TOTAL

FORMAT REKAPITULASI HARIAN PELAKSANAAN VAKS

TINGKAT KABUPATEN/KOTA
KAB/KOTA : SABU RAIJUA
PROVINSI : NTT
FASYANKES : PUSKESMAS DAIEKO

SASARAN

RENTAN + UMUM
TOTAL

MASYARAKAT
KESEHATAN

ANAK-ANAK
NO TANGGAL
PELAYAN SASARAN

REMAJA
PUBLIK
LANSIA
SDM

1 2/14/2022 110 110

2 2/15/2022 108 108
3 2/16/2022 156 156
4 0
5 0
6 0
7 0
0 0 0 0 0 374 374

DOSIS 1 0
NAKES DOSIS 2 0 MASYARAKAT
DOSIS 3 0

DOSIS 1 0
PETUGAS
DOSIS 2 0 REMAJA
PUBLIK
DOSIS 3

DOSIS 1 0
LANSIA DOSIS 2 0 ANAK-ANAK
DOSIS 3
ANAAN VAKSINASI COVID-19

PENERIMA VAKSIN DOSIS 1 (SATU)

TOTAL DOSIS 1
(Semua
Tahapan) MASYARAKAT
SDM PELAYAN
LANSIA RENTAN + REMAJA
KESEHATAN PUBLIK
UMUM

# % # % # % # % # % #

110 100
108 100
156 100
0
0
0
0
374 100 0 0 0 0 0

DOSIS 1 0 DOSIS 1 374

MASYARAKAT DOSIS 2 0 JUMLAH DOSIS 2 0
DOSIS 3 DOSIS 3 0

DOSIS 1 0
TOTAL
REMAJA DOSIS 2 0
SELURUHNYA 374
DOSIS 3

DOSIS 1 374
ANAK-ANAK DOSIS 2 0
DOSIS 3
TU) PENERIMA VAKSIN DOSIS 2 (DUA)
TOTAL DOSIS 2
(Semua
Tahapan)
SDM PELAYAN
REMAJA ANAK-ANAK LANSIA
KESEHATAN PUBLIK

% # % # % # % # % # %

110 100 0 0
108 100 0 0
156 100 0 0
0
0
0
0
374 100 0 0 0 0 0
 PENERIMA
MA VAKSIN DOSIS 2 (DUA) VAKSIN DOSIS
TOTAL DOSIS 3 3
CORONAVAC
MASYARAKAT (1 vial 2 dosi
SDM
RENTAN + REMAJA ANAK-ANAK
KESEHATAN
UMUM

Jmlh Vial
# % # % # % # % # %
Terpakai

0 0 55
0 0 54
0 0 78
0
0
0
0
0 0 0 0 0 0 187
 INDEKS PEMAKAIAN VAKSIN BERDASARKAN MEREK

CORONAVAC VAKSIN COVID-19 BF

ASTRA ZENECA (1 vial 8 dosis)
(1 vial 2 dosis) (Multi Dose Vial)

Jmlh Jmlh Jmlh

Jmlh Vial Jmlh Vial
Diimunisa IP Diimunisa IP Diimunisa IP
Terpakai Terpakai
si si si

110 2.0
108 2.0
0.0

218 1.2 0 0 0 0
DASARKAN MEREK

ASTRA ZENECA (1 vial 10 dosis) MODERNA

Jmlh Jmlh
Jmlh Vial Jmlh Vial
Diimunisa IP Diimunisa IP
Terpakai Terpakai
si si

0 0 0
LAPORAN REKAPITULASI HASIL PELAKSANAAN IMUNISASI COVID-19
TINGKAT KABUPATEN / KOTA
KAB/KOTA : SABU RAIJUA
PROVINSI : NUSA TENGGARA TIMUR

PEMAKAIAN VAKSIN & LOGISTIK

JENIS VAKSIN
NO TANGGAL ADS 0,5 ml SAFETY BOX ALCOHOL SWAB
PELAKSANAAN Coronavac (single dose Vial) Vaksin Covid-19 BF (Multi dose Vial) Sinovac 1 vial 2 dosis Moderna Aztra Zeneca (1 vial 10 dosis) Aztra Zeneca (1 vial 8 dosis)

DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI RUSAK SISA DITERIMA DIPAKAI SISA DITERIMA DIPAKAI SISA
(dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis) (dosis)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
1 2/3/2022 0 0 600 8 592 0 0 0 730 190 540 0 1886 217 3 1666 2 2 0 1866 217 1649
2 2/4/2022 0 0 592 4 588 0 1340 160 1180 0 1666 180 2 1484 0 0 1649 180 1469
3 2/7/2022 0 0 588 28 560 0 0 1180 340 840 0 1484 402 2 1080 0 1469 402 1067
4 2/8/2022 0 0 560 10 550 0 0 840 110 730 0 1080 130 950 0 1067 130 937
5 2/9/2022 0 0 950 10 940 0 0 1530 220 1310 0 1750 252 2 1496 5 2 3 1737 252 1485
6 2/10/2022 0 0 940 30 910 0 780 380 400 0 1496 448 3 1045 3 3 0 1485 448 1037
7 2/11/2022 0 0 910 16 894 0 400 180 220 0 1045 214 831 0 1037 214 823
8 2/12/2022 0 0 894 894 0 220 10 210 0 831 10 821 0 823 10 813
9 2/14/2022 0 0 894 110 784 0 0 210 210 0 821 110 711 0 813 110 703
10 2/15/2022 0 0 784 108 676 0 210 210 0 711 108 603 0 703 108 595
11 2/16/2022 0 0 676 156 520 0 0 0 603 156 3 444 0 595 156 439
12 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 8388 480 0 7908 0 0 0 0 7440 1590 0 5850 0 0 0 0 13373 2227 15 11131 10 7 3 13244 2227 11017
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
NAMA PUSKESMAS / FASYANKES :
KAB/KOTA :
PROVINSI :
HARI / TANGGAL :

