45 KASSI-KASSI 085243863335 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
58 RESKI AKHIRA
7304114502920003 P 4 29 18-30 BONTOWA 085342281612 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
59 7304090107940030 IRFAN L 4 27 18-30 KALUKUANG 085280038390 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
60 7304093005020001 SULSALDI L 4 20 18-30 KALUKUANG 082149578278 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
61 6402042510870002 ARSYAD L 4 34 31-45 KASSI-KASSI 081248759620 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
62 7304115004840001 MURNI P 4 37 31-45 BALANGLOE 082396123932 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
63 7304043112630009 BADOLLAH L 4 57 46-59 BALANGLOE 085233539485 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
64 7304117112920011 ROSNIATI MABAN P 4 25 18-30 BALANGLOE 082396123932 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
65 7304114107700052 ATTI P 4 51 46-59 UJUNG BARAT 085342598755 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
66 7304115504910001 EKAWATI S P 4 30 18-30 BUNGUNG CAMBA081354730849 v Coronovac 2021071351 9/3/2021 MASYARAKAT UMUM
67 '7304114101040002 RISNAWATI P 4 15 0 PACCOLORANG 082189545805 v Coronovac 2021071351 9/3/2021 REMAJA

VAKSIN 1 : BALTAR 58 ORG VAKSIN 2 BALTAR : 4 ORG
VAKNSIN 1 LW : 2 ORG VAKSIN 2 LW : 2 ORG
VAKSIN 2 UJUNG : 1 ORG
TUNDA : 25 ORG
FORMAT PENCATATAN
TINGKAT PUS

Jenis Umur
Peker Kelompok
No NIK Nama Penerima Vaksin Kelam
jaan*
(18-59
Umur
Alamat
in tahun)
1 7304115504050001 NUR NAILA AZHARA P 4 16 0 BALANGLOE

2 7304117112600072 BINTANG P 4 60 0 KAMPUNG BERU
3 7304113112580020 AMIR L 4 62 0 BALANGLOE
4 7304114705850002 SYAMSINA P 4 36 31-45 BALANGLOE
5 7304111804640001 H MAKMUR L 4 57 46-59 KASSI-KASSI
6 7304110107550002 S DG SITUJU L 4 66 0 BONTO UJUNG
7 7304032702820002 SYAMSUDDIN L 4 39 31-45 UJUNG BARAT
8 7304111212780003 AGUS SALIM B H KUB L 4 39 31-45 BONTO UJUNG
9 7304116811090001 NURUL HIKMAH L 4 12 0 BONTO UJUNG
10 7304113112970022 JAMAL L 4 25 18-30 BONTO MANAI
11 7304110501710003 SYAMSUDDIN L 4 50 46-59 BONTO UJUNG
12 7304111303960001 SUMARYO L 4 25 18-30 BONTO UJUNG
13 7304110908980001 AKBAR TANJUNG L 4 23 18-30 UJUNG BARAT
14 7304111506020001 KAHAR L 4 19 18-30 BONTO MASUGI
15 7304111704700001 SYAMSUDDIN AWING L 4 51 46-59 UJUNG BARAT
16 7304110901000001 FIRMANSYAH IRSAN L 4 21 18-30 BONTO UJUNG
17 7304111703030001 MUH DA'I AL MA'RUF L 4 17 0 BONTO UJUNG
18 7304111303800001 SABUR H M L 4 41 31-45 BONTO UJUNG
19 7304112703990001 BAHRI L 4 22 18-30 UJUNG BARAT
20 7304112310010001 IRSAN NURSAL L 4 20 18-30 UJUNG BARAT
21 7304114107860009 RAHMAWATI P 4 35 31-45 BONTO UJUNG
22 7304111212950002 SUPARMAN L 4 25 18-30 UJUNG BUNDU
23 7304034106860004 HASNAH P 4 35 31-45 UJUNG BARAT
24 7304114507800003 HAMSINAH P 4 31 31-45 UJUNG BARAT
25 7304114108020003 NURUL FADILLAH P 4 19 18-30 UJUNG TIMUR
26 7304115102010001 ESTI RAHAU P 4 20 18-30 BONTO UJUNG
27 7304113110960001 ADWAL FADWA MUCH L 4 24 18-30 BONTO UJUNG
28 7304115902020002 NUR ANNISA SRI FEB P 4 19 18-30 BONTO UJUNG
29 7304112406930001 SOFYAN L 4 28 18-30 BONTO UJUNG
30 7304111407000003 MUH FAUSAN A MUB L 4 21 18-30 CAMBA LOJONG
31 7303023004700003 ABDUL KASIM PADUI L 4 51 46-59 JL T A GANI NO 03
32 7304054809010001 HUSNUL KHATIMAH P 4 20 18-30 SAMATARING

VAKSIN 1 : BALTAR 5 ORG
VAKNSIN 1 BONTO UJUNG : 8 ORG
ORMAT PENCATATAN PELAKSANAAN IMUNISASI COVID-19
Tanggal Pemberian
Imunisasi
Tidak Merek
No. Hp Ada Vaksin***
Dosis I Dosis II Dosis I Dosis 2
(centa
ng)
085731872713 v Coronovac 2021071351 9/4/2021

082347000807 v Coronovac 2021071351 9/4/2021
081340174340 v Coronovac 2021071351 9/4/2021
085247002366 Coronovac 2021071351 9/4/2021
085240745152 v Coronovac 2021071351 9/4/2021
085240690918 v Coronovac 2021071351 9/4/2021
085242188189 v Coronovac 2021071351 9/4/2021
085272188712 v Coronovac 2021071351 9/4/2021
085272188712 v Coronovac 2021071351 9/4/2021
085333367867 v Coronovac 2021071351 9/4/2021
085396416127 v Coronovac 2021071351 9/4/2021
081945022930 v Coronovac 2021071351 9/4/2021
085342598755 v Coronovac 2021071351 9/4/2021
082253514909 v Coronovac 2021071351 9/4/2021
082396085617 v Coronovac 2021071351 9/4/2021
085823425478 v Coronovac 2021071351 9/4/2021
085232386509 v Coronovac 2021071351 9/4/2021
085341360196 v Coronovac 2021071351 9/4/2021
085823773412 v Coronovac 2021071351 9/4/2021
082192876990 v Coronovac 2021071351 9/4/2021
085242721367 v Coronovac 2021071351 9/4/2021
085342616027 v Coronovac 2021071351 9/4/2021
085349301591 v Coronovac 2021071351 9/4/2021
082192877468 v Coronovac 2021071351 9/4/2021
085241586579 v Coronovac 2021071351 9/4/2021
085340935966 v Coronovac 2021071351 9/4/2021
085823864472 v Coronovac 2021071351 9/4/2021
085757269726 v Coronovac 2021071351 9/4/2021
085394394050 v Coronovac 2021071351 9/4/2021
085738860737 v Coronovac 2021071351 9/4/2021
082349991595 v Coronovac 2021071351 9/4/2021
081617703541 v Coronovac 2021071351 9/4/2021
YANG DI VAKSIN : 32 ORG

