No No.

Reg NIK NAMA PENERIMA VAKSIN JK

1 3275054107680600 SUTIAH P
2 3275124903830004 LENI MARLENA P
3 3329105508990001 KARMILAH P
4 3275054608630023 SITI ROCHJATI P
5 3174014601920004 LELI ASTUTI P
6 3275055004840025 HELMIA NINGSIH P
7 330420704810002 DEDI PURNAMA L
8 3275120707720008 SAKARMA L
9 3275021405690010 JAMIL MUHARAM L
10 3327066904950007 KHUSNUL KHOTIMAH P
11 3275055701660003 EEN SUHAENAH P
12 3275055109520002 ANIH P
13 327505530260005 ERLIN NINGSIH P
14 322804440389007 IRMAWATI P
15 3275051103590008 SUGANDI L
16 3303021811820005 NUR SOLIKHIN L
17 3216062006010014 IGO RIZKI NASYA PRATAMA L
18 3275053105710012 AFRISAL SE L
19 3275015704720010 NURTANI GULTOM P
20 32755051909040005 MOCH ARIQ NAWWAF L
21 3275050707730021 TEGUH YUGO PURWANTO L
22 3275051802500002 H. SYAEBANI L
23 3275054406760042 RUKAYAH P
24 3275055401710007 MARIANA P
25 3275055508750050 MARIAH P
26 3203175701030005 AL SULASTRI P
27 3275054909690013 ROHANAH P
28 3324164412930002 SITI MAGFIROH P
29 3275056808670015 WORO SUPRIHATIN P
30 3275052303050003 MUHAMMAD TANI AL-FAUZAN L
31 3275051201090013 FADLAN RIDHO HUTAMA L
32 3216062001070015 MUHAMMAD SURYA PRATAMA L
33 3329060050970005 SUSWANTO L
34 327505580600013 YULIANA PUTRI LESTARI P
35 3216065705840024 KURNIA RAHAYU P
36 3275055611860012 AISNAH P
37 3275055410880005 NITA NUR LAELA P
38 3275055410030004 NABILA OKTAVIONITA YASSIN P
39 3275056601000005 RUTH CHISTINE P
40 3275065007940018 SRI DUMILAH P
41 3275054305720021 RAMINI P
42 3275055409000011 TANIA ROSIYANTI P
43 32755052605020012 CHRIST YERITHO L
44 3320061505820004 IWAN HERMAWAN L
45 3275052903870012 TRIS SETIONO L
46 3601185005820006 SA'AMAH P
47 3275055211850015 SHERLY NOVIANTI P
48 3275054402910006 DANIAR MIRZA FEBIYANTI P
49 3275054204640022 MARNI P
50 1806204809950002 FATHKHIYA MAHFUDZOH RALLYA P
51 3321011307990003 NUR FAISAL L
52 32755050512950008 DWI CHRISTIAN HADI SURYA L
53 320936075740004 SUPARDI L
54 3304176201960001 MUAWAMAH P
55 3275055206890021 ALFINDA NURRINDAYI PUTRI P
56 3275052502040005 MUHAMMAD FARIZT PRADHIPTA L
57 3374130209770003 ANUGRAH L
58 3174030602910001 AHMAD ZAKARIA L
59 31750266011710012 SUSANTI P
60 3275055312870008 DECILIANA SYAFHIANTI P
61 3209104103030017 LUTFI DWI RAHAYU P
62 3275054805840015 SITI TARWIYAH P
63 3315047012610004 NGATIYEM P
64 3275056409050003 PUTRI AMALIA P
65 3275055106830022 ASRIYAH P
66 3275055811750010 RIYATI P
67 3275050501900020 BOYLES KARDI NAPITUPULU L
68 3275051310740013 HARI SUHONO L
69 3275051103900006 KHALID JIWANDONO L
70 3275051811780019 JAKA SILIWANGI L
71 3275055701840013 HERNA SUSANTI P
72 3275054808760022 JUBAIDAH P
73 3275055409880019 ROHIMAH DIAH LESTARI P
 74 3275052611690003 AGUS SUPRIANTO L
75 3275054509930004 DILLAH SUHANDANI P
76 3275056606930012 ENI NURAINI P
77 3275052809780015 ADE SUBHAN DARMAWAN L
78 32750531007780010 JAENI EDI MULYONO L
79 3275052003590015 B.RAHMAT L
80 3173071911860004 MUHAMMAD IRZAN MAULUDA L
81 3319042506850003 ARIYANTO L
82 3275094507620013 EEN SAENAH P
83 3275055603630015 SUMIASIH P
84 3307015809970003 SRI WAHYUNINGSIH P
85 3275057005550001 FARIDAH P
86 3275056010730021 SRI MULYANI P
87 3275054402840015 NURMAH P
88 3275054603760031 SINIH WIDIAWATI P
89 3275055706630010 MERIAH UKUR GINTING P
90 3216065506750079 ALISAH P
91 3275115110020002 DAMAYANTI MAULAN I P
92 3275051409090001 RIFQI ZACHARI RAMADANI L
93 3275054807710022 KASMI P
94 3275054310900013 TRIRETNO HANDAYANI P
95 327550503090002 DANIEL FIRMANYAH L
96 1673064408970003 YENI ASTUTI P
97 3329170305790004 DARHAN L
98 3275056808810029 LILI ESNI P
99 3314092208810002 WAHYUDI L
100 3203030801810010 AGUS KUSNANDAR L
101 3203034109800009 YUYU YUNENGSIH P
102
 Umur
Pekerjaan (18-59 Kel Umur Alamat
tahun)