NO NOMOR TIKET NIK

1 P-0J3PB03P 5320050912140001
2 P-0KMVJ7VT 5320013010140001
3 P-0NBU6WTC 5320055509140001
4 P-0OHQRT81 5320014504150001
5 P-0PEVJI6A 5320015312140002
6 P-0QGYNBMS 5320056107150002
7 P-0QIYCNK5 5320011703150002
8 P-0RT2J0JK 5320010912120002
9 P-0SGQ7TZO 5320051903150001
10 P-0SX52L2X 5320021007130001
11 P-0TH3NNKQ 5320022406100001
12 P-0TZ4BV38 5320055704140001
13 P-0ULVEMMV 5320056101140001
14 P-0XNVGSTP 5320054806140002
15 P-0Y5ODUTV 5320016811130002
16 P-0Z5ZSMQA 5320056307130001
17 P-10GGJOZU 5320014709130003
18 P-11CNQ00X 5320056202150003
19 P-13GEY6UZ 5320010806150001
20 P-14G18DHF 5320056404140001
21 P-15I43TK2 5320023012130001
22 P-15O4OK1G 5320051510130002
23 P-1AOF9HNT 5320055911130001
24 P-1AVPZNV1 5320050602140002
25 P-1D6ZVISD 5320055409140001
26 P-1DJA3Q7G 5320021005130002
27 P-1E8YNAGC 5320015010130001
28 P-1FGM3F6W 5320052706140001
29 P-1G2AVOMN 5320020401130001
30 P-1IQ23JVU 5320022803130001
31 P-1ISKR2KI 5320012708120002
32 P-1K1SOIOL 5320024804120001
33 P-1M3FGRW4 5320022409130001
34 P-1MXMUXV4 5320015501120002
35 P-1O2FTVE6 5320015707130001
36 P-1QJ6PMZ3 5320010910120001
37 P-1S4ECYXY 5320012503130002
38 P-1U92HOCA 5320014711120001
39 P-1VOYL8Y4 5320022610120001
40 P-1XLN83ML 5320016806130002
41 P-1XQ7DOLA 5320027101120001
42 P-1ZBXTFDE 5320011903130003
43 P-1ZKXWPBF 5320021408120002
44 P-21VEXIMA 5320014203130001
45 P-28CNRWYO 532001490712005
46 P-2AAJCI74 5320022408130001
47 P-2BOLOM2A 5320012108130002
48 P-2CR3U491 5371040106130002
49 P-2GP88DF0 5320026305130001
50 P-2GTRNJ5W 5320024411120001
51 P-2HRNZJBE 5320020502130001
52 P-2JILO9AG 5320015202140001
53 P-2MABJLOF 5320024204120001
54 P-2MCSOOT2 5320010811110002
55 P-2O03NICU 5320012411110002
56 P-2POMHTFY 5320010608110003
57 P-2R8OC6M1 5320021005120001
58 P-2SFGVHFK 5320025002120001
59 P-2UHHP8TX 5320020604120001
60 P-2V1ZH9JU 5320012309110004
61 P-2XOTX3LR 5320016202110005
62 P-2XOVYDJ5 5320021206120001
63 P-2ZBL7LFC 5320014507120002
64 P-30B6BLOV 5320015811110004
65 P-33CFT6DK 5320024105120002
66 P-33RD2JQG 5320025804120002
67 P-36EKO1K4 5320026111110001
68 P-3772XGAR 5320016510120001
69 P-38K8FARN 5320024103120001
70 P-3B4RSH0N 5320020504120001
71 P-3F5ZQJJX 5320026608110001
72 P-3FCQBQC5 5320014609110001
73 P-3HL1PAMD 5320020612110001
74 P-3IQHQ9ZS 5320020108100002
75 P-3JWOIBC8 5320020407100001
76 P-3K54YYKX 5320025812100001
77 P-3LN8TZ7T 5320022805110003
78 P-3LPAT95E 5320020912100005
79 P-3MWOSOT0 5320012105110004
80 P-3NNPJ5PM 532001705110001
81 P-3OO1VCAH 5320027001210001
82 P-3QC7JT14 5320022002110005
83 P-3SP049K4 5320011404110001
84 P-3V0JE36M 5320021104110001
85 P-3XLOHKYT 5320015708100001
86 P-3YRPYVLX 5320012104110003
87 P-416OTVFI 5320016601110001
88 P-42FGO221 5320010506100001
89 P-44DU58FR 5320026909100001
90 P-46O9QS2P 5320014508100001
91 P-49BL3N5Y 5320025703110001
92 P-4AJOQ47D 5310116011100001
93 P-4D1LZCSH 5320010407100001
94 P-4EH3ERWN 5320026808100002
95 P-4FFSOK7D 5320020610100004
96 P-4GIK2TPW 5320026905110001
97 P-4IM9MHQ9 5320051110140001
98 P-4OGUW959 5320025802110002
99 P-4VIHZAB5 5320021503100001
100 P-5GZEURRE 5320026805100001
101 P-5I62IG1F 5320021803100002
102 P-5L3SA9CG 5320024806100001
103 P-5MFHH943 5311161507100001
104 P-73HJ1ZVA 5320022707100001
105 P-R1WQ46HX 5320021606100002
106 5320020406100001
107 5320014907010002
108 5320010208130002
109 5320020903100002
110 5320011912100004
111
112
113
114
115
116
117
118
119
120
121
122
123
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135
136
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144
145
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148
149
150
151
152
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531
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552
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592
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600
 LAKSANAAN VAKSINASI COVID-19
SYANKES/POS VAKSINASI
DAIEKO
SABU RAIJUA
NTT
2/14/2022

