Dosis 2 27 Desember 2021 Az & Fizer

+
Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS GANDUSAR

Kabupaten/Kota : KAB. BLITAR
Provinsi : JAWA TIMUR
Hari, Tanggal : 18 Oktober 2021
No.
Jam Jenis
Urut
No No. Tiket 2 penyun NIK Nama Penerima Vaksin Kela Pekerjaan*
Penun
tikan 2 min
tikan 2
1 182 10.21 3505150706760004 MU

SUBANDRI L
2 36 8.45 3505175111840003 MU
MALIKATIN P
3 188 10.26 3505154211020001 MU

ULFA NOVITA SARI P
4 189 10.27 3505150607000001 MU
RIKO HERMANSYAH L
5 34 8 3505156810870005 MU
NURYANI P
6 129 9.48 3505150702970002 MU

FAJAR RUBA'I YUSUF L
7 23 8.34 3507056707880009 MU
IRAWATI P
8 39 8.47 3502144110810001 MU
SRI HANDAYANI P
9 88 9.24 3505153011890001 MU
AGUS SETYA BUDI L
10 6 8.2 3505156006900002 MU
PUJIATI P
11 22 8.33 3505154501740002 MU
ROSMINI P
12 187 10.26 3505150203800001 MU

SUPENO L
13 140 9.53 3505116511870001 MU

ERNAWATI P
14 42 8.48 3505154104790002 MU
KATIYAH P
15 76 9.24 3505155611740002 MU
SRI ANI P
16 63 9.11 3505159806990001 MU
YANTI FITRI S P
17 86 9.24 3505152805980004 MU
JEPRIANTO L
18 118 9.43 3505151602880003 MU

SANDI L
19 159 10.08 3505115604860002 MU

KARTIKA SARI P
20 67 9.17 3505150611010001 MU
EKO WAHYUDI L
21 57 9.06 3505150301850001 MU
BUDIONO L
22 121 9.44 3505155805990003 MU

MIYA LESTARI P
23 1 8.13 3505155708740001 MU
HARI SUPRIANA L
24 2 8.14 3505155001990001 MU
SHOFIYANA P
25 157 10.07 3505156912740002 MU

SUMIATI P
26 130 9.48 3505157011890003 MU

CAHYA NOFIRA P
27 134 9.53 3505151512990001 MU

RAMADHAN NURCAHTO L
28 169 10.17 3505155005770001 MU
SUNARMI P
29 117 9.42 3505152709780001 MU

FATAH UMAR L
30 40 8.47 3505154607860001 MU
SUSI TRIANA P
31 153 10.03 3505155506750002 MU

CHUSNUL KHOTIMAH P
32 17 8.27 3505035012850004 MU
SUMILAH P
33 123 9.44 3505114401000001 MU

BINTI SHOIMATUL FITHRIA P
34 21 8.33 3505150909940002 MU
INA DWI SETIYAWAN P
35 146 10.08 3505150308740002 MU

SUNARYO L
36 199 10.47 3505154107720162 MU

SAMINTEN P
37 193 1032 3505154505770011 MU

SITI ASFIYAH P
38 138 9.58 3505152602980001 FEBI BAYU FASTIKO MU

L
39 152 10.11 3505153009990003 MU

SYAIFUL ANWAR L
40 125 9.46 3505152010940003 MU
DEVIT NOVIANTO L
41 148 10.09 3505154702860002 MU

SULIKAH P
42 108 9.4 3505154202900003 MU

SRI WAHYUNI P
43 97 9.34 3518145506790015 MU
TRI WAHYUNI P
44 106 9.36 3505156903370001 MU

ETIK ZULIANA P
45 33 8.41 3505152306960001 MU
ISNA CHOIRUL ANAM P
46 12 8.25 3506020103810005 MU
MOH.WAHID SULTHONI L
47 70 9.19 3505114102930002 MU
DEWI SULISTYORINI P
48 68 9.18 3505151708770006 MU
AGUS SALIM L
49 201 10.49 3505151706740001 MU

BUDIONO L
50 79 9.19 3505151006780005 MU
WASITO L
51 37 8.46 3505156006840001 MU
ROHMIATUN P
52 28 8.36 3505156010740002 MU
SITI SOLIKAH P
53 78 9.19 3505155206840005 MU
SITI AMINAH P
54 160 10.08 3505156306980003 MU

IKA MARATUS SHOLICHAH P
55 16 8.27 3505150603840001 MU
NUR ROZEN L
56 80 9.19 3505151606010004 MU
RONI WIJAYANTO L
57 43 8.5 3505154901960001 MU
EVA NURLITA SARI P
58 9 8.21 6309062707910004 MU
ADI WAHONO L
59 107 9.39 3505151003820005 MU

ANANG HARIYANTO L
60 158 10.08 3505154703990001 MU

MARETA ALIFIA RAHARDINI P
61 122 9.44 3505156412820002 MU

SRI ENDARWATI P
62 191 10.31 3505150112910001 MU

MOCHAMAD NUROKHAYANI L
63 45 8.5 3505181901960001 MU
RISKI HANDOKO L
64 173 10.23 3505151409750001 MU
SUGENG RIYADI L
65 164 10.1 3505154402020003 MU

DWI FEBRIANTI P
66 MU
81 9.2 3505152008980003 RUDI SANTOSO L
67 56 9.05 3505150308030001 MU
AGUNG PRAYITNO L
68 181 10.21 1111101602850001 MU

HAMDANI L
69 65 9.13 3505154904930001 MU
ZULIATI P
70 48 8.55 3505152207870002 MU
RIANTO L
71 71 9.19 3505106610040003 MU
NOVITA AYU R. P
72 87 9.24 3505150401880001 MU
YUSUF ARIFIN L
73 110 9.44 3505150110020001 MU

M. AKIR IBNU FAJAR L
74 198 10.46 3504015905750002 MU

DWI WINARTI L
75 195 10.34 3507074907850001 MU

DARIYAH P
0 76 196 10.34 3505152105810004 MU
MUHAIR L
77 124 9.46 3505152310910002 MU

WAHYUDI L
78 186 10.26 3505152201840001 MU

MUJIONO L
79 72 9.2 3505100107750185 MU
KRAM MARTOYIB L
80 116 9.41 3505152204650002 MU

MUJIMAN L
81 177 10.26 3505154406730002 MU

ISTINGANAH P
82 172 10.2 3505155004780001 MU

SULISTIYANIK P
83 73 9.2 3505155012810001 MU
SRIANA P
84 150 10.1 3505153009930002 MU

RIO DENI WAHYUDI L
85 58 9.07 3505035012850004 MU
SELFI AMALIA P
86 102 9.34 3505156908020002 MU

SITI SOLAEKAH P
87 136 9.56 3505151601890003 MU

RIANTO L
88 105 9.36 3505157009930001 MU
SRI RAHAYU P
89 205 10.54 3505154609730001 MU

MUJIATI P
90 143 10.05 3505152206040001 MU

M.TAUFIK H. L
91 149 10.1 3505150608810002 MU

SUDAROH L
92 156 10.05 3505152707010001 MU

A G KRISNA L
93 214 11.01 3505150708010001 MU

MOCH AHFIDZ M. L
94 210 10.56 3524106512720001 MU

SULISTIANI P
95 142 9.55 3505154511790001 MU

SUNARSIH P
96 3 8.15 3505155010950005 MU
DEWI RATNA SARI P
97 154 10.04 3505154508830005 MU

SITI MARFUAH P
98 200 10.48 3505155506720001

SUTIANI P
99 93 9.3 3505151612810001
SAMSUL HADI L
100 95 9.32 3517105405940001
SITI KOMSATUN P
101 147 10.09 3505151612750002 MU

SUGIANTO L
102 83 9.22 3505155303950002

ANISA RESTUTI A P
103 185 10.25 3505152207980001 MU

DENI SETIAWAN L
104 84 9.23 3603170702890003

MARIYO ENDRIK W L
105 85 9.23 3505156706730001

SUMARSIH P
106 218 11.02 3507147108890001

FRIDA YANTI N P
107 197 8.21 6407122508840002 MU

ROIS KHANAFI SAIFFUDIN L
108 104 9.35 3505150707750003

MUHRONO L
109 162 10.09 3505157012750002

KASAINI P
110 31 8.44 3505150307730003

ASPIANTO L
111 221 11.07 3505151812010003 MU

GILANG IBNU HANIFAH L
112 224 11.08 3505152510750002 MU
KASIANTO L
113 227 11.1 3505154403920006 MU

YUNI KRISTIANI P
114 220 11.03 3505150201910003

ADI PRANYONO L
115 19 8.3 3505155110720001 MU

TUMINAH P
116 137 9.57 3505155209860001 MU

ZULIRIATIN P
117 54 9.04 3505155203720005 MU

SITI MASITOH P
118 247 8.19 3505150608810003 MU

EDI KUSWANTO L
119 215 11.01 3505150404700004 MU

ARIF L
120 170 10.18 3505152912960001 MU

HERU PUJIANTO L
121 91 9.3 350514270900001 MU

TRIONO L
122 90 9.29 3505140107810009 MU

ZAENAL ABIDIN L
123 133 9.53 3505146003000007 MU

RIZKI MUAZIZAH H P
124 135 9.54 3505150711770004 MU
KARIM FAIZIN L
125 30 8.37 3505151808950003 MU

BAGUS PRASETYO L
126 5 8.18 3505045810980005 MU

ANGGI LESTARI L
127 120 9.43 3505155006690001 MU

HARNANIK P
128 103 9.34 3505154808810006 MU

LIWA'UL HAMDAH P
129 175 10.24 3505154307780001 MU

SUYATUN P
130 MASYARAKAT
163 10.09 3505151011770004
SUPANDI L UMUM
131 114 9.4 3505156905740001 MU

ISTATIK MUDI'AH P
132 MASYARAKAT
59 9.07 3505154412910001
ARIK SUSANTI P UMUM
133 77 9.18 3505141504960001

NIZAR ZULMI L MU
134 MASYARAKAT
44 8.5 3517052112830001
WAWAN BUDIONO L UMUM
135 MASYARAKAT
206 10.54 3505152510800001
SURYANI L UMUM
136 89 9.25 3505155405030002 MU
ANIS LAILATUL HIDAYAH P
137 228 11.1 3505156710730001 MU