Karyawan swasta 53 46-57 Kp. Pengasinan

Ibu rumah tangga 38 31-45 Gang pa. inah rt 05/01
Wiraswasta 22 18-30 Kp. Pengasinan NO.08
Ibu rumah tangga 38 31-45 PHP. JL. DELIMA UTARA 2
Karyawan swasta 29 18-30 JL. GARUDA V NO.51 RT04/RW027
Karyawan swasta 37 31-45 KP. PENGASINAN
Pedagang 40 31-46 KEDUNGWRINGIN RT02/04
Wiraswasta 49 46-57 Gang pa. inah rt 05/01 no.53
Wiraswasta 52 46-57 KRANJI RT 04/01 NO.13
Ibu rumah tangga 26 18-30 WANARATA RT 039/ RW 009
Ibu rumah tangga 55 46-57 PURI MUSTIKA D1 NO.14 RT 05/017
Ibu rumah tangga 69 LANSIA KP. PENGASINAN RT 06/ 01
Ibu rumah tangga 61 LANSIA JL. PENEGAK/ 199
Ibu rumah tangga 32 31-45 TEMBONGWAH RT001/RW004
PEGAWAI NEGERI SIPIL (PNS) 62 LANSIA PURI MUSTIKA RT005/17
PETANI/ PEKEBUN 39 31-45 SWADAYA RAYA
PELAJAR/MAHASISWA 20 18-30 JL. SWADAYA A NO.11 KEC. TAMSEL
Karyawan swasta 50 46-57 RAWALUMBU BEKASI
Ibu rumah tangga 49 46-57 JL. BAMBU KUNING 66 RT03/05
PELAJAR/MAHASISWA 17 PELAJAR KP. PENGASINAN
Wiraswasta 48 46-57 JL. PARANG TRITIS RAYA NO.129
PENSIUN 61 LANSIA KP. PENGASINAN
Wiraswasta 46 46-57 BOJONG MENTENG 004/007
Karyawan swasta 50 46-57 KP. SEPATAN RT02/ RW02
Wiraswasta 46 46-57 KP. CIKAYAS RT003/RW002
PELAJAR/MAHASISWA 18 PELAJAR KP. WARGASARI RT001/RW002
Ibu rumah tangga 52 46-57 KP PENGASINAN TENGAH
Ibu rumah tangga 28 18-30 DUSUN SIDOMULYO 001/002
PEGAWAI NEGERI SIPIL (PNS) 54 46-57 JL. NAROGONG JAYA 10
PELAJAR/MAHASISWA 15 PELAJAR KP PENGASINAN TENGAH RT 03/27
PELAJAR/MAHASISWA 12 PELAJAR JL.KAIN RAYA RT006/01
PELAJAR/MAHASISWA 14 PELAJAR PAPAN INDAH BLOK I 11 B NO.3
BURUH TANI/PEKERBUNAN 36 31-45 PRUWATAN KC. BUMIAYU
PELAJAR/MAHASISWA 21 PELAJAR KP. PENGASINAN RT 01/017
Ibu rumah tangga 37 31-45 JL. H. MILUNIA RT03/02
Karyawan swasta 35 31-45 KP. PENGASINAN
Karyawan swasta 33 31-45 JL. BOJONG SARI V NO.3
PELAJAR/MAHASISWA 18 PELAJAR KP. PENGASINAN
PELAJAR/MAHASISWA 21 PELAJAR JL. KENANGA UTARA BLOK G6 NO.02
Ibu rumah tangga 27 18-30 PERUM BHINEKA ASRI 2 BLOK A NO.8
Ibu rumah tangga 49 46-57 JL KENANGA UTARA BLOK G6 NO.02
PELAJAR/MAHASISWA 21 18-30 JL H. ROMLI PENGASINAN
PELAJAR/MAHASISWA 19 18-30 JL. KENANGA UTARA BLOK G6 NO.02
Karyawan swasta 39 31-45 JL. PARISWISATA RAYA NO.9
Karyawan swasta 34 31-45 PHP JL. KENANGA UTARA 2
Ibu rumah tangga 39 31-45 KP. GUNUNG DATAR RT 006/07
Karyawan swasta 36 31-45 JL. PENEGAKI NO.119