NAMA PENERIMA VAKSIN JK PEKERJAAN TGL. LAHIR

DONISON WADU L ANAK 12/9/2014

ARISTON A.TARI DJAMI L ANAK 10/30/2014
AGNES L.LOGO P ANAK 9/15/2014
PASKAH APRILYA DJAMI P ANAK 4/5/2015
JUBLINA RIMA P ANAK 12/13/2014
JULIA VIRA LOBO P ANAK 7/21/2015
HERY ARIFIN RAME L ANAK 3/17/2015
DIRLY SEMANUEL BANGNGU L ANAK 12/9/2012
MAKKA HEPE L ANAK 3/19/2015
HANIS KALE L ANAK 7/10/2013
YUNUS KALE L ANAK 6/24/2010
AGUSTINA MANGNGI P ANAK 4/17/2014
AGNES LIMA P ANAK 1/21/2014
MIDELNY BENGU P ANAK 6/8/2014
NELDA N.DIMA RADJA P ANAK 11/28/2013
YUSNITA DIDA P ANAK 7/23/2013
SEPTINE PUNYA P ANAK 9/7/2013
FEBRYANTI ALU P ANAK 2/22/2015
KING JUNIOR TARI L ANAK 6/8/2015
AYU INTAN P ANAK 4/24/2014
DEVENTER RIWU L ANAK 12/30/2013
ARDIMAS SAPUTRA TARRI L ANAK 10/15/2013
DINCE WELE P ANAK 11/19/2013
ALEXIS A.M BENGU L ANAK 2/16/2014
ESTHER BENGU P ANAK 9/14/2014
DONISIUS MONE L ANAK 5/10/2013
BEVERLY O. TAO P ANAK 10/10/2013
JUNIVER BOBO L ANAK 6/27/2014
CHRISTIAN BOBO L ANAK 1/4/2013
MARIO F. BOBO L ANAK 3/28/2013
CHRISTIAN MITA L ANAK 8/27/2012
 APRIANA RIHI P ANAK 4/8/2012
EDUARD R. WADU L ANAK 9/24/2013
FITRI KALE P ANAK 1/15/2012
JULIANI PUTRI NGATI P ANAK 7/17/2013
KRISTIAN NGATI L ANAK 10/9/2012
MELCHIOR AWE L ANAK 3/25/2013
NOVRIN VIVIAN TARI L ANAK 11/7/2012
OKTO E. RUGE L ANAK 10/26/2012
PUTRI RAME P ANAK 6/28/2013
RAFAEL RIWU P ANAK 10/31/2012
RAFLES PADJI L ANAK 3/19/2013
SHARONICA BENGU P ANAK 8/14/2012
TALI OTO P ANAK 3/2/2013
YUNIARTI TARRI DJAMI P ANAK 7/9/2012
ANDREAS LODO L ANAK 8/24/2013
BENEDIKTUS BENGU L ANAK 8/21/2013
CHAVERIUS J.J MALESSY L ANAK 6/1/2013
CHELSY M. MANU P ANAK 5/23/2013
IREN SAPUTRI WADU P ANAK 11/4/2012
JEREMY BENGU L ANAK 2/5/2013
EFELIN RADJA P ANAK 2/12/2014
ALINDA KANA P ANAK 4/2/2012
ANDIKA Y.DIMA L ANAK 11/8/2011
CHRISTOFEL DJAMI L ANAK 11/24/2011
DANI A.LEBA L ANAK 8/6/2011
DAUD A. KALE L ANAK 5/10/2012
FEBRIYANTI BOBO P ANAK 2/10/2012
FRID KAHO L ANAK 4/6/2012
FRITS STEVEN LIRI L ANAK 9/23/2011
GLADIS F.RIMA P ANAK 2/22/2012
INDRHA A. JUNINYHO L ANAK 6/12/2012
MARIA PUNYE P ANAK 7/5/2012
ANDINI LIRI P ANAK 11/18/2011
MARLIN PE P ANAK 5/1/2012
MARSELINA ALU P ANAK 4/13/2012
MELKIANUS BENGU L ANAK 11/21/2011
MICHEL A.DJAMI P ANAK 10/25/2011
NIOLA C. MONE P ANAK 3/1/2012
SAMUEL WADU L ANAK 4/5/2012
SELVI A. TOGE P ANAK 8/26/2011
 STEFANI DJAMI P ANAK 9/6/2011
XAVIER LAO NADA L ANAK 12/6/2011
AGABUS LIMA L ANAK 8/1/2010
ALEXANDER MIHA L ANAK 7/4/2010
BELANDINA WADU P ANAK 12/18/2010
CHRISYANTO RATO L ANAK 5/28/2011
DELVI KRISTIAN MANGNGI L ANAK 12/9/2010
DENNIS TAO L ANAK 5/21/2011
DINDA HAU P ANAK 5/17/2011
ELSI NISA RATU P ANAK 12/30/2010
FADLY RATO L ANAK 2/20/2011
FANDI KORO L ANAK 4/14/2011
GREAND S.RIWU L ANAK 4/11/2011
HUTRI D.RADJA P ANAK 8/17/2010
IAN A. KOLO L ANAK 4/21/2011
JEANTIKA AWE P ANAK 1/26/2011
JUFRIANTO PADJI L ANAK 6/5/2010
MAJESTY BENGU P ANAK 9/19/2010
MARTA PUNYE P ANAK 8/7/2010
NESTIN S .LOBO P ANAK 3/17/2010
NOVI B. BENI P ANAK 11/20/2010
REHUEL DIMA L ANAK 7/14/2010
RINA T.RIHI P ANAK 8/28/2010
TEOVILUS BOBO L ANAK 10/6/2010
TIRZA P.PE P ANAK 5/29/2011
ROSSI I.HAE L ANAK 10/11/2014
RUTH A.HAE P ANAK 2/18/2011
MARIO REIHAN LODO L ANAK 3/15/2010
RINCE PE P ANAK 5/28/2010
RIO MANGNGI L ANAK 3/18/2010
YOSIA RUGE P ANAK 6/8/2010
ANDRE KANA L ANAK 7/15/2010
JELO M.BENGU L ANAK 7/27/2010
EVENSON ALO L ANAK 6/16/2010
FIZZLE E.KAHO L ANAK 6/4/2010
GLADYS P.DJAMI P ANAK 7/9/2010
LAMBERTUS BANGNGU L ANAK 8/2/2010
MARDY MARIO MANGNGI L ANAK 3/9/2010
DOMINGGUS MANGNGI L ANAK 12/19/2010
 Kepesertaan BPJS (tulis 'Ya' pada kolom
KELOMPOK yang sesuai)
UMUR ALAMAT NO. TELEPON / HP BPJS Non
UMUR BPJS PBI
PBI
7 0 DAIEKO 81258021782
7 0 DJADU 81258021782
7 0 DAIEKO 81258021782
6 0 DJADU 81258021782
7 0 DJADU 81258021782
6 0 MOLIE 81258021782
6 0 RAEDEWA 81258021782
9 0 DJADU 81239924044
6 0 DAIEKO 81258021782
8 0 DAIEKO 85389024223
11 0 DAIEKO 81239228125
7 0 MOLIE
8 0 DAIEKO
7 0 DAIEKO
8 0 RAEDEWA
8 0 MOLIE
8 0 RAEDEWA
6 0 DAIEKO
6 0 DJADU
7 0 MOLIE
8 0 DAIEKO
8 0 DAIEKO
8 0 DAIEKO
7 0 DAEIKO
7 0 DAIEKO
8 0 DAIEKO
8 0 DJADU
7 0 DAIEKO
9 0 DAIEKO
8 0 DAIEKO
9 0 DJADU
9 0 DAIEKO
8 0 DAIEKO
10 0 RAEDEWA
8 0 DJADU
9 0 DJADU
8 0 DJADU
9 0 DJADU
9 0 DAIEKO
8 0 RAEDEWA
9 0 DAIEKO
8 0 DJADU
9 0 DAIEKO
8 0 RAEDEWA
9 0 DJADU
8 0 DAIEKO
8 0 DJADU
8 0 DJADU
8 0 DAIEKO
9 0 DAIEKO
9 0 DAIEKO
8 0 RAEDEWA
9 0 MOLIE
10 0 RAEDEWA
10 0 DJADU
10 0 DJADU
9 0 DAIEKO
9 0 DAIEKO
9 0 DAIEKO
10 0 DJADU
9 0 DJADU
9 0 DAIEKO
9 0 RAEDEWA
10 0 DJADU
9 0 DAIEKO
9 0 DAIEKO
10 0 DAIEKO
10 0 DJADU
9 0 DAIEKO
9 0 DAIEKO
10 0 DAIEKO
10 0 DJADU
10 0 PEDARRO
11 0 DAIEKO
11 0 DAIEKO
11 0 DAIEKO
10 0 DAIEKO
11 0 DAIEKO
9 0 DJADU
10 0 DAIEKO
11 0 WADUMADDI
10 0 DAIEKO
10 0 RAEDEWA
10 0 DAIEKO
11 0 RAEDEWA
10 0 DJADU
11 0 DJADU
11 0 DJADU
11 0 DAIEKO
11 0 RAEDEWA
11 0 DAIEKO
11 0 DAIEKO
11 0 RAEDEWA
11 0 DAIEKO
11 0 DAIEKO
10 0 DAIEKO
7 0 MOLIE
10 0 MOLIE
11 0 DAIEKO
11 0 DAIEKO
11 0 MOLIE
11 0 DAIEKO
11 0 DAIEKO
11 0 DAIEKO
11 0 DAIEKO
11 0 DAIEKO
11 0 DJADU
11 0 DJADU
11 0 DAIEKO
11 0 DJADU
JS (tulis 'Ya' pada kolom
Dosis I
ng sesuai) Nama/Jenis/Merek
TGL. SCREENING Tanggal Pemberian
Non Anggota Vaksin***
Vaksinasi
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
2/14/2022 CORONAVAC 2/14/2022
 Dosis I Dosis 2
Tanggal Pemberian
No. Batch No. Serial No. Batch
Vaksinasi
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
202108154P
sis 2 Keterangan
(Ditunda/Tidak Asal Instansi
No. Serial Diberikan/Lanjut)
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
LANJUT SDG LIGU
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
NAMA PUSKESMAS / FASYANKES :
KAB/KOTA :
PROVINSI :
HARI / TANGGAL :