SRI LESTARI P
138 230 11.11 3505152805710002 MU

PRIANTO L
139 222 11.07 3505156805840002 MU

MUNAFIAH P
140 232 11.14 3505154903830001 MU

DEWI SUNARSIH P
141 213 11 3505154801850003 MU

NORMA SRI WAHYUNI P
142 223 11.08 3505154304760001 MU

LIMATUL BADRIYAH P
143 208 10.55 3505156012940003 MU

HERMIN NINGSIH P
144 167 10.14 3505156111980001 MU

RINA PUJI LESTARI P
145 204 10.53 3505155505730007 MU

SUDARMI P
146 235 11.18 3505152708920002 MU

ANDIK PRASTYO L
147 236 11.18 3505151212910001 MU

KHOIRUL BURHANI L
148 234 11.18 3505150807690003 MU
BADARODIN L
149 240 11.23 3505152007780003 MU

SUMARNO L
150 211 11 350514107860050 MU

SUGIARTI P
151 219 11.02 3505152104900001 MU

MOCH.ROZIK L
152 233 11.17 3505154503770001 MU

WANTINAH P
153 241 11.24 3505154711800001 MU

RUMINI P
154 237 11.19 3505150811830002 MU

SISWANTO L
155 212 11 3505150502720002 MU

SUTRISNO L
156 62 9.09 1807162403830004 MU

ZAINUL MUHTAROM L
157 161 10.08 MU

3505156410770001 SUMARTI P
158 192 10.31 3505094711930002 MU

FITRI NUR JANAH P
159 209 10.56 3505154706700001 MU

SRIANI P
160 92 9.3 3505152504970003 MU
MUHAMAD ROFINGI L
161 18 8.29 3505145808970002 MU

MUNHIDLOTUL UMMAH P
162 111 9.45 3505150807580001 MU

MOH. ISLAM L
163 66 9.17 3313142707730004 MU

SLAMET L
164 100 9.33 3505151207960001 MU

DIO ARDANA L
165 101 9.33 3505151703730002 MU

SUTRISNO L
166 216 11.01 350515510380002 MU

RINIATIN L
167 168 10.14 3505151009920001 MU

MUHAMAD NASRUKIN L
168 207 10.55 3505064512970003 MU

RODIYANI P
169 75 9.23 3505156010720004 MU

SURINI P
170 238 11.21 3505150406650002 50+

PONIDI L
171 231 3505155807840007 MU

11.14 NUR ROHMAH P
172 268 12.22 3505155306980001 MU
FERA JUNITA P
173 254 11.39 3505152005010001 MU

GALIH PRADANA L
174 273 12.24 3505151911010002 MU

IMRON JAMIL L
175 270 12.23 3505151106980001 MU

YULI AGUS P L
176 251 11.34 3505152009920001 MU

AHMAD SAIFUDIN L
177 249 11 3505155605890002 MU

NANA PURWANTI P
178 262 12.18 3504100606720002 MU

HADI SUWINO L
179 263 12.19 3505156108880002 MU

ELY BUDIANTI P
180 276 12.31 3505155108960006 MU

MAMIK WIJAYANTI P
181 278 12.33 3505156703920001 MU

RATNA WINARSIH P
182 265 12.21 3505154803770005 MU

PURWANTI P
183 275 12.26 3505151712880001 MU

MUKLIS SALAM L
184 266 12.21 3505150209930002 MU
ULIN NUHA L
185 272 12.24 3505152002630002 MU

MUJIONO L
186 250 11.33 3505151302970001 MU

INDRA RISNAWAN L
187 255 11.4 3505156611830004 MU

SITI ROSIDAH P
188 261 12.18 3505111201850003 MU

MISDIANTO L
189 284 12.4 3505155508790010 MU

SITI ROMLAH P
190 280 12.38 3505154801000003 MU

STULUSU LAILATIFITROTIN P
191 281 12.38 3505155708560005 MU

SHOLIKAH P
192 289 12.43 3505151804010002 MU

MUHAMAD ZAINUR ROZIQI L
193 285 12.4 3505155609790003 MU

SULASTRI P
194 294 1.02 3505150903800003 MU

BAGIO L
195 287 12.41 3505155712650002 MU

SEMI P
196 290 12.44 3505155301860001 MU
WIWIK INDARTI P
197 291 12.46 3505151505850001 MU

FARID W L
198 295 1.03 3505151406970001 MU

ROBET ADI L
199 296 1.03 3505150209030003 MU

RIZAL FENDI SETTIAWAN L
200 267 12.22 3505155605810004 MU

NUNUK ANDAYANI P
201 299 1.05 3505150210920003 MU

WENDIK SUNANDRIO L
202 277 12.32 3505150107790140 MU

KATIMAN L
203 271 12.24 3505154103980004 MU

RIZA ALYAFI P
204 286 12.41 3505151607930004 MU

NUR HASIM L
205 259 12.26 3505150408940003 MU

AHMAD NAHROWI ANTO L
206 293 12.53 3505150107730023 MU

ANSORI L
207 292 12.52 350151804970002 MU

PRIANTO L
208 274 12.25 3505150110010006 MU
AHMAT ERIK WS L
209 297 1.1 3505152005860001 MU

SUGENG ARIFIN L
210 307 13.46 3505150808800003 MU

RAJIKIN L
211 306 13.44 3505140405860005 MU

ALFAN SAFI'I L
212 303 13.4 3505151801860002 MU

SUWONDO L
213 302 13.38 3505156703850005 MU

SRI ASIH P
214 305 13.44 3505152209960002 MU

FATHUR ROHMAN L
215 308 13.53 350515520580001 MU

SETYANINGSIH P
216 309 13.54 3505155810020003 MU

AULIA SELVI OKTA A P
217 310 13.55 3505150503750002 MU

BUDIDOYO L
218 311 14.05 3505151402770001 MU

ADHARUL MUTAQIN L
219 312 14.09 3505061008830001 MU

AGUS SUPANDI L
30 3505155510000001 MU
TANIA SELFIANTI P
12 3505157110990003 MU
USWATUN KHASANAH P
13 3505112705960002 MU
ENDAR WAHYU PRIYOSUSANT L
15 3505154101880001 MU
PUJI ASTUTIK P
19 3505155303000001 MU
ST.CHOIRIN NIKMAH P
28 3505154302910002 MU
BAITUL RAHMAH P
24 3505154612940005 MU
ERIK HIDAYAH P
33 3505157110890001 MU
AMALINA FUADA P
34 3505152108850003 MU
SUTIKNO L
36 3505155012870004 MU
NIKMATUL IMI P
41 3505150401900003 MU
ANTO L
49 3505152401960002 MU
HUDA ROMADON L
55 3505151910970002 MU
ONI DIAN TRIANTO L
62 3505152302740001 MU
SLAMET L
65 3505151112900002 MU
HERI SESWANTO L
70 3515026503820007 MU
WIJI UTAMI P
74 3505106004950001 MU
IIN YULIANA P
77 3505151409020002 MU
SEPFANDO RIZQI S.A L
79 3505150210920001 MU
JALAL L
82 3505155406930003 MU
SRI WULANDARI P
87 3572031108920005 MU
ANGGRA PRASETYO HADI L
91 3505151710000001 MU
M.SULKAN FUADI L
93 3505152808810004 MU
AGUS WINARTO L
97 3505150204990002 MU
YOGA ARIE SETIAWAN L
98 3578216304820001 MU
ENNY MASIT p
102 3505154808020001 MU
ALIF NUR HIDAYAH P
113 3505151907790001 MU
IMAM PUJINO L
118 3505156707860002 MU
LILIK SRI MULYANTI P
120 3505156503020002 MU
LILIS ISMAWANTI P
122 3505152109930002 MU
ANDIS POLANDA L
126 3505151427400003 MU
KASERI L
130 3505150404810001 MU
MOHIDIN L
132 350616530800005 MU
ASTUTIK P
144 3505150811820004 MU
DARMAWAN L
146 3505055106960002 MU
NURUL HIDAYAH P
148 3505155205810007 MU
SITI NURAINI P
152 3505152907760003 MU
NUH HADI L
154 3505151088740002 MU
SIGIT L
155 3505151309030002 MU
M0CHAMAD MUBIN L
158 3505140806820002 MU
PURWITO L
172 3505175711910001 MU
KESI WIGATI P
173 3505156101730001 MU
GEMIASIH P
177 3505150907900002 MU
DARMAWAN L
182 3505156104960001
PUJI LESTARI P
199 3505152909930003 MU
YAHYA TRI HANDOYO L
196 3505115512970007
HARTATIK P
197 3505153101950001 MU
BAKAT SISWANTO L
207 3505150510800001 MU
SAIFUL ARIFIN L
209 3504183006900002 MU
WIYONO L
210 3375031910740002 MU
AMBAR SANTOSO L
237 3505150101970001 MU
ARI CANDRA YOSI WARDANA P
214 3505151206030002 MU
RENDRA BAYU NUR CAHYO L
227 3505150103820001 MU
YULIANTO L
229 3505154807770007 MU
ISTIQOMAH P
282 35055150909660003 MU
MAHMUDI L
283 3505151902870001 MU
FUAT HASYIM L
285 3505152310010002 MU
KHAFIDHOTUL MUSLIMIN L
287 1506065212800003 MU
ARIEK ANDRAYANI P
278 3505151102980001 MU
FAUZI ASROFI L
279 3505145704970002 MU
IMROAH P
1 3505111701820002 MU
SUYONO L
274 3505150303960002 MU
TRIANTO L
243 3505152605930001 MU
BUDI SALIKIN L
245 3505153011920003 MU
JOKO SUPRIANTO L
256 3505172604760001 MU
SUNARNO L
250 3505155707820003 MU
SRIANIK P
259 3505151606980004 MU
AGUS IRFANI L
272 3505151104590002 MU
MU'ARIB L
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
ESMAS GANDUSARI
Kepesertaan BPJS (tulis 'Ya'

pada kolom yang sesuai)
Umur
Kelomp
Tanggal (18 sd
ok Alamat No. Hp
Lahir ≥ 60
Umur
tahun) BPJS BPJS Non
PBI Non PBI Anggota
47 46-59 081515393621
7-Jun-76 SUMBERAGUNG 03/03
38 31-45 085859099791
11-11-1984 SIDOASRI 03/03
21 18-30 085721779280
02-11-2002 REJOKATON 04/07
22 18-30 081555390011
07-06-2000 REJOKATON 04/07
35 31-45 085804185114
10-28-1987 SIDOASRI 05/03
26 18-30
02-07-1997 SUMBERAGUNG02/01
34 31-45 081555994397
07-27-1988 LODING
41 31-45 085646441905
10-01-1981 SUMBERAGUNG 03/03
33 31-45 SUMBERAGUNG 04/01- 081555861750

11-30-1989 GANDUSARI
32 31-45 085704405950
06-20-1990 LODING 01/05
49 46-59 SUMBERAGUNG 04/05- 081359780149

43 31-45 SUMBERAGUNG 04/01- 085790842569

35 31-45 085606748984
11-25-1987 SIDAOASRI 03/03
44 31-45 085704420796
04-01-1979 LODING 01/05
48 46-59 SUMBERAGUNG 05/01- 085649942120

11-16-1974 GADUSARI
24 18-30 085807437314
02-17-1999 LODING
25 18-30 SUMBERAGUNG 04/01- 081555861502

35 31-45 SUMBERAGUNG 04/06- 081554952721

37 31-45 0852346666665
04-16-1986 SUMBERAGUNG
21 18-30 085704419892
11-06-2001 REJOKATON 04/07
38 31-45
01-03-1985 SUMBERAGUNG 04/01
24 18-30 081515262960
48 46-59 085784141157
08-17-1974 SUMBERAGUNG 01/01
24 18-30
01-10-1999 SUMBERAGUNG 01/01
48 46-59 085730016378
12-29-1974 SUMBERAGUNG 04/04
33 31-45 085740569419
11-30-1989 SUMBERAGUNG 05/05
23 18-30 SUMBERAGUNG 01/02- 081553752416

46 46-59 085850152006
05-10-1977 SUMBERAGUNG 03/04
44 31-45 085649243972
09-27-1978 LODING 03/05
36 31-45 SUMBERAGUNG 04/06- 085856943247

48 46-59
06-15-1975 LODING 03/05
37 31-45 085608973263
12-10-1985 SUMBERAGUNG 04/01
23 18-30 085706203076
01-04-2000 SUMBERAGUNG 02/06
28 18-30 085606271861
09-09-1994 SUMBERAGUNG 03/05
48 46-59
08-03-1974 SUMBERAGUNG 02/04
50 46-59
07-01-1972 SIDOASRI 04/04
46 46-59 085748245622
05-05-1977 SUMBERAGUNG 04/07
25 18-30 081553583227
02-26-1998 SUMBERAGUNG 02/02
23 18-30 081934302747
09-30-1999 SUKOSEWU 02/04
28 18-30 081515262960
10-20-94 REJOKATON 02/07
37 31-45 081553388464
02-07-1986 SIDOASRI 04/04
32 31-45 085853922884
02-20-1991 SIDOASRI 02/04
43 31-45 082331401872
08-15-1979 LODING 01/05
46 46-59 085755644508
03-29-1977 SUMBERAGUNG 02/04
26 18-30 085737604547
06-23-1996 SUMBERAGUNG 01/02
42 31-45 085784027713
03-01-1981 SIDOASRI 01/04
30 18-30 085785749221
02-01-1993 LODING 05/05
45 31-45
49 46-59 859099791159
06-17-1974 SIDOASRI 03/03
45 31-45 081232702669
06-10-1978 SIDOASRI 01/03
38 31-45
06-20-1984 SUMBERAGUNG 02/02
48 46-59 08545564383
10-20-1974 LODING 04/05
39 31-45 085749807433
06-12-1984 SUMBERAGUNG 01/03
24 18-30 SUMBERAGUNG 05/01- 085855367023

06-23-1998 GADUSARI
39 31-45 085608973263
03-06-1984 SUMBERAGUNG 04/01
22 18-30 085749807433
06-16-2001 SIDOASRI 01/03
27 18-30 085856048126
01-09-1996 SUMBERAGUG 5/3
31 31-45 082264488894
07-27-1991 REJOKATON
41 31-45 085851463690
03-10-1982 SUMBERAGUNG 03/01
24 18-30 085745371297
03-07-1999 SIDOASRI 03/04
40 31-45 081335064952
12-24-1982 SIDOASRI 03/03
31 31-45 085706381228
12-01-1991 SIDOASRI 03/04
27 18-30 SUMBERAGUNG 5/3 - 085856978225

47 46-59 081233614357
09-12-1975 SUMBERAGUNG 03/07
21 18-30 081615461752
02-04-2002 SIDOASRI 04/04
24 18-30 081522668239
08-20-1998 SIDOASRI
19 18-30 085856985024
08-03-2003 SUMBERAGUNG 04/01
38 31-45 085895223733
02-16-1985 SUMBERAGUNG 02/05
30 18-30 085806923694
04-09-1993 REJOKATON 01/06
35 31-45
07-22-1987 SUMBERAGUNG 03/05
18 18-30 085784020589
10-26-2004 SUMBERAGUNG 02/05
35 31-45 085645705538
01-04-1988 SIDOASRI 05/04
21 18-30
01-10-2002 SUMBERAGUNG 04/02
48 46-59 085608738148
05-19-1975 SUMBERAGUNG 04/07
37 31-45 082131103029
07-09-1985 REJOKATON 01/06
42 31-45 081252241629
05-21-1981 REJOKATON 01/06
31 31-45 085601160040
10-23-1991 LODING 02/05
39 31-45 085784020500
01-22-1984 LODING 02/05
47 46-59 085855981454
07-01-1975 LODING 02/05
58 46-59
04-22-1965 LODING 02/05
50 46-59 085735627310
06-04-1973 SUMBERAGUNG 03/01
45 31-45 085704429252
04-10-1978 REJOKATON 04/07'
41 31-45 085645225269
12-10-1981 SUMBERAGUNG 3/3
29 18-30 085706862312
09-30-1993 LODING 02/05
27 18-30 085608376601
06-12-1996 REJOKATON 03/06
20 18-30 085645703807
08-29-2002 SIDOASRI 01/04
34 31-45 085755641923
01-16-1989 LODING 02/05
29 18-30 085806412707
09-30-1993 BANGSRI 01/10
50 46-59 85606271665
18 18-30 085859802162
06-22-2004 SUMBERAGUNG 04/01
41 31-45 085646462997
08-06-1981 SIDOASRI 04/04
20 18-30 85721540438
21 18-30 085785824740
08-07-2001 SUMBERAGUNG 04/01
50 46-59 085784975893
12-25-1972 SIDOASRI 01/04
44 31-45 085606271665
05-11-1979 SIDOASRI 1/3
27 18-30 085735904323
10-10-1995 SIDOASRI 3/3
39 31-45 085345122064
08-05-1983 SIDOASRI 03/04
51 46-59 85785760073
06-15-1972 LODING
41 31-45 085854722076
12-16-81 LODING 3/5
29 18-30 085854722076
05-14-1994 LODING 3/5
47 46-59
12-16-1975 REJOKATON 03/07
28 18-30 088226248627
03-13-1995 LODING 3/5
24 18-30 085815315706
07-22-1998 SUMBERAGUNG 04/01
33 31-45 088226248627
07-02-1989 LODING 3/5
49 46-59 0881026702609
09-27-1973 LODING 3/5
33 31-45 08578326899
08-31-1989 SIDOASRI 1/3
38 31-45 81331214134
08-25-1984 SIRAM MAKMUR
47 46-59 085855332551
47 46-59 085607253928
12-30-1975 SIDOASRI 4/4
44 31-45 085893869469
03-07-1979 SBG 5/5
21 18-30 085755523952
12-18-2001 SUMBERAGUNG 02/07
46 46-59 85732127243
25-10-1975 DSN SUMBERAGUNG 1/3
30 18-30 81310986144
12-06-1992 REJOKATON 1/7
32 31-45 085748326899
02-01-1991 SIDOASRI 1/3
50 46-59
10-11-1972 SUMBERAGUNG 05/04
36 31-45 085853728605
09-12-1986 SUMBERAGUNG 04/01
50 46-59
12-03-1972 REJOKATON 2/7
42 31-45 81357040786
06-08-1981 SIDOASRI 2/4
53 46-59
### ### 85536559325

