PENCATATAN DAN PELAPORAN PELAYANAN VAKSINASI BAGI GURU DI KABUPATEN SUMBAWA

Puskesmas : TARANO
Tanggal : 07 JANUARI 2022

KEPERSERTAAN BPJS
(TULIS "YA" PADA KOLOM DOSIS I DOSIS 2
YANG SESUAI) KETERANGAN (DITUNDA/TIDAK
NAMA PENERIMA VAKSIN (SESUAI JENIS TANGGAL
NO NO. REGISTRASI NO. REGISTRASI NIK KTP) KELAMIN TANGGAL LAHIR PEKERJAAN ALAMAT (SESUAI KTP) NO. HP MEREK VAKSIN SCREENING DIBERIKAN/LANJUT), JELASKAN ALASAN BILA
BPJS NON TANGGAL DITUNDA/TIDAK DIBERIKAN
TGL PEMBERIAN
BPJS PBI NON ANGGO VAKSINASI NO. BATCH PEMBERIAN NO BATCH
PBI TA VAKSINASI

1 5204251209770001 IS HARYANTO L 12/9/1977 MU LABUHAN BONTONG 82340903533 PFIZER 12/12/2021 12/12/2021 FF8847 7/1/2022 FL5333

2 5204250708930001 FISKA ARYA P L 7/8/1993 MU LABUHAN BONTONG PFIZER 11/12/2021 FF8847 FL5333

3 5204250507790001 SUPRIYONO L 5/7/1979 MU LABUHAN BONTONG PFIZER 12/12/2021 FF8847 FL5333

4 5204251007930002 FIAN B L 10/7/1993 MU LABUHAN BONTONG PFIZER FF8847 FL5333

5 5204252808960001 IRFAN L 28-08-1996 MU DUSUN PARANG B, LABUHAN BONTONG 85238205713 BIO 7/1/2022 7/1/2022 202106B1351

6 5204252704000002 HAPPY VICTOR L 27-04-2000 MU DUSUN PARANG ATAS, LABUHAN BONTONG 85338130889 BIO 7/1/2022 7/1/2022

7 5204254710730001 AMINAH P 7/10/1973 MU LABUHAN BONTONG PFIZER 7/1/2022 FL5333

8 5204251512980002 KURNIAWAN EKA PUTRA L 15-12-1998 MU DUSUN BONTO 85239999497 BIO 7/1/2022 7/1/2022

9 5204250107530008 SYAMSUDDIN S L 1/7/1953 LANSIA LABUHAN BONTONG 81246100121 SINOVAC 7/1/2021 7/1/2022

10 5204255208980001 HASTIN AKADIANA P 12/8/1998 MU DUSUN PARANG B, LABUHAN BONTONG SINOVAC 7/1/2022

11 5204251402730001 SELAMET RIYASTONO L 14-02-1973 MU DUSUN PARANG ATAS, LABUHAN BONTONG 15-12-2021 PFIZER 7/1/2021 FL5333

12 5204250707620004 SAHABUDDIN L 7/7/1962 MU LABUHAN BONTONG 11/12/2021 PFIZER 7/1/2021 FL5333

13 5204254305780001 SRI HARTATI P 3/5/1978 MU LABUHAN BONTONG PFIZER FL5333

14 5204254705760002 SUHARNI P 7/5/1976 MU LABUHAN BONTONG PFIZER FL5333

15 520410640280001 HAMIDA P 24-02-1980 MU LABUHAN BONTONG PFIZER FL5333

16 5204255001620002 NURBAYA P 10/1/1962 MU DUSUN PARANG B, LABUHAN BONTONG 85337004635 BIO 7/1/2022 7/1/2022

17 5204254901660001 HENDUN P 9/1/1966 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER FL5333

18 5204250107650006 SYAMSUDIN M SAID L 1/7/1965 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER 7/1/2022 FL5333

19 5204140304960001 BIMO PRASETIA DIMANSYAH L 3/4/1996 MU LABUHAN BONTONG 12/12/2021 PFIZER FL5333

20 5204256703060002 SRI SULISTIAWATI P 27-03-2006 REMAJA LABUHAN BONTONG SINOVAC 29-10-2021 SINOVAC

21 5204254603040001 WAHYUNINGSIH P 6/3/2004 REMAJA LABUHAN BONTONG 11/12/2021 PFIZER FL5333

22 5204146412990003 ENI SUHERNI P 24-12-1999 MU LABUHAN BONTONG 11/12/2021 PFIZER FL5333

23 5204254107480007 BINTI P 1/7/1948 LANSIA LABUHAN BONTONG 81246100121 SINOVAC 7/1/2022 7/1/2022

24 5204251705000001 EKI WAHYUDI P 17-05-2000 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER FL5333

25 5204251204800002 IBRAHIM L 12/4/1980 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER FL5333

26 5204255610000001 USWATUN HASANAH P 16-10-2000 MU DUSUN PARANG ATAS, LABUHAN BONTONG 85238797934 BIO 7/1/2021 7/1/2022

27 5204251502990001 DANDI ARDIANSYAH L 15-02-99 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER FL5333

28 5204254706030001 MALASARI P 7/6/2003 MU LABUHAN BONTONG SINOVAC 29-10-21 SINOVAC

29 5204142408860001 SAEFULLAH L 24-08-1986 MU LABUHAN BONTONG 82340513314 PFIZER 11/12/2021 PFIZER

30 5204254908500001 FATMA P 9/8/1950 LANSIA LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

31 5204256010780001 JAMARIAH P 20-10-1978 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

32 5204251507750002 MARWAN L 15-07-1975 MU DUSUN PARANG B, LABUHAN BONTONG PFIZER 15-12-21 PFIZER

33 52042559099910001 NOVI SUSANTI L P 19-09-1991 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