NO NOMOR TIKET NIK

1 P-0J3PB03P 5320050302140001
2 P-0KMVJ7VT 5320026605130001
3 P-0NBU6WTC 5371056501150001
4 P-0OHQRT81 5320051508140001
5 P-0PEVJI6A 5320022907140002
6 P-0QGYNBMS 5320052403150002
7 P-0QIYCNK5 5320020301140002
8 P-0RT2J0JK 5320056412140001
9 P-0SGQ7TZO 5320020706140001
10 P-0SX52L2X 5320011810150001
11 P-0TH3NNKQ 5320052203150001
12 P-0TZ4BV38 5320021805140001
13 P-0ULVEMMV 5320056605150001
14 P-0XNVGSTP 5320055003150001
15 P-0Y5ODUTV 5320024607130001
16 P-0Z5ZSMQA 5320050111140002
17 P-10GGJOZU 5320056111140001
18 P-11CNQ00X 5320022609120002
19 P-13GEY6UZ 5320052803150002
20 P-14G18DHF 5320051412140001
21 P-15I43TK2 5320052410140001
22 P-15O4OK1G 5320024705130001
23 P-1AOF9HNT 5320021308110001
24 P-1AVPZNV1 5320055203130001
25 P-1D6ZVISD 5320014212110003
26 P-1DJA3Q7G 5320026009120001
27 P-1E8YNAGC 5320054301150001
28 P-1FGM3F6W 5320056907140001
29 P-1G2AVOMN 5320025306120003
30 P-1IQ23JVU 5320024408070001
31 P-1ISKR2KI 5320050202150001
32 P-1K1SOIOL 5320021611130001
33 P-1M3FGRW4 5320026008060004
34 P-1MXMUXV4 5320021709120002
35 P-1O2FTVE6 5320056305140001
36 P-1QJ6PMZ3 5320010604140002
37 P-1S4ECYXY 5320026808130001
38 P-1U92HOCA 5320022602140001
39 P-1VOYL8Y4 5320026507130002
40 P-1XLN83ML 5320011805100001
41 P-1XQ7DOLA 5320025701140001
42 P-1ZBXTFDE 5320025201120001
43 P-1ZKXWPBF 5320054605150006
44 P-21VEXIMA 5320015506130001
45 P-28CNRWYO 5320052903140002
46 P-2AAJCI74 5320020303120001
47 P-2BOLOM2A 5320055103140002
48 P-2CR3U491 5320022102120001
49 P-2GP88DF0 5320024110110001
50 P-2GTRNJ5W 5320024309120001
51 P-2HRNZJBE 5320055009130001
52 P-2JILO9AG 5320055206140002
53 P-2MABJLOF 5320025302120001
54 P-2MCSOOT2 5320055508140001
55 P-2O03NICU 5320052312130001
56 P-2POMHTFY 5320026702120002
57 P-2R8OC6M1 5320020102120002
58 P-2SFGVHFK 5320021508110001
59 P-2UHHP8TX 5320020507120001
60 P-2V1ZH9JU 5320021908120001
61 P-2XOTX3LR 5320020611100003
62 P-2XOVYDJ5 5320025407130001
63 P-2ZBL7LFC 5320025602110001
64 P-30B6BLOV 5305025010120001
65 P-33CFT6DK 5320026707120001
66 P-33RD2JQG 5320026612120001
67 P-36EKO1K4 5320021702130001
68 P-3772XGAR 5320026603120002
69 P-38K8FARN 5320051502110002
70 P-3B4RSH0N 5305025806100001
71 P-3F5ZQJJX 5320022308110001
72 P-3FCQBQC5 5320022401130001
73 P-3HL1PAMD 5320026303120003
74 P-3IQHQ9ZS 5320056602120001
75 P-3JWOIBC8 5320026103130001
76 P-3K54YYKX 5320054803150001
77 P-3LN8TZ7T 5320025605100002
78 P-3LPAT95E 5320055501140001
79 P-3MWOSOT0 5320051011120002
80 P-3NNPJ5PM 5320051506100001
81 P-3OO1VCAH 5320026704110001
82 P-3QC7JT14 5320050705110003
83 P-3SP049K4 5320025612100001
84 P-3V0JE36M 5320026002110002
85 P-3XLOHKYT 5320020304110001
86 P-3YRPYVLX 5320024409100001
87 P-416OTVFI 5320022506100003
88 P-42FGO221 5320020110100001
89 P-44DU58FR 5320025405100004
90 P-46O9QS2P 5371025811100001
91 P-49BL3N5Y 5320014401110001
92 P-4AJOQ47D 5320025109100004
93 P-4D1LZCSH 5320020810100002
94 P-4EH3ERWN 5320022008100004
95 P-4FFSOK7D 5320024609100001
96 P-4GIK2TPW 5320026605100001
97 P-4IM9MHQ9 5320025904100002
98 P-4OGUW959 5320022304100001
99 P-4VIHZAB5 5320051303150002
100 P-5GZEURRE 5320052105150001
101 P-5I62IG1F 5320050211140001
102 P-5L3SA9CG 5320022103130002
103 P-5MFHH943 5320054705140001
104 P-73HJ1ZVA 5320022605100003
105 P-R1WQ46HX 5320022104100001
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
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200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
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218
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220
221
222
223
224
225
226
227
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229
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231
232
233
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235
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240
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242
243
244
245
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251
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261
262
263
264
265
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272
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312
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352
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392
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432
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472
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512
513
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531
532
533
534
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537
538
539
540
541
542
543
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550
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552
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560
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569
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579
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588
589
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591
592
593
594
595
596
597
598
599
600
 LAKSANAAN VAKSINASI COVID-19
SYANKES/POS VAKSINASI
DAIEKO
SABU RAIJUA
NTT
2/15/2022