52 46-59
09-27-1970 TALUN
42 31-45 085646504810
06-18-1981 TALUN
### ### 081249430900

20-03-00 DUREN 5/3 TALUN
123 ≥60 85655592450
SUMBERAGUNG 2/1
37 31-45 085895019041
8/18/85 SUMBERAGUNG 5/5
### ### 85736950414

53 46-59 -
41 31-45 85855332551
44 31-45 085745442524
7/3/78 SB AGUNG 3/2
45 31-45 -
10-11-1977 DSN. SIDOASRI 04/04
### ### 85608803584

29-05-1974 DERMOSARI 1/2 GADUNGAN
32 31-45 082289460199
04-12-1991 LODING 5/5
24 18-30 85607697140
39 31-45 081358460948
12/21/83 SIDOASRI
08137147571
085850378184
05-14-2003 REJOKATON 2/7
49 46-59 SUMBERAGUNG 03/03- 081233057399

52 46-59 081233057399
05-25-1971 SIDOASRI 03/03
39 31-45 SUMBERAGUNG 02/01- 085604578801

40 31-45 085649471544
03-09-1983 SIDOASRI 03/03
38 31-45 085891966981
01-08-1985 SIDOASRI 05/03
47 46-59 085735621297
28 18-30 085335604071
12/20/94 SB AGUNG 3/2
24 18-30 085806540238
50 46-59 '085850982397
5/15/73 SB AGUNG 3/2
30 18-30 081217845147
08-27-1992 REJOKATON 04/06
31 31-45 085785541129
11-12-1991 SUMBERAGUNG 04/01
53 46-59 85785814629
44 31-45 085790895587
07-20-1978 SUMBERAGUNG 05/03
36 31-45 085649515249
33 31-45 085815704225
04-21-1990 SUMBERAGUNG 04/01
46 46-59 08121741067
05-03-1977 REJOKATON 4/6
42 31-45 085735922423
07-11-1980 SIDOASRI 1/3
39 31-45
51 46-59 088231141531
40 31-45 082378649397
3/24/83 LAMPUNG
45 31-45 085733132353
10/24/77 SIDOASRI 1/3
28 18-30 085706381228
7/17/1994 SIDOASRI 3/4
53 46-59 085815702588
26 18-30 085806533201
4/25/97 REJOKATON 2/6
35 31-45 085787900321
8/18/87 SIDOASRI 1/4
123 ≥60 085731986057

SUMBERAGUNG 4/2
49 46-59 085228929804
26 18-30 081554369100
7/12/96 SB AGUNG 4/1
50 46-59 081556708378
42 31-45 81235456048
11-3-1980 REJOKATON 2/7
30 18-30 085854707130
9/10/92 LODING 4/5
25 18-30 085755342011
50 46-59 '
38 31-45 081553922443
06-04-1985 SIDOASRI 02/04
38 31-45 085859099791
07-18-1984 SUMBERAGUNG 03/03
24 18-30 081554525771
07-13-1998 REJOKATON 01/07
22 18-30 085855116307
05-20-2001 SIDOASRI
21 18-30 085732709684
11-19-2001 LODING 01/05
25 18-30 085757103825
06-11-1998 SUMBERAGUNG 03/03
30 18-30 085859992018
09-20-1992 SUMBERAGUNG 02/03
34 31-45 085732378141
05-16-1989 SIDOASRI 02/04
51 46-59 082364042872
06-06-1972 REJOKATON 03/07
34 31-45 085812517325
08-21-1988 REJOKATON 01/07
26 18-30 085604578828
08-11-1996 REJOKATON 02/06
31 31-45 081336776788
03-27-1992 LODING 03/05
46 46-59 085735627310
03-08-1977 REJOKATON 03/07
34 31-45 085706868730
12-17-1988 SUMBERAGUNG 04/01
29 18-30 085645723903
09-02-1993 SIDOASRI
60 ≥60 085785480405
02-20-1963 LODING 01/05
24 18-30 85755496708
13-02-1997 SIDOASRI 5/3 SUMBERAGUNG
39 31-45 082009026612
11-26-1983 SUMBERAGUNG 02/01
37 31-45 85791581112
12-01-1985 KARANGREJO GARUM
43 31-45 SUMBERAGUNG 01/02- 085755566882

23 18-30 SUMBERAGUNG 01/01- 085784760067

46 46-59 085745227450
08-17-1976 SUMBERAGUNG 01/01
22 18-30 085812191652
04-18-2001 SUMBERAGUNG 04/07
43 31-45
09-16-1979 SIDOASRI 04/03
43 31-45 085815202516
03-09-1980 LODING 02/05
57 46-59 085785480405
12-17-1965 LODING 01/05
37 31-45 081232035980
01-13-1986 SIDOASRI 02/03
38 31-45 085708444192
05-15-1985 SIDOASRI 02/03
24 18-30 85748330080
14-6-1997 SIDOASRI 4/3
20 18-30 85708742443
02-09-2003 SIDOASRI 2/3
40 31-45 81554266088
16-05-1981 LODING 1/5
32 31-45 85850820972
44 31-45 085731366813
01-07-1979 REJOKATON 4/6
25 18-30 82132527696
29 18-30 85608032522
28 18-30 085745310519
49 46-59
24 18-30 085855572924
18-04-1997 REJOKATON 4/6
22 18-30 085608810576
37 31-45 081517677186
42 31-45 085895010946
8/8/80 SB AGUNG 2/4
37 31-45 085895010945
05-04-1986 SUMBERAGUNG 01/04
37 31-45 085785358886
1/18/86 LODING 1/5
38 31-45 085785358886
3/27/85 LODING 1/5
26 18-30 081554290485
42 31-45 85645827339
12-5-1980 SIDOASRI 1/4
19 18-30 81517339879
18-10-2002 SIDOASRI 1/4
48 46-59
05-03-1975 REJOKATON 4/7
46 46-59 085854996755
02-14-1977 SUMBERAGUNG 04/01
39 31-45 085853922884
08-10-1983 SIDOASRI 02/04
22 18-30 085708446885
10-15-2000 PANTIMULYO
23 18-30 085607332915
10-31-1999 SUMBERAGUNG 01/04
27 18-30 0816514031
35 31-45 SUMBERAGUNG 01/02- 085859419787

23 18-30 SUMBERAGUNG 01/01- 085748814513

32 31-45 085735910065
02-03-1991 SIDOASRI 05/03
28 18-30 SUMBERAGUNG 01/01- 081554959180

33 31-45 SUMBERAGUNG 02/01- 085707194244

37 31-45 085815702564
08-21-1985 LODING 01/05
35 31-45 SUMBERAGUNG 02/01- 085790510440

33 31-45 082331760925
27 18-30 SUMBERAGUNG 01/02- 085714449180
25 18-30 SUMBERAGUNG 01/02- 085015021231

49 46-59 081554523933
02-23-1974 SIDOASRI
32 31-45 081230168410
12-11-1990 SUMBERAGUNG 04/06
41 31-45 SUMBRERAGUNG 4/5 - 085707031781

28 18-30 SUMBERAGUNG 5/3 - 085648668136

20 18-30 85850851636
09-14-2002 SUMBERAGUNG 01/02
30 18-30 085806947930
29 18-30 085784262224
06-14-1994 SIDOASRI 05/04
30 18-30 085815000307
08-11-1992 SUMBERAGUNG 04/01
22 18-30 085236374155
10-17-2000 SUMBERAGUNG 03/01
41 31-45 081372828173
08-28-1981 SUMBERAGUNG 03/02
24 18-30 0881026644130
41 31-45 085755333315
04-23-1982 SUMBERAGUNG 04/01
20 18-30 085748252354
08-08-2002 SIDOASRI 02/03
43 31-45 085749116286
54 46-59 085608148688
07-27-1968 SIDOASRI 01/04
22 18-30 085856069638
03-13-2001 SUKORENO 03/04
29 18-30 085855032536
09-21-1993 PURWOASRI 05/03
49 46-59 085608738198
02-14-1974 REJOKATON 03/07
42 31-45 081615030322
04-04-1981 REJOKATON 03/07
43 31-45 085608738148
02-13-1980 REJOKATON 03/07
40 31-45 081233614357
08-11-1982 REJOKATON 03/07
27 18-30 85850750130
06-11-1996 SIDOMULYO
42 31-45 085815708712
05-12-1981 SUMBERAGUNG 01/01
67 ≥60 082337332880
48 46-59 085745563647
19 18-30 085775624353
09-13-2003 SUMBERAGUNG 04/01
41 31-45 082178638189
06-08-1982 PURWOASRI 03/03
31 31-45 082131363884
11-17-1991 SUMBERAGUNG 04/01
50 46-59 085714413440
01-21-1973 REJOKATON 4/7
32 31-45 082131363884
07-09-1990 SUMBERAGUNG 04/01
27 18-30 085731175064
04-21-1996 SBG 2/2
29 18-30 085655517652
09-29-1993 SUMBERAGUNG 03/01
25 18-30 085755428378
28 18-30 08563511423
01-31-1995 SIDOASRI 02/04
42 31-45 085815200902
10-05-1980 SUMBERAGUNG 04/02
31 31-45 081359758080
30-6-1990 LODING 1/5
48 46-59
10-19-1974 SUMBERAGUNG 03/02
081515202642
1-1-97 SIDOASRI 3/3
20 18-30 08121741067
06-12-2003 SUMBERAGUNG 01/06
41 31-45 856985008
01-03-1982 LODING 1/5
45 31-45 085708107914
56 46-59 085892323591
9-9-66 SIDOASRI 5/4
36 31-45 085735123251
2/19/87 SB AGUNG 2/1
21 18-30 085755405805
10/23/01 SB AGUNG 4/4
42 31-45 082178638189
12/12/80 PURWOASRI 3/3
25 18-30
02/11/98 SIDOASRI 1/4
26 18-30 085807450348
04/17/1997 LODING 2/5
41 31-45 085815702551
01-17-1982 SIDOASRI
27 18-30 081555384247
3/3/96 SB AGUNG 2/6
30 18-30 085784172172
30 18-30 085746506783
47 46-59 081288313038
4-26-76 LINK BERU 1/2
40 31-45 085731174977
7/17/82 SB AGUNG 1/2
25 18-30
06/16/1998 SIDOASRI 4/4
63 ≥60 81358500270
11-4-1959 SIDOASRI 5/4
SI COVID-19
SINASI
\
Dosis I Dosis II
Nama/
Tanggal
Jenis/Merek
Screening
Vaksin*** Tanggal Tanggal
No.
Pemberian No. Batch No. Serial Pemberian No. Serial
Batch
Vaksinasi Vaksinasi
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
Keterangan
(Ditunda/
Tidak
Diberikan/L
anjut)
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS GANDUSA
No. Urut Jam Jenis

No No. Tiket 2 Penuntik penyun NIK Nama Penerima Vaksin Kela
an 2 tikan 2 min
1 126 9 3505154811700001
RINTANI P
2 24 8.34 3505155408650001
SUMINI P
3 7 8.2 3505154703630006
MISTUN P
4 11 8.23 3505111607700003
SUTAJI L
5 127 9.47 3505155005500002

UMI JARIYAH P
6 115 9.41 3505156501490001

NARWIATI P
7 203 10.53 3505154102630004

SUNARTI AL MINARSIH P
8 112 9.45 3505155207600004

SUNARMI P
9 20 8.31 3505155204620005
SUWARTI P
10 52 9 3505157012630001
IDA NURYANTI P
11 38 8.46 3505154900690003
SITI SOFIAH P
12 13 8.23 3505152405710001
IMAM SAFI'I L
13 51 9 3505150206580001
SOEGENG SANTOSO L
14 26 8.35 3505154503660001
SUTIANA P
15 50 8.59 3505150709640003
SAMSURI L
16 174 10.23 3505151210680001
ZAENAL ARIFIN L
17 74 9.21 3505150406700003
LEGIMAN L
18 128 9.47 3505151403450001

IMAM NAHROWI L
19 176 10.25 3505150712600002

KIRNAN L
20 35 8.44 3505152503710001
SUJIANTO L
21 119 9.43 3505150807620002

KADERI L
22 29 8.37 3505152905690003
SUKANTHI L
23 165 10.1 3505154706690001

SUFINATUN P
24 178 10.18 3505155608680002

MARIYEM P
25 98 9.36 3505154107630042
MESINI P
26 25 8.35 3505154304640001
KASIH P
27 155 10.05 3505152810660003

NURHASIM L
28 14 8.24 3505151211669003
BONARI L
29 69 9.18 3505153004560002
KOMARI L
30 8 8.2 3505155011550002
YAHMI P
31 55 9.04 3505151001670001
DJAMALI L
32 166 10.11 3505150607650004