1 : BALTAR 5 ORG VAKSIN 2 BONTO UJUNG : 15 ORG
N 1 BONTO UJUNG : 8 ORG VAKSIN 2 LW : 3 ORG
1 BALBAR : 1 ORG
OVID-19
Keterangan
REMAJA
LANSIA
LANSIA
LANSIA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM

Um Tanggal Pemberian
Jeni Komorbid** No. Batch
ur Imunisasi
s Pek Tidak
(18- Kelompok Merek Keterangan
No NIK Nama Penerima Vaksin Kel erja
59 Umur
ami an* Dosis I Dosis II Dosis I Dosis 2
tahu (centang
n )
n)
1 7304115504050001 NUR NAILA AZHARA P 4 16 0 BALANGLOE 085731872713 v Coronovac 2021071351 9/4/2021 REMAJA
2 7304117112600072 BINTANG P 4 60 0 KAMPUNG BERU 082347000807 v Coronovac 2021071351 9/4/2021 LANSIA
3 7304113112580020 AMIR L 4 62 0 BALANGLOE 081340174340 v Coronovac 2021071351 9/4/2021 LANSIA
4 7304114705850002 SYAMSINA P 4 36 31-45 BALANGLOE 085247002366 Coronovac 2021071351 9/4/2021 LANSIA
5 7304111804640001 H MAKMUR L 4 57 46-59 KASSI-KASSI 085240745152 v Coronovac 2021071351 9/4/2021 MASYARAKAT UMUM

VAKSIN 1 : BALTAR 5 ORG VAKSIN 2 BONTO UJUNG : 15 ORG
VAKNSIN 1 BONTO UJUNG : 8 ORG VAKSIN 2 LW : 3 ORG
FORMAT PENCATATAN P
TINGKAT PU

Umu
r
Jenis Pek
Nama Penerima (18- Kelompok
No NIK Vaksin
Kela erja
59 Umur
Alamat
min an*
tahu
n)
1 [7304116403830001 NURALAM P 4 37 31-45 KASSI-KASSI

2 7304111407720001 HASAN M L 4 49 46-59 BALANGLOE
3 7304114410020001 CITRA AYU LESTARI P 4 18 18-30 CAMBA LOMPOA
4 7304110510780001 JUPRI HAMZAH L 4 42 31-45 BONTO LANGGA
5 7304111212930001 SARIF HIDAYAT L 4 27 18-30 UJUNG BARAT
6 7304111308970001 RACHMAT AGUS SAH L 4 24 18-30 PUNAGAYYA DESA BONTO RA
7 7304112505590001 GUSTI INDRAWAN L 4 26 18-30 PUNAGAYYA DESA BONTO RA
8 7304110201950001 JUSRIANTO L 4 26 18-30 BONTO LANGGA
9 7304116001770001 SAHARIA P 4 44 31-45 KASSI-KASSI
10 7304115905830003 KARTINI AMK P 2 38 31-45 CAMBA LOMPOA

VAKSIN 1 : TINO : 1 ORG
BONTO UJUNG : 1 ORG
BALTAR : 2 ORG
BALBAR : 1 ORG
LW : 2 ORG

PENCATATAN PELAKSANAAN IMUNISASI COVID-19
Tanggal Pemberian
Imunisasi
Tidak Merek
No. Hp Ada Vaksin*** Dosis I Dosis II Dosis I Dosis 2
(centang
)
085341171632 v Coronovac 2021071351 9/8/2021

085398887612 v Coronovac 2021071351 9/8/2021
082316745131 v Coronovac 2021071351 9/8/2021
082348493134 v Coronovac 2021071351 9/8/2021
085397406612 v Coronovac 2021071351 9/8/2021
085298616636 v Coronovac 2021071351 9/8/2021
085298616636 v Coronovac 2021071351 9/8/2021
082348601725 v Coronovac 2021071351 9/8/2021
082337171398 v Coronovac 2021071351 9/8/2021
082399515403 v Coronovac 2021071351 9/8/2021
KSIN : 10 ORG
VAKSIN 2 : TINO : 1 ORG
BALTAR : 1 ORG
NAKES : 1 ORG

NAKES : 1 ORG
Keterangan
(Contoh:
Ditunda/Dirujuk/….)
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
NAKES
FORMAT PENCATATAN
TINGKAT PU

Jenis Umur
Peker Kelompok
jaan*
(18-59
Umur
Alamat
min tahun)
1 7304116904030001 ST NURHIKMA P 4 18 18-30 SEPE/BALBAR

2 7304117112860017 TINA P 4 34 31-45 SEPE/BALBAR
3 7304115109760001 SUPIATI P 4 45 31-45 BONTO BARU/BALBAR
4 7304111703050004 AKMAL L 4 17 0 SEPE/BALBAR
5 7303021601010003 A RIYAD AMAL MUHA L 4 21 18-30 BUNGENG
6 7304114303770001 HAJRAH P 4 44 31-45 BONTO BARU/BALBAR
7 7304114511950001 SUTRIANA P 4 26 18-30 RA'RA/BALBAR
8 7304114108870004 NURDIANA P 4 34 31-45 BONTO BARU/BALBAR

VAKSIN 1 : BALBAR : 4 ORG (REMAJA 1 ORG)
LW : 1 ORG
MAT PENCATATAN PELAKSANAAN IMUNISASI COVID-19
Tanggal Pemberian
Imunisasi
Tidak Merek
(centan
g)
081253823005 v Coronovac 2021071351 09/09/2021

