LAPORAN BULANAN

REKAPITULASI IMUNISASI BAYI BALITA DI PUSKESMAS DAN JEJARINGNYA

UPTD PUSKESMAS PEOT

SATAR PEOT GURUNG LIWUT RANA MASAK BANGKA KANTAR COMPANG KANTAR Luar Wilayah TOTAL
No Elemen Data
L P L P L P L P L P L P L P L+P
I Imunisasi

1 Hb (0 ˂ 7 Hari) 4 5 3 4 2 2 1 3 1 1 12 12 11 15 26

2 BCG 5 3 0 7 0 0 4 4 0 0 9 14 23
3 DPT1/Hb1 - HiB1 (Pentavalen1)
0 0 0 0 0 0 0 0 0 0 0 0 0
4 DPT1/Hb2 - HiB1 (Pentavalen2)
0 0 0 0 0 0 0 0 0 0 0 0 0
5 DPT1/Hb3 - HiB1 (Pentavalen3)
0 0 0 0 0 0 0 0 0 0 0 0 0

6 Polio 1 4 2 0 7 0 0 3 3 2 0 9 12 21

7 Polio 2 3 4 4 1 3 3 5 2 1 1 16 16 32

8 Polio 3 5 4 0 2 0 1 1 2 2 2 8 11 19

9 Polio 4 6 5 4 1 0 1 2 3 2 0 14 10 24

10 Rotavirus 1 0 0 0 0 0 0 0 0 0 0 0 0 0

Rotavirus 2 0 0 0 0 0 0 0 0 0 0 0 0 0

Rotavirus 3 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Campak
2 3 1 2 0 0 6 3 1 2 10 10 20

11 1PV1
4 4 2 0 1 0 2 4 1 3 10 11 21

11 IPV 2
4 4 1 2 1 2 4 0 0 1 10 9 19

12 PCV 1
6 4 4 4 2 5 5 5 5 3 22 21 43
 PCV 2
13 5 3 1 2 1 2 2 3 6 23 15 38

PCV 3
4 2 3 5 3 2 1 2 0 0 11 11 22

Imunisasi Wanita Usia Subur

11a (WUS) :

TT1

TT2

TT3

TT4

TT5

11b Imunisasi Bumil:

TT1

TT2 0 1 0 0 0 0 0 0 0 0 0 1 1

TT3 0 1 0 2 0 2 0 4 0 0 0 9 9

TT4 0 3 0 0 0 1 0 5 0 0 0 9 9

TT5 0 2 0 2 0 1 0 0 0 0 0 5 5
Lanjuta pada usia 18 bln DPT-
12 0 0 0 0 0 0 0 0 0 0 0 0 0
HBHIB Boster

Lanjutan pada usia 24 bln

13 2 3 3 4 0 0 5 3 1 0 11 10 21
Campak Dosis kedua

0 3 1 2 0 0 4 3 0 0 5 8 13
14 Imunisasi Dasar Lengkap
Mengetahui, Peot,03 Maret 2024
Kepala UPTD Puskesmas Peot PJ Imunisasi

Yuliana Adung, A.Md.Kep Martina Daghe

NIP. 19810805 200604 2 027 Nip:19820303201001 2 026
 LAPORAN KEJADIAN IKUTAN PASCA IMUNISASI (KIPI)
TEMPAT PELAKSANAAN *) : Form Laporan KIPI Non Serius
KABUPATEN / KOTA : Manggarai Timur
PROVINSI : Nusa Tenggara Timur
BULAN / TAHUN : Maret 2024
IDENTITAS TEMPAT GEJALA YANG DIALAMI
No Batch / No Batch / PEMBERI PELAYAN TANGGAL LAIN-
JENIS JENIS JENIS
NO NAMA Exp Date Exp Date IMUNISAS AN IMUNISAS DEMAM BENGKAK MERAH MUNTAH
KELAMIN TANGGAL UMUR NAMA
ALAMAT VAKSIN 1 VAKSIN 2 LAIN
ANAK LAHIR (bln) ORTU Vaksin 1 Vaksin 2 I IMUNISAS I (SEBUTK
L/P I Jika ya di tandai ü AN)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jika ditemukan gejala: Mengetahui Peot, 03 Maret 2024

1. Tidak mau menetek/minum Kepala Puskesmas Peot Pelapor
2. Kejang
3. Pucat/biru
4. Sesak nafas
5. Muntah berlebihan
6. Demam tinggi (>39) lebih 1 hari Yuliana Adung, Amd.Kep. Martina Daghe
7. Menangis terus menerus lebih dari 3 jam NIP: 19760617 200312 2 008 NIP :19820303 201001 2 026
8. Kesadaran menurun
 LAPORAN BULANAN
REKAPITULASI PENYAKIT YANG DAPAT DICEGAH DENGAN IMUNISASI (PD3I)
KABUPATEN MANGGARAI TIMUR
UPTD PUSKESMAS PEOT
SATAR PEOT GURUNG LIWUT RANA MASAK BANGKA KANTAR LUAR WILAYAH Total
No. ELEMEN DATA
L P L P L P L P L P L P L+P
Jumlah Penderita PD3I :
1 Penderita Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Pertusis 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tetanus Neonatorum 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tetanus Non Neonatorum 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Polio 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hepatitis 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui, Peot,3 Maret 2024