34 5204264512800006 SANTI P 5/12/1980 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

35 5204255307040001 MARLIYA P 13-07-04 REMAJA LABUHAN BONTONG SINOVAC 29-10-21 SINOVAC

36 5204251207640001 JAMALUDDIN L 12/7/1964 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

37 5204250307680001 SUDIRMAN L 3/7/1968 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

38 5204256409990001 HUSNUL MA'AF P 24-09-99 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

39 5204251207780003 MASIARA L 12/7/1978 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

40 5204143007930002 ANDI AZIS L 30-07-93 MU LABUHAN BONTONG PFIZER 16-12-21 PFIZER

41 5204254107670008 KAMASIA P 1/7/1967 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

42 5204253101960001 ERI SAPUTRA L 31-01-96 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

43 5204251408000003 ADRI ADE W L 14-06-2000 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

44 5204254606880001 YULIATTI P 6/6/1988 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

45 5204252707860003 FAISIN L 27-07-86 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

46 5204250107630035 USMAN L 1/7/1963 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

47 5204255111760001 HARTATI P 11/11/1976 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

48 5204250107800010 SAIPUDIN B L 1/7/1980 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

49 5204251606040002 DANDA L 16-06-2004 REMAJA DUSUN BONTONG, LABUHAN BONTONG 85238188505 BIO 7/1/2022 7/1/2022

50 5204250702540001 A WAHAB L 7/2/1954 LANSIA DUSUN PARANG ATAS, LABUHAN BONTONG 81246100121 BIO 7/1/2022 7/1/2022

51 5204250704740001 ERDY SUFRIADI L 7/4/1974 MU DUSUN TARANO, LABUHAN BONTONG 81353200697 BIO 7/1/2022 7/1/2022

52 5204251407930002 YUD PARTA WIJAYA L 14-07-93 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

53 5204255501790002 SRI MULYANTI P 15-01-79 MU LABUHAN BONTONG SINOVAC 27-11-21 SINOVAC

54 5204250510020001 JUHARDIANSYAH L 5/10/2002 MU LABUHAN BONTONG SINOVAC 12/7/2021 SINOVAC

55 5204255406820001 ERLIYANTINI P 14-06-82 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

56 5204256207020002 YOVI AMITASARI P 12/7/2002 MU LABUHAN BONTONG PFIZER 8/12/2021 PFIZER

57 5204252204860003 LIASANAPIAH L 22-04-1986 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

58 5312110808980001 DANIAL DATU PUKAR L 8/8/1988 MU LABUHAN BONTONG SINOVAC 12/10/2021 SINOVAC

59 5204250706040002 ARJUNA SAPUTRA L 7/6/2004 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

60 5204250107600039 MASJI BOLANG L 1/7/1960 LANSIA LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

61 5204185111820001 RADIYAWATI P 11/11/1982 MU LABUHAN BONTONG PFIZER 16-12-21 PFIZER

62 5204140204830001 HERWANDI L 2/4/1983 MU LABUHAN BONTONG PFIZER 16-12-21 PFIZER

63 5204255707740001 NURMAWATI P 17-7-74 MU LABUHAN BONTONG PFIZER 16-12-21 PFIZER

64 5204254306780001 HERIA M AMIN P 3/6/1978 MU LABUHAN BONTONG PFIZER 16-12-21 PFIZER

65 5204251005890001 RUDI HARTONO L 10/5/1989 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

66 5204252107040001 SAIDIL KAMAL L 21-07-04 REMAJA LABUHAN BONTONG SINOVAC 1/10/2021 SINOVAC

67 5204251901860001 ARDIAN KUSUMAH L 19-01-86 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

68 5204252411030001 FITRA RAMDANI L 24-11-2003 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

69 5204251112950002 HAMDIL FIKRI L 11/12/1995 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

70 5272021006040001 M FIRDAUS L REMAJA LABUHAN BONTONG PFIZER PFIZER

71 5204140705980001 DERI DWI STIAWAN L MU NYERINYING PFIZER 7/1/2021

72 5204254303070001 AMEL PUTRI AYU P 3/3/2007 REMAJA LABUHAN BONTONG SINOVAC 29-10-21 SINOVAC

73 5204255008950001 ROSA NITA P 10/8/1995 MU LABUHAN BONTONG SINOVAC 11/12/2021 SINOVAC

74 5204252805970001 DIKI HERWANSYAH L 28-05-97 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

75 5204251705770002 A KASUM HUSAIN L 17-05-77 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

76 5204252908040001 CANDRA IRAWAN L 29-08-2004 REMAJA LABUHAN BONTONG PFIZER 16-12-21 PFIZER

77 520425410020001 FIRMANSYAH L 24-10-02 MU LABUHAN BONTONG PFIZER 14-12-21 PFIZER

78 5204255004950001 IRAWANSYAH L MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

79 5204250107750034 SAHARUDDIN L MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

80 5204140811940001 SADAM L 5/9/1993 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

81 5204250707860002 ISHAK L 7/7/1986 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

82 5204252806780001 ZUBAIDI L 28-06-78 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER

83 5204252912970001 OSI SAPUTRA L 29-12-97 MU LABUHAN BONTONG PFIZER 15-12-21 PFIZER

84 5204252005010003 DEDI SUSANTO L 20-05-2001 MU LABUHAN BONTONG PFIZER 12-12=21 PFIZER

85 5204256912930001 NUNUNG HERMAYANI P 29-12-93 MU LABUHAN BONTONG PFIZER 11/12/2021 PFIZER

86 5204251110850002 GUNDIYANTO L 11/10/1985 MU LABUHAN BONTONG PFIZER 12/12/2021 PFIZER