085298645214 v Coronovac 2021071351 09/09/2022
081355476823 v Coronovac 2021071351 09/09/2023
081253823005 v Coronovac 2021071351 09/09/2024
081340191175 v Coronovac 2021071351 09/09/2025
082149600556 v Coronovac 2021071351 09/09/2026
085342198438 v Coronovac 2021071351 09/09/2026
082190627332 v Coronovac 2021071351 09/09/2026
NG DI VAKSIN : 08 ORG
RG (REMAJA 1 ORG) VAKSIN 2 : BALBAR : 2 ORG
LW : 1 0RG
Keterangan
….)
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
FORMAT PENCATATAN P
TINGKAT PUSK

Umur
Jenis Peke (18-
Kelompok
No NIK Nama Penerima Vaksin Kela rjaan 59
Umur
Alamat
min * tahun
)
1 7371076511810006 SURIANTI Spd L 2 39 31-45 BUNGENG

2 7304091209030002 TRI DANI SAPUTRA L 4 17 0 BORONGLAMU
3 7304090301000001 NURFAJRIN ASIS L 4 21 18-30 ARUNGKEKE
4 7304111005720004 NUSRIDIN L 4 48 46-59 BALANG BARU
5 7304111712990002 HIKMAL KASMAN L 4 21 18-30 TANAKEKE
6 7304110912000001 AHSWAR SYAM L 4 20 18-30 TAROWANG
7 7304090110030001 MUH SAIFUL L 4 18 18-30
8 7304110410870002 ASWAWAN Spd L 4 33 31-45 BALANGLOE
9 7304112504940003 HIKMAN L 4 27 18-30 TANAKEKE
10 7304111308960001 M FAHRIZAL L 4 24 18-30 TANAKEKE

VAKSIN 1 LW 3 ORG
Tanggal Pemberian
Imunisasi
Tidak Keterangan
Merek
No. Hp Ada Vaksin*** (Contoh: Ditunda/Dirujuk/
Dosis I Dosis II Dosis I Dosis 2 ….)
(cent
ang)
081318940225 v Coronovac 2021071351 9/11/2021 PELAYANAN PUBLIK

082347523308 v Coronovac 2021071351 9/11/2021 REMAJA
081243446280 v Coronovac 2021071351 9/11/2021 MASYARAKAT UMUM
082190380401 v Coronovac 2021071351 9/11/2021 PELAYANAN PUBLIK
G DI VAKSIN : 10 ORG
BAR : 1 ORG VAKSIN 2 BALTAR : 1 ORG
VAKSIN 2 LW : 5 ORG
FORMAT PENCATAT
TINGKAT

Jenis Umur
Peker Kelompok
jaan*
(18-59
Umur
Alamat
min tahun)
1 7304110107030015 ANDI SAPUTRA L 4 17 0 BALANGLOE

2 7304114107460013 SAE L 4 55 46-59 BALANGLOE
3 7304111101840002 BASRI DG NGAWING L 4 37 31-45 BALANGLOE
4 7304091211830001 HASANUDDIN L 4 37 31-45 BALANGLOE
5 7304117112840005 HAMSINA P 4 36 31-45 BALANGLOE
6 7304115005950002 BUNGA P 4 26 18-30 BALANGLOE
7 7304116505930002 KASMAWATI P 4 28 18-30 BALANGLOE
8 7304114107800064 RAHMATIA P 4 41 31-45 BALANGLOE
9 7304113112900029 RUSLI L 4 30 18-30 BALANGLOE
10 7304113112620008 B DG SARRO L 4 58 46-59 BALANGLOE
11 7304114812870001 MARIATI P 4 33 31-45 KAMPUNG BERU
12 7304115905850001 DARMA P 4 36 31-45 KAMPUNG BERU
13 7304114107420009 TUMANG P 4 69 0 KASSI-KASSI
14 7304111404040001 MUH ADNAN L 4 17 0 KASSI-KASSI
15 7304116705000003 RESKI AMALIA PUTRI P 4 21 18-30 BONTOWA
16 7304115705050002 NURHALIZAH P 4 16 0 BONTOWA
17 730412610040002 ANDI SUSILO JAYA L 4 16 0 PACCINONGAN
18 7304110610950002 ABD HALIS L 4 24 18-30 BONTO MASUGI
19 7304116303980001 RESKYANA P 4 23 18-30 BONTO KATANGKA
20 7304110205980001 PATTA SAPUTRA L 4 24 18-30 SAMBURAKAS, KAL
21 7304054801880002 HARIANTI S PD L 4 34 31-45 RANNAYA, KELAR
22 7304111712970001 ARSUANDY MUBARAK L 4 23 18-30 KAMPUNG BERU
23 7304114402920001 SUBIANTI P 4 29 18-30 BORONGLOE
24 7304085708960003 YULI P 4 25 18-30 BALANGLOE
25 7304117112940008 MIRNAWATI P 4 26 18-30 BALANGLOE
26 7304111203870001 PATTALOLO L 4 34 31-45 BALANGLOE
27 7304110107750047 ARIFIN DG GASSING L 4 46 46-59 BALANGLOE
28 7304113112530005 ARIFUDDIN GASSING L 4 67 0 BALANGLOE
29 72710869060-00001 IIN ANJANI NUR P 4 21 18-30 BALANGLOE
30 7304114601800001 AYU P 4 41 31-45 BALANGLOE
31 7304115905060001 ST MARWAH SYAHRIR P 4 15 0 PACCINONGAN
32 7304114511030001 RISMAWANA P 4 16 0 PACCINONGAN
33 7304116205010001 NURSANTI P 4 21 18-30 PACCINONGAN
34 7304011501190001 SYARIF ALWI RAHIM S PD L 4 31 31-45 BONTO UJUNG
35 7304115612030001 NURUL AISYAH P 4 18 18-30 CAMBA LOMPOA
36 7304042407970002 ARSANDI L 4 24 18-30 LING BONTOALA
37 7306085312020010 NURHIDAYAH P 4 18 18-30 PERUM BUMI ZARI