YUSWADI L
33 4 8.17 3505154107710206
HARMANI L
34
10 8.22 3505151806690001 WIYONO L
35 99 9.32 3505150107530025
PANIRAN L
36 96 9.33 3505150105650007
KHAKIM L
37 94 9.31 3505157001700001
MARTINI P
38 27 8.36 3505155010500001
UMI KULSUM P
39 41 8.48 3505156503560001
RUKILAH P
40 202 10.51 3505156509610002
SUNARMI P
41 132 9.49 3505155510550003

KATEMI P
42 279 12 3505154107710017
SUMIYATUN P
43 288 12.42 3505154807630001

ISTINI P
44 248 11.31 3505154410630001

SRI PATONAH P
45 282 12.39 3505155204710001

TUTIK MUJAYATI L
46 298 1.12 3505154711640001

RUMIATUN P
26 3505150712540003
SUKANI L
31 3505154510690001
RIANTI P
16 3505150912540001
BEJO L
12 3505155605630002
SUNARMI P
23 3505154306690005
HARTUTIK P
24 3505155812600001
SUNARMI P
34 3505155805660002
SUNARTI P
42 3505150706580001
SUPARDJI L
44 3505152412610002
TRIMO L
39 3505152407700005
MASTUR EKO R L
49 3505153010650003
SUHARTONO L
50 3505154104700002
SUMARNI P
SASARAN = JUMLAH
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COV
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINAS
: UPT PUSKESMAS GANDUSARI

: KAB. BLITAR
: JAWA TIMUR
: 18 Oktober 2021

Umur
Kelomp
Tanggal (18 sd
Pekerjaan* ok Alamat No. Hp
Lahir ≥ 60
Umur
tahun) BPJS BPJS
PBI Non PBI
50+ 52 46-59 SUMBERAGUNG 02/05- 085755283877

11/8/1970 GANDUSARI
50+ 57 46-59 SUMBERAGUNG 04/05- 085334842096

14-Aug-65 GANDUSARI
50+ 60 ≥60 085704405950

03-07-1963 LODING 01/05
50+ 52 46-59 085804121905
07-16-1970 SUMBERAGUNG 02/04
60+ 73 ≥60 SUMBERAGUNG 04/01- 085785541124

60+ 74 ≥60 SUMBERAGUNG 04/06-

50+ 60 ≥60 SUMBERAGUNG 02/04- 085330566107

50+ 62 ≥60 083117765621

07-12-1960 SUMBERAGUNG 01/06
50+ 61 ≥60 081359228803

01-12-1962 SUMBERAGUNG 05-01
50+ 59 46-59 081333635540

12-30-1963 SUMBERAGUNG 02/02
50+ 53 46-59 085646041082

10-09-1969 SUMBERAGUNG 03/01
50+ 52 46-59 SUMBERAGUNG 01/01- 085755196302

60+ 65 ≥60 081330299340

06-02-1958 SUMBERAGUNG 02/02
50+ 57 46-59 SUMBERAGUNG 04/01- 085856985024

50+ 58 46-59 085895333895

09-07-1964 SUMBERAGUNG 04/04
50+ 54 46-59 08155169938
10-12-1968 SUMBERAGUNG 02/01
50+ 53 46-59 085334953774

06-04-1970 REJOKATON 04/06
60+ 78 ≥60
03-10-1945 SUMBERAGUNG 03/05
60+ 62 ≥60 082334074755

12-07-1960 SIDOASRI 01/03
50+ 52 46-59
03-25-1971 LODING 01/05
50+ 60 ≥60 085806545267

07-08-1962 REJOKATON 01/07
50+ 54 46-59 085746583015

05-29-1969 LODING 04/05
50+ 54 46-59
06-07-1969 SUMBEERAGUNG 03/03
50+ 54 46-59
08-16-1968 REJOKATON 02/07
50+ 59 46-59
07-01-1963 SIDOASRI 04/04
50 ++ 59 46-59 085606748984
50+ 56 46-59 085731146340

10-28-1966 SIDOASRI 04/04
50+ 53 46-59 085735623742
11-12-1969 LODING 03/05
50 + 67 ≥60 085785541124
50+ 67 ≥60 085784619635

11-10-1955 SIDOASRI 02/04
50+ 55 46-59 085704417356

10-01-1967 REJOKATON 4/6
50+ 58 46-59 -
06-07-1965 REJOKATON 4/6
50+ 52 46-59 0857555272068

01-07-1971 SIDOASRI 2/3
50+ 54 46-59 085895010947

06-18-1969 LODING 1/5
60+ 64 ≥60
07-01-1958 SUMBERAGUNG 04/04
50+ 58 46-59 085855824921

05-01-1965 SUMBERAGUNG 01/04
50+ 53 46-59 85784629323

01-30-1970 SUMBERAGUNG 01/04
LANSIA 72 ≥60 -
10-10-1950 SB AGUNG 4/1
LANSIA 65 ≥60 085735380668

03-25-1958 SB AGUNG 5/1
LANSIA 61 ≥60 081555384247
09-25-1961 SB AGUNG 2/6
LANSIA 67 ≥60 081555384066

10-15-1955 REJOKATON 2/6
50+ 51 46-59 SUMBERAGUNG 01/01- 085784814513

50+ 59 46-59 085733027279

07-08-1963 SIDOASRI 02/04
50+ 59 46-59 085784619635

10-04-1963 SIDOASRI
MU 51 46-59 085853927335
8/12/71 SB AGUNG 1/2
50+ 58 46-59
11-07-1964 SUMBERAGUNG 03/01
60+ 68 ≥60 082384341281

12-07-1954 REJOKATON 03/06
50+ 53 46-59 85573021234

10-05-1969 SUMBERAGUNG 01/02
60+ 68 ≥60 085735737786

12-09-1954 SUMBERAGUNG 01/04
50+ 60 ≥60 081234723278

05-16-1963 SUMBERAGUNG 05/01
50+ 54 46-59 085238116599
06-03-1969 REJOKATON 01/06
60+ 62 ≥60 085646441905

12-18-1960 SUMBERAGUNG 03/01
50 + 57 46-59 081555994397
60+ 65 ≥60 085733027279

06-07-1958 SIDOASRI 02/04
60+ 61 ≥60 082233206114

12-24-1961 REJOKATON 3/6
50 + 52 46-59 085236866420
07-24-1970 SUMBRAGUNG 3/6
50+ 57 46-59 085236140698

50+ 53 46-59 085850127729

04-01-1970 SUMBERAGUNG05/05
KSINASI COVID-19
OS VAKSINASI
\
aan BPJS (tulis 'Ya'

Dosis I Dosis II
olom yang sesuai)
Nama/
Tanggal
Jenis/Merek
Screening
Non No.
Pemberian No. Batch No. Serial Pemberian
Anggota Batch
Vaksinasi Vaksinasi
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
osis II
Keterangan
(Ditunda/
Tidak
Diberikan/L
No. Serial anjut)
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
No.
Jam Jenis
Urut
Penun
tikan 2 min
tikan 2
1 113 9.4 3505150510040002 MU

YOGA TAMA NUR SALIM L
2 226 11.1 3505171601970005 MU

AHMAD ARFAN FAUZI L
3 139 9.53 3304030306890001 MU

SLAMET RIYADI L
4 131 9.48 3505046501970005 MU
SITI KALIMAH TUL A P
5 217 11.02 3505151510690002 MU

SUPRIANTO L
6 264 12.19 35055156601650001 MU

PONIYEM P
7 258 11.41 3505182408950001 MU

AGGENG SAPUTRA IMAN L
8 269 12.23 3505152407830002 MU

SUGENG ROMADION L
9 253 11.4 3505170610750002 MU

MOHAMMAD FARUQ YUNAED L
1 MU
3505140107880067 MOH.SYAIFUL MUJAB L
4 35720101840005 MU
ALFIAN ANDRI TRIANTO L
5 3505152706030002 MU
AHMAD MAULANA P
6 3505152912950006 MU
ASHARI NURI NUHA L
10 3505171807970002 MU
RAHMAWAN LUDIANTORO L
11 3505170308880003 MU
MIFTACHUL ANAM L
12 350515040573006 MU
SAIFUL KROMI L
13 3505171704840005 MU
RIO WIHARTO L
15 3304032304840001 MU
SUKARYO L
17 3505152705760002 MU
MUJIANTO L
18 3505151202800003 MU
KHABIBI L
21 3505140210010001 MU
HENDA ARMANDA P
SASARAN = JUMLAH
ESMAS GANDUSARI

Umur
Kelomp
Tanggal (18 sd
ok Alamat No. Hp
Lahir ≥ 60
Umur
PBI Non PBI Anggota
18 18-30 085745443202
10-5-04 DSN SUMBERAGUNG
26 18-30 085745926600
1-16-97 JL. MERAPI RW 2 BABADAN
34 31-45 082231114351
06/03/89 BABADAN 2/2
PONDOK (PUSER,
24 18-30 PUCANGLAHAN 087750993832
25-01-1997 TULUNGAGUNG
53 46-59
56 46-59 085649528124
26-01-1965 REJOKATON RT1 RW 7
27 18-30 08566683330
08/24/95 BAREK 1/2 PLUMBANGAN
39 31-45 0856452249664
7-24-83 DSN SUKORENO
47 46-59 085233302009
35 31-45 85859311689
4/10/1988 PONDOK
39 31-45 JL. MASTRIP NO. 5 1/5 -

01/01/1984 KEPANJEN KIDUL
19 18-30
6-27-03 DSN TULUNGREJO 1/3
27 18-30 081555666822
12/29/95 KRISIK 4/7
25 18-30 081339434104
7-18-1997 JL BROMO 24 2/2 BABADAN
34 31-45 085233880852
08/03/88 BABADAN 1/2
50 46-59 085791405326
3-4-73 DSN GANDUSARI 1/3
39 31-45 081231392006
4-17-84 BABADAN 1/3
39 31-45 LINK GURID 2/2 BABADAN 085341357627

4-23-84 WLINGI
47 46-59 085706554365
5-27-76 SUMBERAGUNG
43 31-45
21 18-30 082231389761
10/2/01 BENDOSEWU 1/1 TALUN
SI COVID-19
SINASI
\
Dosis I Dosis II
Nama/
Tanggal
Jenis/Merek
Screening
No.
Batch
Vaksinasi Vaksinasi
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
12/27/2021 A1087
Keterangan
(Ditunda/
Tidak
Diberikan/L
anjut)
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
FO
Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS GANDUSARI

Hari, Tanggal : 27 Desember 2021
No.
Jam Jenis
Urut Tanggal
No penyun NIK Nama Penerima Vaksin Kela Pekerjaan*
Penun Lahir
tikan 2 min
tikan 2
1 15 8.26 3505156011970001 naila saadah p mu 20/11/97
2 32 8.39 3505154302600001 PAITUN P 60+ 3/2/60

3 46 8.53 3505155804630002 DARMINI P 50+ 4/18/63
4 47 8.56 3505150504710002 SUGENG K L 50+ 05/04/71
5 49 8.56 5171024901860006 NI MADE W L MU 09/01/86
6 53 9 3505151112900002 SISWANTO L MU 12/11/90
7 64 9.12 3505150206940001 TRI PURNAWAN L MU 6/2/94
8 61 9.14 3505156512730001 SUNARMI P MU 25/12/73
9 82 9.21 3505151604940001 ADITYA IRVAN F L MU 16/04/94
10 109 9.42 3578041711810010 RUDY DERMAWAN L MU 17/11/81
11 141 9.54 3505155209700003 LASIYEM P MU 12/09/70

12 144 10.06 1871160406880002 M. MUHTAFID L MU 6/4/88
13 145 10.07 3505155603820001 SUPRIHATIONI P MU 3/16/1982
14 151 10.13 3505155105880003 DUROTUN NASIKAH P MU 5/11/88
15 171 10.19 BINTI AMINAH P MU 01/08/80

3505154708800001
16 179 10.19 3504142808750001 SUROSO L MU 28/08/75
17 180 10.2 3505154910770003 NI'MATUN NISA' P MU 10-9-77
18 183 10.23 3505150104710007 ROHMAT L 50+ 01/04/71
19 184 10.24 6402050209840004 RIBUT EKO M L MU 27/09/84
20 190 10.28 3505152108890001 AGUS PURNOMO L MU 21/08/89

21 194 10.33 3505154507630006 MESIYEM P 50+ 05/07/63
22 225 11.09 3304032608950001 HABIBUL M L MU 8/26/1995
23 229 11.11 3505170302960003 DIAR PRASETYO L MU 03/02/96
24 239 11.22 3505156104700004 ST. MUNDIROH P 50+ 21/04/70
25 242 11.25 3505155612780001 ANIS K P MU 16/12/78
26 243 11.26 3505154509630001 TARWIYAH P 50+ 05/09/63
27 244 11.27 3505150202880003 M. AZIZ S L MU 2/2/1988
28 245 11.28 3505150207860003 M. SAMSI L MU 7/2/86
29 246 11.29 3505156411800001 NIKMATUS SOLIHAH P MU 11-24-1980