Karyawan swasta 30 31-45 JL. TELAGA SARANGAN IV NO.145
Ibu rumah tangga 57 46-57 JL. BOJONG SARI V NO.3
Ibu rumah tangga 26 18-30 PONDOK HIJAU PERMAI
PELAJAR/MAHASISWA 22 18-30 JAMUS GODO RT013/014
PELAJAR/MAHASISWA 26 18-30 JL. KENANGA UTARA BLOK G6 NO.02
Karyawan swasta 47 31-45 CIREBON
Wiraswasta 25 18-30 KP. PENGASINAN
Ibu rumah tangga 32 31-45 JL. RAWA LUMBU TENGAH 2
PELAJAR/MAHASISWA 17 PELAJAR JL. DELIMA UTARA 3 C7/17
Karyawan swasta 44 31-25 JL. HASANUDIN
Karyawan swasta 30 18-30 JL. TELAGA SARANGAN IV NO.145
Karyawan swasta 50 46-57 PERUM MEGA REGENCY BLO K2
Karyawan swasta 34 31-45 GANG ASEM NO 49
TIDAK BEKERJA 18 PELAJAR DESA MUNJUL
Ibu rumah tangga 37 31-45 KUNING BINA WARGA
PETANI/ PEKEBUN 60 LANSIA KP PENGASINAN
PELAJAR/MAHASISWA 16 PELAJAR KP PENGASINAN
Ibu rumah tangga 38 31-45 KP PENGASINAN
Ibu rumah tangga 45 31-45 JL PRANG TRITIS
TIDAK BEKERJA 31 31-45 JL BAMBU KUNING
Karyawan swasta 47 46-57 PERUM RAWA LUMBU
Karyawan swasta 31 31-45 JL.PRAMBANAN
Karyawan swasta 43 31-45 BOJONG RAWA LUMBU
Ibu rumah tangga 37 31-45 BOJONG RAWA LUMBU
Ibu rumah tangga 45 31-45 KP. PENGASINAN
Karyawan swasta 33 31-45 BINTARA JAYA
 Karyawan swasta 52 46-57 KP. PENGASINAN
Karyawan swasta 28 18-30 KP. PENGASINAN
Ibu rumah tangga 28 18-30 JL. MANDOR BENIN
Wiraswasta 43 31-45 JL.GADING RAYA
Karyawan swasta 43 31-46 JL.PENGASINAN
Karyawan swasta 60 LANSIA JL.PENGASINAN
Karyawan swasta 35 31-45 JL. SEMBOJO
BURUH HARIAN LEPAS 36 31-45 PENDURENAN
Ibu rumah tangga 60 LANSIA JL.P IRIAN JAYA
Ibu rumah tangga 58 46-57 JL. PENGASINAN
Ibu rumah tangga 24 18-30 WONOSOBO
Ibu rumah tangga 60 LANSIA KP.PENGASINAN
Ibu rumah tangga 48 46-57 KP.PENGASINAN
Karyawan swasta 38 31-45 KP.PENGASINAN
Karyawan swasta 45 31-45 KP. RAWA PANJANG
PERAWAT 58 46-57 PONDOK HIJAU PERMAI
Ibu rumah tangga 46 46-57 KP. PENGASINAN
PELAJAR/MAHASISWA 19 PELAJAR BEKASI MUSTIKA JAYA
PELAJAR/MAHASISWA 12 PELAJAR JL. PENGASINAN
Ibu rumah tangga 50 46-57 KP.RAWA PANJANG
PELAJAR/MAHASISWA 31 PELAJAR JL. BOTTON 1/31
TIDAK BEKERJA 12 PELAJAR KP PENGASINAN
TIDAK BEKERJA 24 18-30 KP PENGASINAN
BURUH HARIAN LEPAS 42 31-45 MANDOR LONGO
Karyawan swasta 40 31-45 JL.PENGASINAN
Wiraswasta 40 31-45 JL.PENGASINAN
Wiraswasta 40 31-45 KP NANGGLENG
Ibu rumah tangga 41 31-45 CIBAREGBEG
 PENCATATAN PELAKSANAAN VAKSIN COVID 19
TINGKAT PUSKESMAS/FASYANKES/ POS VAKSIN