VAKSIN 1 : 24 ORG
REMAJA : 4 ORG
LANSIA : 1 ORG
MASARAKAT UMUM : 19 ORG
VAKSIN 1: BALTAR : 19 ORG

TINO : 1 ORG
BALBAR : 1 ORG
UJUNG : 1 ORG
LW : 2 ORG
Tanggal Pemberian
Imunisasi
Tidak Merek
No. Hp
Ada Vaksin*** Dosis I Dosis II Dosis I Dosis 2
(centang)
082353124892 v Coronovac 2021071351 9/13/2021

082347000801 v 2021071351 9/13/2021
085298408570 v Coronovac 2021071351 9/13/2021
081342589511 Coronovac 2021071351 9/13/2021
082347509762 v Coronovac 2021071351 9/13/2021
082149466121 v Coronovac 2021071351 9/13/2021
085342181986 v Coronovac 2021071351 9/13/2021
081340055219 v Coronovac 2021071351 9/13/2021
085871092709 v Coronovac 2021071351 9/13/2021
082353124892 v Coronovac 2021071351 9/13/2021
085243468493 v Coronovac 2021071351 9/13/2021
082394833195 v Coronovac 2021071351 9/13/2021
085342181986 v Coronovac 2021071351 9/13/2021
083133699377 v Coronovac 2021071351 9/13/2021
081243736643 v Coronovac 2021071351 9/13/2021
081328726956 v Coronovac 2021071351 9/13/2021
087884178219 v Coronovac 2021071351 9/13/2021
085145700317 v Coronovac 2021071351 9/13/2021
082197352512 v Coronovac 2021071351 9/13/2021
082150884346 v Coronovac 2021071351 9/13/2021
082189617351 v Coronovac 2021071351 9/13/2021
085342416984 v Coronovac 2021071351 9/13/2021
085239256479 v Coronovac 2021071351 9/13/2021
085394388857 v Coronovac 2021071351 9/13/2021
085251942301 v Coronovac 2021071351 9/13/2021
085211117696 v Coronovac 2021071351 9/13/2021
085146108835 v Coronovac 2021071351 9/13/2021
085343639307 v Coronovac 2021071351 9/13/2021
082250900502 v Coronovac 2021071351 9/13/2021
082344824092 v Coronovac 2021071351 9/13/2021
085858022713 v Coronovac 2021071351 9/13/2021
085395563020 v Coronovac 2021071351 9/13/2021
085396536945 v Coronovac 2021071351 9/13/2021
085242867321 v Coronovac 2021071351 9/13/2021
082393088375 v Coronovac 2021071351 9/13/2021
085395645010 v Coronovac 2021071351 9/13/2021
089602282161 v Coronovac 2021071351 9/13/2021
H YANG DI VAKSIN : 37 ORG

VAKSIN 2 : 13 ORG
REMAJA : 3 ORG
AKAT UMUM : 19 ORG
VAKSIN 2 : BALTAR : 6 ORG

TINO : 3 ORG
UJUNG : 1 ORG
BALBAR : 1 ORG
LW : 2 ORG
Keterangan
….)
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
LANSIA
REMAJA
MASYARAKAT UMUM
REMAJA
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
LANSIA
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
FORMAT PENCATATAN
TINGKAT PUSK

Umu
Jeni r
Peke
s (18- Kelompok
No NIK Nama Penerima Vaksin
Kela
rjaan
59 Umur
Alamat
*
min tahu
n)
1 7304114406910003 HIJRIANI S.Pd P 4 30 18-30 BONTO MASUGI

2 7304116105840001 DARMAWATI P 4 37 31-45 CAMBA LOMPOA
3 7304114510030001 LELI P 4 17 0 SEPE/ BALBAR
4 7304111005760002 KASIM L 4 45 31-45 CAMBA LOMPOA
5 SUNARIA
7304115501660001 P 4 55 46-59 CAMBA LOMPOA
6 RIFAL
7304110807980002 L 4 23 18-30 CAMBA LOMPOA
7 7304110107660032 DUDA L 4 55 46-59 CAMBA LOMPOA
8 7304111206010002 SALJU HASRUDDIN L 4 20 18-30 BALANG BARU
9 7303016501940000 YULIA AL IMAMA ADY S P 4 27 18-30 JL PAHLAWAN, BT
10 7304046408840001 NURAENI P 4 37 31-45 TOGO-TOGO
11 7304050602040001 M AS'AD L 4 17 0 TOMBOLO SELATA
12 7303017011960002 AMALIA AL ISYRO ABD P 4 24 18-30 JL PAHLAWAN, BT
13 7304115905030001 NOVITASARI P 4 18 18-30 ALLU
14 7304044710920001 RIKA, AMD,KEB P 4 28 18-30 TOGO-TOGO
15 7304110509740001 NASIR L 4 47 46-59 CAMBA LOMPOA
16 7304114305790003 ERNI ERAWATI P 4 43 31-45 CAMBA LOMPOA
17 7304080107890010 SUARDI L 4 32 31-45 RUMKITBAN TIMIKA

VAKSIN 1 : 14 ORG
REMAJA : 2 ORG
MASARAKAT UMUM : 12 ORG
VAKSIN 1: BALBAR : 8 ORG

LW : 6 ORG
Tanggal Pemberian
Imunisasi
Tidak Merek
(centang
)
081340358627 v Coronovac 2021071351 9/15/2021

085386093119 v Coronovac 2021071351 9/15/2021
087832153739 v Coronovac 2021071351 9/15/2021
082192878459 v Coronovac 2021071351 9/15/2021
082191341220 v Coronovac 2021071351 9/15/2021
082192878459 v Coronovac 2021071351 9/15/2021
082192878459 v Coronovac 2021071351 9/15/2021
081253822947 Coronovac 2021071351 9/15/2021
085255932119 v Coronovac 2021071351 9/15/2021
085326855813 v Coronovac 2021071351 9/15/2021
085298957812 v Coronovac 2021071351 9/15/2021
085255932119 v Coronovac 2021071351 9/15/2021
085397770562 v Coronovac 2021071351 9/15/2021
085241563655 v Coronovac 2021071351 9/15/2021
085298704610 v Coronovac 2021071351 9/15/2021
081243728784 v Coronovac 2021071351 9/15/2021
081339104965 v Coronovac 2021071351 9/15/2021
YANG DI VAKSIN : 17 ORG