30 260 11 3505151010880004 MUHAMMAD NAJIB L MU 10/10/1988
31 252 10 3505154307830001 NAFIDAH P MU 7/3/1983
32 256 11.41 3505155504710004 ISMIATI P MU 15/04/71
33 257 11.42 3505154304850001 DWI ERNAWATI P MU 4/5/1985
34 283 12.45 3505154709580001 SUMINI P 60+ 09/07/58
35 300 1 3505114604960003 HIMATUL AMINAH P MU 06/04/96
36 60 13.23 3505155011010002 RIZKI LAILATUL R P MU 10/11/01
37 301 13.39 3505154510990002 YUHROTUL JANAH P MU 10/5/1999
38 304 14.42 3505154104700003 SITI MUJAIDAH P 50+ 4/1/1970


Umur
Kelomp
(18 sd Tanggal
ok Alamat No. Hp
≥ 60 Screening
Umur
PBI Non PBI Anggota
25 18-30 sumberagung 1/1 -
63 ≥60 SUMBERAGUNG 4/1

60 ≥60 SUMBERAGUNG 1/7
52 46-59 REJOKATON 2/7
37 31-45 SUKOSEWU 4/5
32 31-45 SBG 4/6
49 46-59 SIDOASRI 2/4
29 18-30 SIDOASRI 1/4
41 31-45 GANDUSARI
52 46-59 LODING 1/5

35 31-45 TANGKIL WLINGI
41 31-45 SIDOASRI 3/4
35 31-45 SUMBERAGUNG 1/1
42 31-45 SIDOASRI 4/3
45 31-45 SIDOASRI 4/4
52 46-59 SIDOASRI 4/4
38 31-45 NGANJUK 2/2
33 31-45 LODING 5/5

59 46-59 LODING 4/5
27 18-30 BABADAN 1/6
53 46-59 SBG 2/1
44 31-45 SBG 1/3
59 46-59 SBG 1/2
36 31-45 REJOKATON 3.7
42 31-45 SBG 3/1

34 31-45 SIDOASRI 3/4
39 31-45 LODING 1/5
38 31-45 SIDOASRI 5/3
64 ≥60 SB.AGUNG 4/2
21 18-30 SIDOASRI 5/4

19
Dosis I Dosis II
Keterangan
Nama/ (Ditunda/
Jenis/Merek Tidak
Vaksin*** Tanggal Tanggal Diberikan/L
No.
Pemberian No. Batch No. Serial Pemberian No. Serial anjut)
Batch
Vaksinasi Vaksinasi
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

No.
Jam Jenis
Urut
Penun
tikan 2 min
tikan 2
1 1 110 8.09 3505152007580001 KIDJAN L LANSIA
2 2 57 8.48 3505152701690001 SUJARNO L LANSIA

3 3 108 8.08 3505154202650001 MAYA SARI P LANSIA
4 4 82 9.00 3505151510710001 MUJITO L LANSIA
5 5 10 8.11 3505150107640004 SAHRI L LANSIA
7 6 48 8.37 3505151106600001 SUTRISNO L LANSIA
8 7 49 8.43 3505156503670001 MUSRIYANI P LANSIA
9 8 11 8.1 3505151711590001 MISKUN L LANSIA
10 9 91 9.24 3505154107570028 MULYATI P LANSIA
11 10 83 8.59 3505155112540001 SUNARTI P LANSIA
13 11 34 8.31 3505154107630013 SITI MASTIN P LANSIA
14 12 24.00 8 3505150612590001 ASKAR L LANSIA

16 13 8 8.33 3505221507560001 SUJARNO L LANSIA
17 14 31 8.2 3505155905440001 ISMIAH P LANSIA
18 15 64 8.49 3505156309680001 SUPRIHATIN P LANSIA
19 16 22 8.45 3505151302640001 SURADI L LANSIA
21 17 103 9.11 3505150108460001 ZAROHMAN L LANSIA
22 18 45 8.37 3505155009470001 SUMIATI P LANSIA
24 19 89 9.02 3505150107600161 SUMANI L LANSIA
25 20 133 10.03 3505155208590001 WIYATI P LANSIA
26 21 96 9.05 3505154507550002 SURATI P LANSIA
28 22 76 8.67 3505150107640033 EKWANUDIN L LANSIA

29 23 41 8.54 3505155711550001 SUHARYATI P LANSIA
30 24 14 8.13 3505151206670002 KARMANI HAD L LANSIA
31 25 134 10.02 3505152002560002 WIJIANTO L LANSIA
32 26 1 8.12 3505155003630001 YASMINAH P LANSIA
33 27 7 8.11 3505154106680002 WIWIK SUWARTI P LANSIA
35 28 85 9.04 3505154107450190 DJUWARIYAH P LANSIA
37 29 137 10.10 3505153005630001 WARNOTO L LANSIA
38 30 32 8.2 3505154711510001 NAPIAH P LANSIA
39 31 35 8.31 3505150703550002 HARDJONO L LANSIA
40 32 59 8.49 3505150808690003 AMARI L LANSIA

41 33 102 9.1 3505154107660017 SUPARTI P LANSIA
43 34 94 9.04 3505156908670001 PONIYAH P LANSIA
45 35 13 8.22 3505150801560001 HARYONO L LANSIA
46 36 203 11.59 3505155008510001 SUPIAH P LANSIA
47 37 23 8.25 3505156001620001 SUTINI P LANSIA
48 38 78 8.58 3505150112580001 NURIANTO L LANSIA
51 39 20 8.43 3505156511590002 YUSWATI P LANSIA
52 40 84 9.03 3505150107700029 DARMINTO L LANSIA
54 41 77 8.55 3505150109700003 SUBARI L LANSIA
55 42 118 9.3 3505152005700001 MUBINAS HANAFI L LANSIA

56 43 139 10.09 3505156109680001 ANJAR SULIANAH P LANSIA
57 44 36 8.35 350515906650001 SUNARTI P LANSIA
58 45 72 8.52 3505155604600001 RUSMINI P LANSIA
60 46 80 9.23 3505155911590001 MARYATI P LANSIA
61 47 86 9.01 35051556706540001 PAINI P LANSIA
62 48 204 11.58 3505150107700049 NUR HADI PUTRO L LANSIA
6 3505154107640018 UMI MUSLIKAH P LANSIA
12 3505151004660001 CHOIRUDIN L LANSIA
15 6304056712560001 SUKIYANI P LANSIA

20 3505154710590001 KASIYEM P LANSIA
23 3505152004670001 MULYONO L LANSIA
27 3505150107550014 YUSIANTO L LANSIA
34 3505155107640001 UMI SUYATI P LANSIA
36 3505150107650077 SUGITO L LANSIA
42 3505150107550008 SUKARNI L LANSIA
44 3505152707520001 SUGITO L LANSIA
49 3505150107610013 PATEMI P LANSIA
50 3505154107620012 KASTIWI P LANSIA
53 3505150804550003 MOCH DUCHA L LANSIA

59 3505155709650002 MUDJIATI P LANSIA
ESMAS GANDUSARI

Umur
Kelomp
Tanggal (18 sd
ok Alamat No. Hp
Lahir ≥ 60
Umur
PBI Non PBI Anggota
7/20/58 64 ≥60 SUKOSARI 02/01 81349172924
1/27/69 54 46-59 DERMOSARI 3/1 085732720946

02/02/65 58 46-59 SANDANGREJO 3/1 082143425441
15/10/71 51 46-59 DERMOSARI 3/1 082333559722
07/01/64 59 46-59 SANDANGREJO 4/1 085785324047
06/11/60 62 ≥60 DERMOSARI 3/1 085755250681
25/03/67 56 46-59 GADUNGAN 03/01 085755250681
17/11/59 63 ≥60 SANDANGREJO 4/ 081252237509
07/01/57 66 ≥60 SANDANGREJO 2/1 088102731982
12/11/54 68 ≥60 DAWUHAN 2/1 08124933391
01/07/63 59 46-59 DAWUHAN 01/01 081246273652
12/06/59 64 ≥60 DERMOSARI 3/1 081217453874

7/15/1956 66 ≥60 SELOPURO 081252434499
19/05/44 79 ≥60 DERMOSARI 1/2 -
23/09/68 54 46-59 DERMOSARI 2/1 085736554526
13/02/64 59 46-59 DERMOSARI 1/2 082141240432
08-01-1946 ### ### DERMOSARI 02/02 81232648878
09/10/47 75 ≥60 DAWUHAN 1/1 081334362747
07/01/60 63 ≥60 SANDANGREJO 1/1 085815710393
08/12/59 63 ≥60 SANDANGREJO 1/1 085895014828
07/05/55 68 ≥60 SUKOSARI 02/01 085335263632
07/01/64 59 46-59 SANDANGREJO 2/1 082217968761

17/11/55 67 ≥60 DERMOSARI 3/1 081234978767
06/12/67 55 46-59 SUKOSARI 1/1 081333671128
20/02/56 67 ≥60 SANDANGREJO1/1 085895014828
03/10/63 59 46-59 DERMOSARI 085708437389
06/01/68 55 46-59 SUKOMULYO 3/1 085732065256
07/01/45 78 ≥60 DERMOSARI 3/2 082141240432
30/05/63 60 ≥60 DAWUHAN 085745988543
11/07/51 71 ≥60 DAWUHAN 3/1 085745988543
03/07/55 67 ≥60 GADUNGAN 4/1 08155633261
08/08/69 53 46-59 SANDANGREJO 3/1 081336206250

07/01/66 57 46-59 SANDANGREJO 1/1 081246724932
8/29/67 55 46-59 SANDANGREJO 1/1 085745899015
01/08/56 66 ≥60 SUKOMULYO 1/2 085232712658
08/10/51 71 ≥60 DAWUHAN 3/1 085850127773
1/20/62 61 ≥60 DAWUHAN 1/1/ 082244176378
12/01/58 65 ≥60 SANDANGREJO 3/1 081231131381
25/11/59 63 ≥60 SUKOMULYO 1/2 081259419751
07/01/70 53 46-59 DERMOSARI 1/1 085607332968
08/01/70 53 46-59 SANDANGREJO 08234194153
20/05/70 53 46-59 DAWUHAN 085232488199

21/09/68 54 46-59 DERMOSARI 3/2 08125218113
19/06/65 58 46-59 DAWUHAN 2/1 081331660266
16/04/60 63 ≥60 DERMOSARI 1/2 085655492613
19/11/59 63 ≥60 PUTUKREJO 2/1 085853755923
27/06/54 68 ≥60 PUTUKREJO 2/1 085853755923
07/01/70 53 46-59 SANDANGREJO 3/1 081330238830
07/01/64 59 46-59 SANDANGREJO 1/1 085815710393
04/10/66 56 46-59 DAWUHAN 1/1 085790241575
12/27/56 66 ≥60 DERMOSARI 3/2 082159644863

10/07/59 63 ≥60 SANDANGREJO 081252434449
20/04/67 56 46-59 DERMOSARI 2/1 085607173544
07/01/55 68 ≥60 DERMOSARI 1/1 085258489004
07/11/64 58 46-59 DAWUHAN 3/1 08228122264
07/01/65 58 46-59 SANDANGREJO 3/1 082141240432
07/01/55 68 ≥60 DERMOSARI 1/1 085258468360
27/07/52 70 ≥60 SUKOMULYO 3/1 082334822009
07/01/61 62 ≥60 DERMOSARI 1/1 085258468360
07/01/62 61 ≥60 DERMSOARI 3/2 082141240432
04/08/55 67 ≥60 DAWUHAN 1/1 08523354446

17/09/65 57 46-59 PUTUKREJO 085336642119
SI COVID-19
SINASI
\
Dosis I Dosis II
Nama/
Tanggal
Jenis/Merek
Screening
No.
Batch
Vaksinasi Vaksinasi
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
Keterangan
(Ditunda/
Tidak
Diberikan/L
anjut)
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
FO

No.
Jam Jenis
Urut Tanggal
Penun Lahir
tikan 2 min
tikan 2
1 15 8.21 3505150609690002 WALUYO L 06/09/69
2 19 8.16 3505154507640001 MASLIKATUN NIKMAH P 7/5/64

3 21 8.44 3505155011010006 ULYA KHOIRUN NISA P 11/10/01
4 42 8.38 3505110206760002 JOKO WALOYO L 02/06/76
5 43 9.01 3505156510780001 BINTI SUWANTI P 25/10/78
6 75.00 9 3505072303940003 LUKMAN AFANDI L 6/25/94
7 208 8.49 3573034709720003 SUYARMI P 9/7/72
8 79 8.59 3505015105840002 ETIS WINALIKA P 11/05/84
9 87 9.05 3505151304020001 AUDIKO ARYO LAKSONO L 13/04/02
10 95 9.27 3505156306940001 PUTRI SURYANING P 23/06/94
11 97 9.09 3505153009610004 WAHYUDI L 30/09/61

12 101 9.39 3505152005920001 RONY HERMAWAN L 5/20/92
13 112 9.29 3505154703930001 DWI ANA SUPRIHATIN P 3/7/1993
14 113 9.28 3505222808880002 AGUS PURWANTO L 8/28/88
15 117 9.1 3505150808970002 KANZUN MUCHFIAN L 08/08/97
16 136 9.56 3505150407990002 TEGUH L 04/07/99
17 140 10.07 3505156008570001 MIN AYATIN P 8/20/1957
18 159 10.15 3505151909730003 SUPRIONO L 19/09/73
19 171 10.36 3505146405880002 NINING MEI P P 24/05/88
20 133 10.35 6309062106860002 RAMADHANI RAHMAN L 21/06/86

21 99 9.10 3505142010880001 LUQMAN HAKIM L 20/10/88
22 189 11.00 3505150901800003 SON HAJI L 1/4/1980
23 187 10.58 3505155708870001 SRI ANJARWATI P 17/08/87
24 191 1029 3505152001030002 RHIZQI SUGENG P L 20/01/03
25 192 10.31 3505152307970002 FARID AUFA L 22/07/97
26 193 10.30 3505156907010002 NERLYN NERISSA P P 29/07/01
27 194 11.05 3505151008760002 SLAMET HARIADI L 8/10/1976
28 201 10.09 3505153007650001 SUDARJI L 7/30/65


