Vaksin SD KRD

Nama Puskesmas/Fasyankes/Pos
Kabupaten/Kota
Provinsi
Hari, Tanggal
No No. Tiket NIK
1 P-6A6NRV0Q 140502030810001
2 P-4LN7UQH0 6401095707140001
3 P-4QDFLV0U 7315096503150001
4 P-ZIUR3OLP 7315095209090002
5 P-4RB1COFS 6302201210140001
6 P-4OPLDJIE 6311026406140001
7 P-4TVFNZT8 6401094701150002
8 P-4K1YMFSL 631001807140001
9 P-4SZSW1JU 6311015502150001
10 P-96YPFBTG 6401090502100001
11 P-8I695L5K 6203172307120002
12 P-5IA7NUW4 7315096312090001
13 P-5PZK9CYM 6202141003120001
14 P-ACHBGSWR 6401090701100001
15 P-5E74C5OH 3520021110120003
16 P-9TRQ3NL3 6311013010100001
17 P-83ILCQXQ 6401091908130001
18 P-4Z7AUJPI 6401091901150001
19 P-4WCMOTD0 3511066002150002
20 P-6I0MD2UW 6310095601090002
21 P-7QGDJWXK 6401096703130001
22 P-B5HJK1H 6401092807100001
23 P-BLQLGQRX 6401090901100001
24 P-8V9EIHSN 6401096208120001
25 P-6961CAT7 7314020112120001
26 P-9RWPMRYO 6302065711120003
27 MANUAL 6401092009180001
28 P-6BSYL6MU 6401090710120001
29 P-7VXE6B15 6401096202130001
30 P-CNJZ6AB0 6401095410130001
31 P-BK48ZBQ0 7601120902140001
32 P-6153IM5S 6401094911120001
33 P-6HMVCF2M 64010191010120001
34 P-C4XEPIGD 6401095407100001
35 P-B7V5FLU6 631102101140001
36 P-BHXVJO50 6308046009130001
37 P-AXOMAQ0Q 7315091102140001
38 P-8IZO8SJW 6401096002100001
39 P-C8BMHNC 6401092504130001
40 P-BOSV0OIC 6401096602140001
41 P-COCFSVLW 6401096107130002
42 P-AEXESXH9 6401092906140001
43 P-ALCSO4OO 7315035412130001
44 P-A92D0K5Q 6401090407140001
45 MANUAL 6310060410120001
46 P-AUOVC6G3 6401092001100001
47 P-MRR7HLNL 640192507110001
48 MANUAL 6401095403090002
49 MANUAL 640109501080003
50 P-A7SJ98DO 6311012104110001
51 P-KWAYXRAS 640104907140001
52 P-A1KBLORQ 6401092109130001
53 P-G2E14PH2 6401092505110001
54 P-5PR91RV0 6401090106110001
55 P-B4U7CVS8 640109507090001
56 P-87Z41ZK6 640109502090001
57 P-C1KA7Q3F 6401095107100001
58 P-A0TS2V4V 6401091912100001
59 P-B6WG1F9N 6401095911110001
60 P-3XL32YCE 6401091503120001
61 P-IVIEYO4Y 6401095111120001
62 P-43XJ56J9 2171122302130002
63 P-AANC1GA2 6401092306110001
64 P-8TUR2BPO 6401096103120001
65 P-4P2P67ZV 6401097006100001
66 P-2PO8PWY 6401090211100002
67 P-4TF1MMNO 6401095712100002
68 P-3JY2BK78 640109203110001
69 P-IF822F5R 6401092212130003
70 P-2D8TMEAJ 640109102110001
71 P-0RNYKNQB 72070660308110001
72 P-3ZFZGD1C 6401094102110001
73 P-2OQUF1IY 6401096707120002
74 P-LKCHB80M 6401093112080001
75 P-LU0DTGC2 6401092909080001
76 MANUAL 6401092708110001
77 MANUAL 6401044411110002
78 P-C0XR2ZKE 1805083010110002
79 P-HFBPWOE2 63110183150001
80 P-I6EHG647 6401091101120002
81 P-K2BTNRGG 6401092807110001
82 P-JQTC3Y3M 6409032408130001
83 P-KJL80FW 6401094309090001
84 P-JL6AKFJZ 6401091212090001
85 P-GQUSZJGK 6401096007120001
86 P-HANTLRWV 640109511130001
87 P-CCQC2NAS 7315092006110001
88 P-E15TFUFA 7205082406110000
89 MANUAL
90 P-TD04R517 6401092112090000
91 P-SGYOCTRH 6401010604100000
92 P-RPA88BB1 6310102906100001
93 P-QSIG4D3L 6311015001100001
94 P-Z6BS57MG 6311024803100001
95 P-S5C9TNYR 6302206109080001
96 MANUAL 7306194605070002
97 P-UZWQ2X9J 63110151808002
98 P-VDTPFL7E 6401095708090000
99 P-QBD5OCAA 6401092707110001
100 P-EC1GXBWY 6401092603120001
101 P-RLZIIDM8 6401096506100002
102 P-PTQB96ZD 6401094810130001
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
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: KERANG
: PASER
: KALTIM
: KAMIS, 04/10/2021
Nama Penerima Vaksin Jenis Kelamin Pekerjaan*
GUSTIANSYAH KUSNANDAR L
KHADIJAH P
KHAIRIN ZAHKIRA P
SARTINA P
MUHAMMAD ZIKRI ADITYA L
HILDA P
WINDI LIANA ZAHIRA P
AKHAMD ZAINUR RASYIDI L