VAKSIN 2 : 3 ORG
KAT UMUM : 12 ORG
VAKSIN 2: BALBAR : 2 ORG

LW : 1 ORG
VID-19
Keterangan
….)
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
FORMAT PENCATATAN
TING

Jenis Peke Umur

Nama Penerima Kelompok
No NIK Vaksin
Kela rjaan (18-59
Umur
Alamat
min * tahun)
23 7304114605710001 IDA SIKKI P 4 40 31-40 BONTO MASUGI

33 7304111911950001 Yusril Yus hendra L 4 56 51-60 BONTO MASUGI
18 7304114511950001 SUTRIANA P 4 26 18-30 RA'RA
22 7304114107870003 SYARMILA P 34 31-45 RA'RA
23 7304116808790001 NURAEDA P 4 41 31-45 RA'RA
25 7304114106760004 HARIATI P 4 46 46-59 RA'RA
27 7304114111690001 HAPSA P 4 51 46-59 RA'RA
28 7304117007720001 JAMILA NAZAR P 4 48 46-59 RA'RA
41 7304115802800002 YATI P 31 31-45 RA'RA
44 6402130811900002 AKBAR SAID L 4 30 18-30 BONTOMANAI
45 7304115010950005 NURAENI P 4 25 18-30 BONTOMANAI
48 7304112401860001 LUKMAN L 45 31-45 BONTO MASUGI
57 7303054203870006 SUMARNI P 34 31-45 BALANG BARU
96 7304110509740001 NASIR L 46 46-59 CAMBA LOMPOA
97 7304110303710006 MUH. ALI L 50 46-59 CAMBA LOMPOA
99 7304116909760003 NIARTI P 44 31-45 CAMBA LOMPOA
2 7304113112570009 SUNU DG TIKA L 4 64 0 CAMBA LOMPOA
12 7304116706800005 NURHIKMA P 4 41 31-45 RA'RA
13 7304115801010002 EKA WULANDARI NEN P 4 20 18-30 RA'RA
14 7304115509830001 SUMARNI P 4 38 31-45 RA'RA
17 7372031708810002 ROSMIATI P 2 40 31-45 BALANG BARU
14 7304114402860001 WAWAN SAHRIR L 4 18 18-30 CAMBA LOMPOA
25 7304114203700003 ST HARDIANA P 51 46-59 RA'RA
133 7304110107710005 BASNUR L 50 46-59 CAMBA LOMPOA
7 7304112307950001 ANWAR L 4 25 18-30 BALBAR
8 7304114906010001 RITA NANDA SARI P 4 20 18-30 BALBAR
9 7304111707540001 KH MUH BAHTIAR H L 4 67 0 CAMBA LOMPOA
10 7304111304770001 SAHRIR L 4 44 31-45 BALBAR
22 7304116511990003 YUSNAWATI P 21 18-30 SEPE
60 7304110510940002 ASFAR L 26 18-30 CAMBA LOMPOA
64 7304116205770001 SYAMSIAH P 44 31-45 RA'RA
69 7304110112700001 SYARIFUDDIN L 51 46-59 CAMBA LOMPOA
71 7304115802770001 HIKMAWATI P 44 31-45 CAMBA LOMPOA
72 7304111509780001 JUFRIANTO L 43 31-45 CAMBA LOMPOA
96 7304115504040001 SALSABILAH HAERA P 17 0 BALANG BERU
98 7304117112720013 MAINNA P 48 46-59 CAMBA LOMPOA
100 7304117004010001 NURLAITA ARIANTO P 20 18-30 CAMBA LOMPOA
101 7304115111010002 NURFIMA RAHMI SY P 20 18-30 CAMBA LOMPOA
103 7304117112870014 SARIBONE P 33 31-45 CAMBA LOMPOA
7 7304111902960002 AKBAR SYARIF L 4 25 18-30 CAMBA LOMPOA
8 7302095707850001 RAHMATIA L P 4 36 31-45 CAMBA LOMPOA
9 7304115103950003 RIA SELFIANA P 4 26 18-30 BONTO BARU
10 7304111905030001 FIKRAN L 4 18 18-30 BONTO BARU
11 7304114703770001 HIJRAH P 4 44 31-45 BONTO BARU
14 7304116304010002 ASMILA SYARIF P 4 20 18-30 CAMBA LOMPOA
16 7304111405810002 SOFYAN DG LAU L 4 40 31-45 BONTO BARU
17 7304116612720001 HAJISA P 2 48 46-59 CAMBA LOMPOA
19 7304117112870008 HARTINA P 4 33 31-45 BONTOMANAI
22 7304112507050004 SANDI L 16 0 BONTO MANAI
24 7304112104960002 ASWIN L 25 18-30 RA'RA
25 7304110404760002 MANSUR L 45 31-45 CAMBA LOMPOA
27 7304115106030001 NURFITRAH DINANTI P 19 18-30 BONTO BARU
34 730411640400000 ALMAIDAH P 21 18-30 SEPE'
38 7304112810000001 DENI CHANDRA L 20 18-30 CAMBA LOMPOA
40 7304110510000002 ACHMAD KURNIAWAN L 20 18-30 CAMBA LOMPOA
41 7304112307970001 ASRUL L 24 18-30 BONTO BARU
42 7304111207890002 ASRI L 32 31-45 BONTO BARU
50 7304111506800001 ABD RAHMAN L 41 31-45 CAMBA LOMPOA
30 7304111002030001 WAWAN SAHNUR L 4 18 18-30 CAMBA LOMPOA
40 7304115905830003 KARTINI P 2 37 31-45 CAMBA LOMPOA
8 7304111304770001 SAHRIR L 4 44 31-45 BALANG BARU
51 7304110405780001 SUKRI L 4 43 31-45 BT BARU
63 7304114505690002 HADAWIAH P 4 51 46-59 BONTO MANAI
19 7304117112870014 SARIBAU P 4 31 31-45 CAMBA LOMPOA
20 7304115111010002 NURFINA RAHMI SY P 4 20 18-30 CAMBA LOMPOA
21 7304117112720013 MAINNA P 4 49 46-59 CAMBA LOMPOA
47 7304115509830001 SUMARNI P 4 37 31-45 RA'RA
65 7304111902960002 AKBAR SYARIF L 4 25 18-30 CAMBA LOMPOA
68 7304116304010002 ASMILA SYARIF P 4 20 18-30 CAMBA LOMPOA
94 7304110607750002 H KAHARUDDIN, SE L 4 46 46-59 BONTO MASUGI
95 7304115612030001 NURUL AISYAH AZI P 4 17 0 CAMBA LOMPOA
96 7304114204760001 NURLIA P 4 45 31-45 CAMBA LOMPOA
1 7304110503680004 ANTO L 4 53 46-59 RA'RA
3 7304116706800005 NURHIKMAH P 4 41 31-45 RA'RA
14 7304112104960002 ASWIN L 4 25 18-30 RA'RA