Umur
Kelomp
(18 sd Tanggal
ok Alamat No. Hp
≥ 60 Screening
Umur
PBI Non PBI Anggota
53 46-59 DERMOSARI 3/2
58 46-59 DAWUHAN 1/1

47 46-59 KEMLOKO
VAKSIN PERTAMA
50 46-59 MADYOPURO
DI LUAR NEGERI
39 31-45 DAWUHAN 1/1
21 18-30 GADUNGAN 4/1
61 ≥60 SUKOMULYO 3/1

31 31-45 SUKOMULYO 3/1
30 18-30 DERMOSARI
23 18-30 SUKOSARI 2/1
65 ≥60 DERMOSARI 2/1
35 31-45 SUMBERJO TALUN
36 31-45 TALUN
34 31-45 BENDOSEWU 5/2
43 31-45 SANDANGREJO 1/1
20 18-30 REJOSARI 1/2
25 18-30 GANDUSARI 2/1
21 18-30 TAMBAKAN 2/2
46 46-59 DAWUHAN 2/1

19
Dosis I Dosis II
Keterangan
Nama/ (Ditunda/
Jenis/Merek Tidak
No.
Batch
Vaksinasi Vaksinasi
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan
12/27/2021 A1087 Diberikan

No.
Jam Jenis
Urut
Penun
tikan 2 min
tikan 2
1 1 30 8.48 7271011004720007 LANI P MASY UMUM
3 2 54 8.47 3505154107750167 NURYANTI P MASY UMUM

4 3 105 8.10 350515010772005 SUYANTO L MASY.UMUM
5 4 70 8.5 3505151008800001 HARIYANTO L MASY UMUM
6 5 81.00 9.01 350515505760003 MUNAWAROH P MASY.UMUM
7 6 3 8.15 3505156303840001 HANDAYANI P MASY.UMUM
8 7 50 8.46 3505152711950003 WAHYUDIONO L MASY UMUM
10 8 69 9.14 3505150406890001 ADI DWI PRADANA L MASY UMUM
11 9 25 8.14 3505150602980001 CHOIRUL ANWAR L MASY UMUM
12 10 17 8.17 3505157007980001 BINTI MAHMUDAH P MASY UMUM
13 11 63 9.17 3505155801010001 RISKA DEWI AGUSTINA P MASY UMUM

14 12 5 8.12 3505156702890001 SRI NURHAYATI P MASY UMUM
15 13 2 8.28 3505173005890001 SAKTI YOGATAMA L MASY UMUM
17 14 135 9.58 3505151208750001 MUCHOLIQ L MASY.UMUM
19 15 18 8.12 3505150107950051 MOHAMMAD NOFRIANTO L MASY UMUM
20 16 92 9.24 3501061104750003 KARNI L MASY UMUM
21 17 106 8.05 3505155208740001 SUTRIANI P MASY UMUM
23 18 6 8.11 3505151207990001 KELVIN FAJAR JULIONO L MASY UMUM
24 19 132 3505155108880001 SUMARTIN P MASY UMUM
25 20 39 8.53 3505150611890001 NOVA MUSTAJIB L MASY UMUM

26 21 61 8.51 3505156607820004 ARIYALIN P MASY UMUM
27 22 44 8.41 3505151602020001 CANDRA ALDIKA L MASY UMUM
28 23 115 8.29 3505152310800001 YASIFUL ANAM L MASY UMUM
29 24 28 8.27 3505156401960001 NI'AM ISTATUL FUTARA P MASY.UMUM
30 25 109 8 3509062509810008 ABD.HAMID SANTOSO L MASY. UMUM
32 26 93 9.07 3505150105960001 AKBAR FAUZAN L MASY. UMUM
33 27 37 8.52 3505151704740001 LUMADI L MASY.UMUM
34 28 60 8.49 3505140107820001 KAMIM MASRUKIN L MASY UMUM
36 29 65 8.52 3505154309730002 SUKATI P MASY UMUM

37 30 46 8.38 3505151703010001 MOHAMAD ILHAM F L MASY UMUM
38 31 188 10.51 3505156808030001 FIRDA HUMAYUN P MASY UMUM
39 32 88 9.06 3505150107830076 HERU SANTOSO L MASY UMUM
41 33 16 8.39 3505152109760001 SULAIMI L MASY UMUM
42 34 107 8.06 3505154205740002 PURWANTI P MASY UMUM
43 35 68 8.54 3505152710020001 RIZKI STIAWAN L MASY.UMUM
44 36 178 10.40 3505152407020001 HANDARU L MASY UMUM
46 37 119 9.38 3505154602760001 SRIANAH P MASY.UMUM
47 38 160 10.30 3505152305830001 ENDRO NURCAHYO L MASY.UMUM
48 39 47 8.45 3505154310850002 TUTIK HIDAYATI P MASY UMUM
49 40 114 9.02 3505155412720001 FATIMAH P MASY UMUM

50 41 38 8.33 3505154807770001 UMA LAYALIA P MASY UMUM
51 42 67 8.49 3505150207770002 ROFIK L MASY UMUM
52 43 116 9.34 3505155011840007 SRI SUKATMI P MASY UMUM
53 44 138 9.59 3505154904740002 WINARTI P MASY UMUM
54 45 66 9.15 3505150305730002 SUKAJI L MASY UMUM
56 46 111 8.09 3505155011770001 SUWARTI P MASY UMUM
57 47 177 10.41 3505154101820006 YENNI INDRA W P MASY UMUM
58 48 104 9.12 3505151504770001 WAHYUDI L MASY UMUM
59 49 194 11.04 3505155407790002 ISTI KHOMATUN P MASY UMUM
60 50 12 8.23 3505153009990002 ANGGA PRATAMA L MASY UMUM
61 51 74 8.57 3505152412940004 CANDRA STIAWAN L MASY UMUM
64 52 55 8.47 3505155509720002 TUKILAH P MASY UMUM

66 53 52 8.46 3505151308980001 AJI UTOMO MASY UMUM
67 54 73 8.56 3217104106O6033 ENDAH PRATIWI P MASY UMUM
68 55 40 8.53 3505150107780130 SULARDI L MASY UMUM
71 56 100 9.07 3505150807750003 MUHAMAD IBA' ROHMAN L MASY UMUM
73 57 29 8.48 3505157007790001 SRI RAHAYU P MASY UMUM
75 58 33 8.5 3505151506730001 PODO SUTRISNO L MASY UMUM
76 59 71 8.55 3505153107980001 SINDU DIAH L MASY UMUM
78 60 27 11.3 3505150812810003 EDI KUSWANTO L MASY UMUM
79 61 26 8.26 3505080810930001 HENDRO W L MASY UMUM
80 62 90 9.06 3505151411960001 NOVANDA RIZQI BIMA L MASY UMUM
81 63 4 8.15 3505154401720001 WINARSEH P MASY UMUM
82 64 53 8.47 3505155508020001 ANGGRAINI DIAH P MASY UMUM

83 65 99 9.15 3505152511020007 ILHAM BAYU Y L MASY UMUM
84 66 59 8.48 3505154203880002 ANIK SUCIATI P MASY UMUM
86 67 56 8.49 3505154811790002 INGANATUR ROFI'AH P MASY UMUM
87 68 98 9.06 3505155512900001 USWATUN HASANAH P MASY UMUM
88 69 51 8.45 3505151007820002 IMAM SAFI'I L MASY UMUM
89 70 202 11.59 3505141601960002 M. AZIZ FIKRI MASY UMUM
90 71 9 8.12 3505175811990001 SILVIA E K P MASY UMUM
2 3505155708870001 SRI ANJARWATI P MASY UMUM
9 3505151002820007 ERMANTO L MASY UMUM
16 3505156512890004 IKA DWIANA P MASY UMUM

18 3573011408800006 AGUS SANTOSO L MASY UMUM
22 3505156402030001 ARISTA AMELIA P MASY UMUM
31 3505152308810006 KHOIRUL MUSTOFA L MASY. UMUM
35 3505151010730002 NAFIUL HUDA ROHMAN L MASY UMUM
40 3505155803950001 CHOIRUL ANA FITRIA P MASY UMUM
45 3505156808840005 SRI AGUSTINA P MASY UMUM
55 3505153129500002 KRISNA L MASY UMUM
62 3505150306010001 AMIN MUSTOFA L MASY UMUM
63 3505151511890001 MOHAMMAD IRVAN L MASY UMUM

65 3505156410730002 SUGIANIK MASY UMUM
69 3505150401800003 SON HAJI L MASY UMUM
70 3505150804930003 AMAT MUJITO L MASY UMUM
72 3505150507830002 YULIANTORO L MASY UMUM
74 3505154107760015 SATIYEM P MASY UMUM
77 3505155712940001 DINA ROSYITA P MASY UMUM
85 3505151212720006 GATOT SULIONO L MASY UMUM
91 3505152702990001 SHOLIHUL MAJID L MASY.UMUM

ESMAS GANDUSARI

Umur
Kelomp
Tanggal (18 sd
ok Alamat No. Hp
Lahir ≥ 60
Umur
PBI Non PBI Anggota
04/10/72 50 46-59 DERMOSARI 02/01 081280767527
1/7/75 48 46-59 DERMOSARI 3/2 085745450578

07/01/72 51 46-59 SANDANGREJO 4/1
10/08/80 42 31-45 SANDANGREO 04/01 088803607790
5/25/76 47 46-59 DERMOSARI 0822333559722
3/23/84 39 31-45 DERMOSARI 03/01 085645711944
27/11/95 27 18-30 SANDANGREJO 4/1 085859086514
06/04/89 34 31-45 DAWUHAN 3/1 0882009565125
02/06/98 25 18-30 DAWUHAN 1/1 0812343433992
7/30/98 24 18-30 DERMOSARI 1/1
1/18/2001 22 18-30 DAWUHAN 1/1 081246273652

2/27/89 34 31-45 SANDANGREJO 3/1 082143425441
30/05/89 34 31-45 SANDANGREJO 3/1 082143425441
08-12-1976 ### ### SANDANGREJO 3/1 082143075407
11/08/95 27 18-30 DERMOSARI 3/2 085812517382
04/11/75 47 46-59 SANDANGREJO 3/1 085231500077
08/12/74 48 46-59 SANDANGREJO 1/1 082359173972
13/06/99 24 18-30 SANDANGREJO 01/01 08817006561
11/08/88 34 31-45 SANDANGREJO 03/01 0881036743359
10/06/89 34 31-45 SANDANGREJO 2/1 0882009042372

26/07/82 40 31-45 SANDANGREJO 02/01 082233430443
2/16/2002 21 18-30 DAWUHAN 1/1 081334362747
10/23/80 42 31-45 SANDANGREJO 081553752601
01-24-1996 27 18-30 DERMOSARI 02/02 081226262845
9/25/1981 41 31-45 SUKOSARI 01/01 081341288552
01/05/96 27 18-30 DERMOSARI 03/01 085812512771
4/17/1974 49 46-59 DAWUHAN 085233015393
07/01/82 41 31-45 SANDANGREJO 2/1 082233430443
09/03/73 50 46-59 DERMOSARI 2/1 085607173544

3/19/2001 22 18-30 DERMOSARI 1/2 085710229739
8/23/2003 19 18-30 DERMOSARI 2/2 081357760917
07/01/83 40 31-45 SANDANGREJO 4/1 088217131271
9/21/76 46 46-59 DERMOSARI 3/2 081234340066
05/02/74 49 46-59 PUTUKREJO 1/1 085853755923
27/10/02 20 18-30 DAWUHAN 03/01 081337486013
24/06/02 20 18-30 ERMOSARI 03/01 085755428467
02-06-1979 ### ### DAWUHAN 081357760917
5/23/1983 40 31-45 SUKOMULYO03/01 81515657099
23/11/89 33 31-45 DERMOSARI 01/02 82232474861
14/12/72 50 46-59 SANDANGREJO 3/1 82332369240

07/08/77 45 31-45 DERMOSARI 2/2 085707938593
07/02/77 46 46-59 DAWUHAN 3/1 085655566378
11/10/84 38 31-45 SANDANGREJO 3/1 081336206250
04/09/74 48 46-59 DAWUHAN 085745988543
05/03/75 48 46-59 SUKOMULYO 3/1 085806533493
11/10/77 45 31-45 SANDANGREJO 4/1 081283025561
01/01/82 41 31-45 DERMOSARI 3/1 085755428467
15/04/77 46 46-59 DERMOSARI 02/02 3505151504770001
14/07/79 43 31-45 DAWUHAN 02/01 08124933391
10/09/99 23 18-30 SANDANGREJO 4/1 082131532982
24/12/94 28 18-30 DERMOSARI 01/01
15/09/72 50 46-59 SANDANGREJO 01/01 085785323886

08/13/1998 24 18-30 SANDANGREJO 01/01 085815710479
01/06/96 27 18-30 DERMOSARI 01/01 085607332968
10/10/77 45 31-45 SANDANGREJO 03/01 081333452433
08/07/75 47 46-59 DERMOSARI 2/2 082232185911
30/07/79 43 31-45 PUTUKREJO 01/01 085853755923
15/06/73 50 46-59 PUTUKREJO 01/01 085853755923
7/31/98 24 18-30 DERMOSARI 2/1 0852228431957
08/12/81 41 31-45 SANDANGREJO 03/01 082245307139
10/08/93 29 18-30 SANDANGREJO 2/1 085749577265
11/14/96 26 18-30 DAWUHAN 2/1 085784858171
01/04/72 51 46-59 SANDANGREJO 1/1 085706703135
8/15/2002 20 18-30 PUTUKREJO 1/1 081357145488