Kepesertaan BPJS Dosis I

No. Hp Merek Tanggal Tanggal

BPJS Non Vaksin*** Screening
BPJS PBI PBI Non Ang Pemberian No. Batch
Vaksinasi

08999072168 SINOVAC 23-Oct-21

085213764130 SINOVAC 23-Oct-21
085738336199 SINOVAC 23-Oct-21
081210675585 SINOVAC 23-Oct-21
085711178399 SINOVAC 23-Oct-21
085287650202 SINOVAC 23-Oct-21
082127282304 SINOVAC 23-Oct-21
08128880475 SINOVAC 23-Oct-21
08159092198 SINOVAC 23-Oct-21
08230743809 SINOVAC 23-Oct-21
081212388421 SINOVAC 23-Oct-21
088212234689 SINOVAC 23-Oct-21
0895601276793 SINOVAC 23-Oct-21
08801399031 SINOVAC 23-Oct-21
08128500903 SINOVAC 23-Oct-21
087880976177 SINOVAC 23-Oct-21
0813428959 SINOVAC 23-Oct-21
081808230853 SINOVAC 23-Oct-21
08987074961 SINOVAC 23-Oct-21
085781445494 SINOVAC 23-Oct-21
085777902430 SINOVAC 23-Oct-21
0895424042029 SINOVAC 23-Oct-21
087782259465 SINOVAC 23-Oct-21
081210557752 SINOVAC 23-Oct-21
083890027975 SINOVAC 23-Oct-21
082117829619 SINOVAC 23-Oct-21
08121039059 SINOVAC 23-Oct-21
0897234796 SINOVAC 23-Oct-21
081210913144 SINOVAC 23-Oct-21
082260109737 SINOVAC 23-Oct-21
08998705821 SINOVAC 23-Oct-21
085890814723 SINOVAC 23-Oct-21
087880975798 SINOVAC 23-Oct-21
083873095442 SINOVAC 23-Oct-21
085780560809 SINOVAC 23-Oct-21
08856163969 SINOVAC 23-Oct-21
081290357060 SINOVAC 23-Oct-21
081383897973 SINOVAC 23-Oct-21
0895388710008 SINOVAC 23-Oct-21
087857201679 SINOVAC 23-Oct-21
081213068493 SINOVAC 23-Oct-21
089676225339 SINOVAC 23-Oct-21
0895337460959 SINOVAC 23-Oct-21
083153375917 SINOVAC 23-Oct-21
087855251375 SINOVAC 23-Oct-21
081585635722 SINOVAC 23-Oct-21
089644171109 SINOVAC 23-Oct-21
085716558669 SINOVAC 23-Oct-21
0895321028146 SINOVAC 23-Oct-21 23-Oct-21 24006621
081271429361 SINOVAC 23-Oct-21 23-Oct-21 24006621
0878797033883 SINOVAC 23-Oct-21 23-Oct-21 24006621
089604300591 SINOVAC 23-Oct-21 23-Oct-21 24006621
085771401737 SINOVAC 23-Oct-21 23-Oct-21 24006621
082113207571 SINOVAC 23-Oct-21 23-Oct-21 24006621
089604413883 SINOVAC 23-Oct-21
081283279743 SINOVAC 23-Oct-21
085700251080 SINOVAC 23-Oct-21
082218646688 SINOVAC 23-Oct-21
081315341655 ASTRAZENETA 23-Oct-21
081285600600 ASTRAZENETA 23-Oct-21