15 7304114309880002 YULIATI AMD KEB P 2 33 31-45 CAMBA LOMPOA
16 7304116404000001 ALMAIDA P 4 21 18-30 SEPE
29 7304111009700002 TAJUDDIN DG MAS L 4 50 46-59 RA'RA
10 7304115103950003 RIA SELFIANA P 4 26 18-30 BONTO BARU
12 7304116511990003 YUSNAWATI P 4 21 18-30 SEPE
27 7304112812750002 YACENG L 4 45 31-45 CAMBA LOMPOA
2 7304117004010001 NURLAILA ARIANTO P 4 20 18-30 CAMA LOMPOA
25 7304113112800023 SUDIRMAN L 4 40 31-45 RA'RA
50 7303011508880004 ALIE AL AKBAR ABD L 4 33 31-45 CAMBA LOMPOA
5 7304111905030001 FIKRAM L 4 18 18-30 BONTO BARU/BALB
13 7304113009940001 MUH IDRUS L 4 25 18-30 BONTO MANAI/BALB
14 7304110405030001 RUSLAN L 4 18 18-30 BONTO MANAI/BALB
15 7304110901030001 RESKI L 4 18 18-30 BONTO MANAI/BALB
16 7304110707790001 ELI L 4 29 18-30 BONTO MANAI/BALB
17 7304114401040001 HERFINA S P 4 17 0 BONTO MASUGI
18 7304116909000001 SAUFIKA P 4 21 18-30 BONTO MASUGI
19 7304110807980001 ALDI ADRIAN SUAG L 4 24 18-30 BONTO BARU/BALB
1 7304110606670001 ABDULLAH L 4 54 46-59 CAMBA LOMPOA
2 7304114803060001 WIDA WULANDARI P 4 15 0 BONTO MASUGI
3 7304113112790041 SULTAN L 4 41 31-45 CAMBA LOMPOA
4 7304117112750048 ROSMITA P 4 45 31-45 CAMBA LOMPOA
5 7304115712050002 SUCI DWI RAMADHAN L 4 15 0 CAMBA LOMPOA
6 7304111908970001 MUHAMMAD ASWAN L 4 25 18-30 CAMBA LOMPOA
7 7304115806060002 ELMAWATI P 4 15 0 CAMBA LOMPOA
8 7304112610050002 RYAN HIDAYAT L 4 15 0 CAMBA LOMPOA
9 7304110211790001 SUHARDI L 4 41 31-45 CAMBA LOMPOA
10 7304115906740001 AISYAH P 4 47 46-59 CAMBA LOMPOA
11 7304114107450046 SARI BAU P 4 46 46-59 CAMBA LOMPOA
12 7304111303050001 PRIA DWI ANUGRAH L 4 16 0 CAMBA LOMPOA
13 7304114703960001 NURBAYA P 4 25 18-30 CAMBA LOMPOA
14 7304119392920004 IDRIS L 4 28 18-30 CAMBA LOMPOA
15 7304113112770031 SAKKIR L 4 43 31-45 BONTO MASUGI
16 7304117112770028 JUMRIANI P 4 43 31-45 BONTO MASUGI
17 7304115209020001 LEONI P 4 18 18-30 CAMBA LOMPOA
18 7304111608010001 YUSRAN HAERUL L 4 20 18-30 BONTO MASUGI
19 7304112901010001 HERI SAPUTRA L 4 20 18-30 BONTO MASUGI
20 7304110108970002 ASRULLAH L 4 24 18-30 CAMBA LOMPOA
21 7304116505750017 AISYAH P 4 46 46-59 CAMBA LOMPOA
22 7304110607760001 KAMIRUDDIN L 4 45 31-45 BONTO MASUGI
23 7304054305890001 ROSMIATI P 4 36 31-45 CAMBA LOMPOA
24 7304110709990004 RIFALDY ALSYAM L 4 25 18-30 CAMBA LOMPOA
25 7371107112680127 SYAMSIAH P 4 52 46-59 CAMBA LOMPOA
26 7304115305000001 SRI AYU NINGSIH P 4 21 18-30 SEPE
33 7304110404760002 MANSUR L 4 45 31-45 CAMBA LOMPOA
34 7304114605710001 IDA SIKKI P 4 50 46-59 BONTO MASUGI
35 7304115504040001 SALSAILAH HAERANI P 4 17 0 BALANG BARU
36 7304110303710006 M ALI L 4 50 46-59 CAMBA LOMPOA
36 7304110303710006 M ALI L 4 50 46-59 CAMBA LOMPOA
3 7304114203920001 HASNAWATI P 4 29 18-30 CAMBA LOMPOA
14 7304111506020001 KAHAR L 4 19 18-30 BONTO MASUGI
30 7304111407000003 MUH FAUSAN A MU L 4 21 18-30 CAMBA LOJONG
3 7304114410020001 CITRA AYU LESTAR P 4 18 18-30 CAMBA LOMPOA
10 7304115905830003 KARTINI AMK P 2 38 31-45 CAMBA LOMPOA
1 7304116904030001 ST NURHIKMA P 4 18 18-30 SEPE/BALBAR
2 7304117112860017 TINA P 4 34 31-45 SEPE/BALBAR
3 7304115109760001 SUPIATI P 4 45 31-45 BONTO BARU/BALB
4 7304111703050004 AKMAL L 4 17 0 SEPE/BALBAR
5 7303021601010003 A RIYAD AMAL MU L 4 21 18-30 BUNGENG
6 7304114303770001 HAJRAH P 4 44 31-45 BONTO BARU/BALB
7 7304114511950001 SUTRIANA P 4 26 18-30 RA'RA/BALBAR
8 7304114108870004 NURDIANA P 4 34 31-45 BONTO BARU/BALB
4 7304111005720004 NUSRIDIN L 4 48 46-59 BALANG BARU
18 7304110610950002 ABD HALIS L 4 24 18-30 BONTO MASUGI
35 7304115612030001 NURUL AISYAH P 4 18 18-30 CAMBA LOMPOA
1 7304114406910003 HIJRIANI S.Pd P 4 30 18-30 BONTO MASUGI
2 7304116105840001 DARMAWATI P 4 37 31-45 CAMBA LOMPOA
3 7304114510030001 LELI P 4 17 0 SEPE/ BALBAR
4 7304111005760002 KASIM L 4 45 31-45 CAMBA LOMPOA
5 7304115501660001 SUNARIA P 4 55 46-59 CAMBA LOMPOA
6 7304110807980002 RIFAL L 4 23 18-30 CAMBA LOMPOA
7 7304110107660032 DUDA L 4 55 46-59 CAMBA LOMPOA
8 7304111206010002 SALJU HASRUDDIN L 4 20 18-30 BALANG BARU
15 7304110509740001 NASIR L 4 47 46-59 CAMBA LOMPOA
Komorbid** No. Batch Tanggal Pemberian Imunisasi
Merek
No. Hp Tidak Ada Vaksin*** Dosis I Dosis II Dosis I
(centang)
082347931042 v sinovac 24003721 6/29/2021