NOR AZMI HANIPAH P
AKHMAD FAHRIAZI L
I PUTU WIJAYA L
ALIANA ALIAS P
RIZKI ARDIANTO P
MUHAMAD YUSUF FIRDAUS L
PUTRA PRATAMA RIYANTO L
ABDUL HAMID L
MUHAMAD ROBI ANSORI L
MUHAMMAD PUJIANSYAH L
NUR AYSATUL JANNAH P
RAYDATUL JANNAH P
RAISHA AINA JASMINE P
SATRIA JUNIOR NUR A.B L
MUAHAMAT SARIPPUDIN L
YASINTA SISILIA LEGO P

AHMAD FAUZAN L
ADZANIA AFIQAH NAHDANA L
M. AKBAR RAMADAN L
AHMAD ALI WAFA L
AINIA FAIDA AZMI P
ITASARI RABBIATUL KOFTIAH P
MUHAMMAD AKSAR L
ZASKIA HAFIDZA ALBA P
MUHAMMAD HAIKAL L
KEYSIA ZILLIVIA P
RIDHAN MUHAMMAD YAHYA L
NANDA LARISSA L
MUHAMMAD ZAIFUL L
LAILA AZKIYA P
NAZRIL ILHAM L
SHIFA SAUKIAH P
AQILLA CESYA AZ-ZAHRA P
WAHYU AHMAD RAMADHAN L
NUR SRI WAHYUNI P
MUHAMMAD RIZKI RAMADHAN L
MUHAMMAD SALMAN L
AFDAL RASYD L
RIZKI SAPUTRA L
YASINTA DHANE P
SITI AISAH P
AHMAD HAIKAL L
ULFA ALYA RAHMADHANI P
DELFIN SEPTIAWAN L
AHMAD BADAWI L
RIZKIY SANDIAGO L
MUHAMMAD RIFAN L
MAWARDAH P
MURTINI P
MUHAMMAD DIKA SAPUTRA L
NAILA SELPINA P
ARYA DWI PUTRA P
NOPITA SARY P
DIAS FEBRIADI HUTABARAT L
MUHAMMAD DZAKY PRATAMA L
MARSELLA NOFITRI SIKI P
ATQAL HUDA AULIA P
TYAS ANUGRAH P
JUMAYAH ARDIASTUTI P
RABIATUL ADAWIYAH P
RAFFA ALVIANO L
MUHAMMAD RAFI'I L
SAIBUR RAHIM JAIMAN L
SAIDAH P
SITI RAHMA DHANI P
MUHAMMAD GALIH ADE SAPUTRA L
ADIT RAHMADANI L
MARIANUS ADI PUTRA SIKO L
NUR DEWI P
WAYAN BINTANG PRATAMA L
M.HUSYAIRIN L
FAZRIANUR L
MUHAMMAD RIVAN ADITYA L
SULTAN ACHMAD AL-FATIH L
MUTIYA AZAHRA P
MUHAMMAD SAUFI L
NAZWA SAFIRA P
NOR LAYLA ASYIFFA P
MUH. ASHAR L
MUH.YASIN L
MAULIDA PUTRI L
MUHAMMAD MUJIB L
M.KHAIRUL IKHSAN L
ABDI PUTRA PRATAMA L
DEA MILLATI P
NOR HALISA P
DHEA RAMADANI P
SIFATUL HASANA P
LAILA SAADAH P
AGUSTINA P
ADIL PRATAMA L
M.LUTHFI L
ZHABRUNA KAYLA PUTRI P
MARGARETA SANDIKA SOI P