NAMA PENERIMA VAKSIN JK PEKERJAAN TGL. LAHIR

ARIYANTO LORO L ANAK 2/3/2014

MUTIA DJORO ULY P ANAK 5/26/2013
RUTH IMANUELA LULU P ANAK 1/25/2015
BRYAN CHRISTIANO RATU L ANAK 8/15/2014
ALFA JULIANO DOKO L ANAK 7/29/2014
FANKLYAN MARCHSON LAPPA L ANAK 3/24/2015
HILARIUS HUKI DUDU L ANAK 1/3/2014
IRENASTIN CHAROLIN PE P ANAK 12/23/2014
KALVINUS OLA NILO L ANAK 6/7/2014
MARTEN LUTER TALO L ANAK 10/18/2015
MARTIN LODO L ANAK 3/22/2015
MIKAEL KRISPATI RIDHO L ANAK 5/18/2014
MELIANY WILA LOMI P ANAK 5/26/2015
MARETY HERLINCE WATTY P ANAK 3/10/2015
MIKE APRILENS RATU PA P ANAK 7/6/2013
MOSES SHARIS KELO L ANAK 11/1/2014
NOVANTY ECLESIA PE P ANAK 11/21/2014
SEPRIYANTO MARA L ANAK 9/26/2012
RIKARDUS BANU L ANAK 3/28/2015
RIVANDES RATU PA L ANAK 12/14/2014
RIVANUS KANA WILA L ANAK 10/24/2014
TIGE DUBU P ANAK 5/7/2013
ALEXANDER LORO L ANAK 8/13/2011
NADINE CHRISTIANI PE P ANAK 3/12/2013
INGGRID CHRISTIANI SIMATUPANG P ANAK 12/2/2011
MARTHA MITA P ANAK 9/20/2012
VIELLA TRIELIANA RIHI P ANAK 1/3/2015
GRACE DJEHU P ANAK 7/29/2014
YUNITA EUNIKE DOKO P ANAK 6/13/2012
BERTA RATU P ANAK 11/9/2011
STEPANUS YOSUA WILA L ANAK 2/2/2015
 ALDI SAPUTRA WILA L ANAK 11/16/2013
AGUSTINA RIHI P ANAK 8/22/2013
MARTHEN MIHA L ANAK 9/17/2012
ANGGI MERYONES LEBA P ANAK 5/23/2014
DANIEL REKE WAHI L ANAK 4/6/2014
EUNIKE AGUSTINA NILO P ANAK 8/28/2013
GRATIAN CRISTO WATTY L ANAK 2/26/2014
IBU BINU P ANAK 7/25/2013
MELKISEDEK YESYURUN MARA L ANAK 10/8/2010
LINCE JANUANTY WATTY P ANAK 1/17/2014
DORKAS DARIANI KU P ANAK 1/12/2012
MARSOVIA MANGNGI P ANAK 5/6/2015
ZHUSAN JUANI THAMARA P ANAK 6/15/2013
MARSILUS HEPE L ANAK 3/29/2014
CHARIS MARTURIA RATO L ANAK 3/3/2012
NATALIA DIDA P ANAK 3/11/2014
FERDINAND WILA L ANAK 2/21/2012
MINCE DIDA DJAMI KALE P ANAK 11/1/2012
ESTER TOBO P ANAK 9/3/2012
SUMIYATHI ASANTHI KADJA P ANAK 9/10/2013
TABITA HAE P ANAK 6/12/2014
HILARIA VALENTINA WILA DUDU P ANAK 2/13/2012
LISABET WILA P ANAK 8/15/2014
TENTRIDES NGADDE UDJU L ANAK 12/23/2013
FEBI DJU P ANAK 2/27/2012
DEDY VALENTINO RIHI L ANAK 2/1/2012
KORNELIUS WILA L ANAK 8/15/2011
JOSE ARMANDO MARA L ANAK 7/5/2012
ALVRED THYNO MEHE L ANAK 8/19/2012
PETRUS HAE L ANAK 11/6/2010
BETRIANI KRISTINA RATU PA P ANAK 7/14/2013
FANNY AGSELIANI MANGNGI P ANAK 2/16/2011
BOIN OLIVIA MARO P ANAK 10/10/2012
TINA WADU P ANAK 7/27/2012
CHRISTIN NATALIA EMMANUEL EDDO
P ANAK 12/26/2012
HUKY
DOMINGGUS BANU L ANAK 3/17/2013
TRISIA RUGE P ANAK 3/26/2012
FALLEND KOLO L ANAK 2/15/2011
STEPHANNY PAULA MARO P ANAK 6/18/2010
GUSTI HERISON HEPE L ANAK 8/23/2011
 JEVEN JERISON KALE L ANAK 1/24/2013
LITA ROSANDI LODO P ANAK 3/23/2012
MAYA SARLITA KADJA P ANAK 2/26/2012
LISA MANGNGI P ANAK 3/21/2013
MERCHYAN SUSANTY LODO P ANAK 3/8/2015
RUTH SAPUTRI BALE LORO P ANAK 5/16/2010
ANITA SARTIKA LODO P ANAK 1/5/2014
GLEN MEARCHILIN LODO L ANAK 11/10/2012
JORGEN LORENSO LODO L ANAK 6/15/2010
AGNES AFRINA RUGE P ANAK 4/27/2011
ADITYA DEVILTON PE L ANAK 5/7/2011
DESY ANITHA DIDA P ANAK 12/16/2010
FITRIA KRISTIANI LOBO P ANAK 2/20/2011
FARNANDO APRIELO LAPPA L ANAK 4/3/2011
IRENS SANTI TOBO P ANAK 9/4/2010
JONI JEFRISAN RIDHO L ANAK 6/25/2010
JEAN LEARNS NIKOLAS MITA L ANAK 10/1/2010
MARINCE LODO P ANAK 5/14/2010
NONCI AMERTA NARA HEGI P ANAK 11/18/2010
SHIREEN FITRIA MARA P ANAK 1/4/2011
SHANICE JOSEVA RUGE P ANAK 9/11/2010
VIKTOR OKTIANI MEHE L ANAK 8/9/2010
BRIAN SAPUTRA ADITIA KALE L ANAK 8/20/2010
SENI SEPTIANI WATTY P ANAK 9/6/2010
INTAN STONES GRAHAYU BUKY P ANAK 5/26/2010
SEPRIANA MAPE P ANAK 4/19/2010
MARKUS LEDE L ANAK 4/25/2010
RU DJARA L ANAK 3/13/2015
TADIUS NGAHU L ANAK 5/21/2015
VICHAN NOVENTUS RUGE L ANAK 11/2/2014
KALEB PUTRA OPNIEL LODO OMA L ANAK 3/21/2013
ESTER MITA P ANAK 5/7/2014
PUTRA ADERAI DJORO ULY L ANAK 5/26/2010
NYOMAN WEDNESDAY PADA L ANAK 4/21/2010
 Kepesertaan BPJS (tulis 'Ya' pada kolom
KELOMPOK yang sesuai)
UMUR ALAMAT NO. TELEPON / HP BPJS Non
UMUR BPJS PBI
PBI
8 0 082144078282
8 0 082144078282
7 0 085239296123
7 0 082146958543
7 0 085239115651
6 0 085239115651
8 0 085239115651
7 0 081236603709
7 0 081337835894
6 0 082116806066
6 0 081239678287
7 0 085239115651
6 0 085239115651
6 0 085239115651
8 0 082144078282
7 0 081246499029
7 0 081338720171
9 0 082144078282
6 0 081246499029
7 0 081246499029
7 0 081246499029
8 0 082144078282
10 0 082144078282
8 0 081236603709
10 0 085374149576
9 0 082144078282
7 0 081246499029
7 0 081246499029
9 0 082144078282
10 0 081239291789
7 0 081246499029
8 0 081236656912
8 0 081236656912
9 0 082144078282
7 0 081236656912
7 0 081236656912
8 0 081236656912
7 0 081236656912
8 0 081236656912
11 0 081246329959
8 0 081236656912
10 0 081246329959
6 0 085239115651
8 0 082144078282
7 0 081236656912
9 0 081246329959
7 0 081353715692
9 0 081246329959
9 0 082144078282
9 0 081246329959
8 0 081236656912
7 0 081236656912
10 0 082144078282
7 0 081236656912
8 0 081236656912
9 0 081246329959
10 0 082144078282
10 0 082144078282
9 0 082144078282
9 0 082144078282
11 0 082144078282
8 0 082144078282
10 0 081246329959
9 0 081338720171
9 0 082144078282
9 0 082144078282
8 0 082144078282
9 0 082144078282
11 0 081246329959
11 0 082144078282
10 0 082144078282
9 0 082144078282
9 0 082144078282
9 0 082144078282
8 0 082144078282
6 0 085239115651
11 0 082247037781
8 0 081236656912
9 0 082144078282
11 0 082247037781
10 0 082247037781
10 0 082247037781
11 0 082247037781
10 0 082247037781
10 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 082247037781
11 0 081237204523
11 0 081237204523
11 0 081237204523
6 0 085239296123
6 0 081246499029
7 0 081246499029
8 0 082144078282
7 0 085239115651
11 0 082247037781
11 0 081237204523
JS (tulis 'Ya' pada kolom
Dosis I
ng sesuai) Nama/Jenis/Merek
TGL. SCREENING Tanggal Pemberian
Non Anggota Vaksin***
Vaksinasi
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
15/02/2022 CORONAVAC 15/02/2022
 Dosis I Dosis 2
Tanggal Pemberian
No. Batch No. Serial No. Batch
Vaksinasi
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
20109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202108188M
202109188M
202109188M
202109188m
202109188m
202109188M
202109188M
202109188m
202109188m
202109188M
202109188M
202109188M
202109188M
202109188m
202109188m
202109188M
202109188M
202109188M
202109188M
sis 2 Keterangan
(Ditunda/Tidak Asal Instansi
No. Serial Diberikan/Lanjut)
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
LANJUT SDI DAIEKO
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
NAMA PUSKESMAS / FASYANKES :
KAB/KOTA :
PROVINSI :
HARI / TANGGAL :