Kepala UPTD Pusk Peot Yang Melapor,

Yuliana Adung, Amd.Kep Martina Daghe

Nip : 19760617 200312 2 008 Nip:19820303 201001 2 026
 DINAS KESEHATAN KABUPATEN MANGGARAI TIMUR
UPTD PUSKESMAS PEOT
LAPORAN BULANAN BAYI DENGAN IMUNISASI DASAR LENGKAP
BULAN : Maret 2024

DPT -HB POLIO PCV ROTAVIRUS

NO Nama bayi Tgl lahir L/P Kel/Desa Posyandu HB 0 BCG
1 2 3 1 2 3 4 1 2 3 1 2

KLOTILDA E.YOPEN 8/19/2023 9/14/2023 11/18/2023 12/14/2023 8/10/2023 9/14/2023 10/21/2023 12/14/2023 9/14/2023 10/12/2023
1 6/3/2023 P S. PEOT KEMBUR 6/3/2023 9/23/2023 10/21/2023

GISELA K.GAPI 6/17/2023 7/22/2023 8/19/2023 9/23/2023 8/11/2023 9/23/2023 10/21/2023 12/16/2023 9/23/2023 11/18/2023
2 5/17/2023 P PEOT 2 5/17/2023

ALEANDRIA M.FAUSTA 7/22/2023 8/11/2023 9/8/2023 11/18/2023 8/11/2023 9/8/2023 10/21/2023 1/12/2023 9/23/2023 11/18/2023
3 5/20/2023 P PEOT 2 5/20/2023 9/23/2023 10/21/2023

YUSTINA WEWENG 6/13/2023 7/14/2023 8/11/2023 10/11/2023 8/11/2023 10/11/2023

4 5/8/2023 P G.LIWUT REHES 5/8/2023 9/13/2023 12/13/2023 10/11/2023 11/14/2023 11/14/2023

ELISABET JIUNG 7/14/2023 8/11/2023 9/13/2023 11/14/2023 8/11/2023 9/13/2023 10/11/2023 11/14/2023 10/11/2023 11/14/2023
5 6/13/2023 P MBELING 6/13/2023

MARIA S.LINDA 11/17/2023 11/17/2023 12/16/2023 2/17/2024 1/16/2023 3/18/2023

6 2/16/2023 P B.KANTAR MONDO 2/16/2023 1/20/2023 2/17/2023 12/16/2023 1/20/2024

MELANIA IDUT 9/16/2023 7/17/2023 8/16/2023 9/16/2023 4/18/2023

7 5/9/2023 L LODOS 5/9/2023 8/16/2023 9/16/2023 10/17/2023 10/17/2023 12/18/2023

BEATO 4/17/2023 5/18/2023 8/16/2023 4/17/2023 10/17/2023

8 3/19/2023 L LONGKO 3/19/2023 6/17/2023 8/16/2023 9/16/2023 10/17/2023 11/15/2023

IMELDA MURTINI 3/16/2023 5/17/2023 7/17/2023 3/16/2023 10/17/2023

9 3/2/2023 P LODOS 3/2/2023 6/17/2023 8/14/2023 9/16/2023 10/17/2023 12/18/2023

HUMILITA FIRNA 1/15/2023 4/28/2023

10 1/5/2023 P MONDO 1/5/2023 4/22/2023 12/16/2023 5/22/2023 5/22/2023 11/16/2023 1/20/2024 3/18/2024 1/20/2024

KRISTINA NOVIANA 5/17/2023 7/17/2023 8/16/2023 9/16/2023 7/17/2023 7/17/2023 10/17/2023 11/17/2023 10/17/2023 12/18/2023
11 5/6/2023 L JENGOK 5/6/2023

ANCENGELO JEMATU 7/1/2023 8/1/2023 11/17/2023 12/16/2023

12 5/22/2023 L LONGKO 5/22/2023 7/6/2023 8/1/2023 11/17/2023 12/16/2023 11/17/2023 12/16/2023

Mengetahui Peot,03 Maret 2024

Kepala UPTD Puskesmas Peot PJ Imunisasi

Yuliana Adung Martina Daghe

Nip:19760617 200312 2 008 Nip:19820303 201001 2 026
ROTAVIRUS IPV
CAMPAK
3 1 2

12/14/2023 12/14/2023 3/23/2024 3/23/2024

11/18/2023 3/8/2024 3/23/2024

1/12/2024 3/8/2024 3/23/2024

9/13/2023 3/15/2024 3/15/2024

10/11/2023 3/15/2024 3/15/2024

12/16/2023 3/18/2024 3/18/2024

10/17/2023 3/18/2024 3/18/2024

8/16/2023 3/18/2024

12/16/2023 3/18/2024

3/18/2024 3/18/2024

9/16/2023 3/18/2024 3/18/2024

11/15/2023 3/18/2024 3/18/2024