FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS /FASYANKES/ POS VAKSINASI

Nama Puskesmas/ Fasyankes/Pos : Puskesmas Wolio

Kab/ Kota : Baubau
Propinsi : Sulawesi Tenggara
Bulan 26 DESEMBER 2022
Lokasi : Puskesmas Wolio

Umur
No No. Tiket NIK Nama Penerima Vaksin JK Pekerjaan* Alamat No. Hp
1
Q-000E3VF5 740316******0001 ARIFIN LA MANISI 26 082350128334

2
Q-001PHUOZ 747206******0001 WA ODE FAJAR ANDRIANI 22 081340407136

3 IRT JLN. GATOT SUBROTO

Q-002KFP8S 7471034909970004 NILAN SARI 25 085241995192

4
Q-003CHIB7 747206******0002 MARIFAT F 39 085656326148

5 JLN. GATOT SUBROTO

Q-003CHKC9 7472020107730046 LA YASA 50 082399985544

6 JLN. BAKTI ABRI

RX-000HNL0 7472025012810002 MEGAWATI 41 085342406827

7
RX-000T869 747206******0003 FIFIYANTI 38 085395331539

8 JL. PAHLAWAN
UU-0061QF3 7472022912760001 ABDUL BAYNAL 46 085824277925

9 KEL. WANGKANAPI
UU-0061RSY 7472052405640001 MASRIN 58 085242882609

TA MAHASISWA KEL. LAMANGGA

UU-006S61Y 7472060204960003 ASMON A M 26 081356111970

11
UU-008JA33 747202******0005 WA ODE BELIAWATI SALBIYAH 27 082344344837

12
UU-009P20L 740614******0001 NOVA PRIHATIN DAWASA 26 082291556571

13
UU-00ATM41 747202******0001 REGITA ANJANI ANWAR 23 082293289056

14
UU-00BZK0W 747208******0001 ERIK DJUNAEDI 22 082198890740

15 KEL. TARAFU
UU-00LWE9A 7472061103980002 MUH. CHAIRIL SADANG 25 082230808843

16
UU-00LWM1V 747206******0003 LA ODE BANDRI SH MSi 53 082193224576

17
UU-00MGRPJ 530718******0001 ROBERT JONSON PUTRA 21 0895384897849

18
UU-00YE6TP 740424******0001 RAHAYU KURNIAWATI 25 082386714089

19
UU-019XW29 747202******0003 Alfiana 35 085341210612

20
UU-01FDR32 747202******0001 FAJAR JAMAL 25 085298272321

21
UU-01H8QP9 637103******0007 HANIFA 49 082344333353

22
UU-01IW8D5 740431******0001 NINING SEPTIANI KONTJE 26 081335231600

23 IRT KEL. LIPU

UU-01JJ4PN 7406066309930002 LILIS KARLINA 29 085395225618

24 KEL. LAMANGGA
UU-01PAA7I 7404240107660005 JUNAEDI 56 082386714089

25 JL. GATOT SUBROTO

UU-01QMLOG 7472024308980001 SATRIANA 24 082271201918

26
UU-01QUR5Q 747202******0001 ZULFIKAR 25 081387672887

27 KEL. TALAGA RAYA

UU-022C3CA 7404184107560014 WA MOU 66 085342547132

28
UU-022VK0L 747206******0003 SUFIATI 38 085241579288

29 KEL. BWI
UU-025BLK5 7472024809810001 WA ODE DARWIAH 41 081355461670

30
Z-000CJ0WN 747204******0001 HADIJAH 37 081241343065

31

32
D-19

Dosis I N Dosis 2 Dosis 3

Keterangan
o
(
.
Ditunda/Tidak
Tanggal Screening Nama/Jenis/Merek Vaksin***
Tanggal Tanggal Tanggal diberikan/lanj
S Pemberian No.
Pemberian No. Batch e Vaksinasi
No. Batch Pemberian No. Batch
Serial
ut)
Vaksinasi Vaksinasi
r
i
a
l
26/12/2022 COVID-19 Vaccine Pfizer FX2761 2

26/12/2022 COVID-19 Vaccine Pfizer FX2761 2

26/12/2022 COVID-19 Vaccine Pfizer FX2761 2

26/12/2022 COVID-19 Vaccine Pfizer FX2761 2

26/12/2022 COVID-19 Vaccine Pfizer FX2761 2

26/12/2022 COVID-19 Vaccine Pfizer FX2761 4

26/12/2022 COVID-19 Vaccine Pfizer FX2761 4

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 3

26/12/2022 COVID-19 Vaccine Pfizer FX2761 2

 FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS /FASYANKES/ POS VAKSINASI

Nama Puskesmas/ Fasyankes/Pos : Puskesmas Wolio

Kab/ Kota : Baubau
Propinsi : Sulawesi Tenggara
Bulan : 15 DESEMBER 2022
Lokasi : Puskesmas Wolio

Dosis I N Dosis 2 Dosis 3

Keterangan
o
(
.
Umur Ditunda/Tidak
No No. Tiket NIK Nama Penerima Vaksin JK Pekerjaan* Alamat No. Hp Tanggal Screening Nama/Jenis/Merek Vaksin***
Tanggal Tanggal Tanggal diberikan/lanj
S Pemberian No.
Pemberian No. Batch e Vaksinasi
No. Batch Pemberian No. Batch
Serial
ut)
Vaksinasi Vaksinasi
r
i
a
l

1 SWASTA KEL. LAMANGGA

UL-003VEOO 7472060107550079 SUTARDI 67 08179455789 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

2 PNS JLN. PAHLAWAN

UU-0061PAB 7472020608720001 LA NIU 50 081244454765 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

3 IRT KEL. LAMANGGA

UU-00LVZ6D 7472064107626090 SURATMI 60 08179455789 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

4 BELUM BEKERJA WANGKANAPI

UU-01DXIRN 7472024108970001 MIRNA IBRAHIM 25 082239209537 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

5 IRT LRG. HOGA

UU-01E1IN2 7407064808920001 DEWIANI 30 085346132941 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

6 BELUM BEKERJA JLN. KELAPA

UU-01GYY1R 7472026512030002 NURUL HIDAYAH 19 0822961770005 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

7 IRT JLN. LAMANGGA

UU-020RQ6R 7472024107760040 NUR AINI 45 082199287533 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

8 MAHASISWA JLN. DIPONEGORO

UU-021WP0N 7472024504040001 WD.NURUL MUNTIA AULIA 18 081355741005 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

9 SWASTA KEL. BWI

UU-0238ZWB 7472020806730001 JAMUDIN 49 082349178163 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

10
UU-023V11M 352209******0001 HAFIDZ MUAWWINUDDIN 21 085850706018 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

11 SUPIR LASALIMU SELATAN

UU-0240E5F 8106012503950002 LA ARMIN 27 081244859944 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

12
UU-024PJGL 747202******0002 AMINUDIN 33 081344545841 15/12/2022 COVID-19 Vaccine Pfizer 15/12/2022 FX276I 3

13

14

15

16

17

18

19

20

21

22