NO NOMOR TIKET NIK

1 5320050806150001
2 5320050606150001
3 5320050910140001
4 5320052202150001
5 5320054807150002
6 5320055812140001
7 5320050807150002
8 5320051604150001
9 5320055507150001
10 5320050402150002
11 5320050704150002
12 5320050701140001
13 5320051310150001
14 5371022506150004
15 5320055708150001
16 5320050106150001
17 5320055109150002
18 5320051805130001
19 5320054704140002
20 5320054704140001
21 5320050208140003
22 5320024701140001
23 5320053001140002
24 5320021006140001
25 5320050608140001
26 5320055604140001
27 5320025609130002
28 5320026306140001
29 5320055906140002
30 5320054407140002
31 5320051910140001
32 5320052611140001
33 5320056410140002
34 5371021502140002
35 5320051104140001
36 5320052509130001
37 5320056004140002
38 5320055610140001
39 5320056709140001
40 5320057101140001
41 5320050212130001
42 5320022504120001
43 5320024702140001
44 5320055012140001
45 5320053108150001
46 5320054105150001
47 5320056107150001
48 5320055505150003
49 5320020509130001
50 5320050605150001
51 5320052505150003
52 5320054107130001
53 5320050406110001
54 5320025611120002
55 5320021010120001
56 5320055001130001
57 5320054808130001
58 5320022210100004
59 5320025202130002
60 5320054811150001
61 5320055411150001
62 5320021207120001
63 5320051907130001
64 5320021609120001
65 5320055106130001
66 5320022903130001
67 5320065401130001
68 5320025512120002
69 5320023001130001
70 5320050512120001
71 5320024910120001
72 5320022002120003
73 5320021507120002
74 5320025609110001
75 5320020604110001
76 5320025808120001
77 5320024211110001
78 5320022710110001
79 5320024602100001
80 5320022905110003
81 5320021201120002
82 5320056411120001
83 5320022212110001
84 5320064707120001
85 5320056301130002
86 5320052711120002
87 5320020209120001
88 3603141405120003
89 5320021501130001
90 5320020408120001
91 5320025307120002
92 5320021007120001
93 5320024707120002
94 5320054807120001
95 5320022404120001
96 5320021901130001
97 5320025901130001
98 5320024703120002
99 5320056208150001
100 5320022207120002
101 5320026702130001
102 5320025009110001
103 5320024406120003
104 5320026103100001
105 5320020409120001
106 5320025512100002
107 5320018805110002
108 5320026810100001
109 5320024108100001
110 5320027112110003
111 5320020102120004
112 5320026412110003
113 5320021312110004
114 5320024712110002
115 5320026310110001
116 5320024309110002
117 5320055801110002
118 5320021005110002
119 5320020405110002
120 5320026911110003
121 5320026007070001
122 5320021404120001
123 5320052102130001
124 5320020406110001
125 5320020309100003
126 5320024402120002
127 5320025711110002
128 5316014909120002
129 5320025305110002
130 5320027010010002
131 5371022310100001
132 5320056702110001
133 5320021710110001
134 5320020904100002
135 5320021202120001
136 5320026910100001
137 5320024602110001
138 5320064109110002
139 5320024911110002
140 5320026309110002
141 5320020303100001
142 5320022004100001
143 5320021705100004
144 5320024704100004
145 5320024407100001
146 5320025104100001
147 5320024806100002
148 5320024706100004
149 5320025301110002
150 5320025106110002
151 5320027012110001
152 5320020710100002
153 5320056212110001
154 5320026005100002
155 5320021306110002
156 5320025710110001
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
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183
184
185
186
187
188
189
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191
192
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232
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 PELAKSANAAN VAKSINASI COVID-19
FASYANKES/POS VAKSINASI
DAIEKO
SABU RAIJUA
NTT
2/16/2022