089663311668 SINOVAC 23-Oct-21
08810847607 SINOVAC 23-Oct-21
083890140882 SINOVAC 23-Oct-21
081585135411 SINOVAC 23-Oct-21
089561891088 SINOVAC 23-Oct-21
0895327275824 SINOVAC 23-Oct-21
085217447972 SINOVAC 23-Oct-21
081211597718 SINOVAC 23-Oct-21
0853120225668 SINOVAC 23-Oct-21
081211058621 SINOVAC 23-Oct-21
083143064207 SINOVAC 23-Oct-21
089602632275 SINOVAC 23-Oct-21
083190169618 SINOVAC 23-Oct-21 23-Oct-21 24006621
 08571807678 SINOVAC 23-Oct-21 23-Oct-21 24006621
089512625806 ASTRAZENETA 23-Oct-21
0895329144399 ASTRAZENETA 23-Oct-21
085920783210 ASTRAZENETA 23-Oct-21
085719015506 ASTRAZENETA 23-Oct-21
089629050779 SINOVAC 23-Oct-21
081218300400 SINOVAC 23-Oct-21
082116068367 SINOVAC 23-Oct-21
081316080139 SINOVAC 23-Oct-21
0896291050119 SINOVAC 23-Oct-21
089518482752 SINOVAC 23-Oct-21
085719015506 SINOVAC 23-Oct-21
085718445624 SINOVAC 23-Oct-21
081291581991 SINOVAC 23-Oct-21
087878713696 SINOVAC 23-Oct-21 23-Oct-21 24006621
081287452113 SINOVAC 23-Oct-21 23-Oct-21 24006621
0895322019739 SINOVAC 23-Oct-21
087720778470 ASTRAZENETA 23-Oct-21
081399997958 SINOVAC 23-Oct-21
08139291387 SINOVAC 23-Oct-21
081283642036 SINOVAC 23-Oct-21
081394279406 SINOVAC 23-Oct-21
081274694437 SINOVAC 23-Oct-21
089561915454 SINOVAC 23-Oct-21
082111562922 ASTRAZENETA 23-Oct-21 23-Oct-21 LOT.AI073
089534262221 SINOVAC 23-Oct-21
085719787503 SINOVAC 23-Oct-21
085606755619 SINOVAC 23-Oct-21
 VAKSIN COVID 19
NKES/ POS VAKSIN

Dosis 2
Ket/
ditunda/
Tanggal tdk
Pemberian No. Batch diberikan/
Vaksinasi lanjut

23-Oct-21 24006621 LANJUT

23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
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LANJUT
LANJUT
LANJUT
LANJUT
LANJUT
LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
LANJUT
 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT
LANJUT
LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 LOT. AI073 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
23-Oct-21 24006621 LANJUT
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LANJUT
23-Oct-21 24006621 LANJUT
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23-Oct-21 24006621 LANJUT