11/25/2002 20 18-30 DAWUHAN 3/1 08816053973
03/02/88 35 31-45 DERMOSARI 3/1 085812233250
08/11/79 43 31-45 DERMOSARI 03/02 081336213172
12/15/1990 32 31-45 SANDANGREJO 4/1 085236825990
07/10/82 40 31-45 SANDANGREJO 3/1 085895161885
16/01/96 27 18-30 SANDANGREJO 03/01 081330238830
18/11/99 23 18-30 SANDANGREJO 02/01 85785491018
8/17/87 35 31-45 SUKOMULYO 2/2 085731174944
02/10/82 40 31-45 DAWUHAN 3/1 088901827272
25/12/89 33 31-45 DERMOSARI 3/2 081357900416

14/08/80 42 31-45 DERMOSARI 3/2 082142312889
2/26/2003 20 18-30 SANDANGREJO 1/1 085859422669
9/23/1981 41 31-45 SANDANGREJO 02/01 081357854391
10/10/73 49 46-59 DERMOSARI 1/2 082141240432
3/18/1995 28 18-30 DERMOSARI 2/2 081231222277
28/08/84 38 31-45 DERMOSARI 02/02 081234513170
12/13/95 27 18-30 SUKOMULYO 3/1 085875263493
03/06/01 22 18-30 DAWUHAN 81357761457
15/11/89 33 31-45 DAWUHHAN 02/01 081294777781

24/10/73 49 46-59 SANDANGREJO 04/01 088231436612
01/04/80 43 31-45 SANDANGREJO 1/1 085855862710
04/08/93 29 18-30 SANDANGREJO 3/1 085855549486
05/07/83 39 31-45 SUKOMULYO 03/01 082232185911
07/01/76 47 46-59 DERMOSARI 1/1 085608199473
12/17/94 28 18-30 DERMOSARI 3/2 085733336915
12/12/72 50 46-59 GADUNGAN 03/01 81234728498
02-27-1999 24 18-30 DERMOSARI 03/02 87753158674

SI COVID-19
SINASI
\
Dosis I Dosis II
Nama/
Tanggal
Jenis/Merek
Screening
No.
Batch
Vaksinasi Vaksinasi
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166 12/27/2021 A1087
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
ASTRA
14-10-2021 14-10-2021 PW40166
ZENECA
Keterangan
(Ditunda/
Tidak
Diberikan/L
anjut)
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
Diberikan
FO

No.
Jam Jenis
Urut Tanggal
Penun Lahir
tikan 2 min
tikan 2
1 1 08.00 3505152606690001 RIWAYATNO L L 50+ 26/06/69
2 2 08.00 3505152707990001 CHOIRUL ANWAR L MU 7/27/99

3 3 09.25 3505150210590001 HARMANI / SAMANI L L 60+ 10/2/59
4 4 09.20 3505156806880003 SRI WAHYUNI P HAMIL 28/06/88
5 5 09.00 3505155005640001 KAYATI P L 50+ 10/05/64
6 6 09.20 3505155606920005 PUTRI DWI SUSANTI P MU 6/16/92
7 7 09.50 3505155704920006 SULISTIANI P MU 4/17/92
8 8 09.15 3505141711970003 YOHANES ALEK SAPUTRA L MU 17/11/97
9 9 09.15 3505154107630317 MARSIYEM P L 50+ 01/07/63
10 10 09.17 3505151105600001 SUKARNI L L 60+ 11/05/60
11 11 09.18 3505150107530246 SUDARTO L L 60+ 01/07/53

12 12 09.20 3505155706620003 DJINEM P L 50+ 6/17/62
13 13 09.21 3505150912680004 WINARKO L L 50+ 12/9/1968
14 14 09.21 3505154107650235 JAMI L L 50+ 7/1/65
15 15 09.22 3505155604710004 MUNTIAH P L 50+ 16/04/71
16 16 09.22 3505150107650002 SAERAN L L 50+ 01/07/65
17 17 09.23 350515503770002 SUTIN INDRAWATI P MU 3/11/77
18 18 09.23 3505152511920001 FERI KRISTIANTO L MU 25/11/92
19 19 09.24 3505150107610183 SUYANTO L L 60+ 01/07/61
20 20 09.25 3505154507580004 MISRI P L 60+ 05/07/58

21 21 09.26 3505154102650005 MUJIATI P L 50+ 01/02/65
22 22 09.27 350515681750001 MUJIATI P MU 11/28/1975
23 24 09.29 3505150209930001 AGUNG TOTO PRAMUSILO L MU 02/09/93
24 25 09.30 3505150107620153 TEKAD SUPRIYANTO L L 50+ 01/07/62
25 26 09.30 3505140312760001 MUKHALIQ EFENDI L MU 03/12/76
26 27 09.31 3505152508850003 ANDIK SETIAWAN L MU 25/08/85
27 29 10.18 3505154107610214 MIATI P L 60+ 7/1/1961
28 30 10.14 3505154901690001 MESIATI P L 50+ 1/9/69
29 31 10.00 3505192010870001 ARIF SETIAWAN L MU 10-20-1987

30 32 10.01 3505155703970003 ITA PUJI SAPUTRI P MU 3/17/1997
31 33 10.05 3505155909820001 IDA WATI P MU 01/07/82
32 34 10.1 3505154604740001 SITI ROKAYAH P MU 06/04/74
33 36 10.18 3505152512630001 SLAMET L L50+ 25/12/63
34 37 10.18 3505150202900003 RAJIS FEBRI WINARKO L MU 02/02/90
35 38 10.22 3505153101040001 M.RIDHO ANDRIYAN L REMAJA 1/30/2004
36 39 10.22 3505150102040002 FRENDI SETIAWAN L REMAJA 2/1/2004
37 40 10.3 3505154104760002 SRI SUMIATI P MU 01/04/76
38 41 10.34 3504020511890004 EKO YUDIANTO L MU 5/11/1989

39 42 10.36 3505150107780128 SULEMI P MU 7/1/78
40 43 12.39 3505150319010001 ONGKI SEPTA L MU 03/04/01
41 44 12.4 AHMAD ABDURRUZAQ L MU 04/06/96

3505150406960003
MU 24/04/80
42 46 12.41 350515240480002 SUGENG ISWANTO L
43 47 12.41 3505150106450001 KUSEN L L60+ 01/06/45
44 48 12.55 3505155309620002 MESILAH P L50+ 9/13/62


Umur
Kelomp
(18 sd Tanggal
ok Alamat No. Hp
≥ 60 Screening
Umur
PBI Non PBI Anggota
53 46-59 NGARINGAN 2/2 082334785789
23 18-30 GONDOROSO 1/2 085895915838

63 ≥60 GONDOROSO 2/2 085607056669
34 31-45 NGARINGAN 3/2 085748188737
59 46-59 NGARINGAN 2/2 082334785785
31 31-45 BINTANG 2/1 085648801797
31 31-45 BINTANG 2/1 085648801797
25 18-30 NGARINGAN 2/2 081252434558
59 46-59 BINTANG 4/1 085648801797
63 ≥60 NGARINGAN 2/3 082245089801
69 ≥60 GONDOROSO 3/2 085607056669

61 ≥60 NGARINGAN 2/3 082245089801
54 46-59 GONDOROSO 1/1 085607056669
57 46-59 GONDOROSO 2/1 085607056669
52 46-59 NGARINGAN 4/2 081464484359
57 46-59 PURWOSARI 1/1 082234138332
46 46-59 NGARINGAN 1/3 085331738283
30 18-30 NGARINGAN 5/1 085749904944
61 ≥60 PURWOSARI 4/2 081249527875
64 ≥60 PURWOSARI 4/2 081249527875

58 46-59 BINTANG 2/1 085648801797
47 46-59 PURWOSARI 4/2 081249527875 MANUAL
29 18-30 NGARINGAN 1/3 082334583778
60 ≥60 PURWOSARI 4/1 082234138332
46 46-59 NGARINGAN 4/1 0857499904944
37 31-45 BINTANG 2/2 082141239310
61 ≥60 BINTANG 4/1 085648801797
54 46-59 NGARINGAN 3/2 082333852900
35 31-45 PURWOSARI 2/2 081232572405

26 18-30 BINTANG 2/1 08568801797
41 31-45 NGARINGAN 1/3 081331316820
49 46-59 BINTANG 1/1 082141239310
59 46-59 NGARINGAN 5/1 082334785789
33 31-45 PURWOSARI1/2 085335731478
19 18-30 BINTANG 1/1 085607316871
19 18-30 BINTANG 1/1 085732127454 MANUAL
47 46-59 PURWOSARI1/2 085731154388
34 31-45 NGARINGAN 3/2 082140734940

44 31-45 PURWOSARI 2/2 081332169878
22 18-30 NGARINGAN 2/2 082334785789
27 18-30 GONDOROSO 4/1 085165546745
43 31-45 PURWOSARI 1/1 081233099199
78 ≥60 PURWOSARI 3/1 081233099199
60 ≥60 PURWOSARI 1/1 08123309199

19
Dosis I Dosis II
Keterangan
Nama/ (Ditunda/
Jenis/Merek Tidak
No.
Batch
Vaksinasi Vaksinasi
12/27/2021 FK9707 DIBERIKAN






No. Urut Jam Jenis

No Penuntik penyun NIK Nama Penerima Vaksin Kela Pekerjaan*
an 2 tikan 2 min
1 179 9.43 3505150205690001 SUTRISNO L
2 122 9.44 3505151909810001 MUSLIMIN P

3 120 9.15 3505151106710001 SUWANTO L
4 121 9.51 3505150706970008 TRI EFENDI L
5 123 9.46 3505151703460002 JEMINO L
6 210 9.48 3505151601690001 MUJIT L
7 125 9.45 3505155107840002 YAYUK RATNA WATI P
8 126 9.46 3505152602980002 MEGI SUPRIADI P
9 147 9.5 3505155707820002 MUDAWAROH P
10 127 9.49 3505150107580189 MURI L
11 128 9.5 3505155202580002 SIT MI'ANAH P

12 129 9.47 3505150104000001 PUTRA AGAUTAMA L
13 130 10.38 3505155809570001 MU'ANAH P
14 131 9.49 3505155201490001 SULAMI P
15 142 9.54 3505154606720003 SITI NADIROH P
16 143 9.56 3505154409090002 SEPTIA RAHMA DHANI P
17 161 10.14 3505155104550003 SAMAWATI P
18 144 9.54 3505156711570001 MESIRAH P
19 145 9.59 350515570600001 TRIASIH P

20 146 9.55 3505155510660001 SUGIANTI P
21 148 9.55 3505151610710004 KARYAD L
22 173 10.40 3505150609510001 MARSOID L
23 149 9.52 3505152901410001 KASERI L
24 162 10.16 3505153010750001 SUGIONO L
25 163 10.15 3505151011580001 SUMEDI L
26 150 9.57 3505150306700004 MARIASIP L
27 151 10.08 3505150407840001 EKO ROKHIM L

28 153 10.06 3505150511510001 SUPADI L
29 152 10.05 3505150711970004 M.TAUFIK QURRAHMAN L
30 154 10.11 3505150707770001 YULIANTO L
31 155 10.10 3505154511570001 GINTEN P
32 156 10.11 3505150906720002 SUKRI L
33 157 10.11 3573050202840009 WIGIYONO L
34 158 10.11 3505152603460001 ANSORI L
35 164 10.18 3505154506690003 SUMINI P

36 165 10.16 3505152711030001 MAFAZA MAGHFUR P
37 166 10.15 3505152104680001 SUHARI L
38 167 10.12 3505151311970001 PURNAWAN L
39 168 10.12 3505150612720001 SURYANTO L
40 169 10.12 3505150403640001 SUNDARI P
41 170 10.12 3505152104640001 DARIONO L
42 196 11.38 3505156003530001 UTAMI L
43 174 10.39 350515440657000` SUTILAH P

44 197 11.39 3505155206660002 SITI KOPSOH P
45 175 10.39 3505155108690001 NUR MUJAYANAH P
46 198 11.40 3505151712430001 MISWAN L
47 176 10.46 3505151011600002 YAHUDI L
48 185 10.52 3505116809890002 LINARTI P
49 180 10.55 3505154911820001 SURAMI P
50 181 10.5 3505151303000001 MIKO BUDIONO L
51 186 10.57 3505152711700001 IMAM BASUKI L

52 182 10.49 3505152108730001 AGUS SUPRIONO L
53 183 10.49 3505153009580001 SUTRISNO L
54 124 11.08 35051151712940001 DIKA LUVITA P
55 184 10.45 3505155807520001 SUJARMIATI P
56 190 11.15 3505154112550001 NASIYATI P
57 78 12.35 3505151702920002 RIKA HADI WIYONO L
58 200 11.5 3505152605770001 EDI SUTRISNO L
59 207 12.15 3505066504930003 PUJI LESTARI P

60 205 11.09 3505151505790002 SUSIANTO L
61 206 11.57 350515010756006 TURASMIDI L
62 62 12.2 3505150609650008 SAERI L
63 211 12.59 3505150701520001 SUKIRNO L
64 212 12 3505155705650001 MUDJIAH P

ESMAS GANDUSARI

Umur
Kelomp
Tanggal (18 sd
ok Alamat No. Hp
Lahir ≥ 60
Umur
PBI Non PBI Anggota
02/05/69 54 46-59 SUKOMULYO 082334822009
9/19/81 41 31-45 SUKOSARI 2/1 088190086658