NAMA PENERIMA VAKSIN JK PEKERJAAN TGL. LAHIR

ABRAHAM BANGA L ANAK 6/8/2015

ABRAHAM RIHI L ANAK 8/6/2015
ADI RADJA L ANAK 10/9/2014
ALFA GRATIO HUKI L ANAK 2/22/2015
ARCE KADJA KORE P ANAK 7/8/2015
DESRIN KADJA P ANAK 12/18/2014
DIVAN BANGNGU L ANAK 7/8/2015
GRENDAY HIDU L ANAK 4/16/2015
RIKASY LABU P ANAK 7/15/2015
RADIANTO MAKO DAHE L ANAK 2/4/2015
KRISTOVEL DARA LEO L ANAK 4/7/2015
JANUARIUS WEO L ANAK 1/7/2014
RENDY SHAPUTRA LAPE L ANAK 10/13/2015
RIZKY JUNIOR L ANAK 6/25/2015
HUTRI PRISKILA RATU P ANAK 8/17/2015
JUNIOR NGURU PA L ANAK 6/1/2015
FALENTIN BALA KORE P ANAK 9/11/2015
BENYAMIN RUBEN LOMI L ANAK 5/18/2013
AIRIN APRIANI MANGNGI LONI P ANAK 4/7/2014
ASTRID SUSANTY DIDA P ANAK 4/7/2014
ALDEN BERDAT ADO L ANAK 8/2/2014
CENAYA KADJA KORE P ANAK 1/7/2014
MORENO JANUARD KOBU L ANAK 1/30/2014
KAISAR RADJA L ANAK 6/10/2014
CINO KACA SELADA LABU L ANAK 8/6/2014
BERTHA DJAMI DARA P ANAK 4/16/2014
PRISLIA AKNETIA MANGNGI LONI P ANAK 9/16/2013
ESTI IA LOMI P ANAK 8/23/2014
FENTY SUSANTI BIRI PA P ANAK 6/19/2014
FOURD JULIA LABU P ANAK 7/4/2014
DOMINGGU TUDU L ANAK 10/19/2014
 NOLDY ROHI L ANAK 11/28/2014
RANI OLIVIA NEDO P ANAK 10/24/2014
REXY VALENTINO L ANAK 2/15/2014
SEFRIANTO KADJA DIWI L ANAK 4/11/2014
STEVEN REINHARD RADJA L ANAK 9/25/2013
SANTRI WILA P ANAK 4/20/2014
SARA SAPUTRI DIDA P ANAK 10/16/2014
PUTRISIA LEO P ANAK 9/27/2014
TITILSIAN BALA KORE P ANAK 1/31/2014
TOBIAS WELE L ANAK 12/2/2013
WASTI MIHA P ANAK 4/25/2012
ANGELICA MANGNGI P ANAK 2/7/2014
DESWARNI RATU P ANAK 12/10/2014
AKRIS MAMO L ANAK 8/31/2015
ASNAT CECILIA LAY LELE P ANAK 5/1/2016
DJULIA TALO RIHI P ANAK 7/21/2015
VANIA DANIATI KALE P ANAK 5/15/2015
SEPTO FILEMON KALE L ANAK 9/5/2013
APRIYANTO WILA L ANAK 6/6/2015
METZAL YUDISTHIRA WAHI L ANAK 5/25/2015
VIDER YUSLIA WAHI P ANAK 7/1/2013
OKTAFIAN DEFIANDA HADJA L ANAK 6/4/2011
SERLI TUSELA NARA P ANAK 11/16/2012
OKTOVIANUS KOLO L ANAK 10/5/2012
KEYLLA WEO P ANAK 1/10/2013
GRAZELLA ANGGIKA MANGNGI LENA P ANAK 6/8/2013
HAM DJAMI DARA L ANAK 10/12/2010
RUTH DJAMI DARA P ANAK 3/12/2013
CHERIL ERITA ELI LOMI P ANAK 11/8/2015
XELLA VARISKA ELI LOMI P ANAK 11/14/2015
HOSEA MANGNGI LENA L ANAK 7/12/2012
SEFEN MARIANTO RADJA L ANAK 7/19/2013
SEM KADJA LOMI L ANAK 9/16/2012
JUNINGSI REANATI HAE P ANAK 9/11/2013
PILUS DULE L ANAK 2/13/2013
JENNY KARMENLIA LEO DJA P ANAK 1/14/2013
BEVERLIN FERLINSIA NARA LEDE P ANAK 12/15/2012
CRISTIAN DARA LEO L ANAK 1/30/2013
ADITYA KALE L ANAK 12/5/2012
CINDY TETOMANU BATA LOMI P ANAK 10/9/2012
 BONA SATIA KALE L ANAK 2/20/2012
ARGA JUANDRI BANGNGU L ANAK 7/15/2012
SELVIANI DIDA P ANAK 9/16/2011
ANDERSHON PASKALINO LEDE L ANAK 4/6/2011
AKGNES LOBO P ANAK 6/18/2012
ESTER DJARA KORE P ANAK 11/2/2011
HEPI BALA KORE L ANAK 10/27/2011
MARSELIN BALA KORE P ANAK 2/6/2011
RENHART DADI LELE L ANAK 5/29/2011
RODJAK DJARA KORE L ANAK 1/12/2012
DELIMA NOVITA SARI LOBO P ANAK 11/24/2012
DIDIMUS ROHI L ANAK 12/22/2011
AYRYN SUKITA ELY LOMI P ANAK 7/7/2012
SILVIA CLAUDIA ADO P ANAK 1/23/2013
ROFINUS MAMO L ANAK 11/27/2012
SETIAN WEO L ANAK 9/2/2012
ELBERTH MELANO BUTAK BUNAN L ANAK 5/14/2012
RISKI WILA LADO L ANAK 1/15/2013
PUTRA RADJA L ANAK 8/4/2012
NURHAYATI DJAMI LELE P ANAK 7/13/2012
YANDRI OKTOVIANUS RATU L ANAK 10/7/2012
JHULYET FLORENCE MANGNGI P ANAK 7/7/2012
SRI YULIANTI RATU P ANAK 7/8/2012
HABEL DIDA L ANAK 4/24/2012
JAVER HERNANDES PADJI DOGI L ANAK 1/19/2013
JEVIN CAROL PADJI DOGI P ANAK 1/19/2013
GRACE ARSITA LIMA P ANAK 3/7/2012
TANIA KABA MANGNGI P ANAK 8/22/2015
DOMISIUS WILA L ANAK 7/27/2012
CRISTIANI KADJA KORE P ANAK 2/27/2013
AGNESIA SUSANTI BANGNGU P ANAK 9/10/2011
ENJELITA KABA MANGNGI P ANAK 6/4/2012
YULIANTA KABA MANGNGI P ANAK 3/21/2010
DANIEL KADJA LOMI L ANAK 9/4/2012
ANATASYA SIPUTRI LULU P ANAK 12/15/2011
ARNOL DJAMI DARA L ANAK 5/8/2011
CIKA SARTIKA NGURU PARA P ANAK 10/28/2010
AGUSTINA HIDU P ANAK 8/1/2010
AURELIA CALISTA WELE P ANAK 12/31/2011
ARISON ADO L ANAK 1/2/2012
 BLANTIKA KADJA KORE P ANAK 12/24/2011
DESMON WELE L ANAK 12/13/2011
FIONIKRA KHARIGMA BUNGA P ANAK 12/7/2011
CHINDY CLAUDIA WELEM P ANAK 10/23/2011
FLORIDA DARA LEO P ANAK 9/13/2011
INDAH DWI PUTRIA LABU P ANAK 1/18/2011
DJANE BUKY L ANAK 5/10/2011
HARIS RADJA L ANAK 5/4/2011
FILA RATU BUNGA P ANAK 11/29/2011
TABITA TUDU P ANAK 7/20/2010
IRZAT ADO L ANAK 4/14/2012
MARYO FEBRIAN SAPUTRA MARA L ANAK 2/21/2013
JEISPER DRAGON KALE DITA L ANAK 6/4/2011
JOSHUA SILVESTER LABU L ANAK 9/3/2010
KIREY PADJI LOMI P ANAK 2/4/2012
MISEHEL KAROLIN LEO P ANAK 11/17/2011
YOLANDA SANDRINA WELE P ANAK 9/19/2012
NOVITA MANGNGI LENA P ANAK 5/13/2011
MARZA BATA LOMI P ANAK 10/30/2011
OKNI NOGO L ANAK 10/23/2010
MARISCHKA FEBRIANTI MARSELINA MARA P ANAK 2/27/2011
SIXTON LABU L ANAK 10/17/2011
ANDRA MANGNGI L ANAK 4/9/2010
VALENTINO KADJA DIWI L ANAK 2/12/2012
TIME AVENTI LABU P ANAK 10/29/2010
TIFFANY LEWO DJO P ANAK 2/6/2011
CINTA DEMIAN BOLE P ANAK 9/1/2011
SELFI FLORIDA LAPE P ANAK 11/9/2011
SELVIN WADU P ANAK 9/13/2011
KENNARD PROSPER DIDA L ANAK 3/3/2010
AGIL S. KALE L ANAK 4/20/2010
FREDIKA S. LOBO L ANAK 5/17/2010
MISREL AINI KOBU P ANAK 4/7/2010