FORMAT PENCATATAN PEL
TINGKAT PUSKESMAS
Umur
Tanggal Lahir Kelompok Umur
(18 sd ≥ 60 tahun)
3/8/2010 11 ANAK SEKOLAH
17/7/2014 7
25/3/2015 6
09/12/2009 12
10/12/2014 7
24/6/2014 7
01/07/2015 6
18/7/2014 7
15/2/2015 6
02/05/2010 11
23/7/2012 9
23/12/2009 12
03/10/2010 9
01/07/2010 12
10/11/2012 9
30/10/2010 11
19/8/2013 8
19/1/2015 9
20/2/2015 8
16/1/2009 13
27/3/2013 8
28/7/2010 11
01/09/2010 12
22/8/2012 9
01/02/2012 9
17/11/2012 9
25/7/2014 7
10/07/2012 7
22/2/2013 8
14/0/2013 8
02/09/2014 7
11/09/2012 7
10/10/2012 7
14/7/2010 11
13/1/2014 8
20/9/2013 8
11/2/2014 8
20/2/2010 11
25/4/2013 8
26/2/2014 8
21/7/2013 8
29/06/2014 8
4/12/2013 8
4/7/2014 8
4/1/2012 9
20/1/2010 12
26/7/2011 10
14/3/2009 11
3/3/2009 11
21/4/2011 10
9/7/2016 8
21/9/2013 8
25/5/2011 10
06/01/2010 10
07/05/2009 11
02/05/2009 11
07/11/2010 11
19/12/2010 11
19/11/2011 10
15/3/2012 11
11/11/2012 11
23/2/2013 8
23/6/2011 10
21/3/2012 11
30/6/2010 11
11/02/2010 11
17/12/2010 11
03/02/2011 10
22/12/2013 8
02/01/2011 10
08/03/2011 10
02/01/2011 10
27/7/2012 11
31/12/2008 13
29/9/2008 13
28/8/2011 10
11/04/2011 10
30/10/2011 10
18/3/2015 6
01/11/2012 11
28/7/2011 10
24/8/2013 8
09/03/2009 12
12/12/2009 12
20/7/2012 11
25/11/2013 8
20/6/2011 10
25/6/2011 10
25/04/2007 14
21/12/2009 12
6/4/2010 11
29/06/2010 11
10/1/2010 11
8/3/2010 11
21/09/2008 13
9/12/2009 12
11/8/2008 13
17/08/2009 12
27/07/2011 10
26/03/2012 9
25/06/2010 11
8/10/2013 8
PENCATATAN PELAKSANAAN VAKSINASI COVID-19
GKAT PUSKESMAS/FASYANKES/POS VAKSINASI
Kepesertaan BPJS (tulis 'Ya' pada kol

sesuai)
Alamat No. Hp
BPJS PBI
DESA KERANG DAYO 081549104414
PT.SARAS WATI 082129825185



DESA KERANG DAYO '081345492559




OVID-19
ASI
ertaan BPJS (tulis 'Ya' pada kolom yang

sesuai)
Tanggal Screening
BPJS Non PBI Non Anggota
20-01-2022
20-01-2022
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Dosis I
Nama/Jenis/Merek Vaksin***
Tanggal Pemberian
No. Batch
Vaksinasi
CORONAVAC 20-01-2022 202109204F
CORONAVAC 20-01-2022
Dosis 2
No. Serial Tanggal Pemberian Vaksinasi No. Batch No. Serial

Keterangan
(Ditunda/Tidak Diberikan/Lanjut)

Vaksin SD KRD

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Nama Puskesmas/Fasyankes/Pos

No No. Tiket NIK

100 P-EC1GXBWY 6401092603120001

101 P-RLZIIDM8 6401096506100002

102 P-PTQB96ZD 6401094810130001

Nama Penerima Vaksin Jenis Kelamin Pekerjaan*

MUHAMMAD ZIKRI ADITYA L

WINDI LIANA ZAHIRA P

AKHAMD ZAINUR RASYIDI L

MUHAMAD YUSUF FIRDAUS L

PUTRA PRATAMA RIYANTO L

MUHAMAD ROBI ANSORI L

NUR AYSATUL JANNAH P

RAISHA AINA JASMINE P

SATRIA JUNIOR NUR A.B L

YASINTA SISILIA LEGO P

ADZANIA AFIQAH NAHDANA L

AHMAD ALI WAFA L

AINIA FAIDA AZMI P

ITASARI RABBIATUL KOFTIAH P

ZASKIA HAFIDZA ALBA P

RIDHAN MUHAMMAD YAHYA L

WAHYU AHMAD RAMADHAN L

NUR SRI WAHYUNI P

MUHAMMAD RIZKI RAMADHAN L

ULFA ALYA RAHMADHANI P

MUHAMMAD DIKA SAPUTRA L

ARYA DWI PUTRA P

DIAS FEBRIADI HUTABARAT L

MUHAMMAD DZAKY PRATAMA L

MARSELLA NOFITRI SIKI P

ATQAL HUDA AULIA P

SAIBUR RAHIM JAIMAN L

MUHAMMAD GALIH ADE SAPUTRA L

MARIANUS ADI PUTRA SIKO L

WAYAN BINTANG PRATAMA L

MUHAMMAD RIVAN ADITYA L

SULTAN ACHMAD AL-FATIH L

NOR LAYLA ASYIFFA P

ABDI PUTRA PRATAMA L

ZHABRUNA KAYLA PUTRI P

MARGARETA SANDIKA SOI P

3/8/2010 11 ANAK SEKOLAH

Kepesertaan BPJS (tulis 'Ya' pada kol

DESA KERANG DAYO 081549104414

PT.SARAS WATI 082129825185

DESA KERANG DAYO 085752759115

DESA KERANG DAYO 085345859019

DESA KERANG DAYO 081291984935

DESA KERANG DAYO 082217984610

DESA KERANG DAYO 082152736598

DESA KERANG DAYO 082350170012

DESA KERANG DAYO 085753358487

DESA KERANG DAYO 085248465506

DESA KERANG DAYO 085298093494

DESA KERANG DAYO 085651326938

DESA KERANG DAYO 085750518803

DESA KERANG DAYO 085861598441

DESA KERANG DAYO 081649577042