6/11/71 52 46-59 SUKOSARI 2/1 085335236632
07/06/97 26 18-30 DERMOSARI 3/1 085749823880
17/03/46 77 ≥60 SLUMBUNG 1/2 08124933391
1/16/69 54 46-59 DAWUHAN 3/1 0812493391
7/11/84 38 31-45 SUKOSARI 1/1 0882009092792
26/02/98 25 18-30 SANDANGREJO 3/1 08586087087
17/07/82 40 31-45 SUKOMULYO 2/1 08563256784
01/07/58 64 ≥60 SANDANGREJO 3/1 0852493339
12/02/58 65 ≥60 DAWUHAN 1/1 081246273652

4/1/00 23 18-30 DAWUHAN 1/1 085704109884
9/18/1957 65 ≥60 SUKOMULYO 2/1 086860875144
1/12/49 74 ≥60 PUTUKREJO 1/1 081336066356
04/06/72 51 46-59 GADUNGAN 3/1 082141240432
04/09/09 13 0 SUKOSARI 1/1 081215059156
4/11/1939 84 ≥60 SUKOSARI 2/1 082127051239
27/11/57 65 ≥60 PUTUKREJO 2/1 085853755023
17/06/00 23 18-30 PUTUKREJO 1/1 085853755923

15/10/66 56 46-59 SUKOMULYO 1/1 082141240432
16/10/71 51 46-59 GADUNGAN 2/1 082141240432
9/6/1951 71 ≥60 DAWUHAN 3/1 08124933391
29/01/41 82 ≥60 SUKOMULYO 1/1 082141240432
30/10/75 47 46-59 DAWUHAN 2/1 082331206844
10/11/58 64 ≥60 DAWUHAN 1/1 08124933391
03/06/70 53 46-59 GADUNGAN 1/1 082370800051
7/4/1984 38 31-45 DERMOSARI 3/1 085748188761

11/5/51 71 ≥60 SUKOMULYO 2/2 085233439274
11-07-1997 25 18-30 SUKOMULYO 1/1 085806533737
7/7/1977 45 31-45 SUKOSARI 1/1 085335236632
11/5/1957 65 ≥60 SUKOMULYO 1/1 082141240432
09/06/72 51 46-59 GADUNGAN 2/1 081355558839
2/2/1984 39 31-45 SANDANGREJO 4/1 085731510612
26/03/46 77 ≥60 DERMOSARI 3/2 081336213172
05/06/59 64 ≥60 SUKOSARI 3/1 085755327015

27/11/03 19 18-30 DERMOSARI 3/2 085646488077
4/21/1968 55 46-59 GADUNGAN 2/1 085335236632
11/13/1997 25 18-30 GADUNGAN 4/1 082334639219
06/12/72 50 46-59 SANDANGREJO 3/1 081335548274
3/4/1984 39 31-45 GADUNGAN 1/1 085608482569
4-21-1964 59 ≥60 DERMOSARI 1/1 085731927686
20/03/53 70 ≥60 DAWUHAN 2/1 085850851068
04/06/57 66 ≥60 DAWUHAN 3/1 08124933391

12/06/66 57 46-59 DAWUHAN 1/1 085334035201
11/08/69 53 46-59 DERMOSARI 2/1 085546299488
12/17/1943 79 ≥60 DAWUHAN 3/1 08124933391
11/10/1960 62 ≥60 GADUNGAN 2/1 085232525403
28/09/89 33 31-45 SUKOMULYO 2/1 085708440645
09/11/82 40 31-45 SUKOMULYO 2/1 085791604134
13/03/00 23 18-30 DERMOSARI 3/2 081330818569
27/11/70 52 46-59 SUKOMULYO 1/1 082334822009

21/08/73 49 46-59 DERMOSARI 3/2 081330818569
30/09/58 64 ≥60 DAWUHAN 2/1 082231548720
17/12/94 28 18-30 SUKOMULYO 3/1 085731940736
7/18/52 70 ≥60 SUKOMULYO 3/1
01/12/55 67 ≥60 SANDANGREJO 1/1 085706970986
2/17/1992 31 31-45 SUKOMULYO 1/1 085853418910
26/05/77 46 46-59 SUKOMULYO 1/1 085736586314
25/04/93 30 18-30 GADUNGAN 1/1 085895013277

15/05/79 44 31-45 SUKOMULYO 08563256784
01/07/56 66 ≥60 DERMOSARI 3/2 085607998781
06/09/65 57 46-59 DERMOSARI 3/1 08124933391
07/01/52 71 ≥60 DERMOSARI 1/2 08154645229
17/05/65 58 46-59 DERMOSARI 1/2 082141240432

SI COVID-19
SINASI
\
Dosis I Dosis II
Nama/
Tanggal
Jenis/Merek
Screening
No.
Batch
Vaksinasi Vaksinasi
PFIZER 11-3-2021 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707

PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
PFIZER 12-27-2021 FK9707
12-27-2021 FK9707
12-27-2021 FK9707
Keterangan
(Ditunda/
Tidak
Diberikan/L
anjut)
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
DIBERIKAN
FO

No.
Jam Jenis
Urut Tanggal
Penun Lahir
tikan 2 min
tikan 2
1 1 08.00 3505156712740001 HUSNUL MU'AWANAH P MU 27/12/74
2 2 08.00 3505154605780002 ENI KUSRINI P MU 5/6/70

3 3 08.10 3510220404640003 SYAMSUDIN L L 50+ 4/4/64
4 5 08.00 3505150805940001 MIFTAKUL KHOIRI L MU 08/05/94
5 6 08.20 350517070787001 ERWIN JULIANTO L MU 07/07/87
6 7 08.25 3505150606680009 MOHAMAD MASTRUM L L 50+ 6/6/68
7 8 08.00 3505150107390083 MUKANI L L 60+ 7/1/39
8 9 08.20 3505150508990001 MOHAMMAD EFENDI L MU 05/08/99
9 10 08.00 3505146602650002 SUMINEM P L 50+ 26/02/65
10 12 08.30 3505156611830005 UMI NURHAYATI P MU 26/11/21
11 15 08.00 3505151905950001 DODIK KURNIAWAN L MU 19/05/95

12 16 09.05 3505150107630083 JAMIL L L 50+ 7/1/63
13 17 09.00 3505150107970064 RIZKI EFENDI L MU 7/1/1996
14 18 09.30 3505156812880005 ULFA MUBAROKAH P MU 12/28/88
15 19 09.00 3505154706710004 ENY NURHIDAYATI P MU 07/06/71
16 20 09.30 3505151402040002 MOHAMMAD DANDA L R 14/02/04
17 21 09.00 3505157012690006 WIWIK WIBAWATI P MU 12/30/69
18 22 09.00 3505156708700002 NARFIAH P L 50+ 27/08/70
19 23 10.00 3505154603770003 SARININGSIH P MU 06/03/77
20 24 09.50 3505150203730003 JARIEL LUKMAN HAKIM L MU 02/03/73

21 25 09.40 3574031107940001 TOMI CANDRA ARDIANTO L MU 11/07/94
22 26 10.00 3505150107480042 MUJIONO L L 60+ 7/1/1948
23 27 10.10 3578232110930001 FEBRIANTO OKTORA L MU 21/10/93
24 28 10.30 350515203840001 SRI RAHAYU P MU 12/03/84
25 29 10.40 3505156204040001 KARINA APRILIA P R 22/04/04
26 30 10.00 3505154107630240 SUHARTI P L 50+ 01/07/63
27 31 10.40 3505151409910004 MUHAMAD SYAFIL ANAM L MU 9/14/1991
28 32 10.40 3505150607910007 RUDI SETYAWAN L MU 7/6/91
29 33 10.45 3505111211770007 SUPARNO L MU 11-12-1977

30 34 10.40 3505152406740003 ARUM FAUZI L MU 6/24/1974
31 35 10.40 3505150201960001 ENDI WAHYUDI L MU 1/2/1996
32 40 12.40 3505151010740010 IMAM KHOIRI L MU 10/10/74
33 41 11.30 3505152812710001 HARMINTO L L 50+ 12/28/1971
34 42 12.11 3505150808760001 MAHMUDI L MU 08/08/76
35 43 11.00 3505154107840076 PUJI HANDAYANI P MU 01/07/84
36 44 11.00 3505151208820010 MUHAIMIN L MU 12/08/82
37 45 11.00 3505150501040001 DIMAS PRAYOGO L REMAJA 1/5/2004
38 46 10.40 3505150405050003 ADIT KURNIAWAN L REMAJA 5/4/2005


Umur
Kelomp
(18 sd Tanggal
ok Alamat No. Hp
≥ 60 Screening
Umur
PBI Non PBI Anggota
48 46-59 SUKORENO 2/3 082336492770
53 46-59 SUKOSEWU 1/5 081216884169

59 46-59 SUKORENO 4/6 081553798211
29 18-30 SUKOSEWU 1/6 081553415011
35 31-45 SUKOSEWU 1/2 085816559397
55 46-59 SUKOSEWU 4/4 085816350324
83 ≥60 SUKORENO 2/2/ 081553798211
23 18-30 SUKOSEWU 3/5 081553936967
KAMULAN 1/1 / SUKOSEWU

58 46-59 085608193519
4/2
83 ≥60 SUKOSEWU 1/8 085755076555
28 18-30 SUKOSEWU 1/8 085856207313

59 46-59 SUKOSEWU 3/4 085755076555
26 18-30 SUKOSEWU 3/4 085823406914
34 31-45 SUKOSEWU 4/1 085706377640
52 46-59 SUKOSEWU 1/3 085785555494
19 18-30 SUKORENO 1/6 0881026537007 DOSIS 1 MANUAL
53 46-59 SUKORENO 2/5 085707048838
52 46-59 SUKOSEWU 1/8 085704107140
46 46-59 SUKORENO 2/2 082139671160
50 46-59 SUKOSEWU 1/8 085746002773

28 18-30 SUKOSEWU 1/1 081252259058
74 ≥60 SUKOSEWU 4/4 085755076555
29 18-30 SUKOSEWU 2/1 085755076555
39 31-45 SUKOSEWU 4/6 085707592360
19 18-30 SUKOSEWU 2/3 082228026400
59 46-59 SUKOSEWU 4/6 081554516616
31 31-45 SUKORENO 3/6 081335933988
31 31-45 SUKOSEWU 4/4 085791226286
45 31-45 SUKOSEWU 4/4 085791226286

48 46-59 BUTUN 3/ 085746635195
27 18-30 SUKORENO 3/6 085704553099
48 46-59 SUKORENO 5/3 085645702199
51 46-59 SUKORENO 4/4 081553798211
46 46-59 SUKORENO 3/6 085645702199
38 31-45 SUKORENO 3/6 085645702199
40 31-45 SUKORENO 3/6 085645702199
19 18-30 SUKORENO 3/6 085731981298
18 18-30 SUKORENO 4/3 083846779812

19
Dosis I Dosis II
Keterangan
Nama/ (Ditunda/
Jenis/Merek Tidak
No.
Batch
Vaksinasi Vaksinasi





Dosis 2 27 Desember 2021 Az & Fizer

Uploaded by

Copyright:

Available Formats

You might also like

Dosis 2 27 Desember 2021 Az & Fizer

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dosis 2 27 Desember 2021 Az & Fizer

Uploaded by

Copyright:

Available Formats

+

Nama Puskesmas/Fasyankes/Pos : UPT PUSKESMAS GANDUSAR

1 182 10.21 3505150706760004 MU

3 188 10.26 3505154211020001 MU

6 129 9.48 3505150702970002 MU

12 187 10.26 3505150203800001 MU

13 140 9.53 3505116511870001 MU

18 118 9.43 3505151602880003 MU

19 159 10.08 3505115604860002 MU

22 121 9.44 3505155805990003 MU

25 157 10.07 3505156912740002 MU

26 130 9.48 3505157011890003 MU

27 134 9.53 3505151512990001 MU

29 117 9.42 3505152709780001 MU

31 153 10.03 3505155506750002 MU

33 123 9.44 3505114401000001 MU

35 146 10.08 3505150308740002 MU

36 199 10.47 3505154107720162 MU

37 193 1032 3505154505770011 MU

38 138 9.58 3505152602980001 FEBI BAYU FASTIKO MU

39 152 10.11 3505153009990003 MU

41 148 10.09 3505154702860002 MU

42 108 9.4 3505154202900003 MU

44 106 9.36 3505156903370001 MU

49 201 10.49 3505151706740001 MU

54 160 10.08 3505156306980003 MU

59 107 9.39 3505151003820005 MU

60 158 10.08 3505154703990001 MU

61 122 9.44 3505156412820002 MU

62 191 10.31 3505150112910001 MU

65 164 10.1 3505154402020003 MU

68 181 10.21 1111101602850001 MU

73 110 9.44 3505150110020001 MU

74 198 10.46 3504015905750002 MU

75 195 10.34 3507074907850001 MU

77 124 9.46 3505152310910002 MU

78 186 10.26 3505152201840001 MU

80 116 9.41 3505152204650002 MU

81 177 10.26 3505154406730002 MU

82 172 10.2 3505155004780001 MU

84 150 10.1 3505153009930002 MU

86 102 9.34 3505156908020002 MU

87 136 9.56 3505151601890003 MU

89 205 10.54 3505154609730001 MU

90 143 10.05 3505152206040001 MU

91 149 10.1 3505150608810002 MU

92 156 10.05 3505152707010001 MU

93 214 11.01 3505150708010001 MU

94 210 10.56 3524106512720001 MU

95 142 9.55 3505154511790001 MU

97 154 10.04 3505154508830005 MU

98 200 10.48 3505155506720001

101 147 10.09 3505151612750002 MU

102 83 9.22 3505155303950002

103 185 10.25 3505152207980001 MU

104 84 9.23 3603170702890003

105 85 9.23 3505156706730001