085256194711 v sinovac 24003721
085342198438 v Coronovac 24003721 06/07/2021
085240021835 v Coronovac 24003721 06/07/2021
085656362718 v Coronovac 24003721 06/07/2021
085247949076 v Coronovac 24003721 06/07/2021
085395414572 v Coronovac 24003721 06/07/2021
085240280977 v Coronovac 24003721 06/07/2021
082188386048 v Coronovac 24003721 06/07/2021
081350198461 v Coronovac 24003721 06/07/2021
082286665852 v Coronovac 24200121 06/07/2021
082347141501 v Coronovac 24200121 06/07/2021
085343759520 v Coronovac 24200121 06/07/2021
085298704610 v Coronovac 24200121 06/07/2021
085256732113 v Coronovac 24200121 06/07/2021
085242226158 v Coronovac 24200121 06/07/2021
082393570937 v Coronovac 24200121 07/07/2021
085255164535 v Coronovac 24200121 08/07/2021
085247001646 v Coronovac 24200121 08/07/2021
085299624872 v Coronovac 24200121 08/07/2021
085240270971 v Coronovac 24200121 08/07/2021
085256516037 v Coronovac 24200121 14/07/2021
082393514903 v Coronovac 24200121 7/14/2021
085146416281 v Coronovac 24200121 14/07/2021
085256486425 v Coronovac 24200121 15/07/2021
085352711477 v Coronovac 24200121 15/07/2021
085299341221 v Coronovac 24200121 15/07/2021
085352711477 v Coronovac 24200121 15/07/2021
085656800634 v Coronovac 24200121 15/07/2021
082347509766 v Coronovac 24200121 15/07/2021
082347955686 v Coronovac 24200121 15/07/2021
085242152711 v Coronovac 24200121
085346191797 v Coronovac 24200121
085346191799 v Coronovac 24200121
082393514903 v Coronovac 24200121 7/15/2021
081242152711 v Coronovac 24200121 7/15/2021
082393096239 v Coronovac 24200121 7/15/2021
085242152711 v Coronovac 24200121 7/15/2021
085242152711 v Coronovac 24200121 7/15/2021
081243728784 v Coronovac 24200121 7/21/2021
082394423218 v Coronovac 24200121 7/21/2021
081245248070 v Coronovac 24200121 7/21/2021
082149600556 v Coronovac 24200121 7/21/2021
085197550373 v Coronovac 24200121 7/21/2021
082149600556 v Coronovac 24200121 7/21/2021
085657321088 v Coronovac 24200121 7/21/2021
085347225476 v Coronovac 24200121 7/21/2021
082346206442 v Coronovac 24200121 7/21/2021
085298455700 v Coronovac 24200121 7/21/2021
085240270988 v Coronovac 24200121 7/21/2021
082357447567 v Coronovac 24200121 7/21/2021
085242238982 v Coronovac 24200121 7/21/2021
082347289517 v Coronovac 24200121 7/21/2021
085244364540 v Coronovac 24200121 7/21/2021
085824161948 v Coronovac 24200121 7/21/2021
085233085868 v Coronovac 24200121 7/21/2021
083132928758 v Coronovac 24200121 7/21/2021
083135065999 v Coronovac 24200121 7/21/2021
085245560639 v Coronovac 24200121
085256516037 v Coronovac 24003121
082399515403 v Coronovac 24003121 05/082021
085352711477 v Coronovac 24004721
082188844966 v Coronovac 24004721
082399267268 v Coronovac 24004721
085242152711 v Coronovac 24004721
085242152711 v Coronovac 24004721
085242152711 v Coronovac 24004721
085299624872 v Coronovac 24004721
082394423218 v Coronovac 24004721
085657321088 v Coronovac 24004721
085242194536 v Coronovac 24004721 8/14/2021
082393088375 v Coronovac 24004721 8/14/2021
081232632722 v Coronovac 24004721 8/14/2021
081241441379 v Coronovac 24004721
085255164535 v Coronovac 24004721
082357447567 v Coronovac 24004721
085397265396 v Coronovac 24004721
085244364540 v Coronovac 24004721
082344416512 v Coronovac 24004721 19/082026
082149600556 v Coronovac 24004721
085656800634 v Coronovac 24004721
081232632722 v Coronovac 24004721 8/20/2021
082399096239 v Coronovac 24004721
085321761785 v Coronovac 24004721 25/08/2021
085342198456 v Coronovac 24004721 25/08/2021
082150629914 v Coronovac 24202221
082333999394 v Coronovac 24202221 8/31/2021
082333999394 v Coronovac 24202221 8/31/2021
085389301901 v Coronovac 24202221 8/31/2021
085298239775 v Coronovac 24202221 8/31/2021
085289679417 v Coronovac 24202221 8/31/2021
085289679417 v Coronovac 24202221 8/31/2021
085242356262 v Coronovac 24202221 8/31/2021
082346211451 v Coronovac 24202221 9/1/2021
085256928256 v Coronovac 24202221 9/1/2021
085299204131 v Coronovac 24202221 9/1/2021
085299204131 v Coronovac 24202221 9/1/2021
085299204131 v Coronovac 24202221 9/1/2021
085394518769 v Coronovac 24202221 9/1/2021
085240268612 v Coronovac 24202221 9/1/2021
085394518769 v Coronovac 24202221 9/1/2021
081254824019 v Coronovac 24202221 9/1/2021
082346211451 v Coronovac 24202221 9/1/2021
085341457501 v Coronovac 24202221 9/1/2021
082347849617 v Coronovac 24202221 9/1/2021
085244995696 v Coronovac 24202221 9/1/2021
085244995696 v Coronovac 24202221 9/1/2021
085256928250 v Coronovac 24202221 9/1/2021
085256928250 v Coronovac 24202221 9/1/2021
085342181932 v Coronovac 24202221 9/1/2021
081340553183 v Coronovac 24202221 9/1/2021
082124187049 v Coronovac 24202221 9/1/2021
082345619525 v Coronovac 24202221 9/1/2021
082352029654 v Coronovac 24202221 9/1/2021
082253614959 v Coronovac 2021071351 9/1/2021
082180160254 v Coronovac 2021071351 9/1/2021
082346211451 v Coronovac 2021071351 9/1/2021
082346211451 v Coronovac 2021071351 9/1/2021
082347806029 v Coronovac 2021071351 9/1/2021
085242238982 v Coronovac 24202221
082347931042 v Coronovac 2021071351
082393514903 v Coronovac 24202221
085342181932 v Coronovac 24202221
085342181932 v Coronovac 24202221
085320090142 v Coronovac 2021071351 9/2/2021
082253514909 v Coronovac 2021071351 9/4/2021
085738860737 v Coronovac 2021071351
082316745131 v Coronovac 2021071351 9/8/2021
082399515403 v Coronovac 2021071351
081253823005 v Coronovac 2021071351 09/09/2021
085298645214 v Coronovac 2021071351 09/09/2022
081355476823 v Coronovac 2021071351 09/09/2023
081253823005 v Coronovac 2021071351 09/09/2024
081340191175 v Coronovac 2021071351 09/09/2025
082149600556 v Coronovac 2021071351
085342198438 v Coronovac 2021071351
082190627332 v Coronovac 2021071351
085349669110 v Coronovac 2021071351 9/11/2021
085145700317 v Coronovac 2021071351 9/13/2021
082393088375 v Coronovac 2021071351
081340358627 v Coronovac 2021071351 9/15/2021
085386093119 v Coronovac 2021071351 9/15/2021
087832153739 v Coronovac 2021071351 9/15/2021
082192878459 v Coronovac 2021071351 9/15/2021
082191341220 v Coronovac 2021071351 9/15/2021
082192878459 v Coronovac 2021071351 9/15/2021
082192878459 v Coronovac 2021071351 9/15/2021
081253822947 v Coronovac 2021071351 9/15/2021
085298704610 v Coronovac 2021071351
081243728784 v Coronovac 2021071351
nggal Pemberian Imunisasi
Keterangan
Dosis 2 ….)
6/29/2021
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
LANSIA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
7/15/2021 MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
7/21/2021
8/5/2021
8/7/2021
07/0/82021
8/7/2021
8/14/2021
8/14/2021
8/14/2021
8/14/2021
8/14/2021
8/14/2021
8/19/2021
8/19/2021
8/19/2021
8/19/2021
8/19/2021
8/20/2021
8/20/2021
25/08/2021

MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
REMAJA
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
9/1/2021 REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
9/8/2021 NAKES
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
REMAJA
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM
MASYARAKAT UMUM

Form Penugasan RR Imunisasi Covid19 - v2

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Form Penugasan RR Imunisasi Covid19 - v2

Diunggah oleh

Hak Cipta:

Format Tersedia

Nama Puskesmas/Jejaring : Puskesmas Tino

Nama Penerima Jenis

52 7304117006960001 Puji Astuti P

Keterangan **Komorbid: ***Merek Vaksin

Kepesertaan BPJS (tulis 'Ya'

4 32 31-45 sepe 081344043322

4 72 46-59 Camba lompoa 082346211451

4 18 18-30 Sepe 082347119715

4 18 18-30 Sepe 085342556958

4 44 31-45 bonto manai 082399229798

4 48 46-59 Bonto manai 081340524356

4 54 46-59 Sepe 085342556958

4 49 46-59 bonto manai 082399229798

4 50 46-59 ra'ra 085343993816

4 50 46-59 Camba lompoa 082193613655

4 20 18-30 ra'ra 081241441379

4 43 31-45 bonto masugi 082340141194

4 41 31-45 Bonto manai 082399267268

4 21 18-30 Bonto manai 082399267268

4 56 46-59 Bonto masugi 085255806805

4 36 31-45 Bonto masugi 087346770165

4 44 46-59 Bonto masugi 081330258685

4 29 18-30 Bonto masugi 085395823565

4 53 46-59 Bonto masugi 082336169043

4 41 31-45 Bonto baru 081355476823

4 28 18-30 Camba lompoa 082346704408

4 21 18-30 Camba lompoa 08234807237

4 38 31-45 Bonto masugi 082290252132

4 36 31-45 Bonto masugi 082348449157

4 25 18-30 Bonto masugi 085256194761

Kepesertaan BPJS Pekerjaan

an BPJS (tulis 'Ya' Tanggal Pemberian

v Sinovac 202009009 202009009

v Sinovac 202009009 202009009 2/5/2021

v Sinovac 202009009 202009009 2/5/2021

v Sinovac 202009009 202009009 2/5/2021

v Sinovac 202009009 202009009 2/5/2021

v Sinovac 202009009 202009009

v sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

sinovac 24001921 4/27/2021

Tunda(3 Bulan Ke depan)

Keterangan Komorbid: *Merek Vaksin