INGGRID E. KADJA DIWI P ANAK 7/4/2010
NAVA S. LAY P ANAK 4/11/2010
PUTRI J.A. PIDU P ANAK 6/8/2010
FALERENSIA NARA LEDE P ANAK 6/7/2010
VENTY DJAMI LELE P ANAK 1/13/2011
REINA RATU BUNGA P ANAK 8/11/2011
RISKA GLORIA RADJA P ANAK 12/30/2011
 OKTOVIANUS LABU L ANAK 10/7/2010
PUTRI AGNESIA WILA P ANAK 12/22/2011
GIZELA PRISKILA WEO P ANAK 5/20/2010
YERIKO KADJA KORE L ANAK 6/13/2011
YANSELIN NGURU P ANAK 10/17/2011
 Kepesertaan BPJS (tulis 'Ya' pada kolom
KELOMPOK yang sesuai)
UMUR ALAMAT NO. TELEPON / HP BPJS Non
UMUR BPJS PBI
PBI
6 0 LOBOHEDE 081246351790
6 0 LEDERAGA 081246351790
7 0 LOBOHEDE 081246351790
6 0 LOBOHEDE 081246351790
6 0 LEDERAGA 081246351790
7 0 LOBOHEDE 081246351790
6 0 LEDERAGA 081246351790
6 0 LOBOHEDE 081246351790
6 0 LOBOHEDE 081246351790
7 0 LEDERAGA 081246351790
6 0 LEDERAGA 081246351790
8 0 LEDERAGA 081246351790
6 0 LEDERAGA 081246351790
6 0 LEDERAGA 081246351790
6 0 LEDERAGA 081246351790
6 0 LOBOHEDE 081246351790
6 0 LEDERAGA 081246351790
8 0 LEDERAGA 081246351790
7 0 LOBOHEDE 081246351790
7 0 LOBOHEDE KELAS 2
7 0 LOBOHEDE KELAS 2
8 0 LOBOHEDE KELAS 2
8 0 LEDERAGA KELAS 2
7 0 LOBOHEDE KELAS 2
7 0 LOBOHEDE KELAS 2
7 0 LEDERAGA KELAS 2
8 0 LOBOHEDE KELAS 2
7 0 LEDERAGA KELAS 2
7 0 LEDERAGA KELAS 2
7 0 LOBOHEDE KELAS 2
7 0 LEDERAGA KELAS 2
7 0 LEDERAGA KELAS 2
7 0 LEDERAGA KELAS 2
8 0 LEDERAGA KELAS 2
7 0 LEDERAGA KELAS 2
8 0 LOBOHEDE KELAS 2
7 0 LOBOHEDE KELAS 2
7 0 LEDERAGA KELAS 2
7 0 LEDERAGA KELAS 2
8 0 LEDERAGA KELAS 2
8 0 LEDERAGA KELAS 2
9 0 LEDERAGA KELAS 2
8 0 LEDERAGA KELAS 2
7 0 LEDERAGA KELAS 2
6 0 LOBOHEDE 081246351790
5 0 LOBOHEDE 081246351790
6 0 LEDERAGA 081246351790
6 0 LOBOHEDE 081246351790
8 0 LOBOHEDE 082298318748
6 0 LEDERAGA 081246351790
6 0 LOBOHEDE 081246351790
8 0 LOBOHEDE 082298318748
10 0 LOBOHEDE 81246686319
9 0 LOBOHEDE 81246686319
9 0 LEDERAGA 81246686319
9 0 LEDERAGA 81246686319
8 0 LOBOHEDE 81246686319
11 0 LEDERAGA 81246686319
8 0 LEDERAGA 082298318748
6 0 LEDERAGA 082298318748
6 0 LEDERAGA 082298318748
9 0 LOBOHEDE 81246686319
8 0 LEDERAGA 81246686319
9 0 LEDERAGA 81246686319
8 0 LOBOHEDE 81246686319
9 0 LEDERAGA 81246686319
9 0 LEDERAGA 81246686319
9 0 LOBOHEDE 81246686319
9 0 LEDERAGA 81246686319
9 0 LOBOHEDE 81246686319
9 0 LEDERAGA 81246686319
9 0 LOBOHEDE 81246686319
9 0 LEDERAGA 81246686319
10 0 LOBOHEDE 81246686319
10 0 LOBOHEDE 81246686319
9 0 LEDERAGA 81246686319
10 0 LOBOHEDE 81246686319
10 0 LEDERAGA 81246686319
11 0 LEDERAGA 81246686319
10 0 LOBOHEDE 81246686319
10 0 LOBOHEDE 81246686319
9 0 LOBOHEDE 81246686319
10 0 LEDERAGA 81246686319
9 0 LEDERAGA 81246686319
9 0 LOBOHEDE 82147025617
9 0 LOBOHEDE 82147025617
9 0 LEDERAGA 82147025617
9 0 LOBOHEDE 82147025617
9 0 LEDERAGA 82147025617
9 0 LOBOHEDE 82147025617
9 0 LEDERAGA 82147025617
9 0 LEDERAGA 82147025617
9 0 LOBOHEDE 82147025617
9 0 LEDERAGA 82147025617
9 0 LEDERAGA 82147025617
9 0 TANAJAWA 82147025617
9 0 TANAJAWA 82147025617
9 0 LOBOHEDE 82147025617
6 0 LEDERAGA 081246351790
9 0 LEDERAGA 82147025617
8 0 LEDERAGA 82147025617
10 0 LEDERAGA 82147025617
9 0 LEDERAGA 82147025617
11 0 LEDERAGA 85239548469
9 0 LEDERAGA 81246686319
10 0 LOBOHEDE 85239548469
10 0 LEDERAGA 85239548469
11 0 LOBOHEDE 85239548469
11 0 LOBOHEDE 85239548469
10 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
10 0 LOBOHEDE 85239548469
10 0 LEDERAGA 85239548469
10 0 LOBOHEDE 85239548469
10 0 LOBOHEDE 85239548469
10 0 LEDERAGA 85239548469
11 0 LOBOHEDE 85239548469
10 0 RAMEDUE 85239548469
10 0 LEDERAGA 85239548469
10 0 LOBOHEDE 85239548469
11 0 LEDERAGA 85239548469
9 0 LOBOHEDE 85239548469
8 0 LOBOHEDE 082298318748
10 0 LEDERAGA 85239548469
11 0 LOBOHEDE 85239548469
10 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
9 0 LEDERAGA 4B
10 0 LOBOHEDE 85239548469
10 0 LEDERAGA 85239548469
11 0 LEDERAGA 85239548469
10 0 LOBOHEDE 85239548469
10 0 LOBOHEDE 85239548469
11 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
11 0 LOBOHEDE 85239548469
11 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
11 0 LOBOHEDE 85239548469
11 0 LOBOHEDE 85239548469
11 0 LOBOHEDE 85239548469
11 0 LEDERAGA 85239548469
11 0 LEDERAGA 85239548469
11 0 LOBOHEDE 85239548469
11 0 LOBOHEDE 85239548469
11 0 LOBOHEDE 85239548469
11 0 LEDERAGA 85239548469
10 0 LOBOHEDE 85239548469
10 0 LOBOHEDE 85239548469
11 0 LOBOHEDE 85239548469
10 0 LOBOHEDE 85239548469
11 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
10 0 LEDERAGA 85239548469
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
122 0
JS (tulis 'Ya' pada kolom
Dosis I
ng sesuai) Nama/Jenis/Merek
TGL. SCREENING Tanggal Pemberian
Non Anggota Vaksin***
Vaksinasi
2/16/2022 CORONAVAC 2/16/2022
CORONAVAC 2/16/2022
CORONAVAC 2/16/2022
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 Dosis I Dosis 2
Tanggal Pemberian
No. Batch No. Serial No. Batch
Vaksinasi
202109154P
202109154P
202109154P
202109154P
202109154P
202109154P
202109154P
202109154P
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
202109188M
sis 2 Keterangan
(Ditunda/Tidak Asal Instansi
No. Serial Diberikan/Lanjut)
LANJUT SDN LEDERAGA
LANJUT
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