FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS

Nama Puskesmas/Jejaring : JANTI

Kabupaten/Kota : MALANG
Provinsi : JAWA TIMUR

Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

1 3573040101560012 SUGITO L 65 S SUPRIADI VI 2358 083120274906 CORONAVAC 08/10/2021 24006821

2 3573047001810001 ENDAH PUJI ASTUTIK P 40 S SUPRIADI X 26 17/06 081334725270 CORONAVAC 08/10/2021 24006821
3 3573046609710002 TRI WAHYUNI P 50 S SUPRIADI VI 22 10/06 087899704161 CORONAVAC 08/10/2021 24006821
4 3573044208930001 ANTILIYA P 28 JANTI UTARA V 39 087750756276 CORONAVAC 08/10/2021 24006821
5 3573044402490001 YASMINAH P 72 S SUPRIADI X 26 17/06 081334725270 CORONAVAC 08/10/2021 24006821
6 3573034101320025 MISARAH P 89 GALTIK DALAM 5 08319479961 CORONAVAC 08/10/2021 24006821
7 3573045810950003 KHOLIDYAH FADLILAH P 26 S SUPRIADI 7 20 07/02 085791389912 CORONAVAC 08/10/2021 24006821
8 3573046509580002 JUMAANI P 63 S SUPRIADI VIII 11 13/06 085932275573 CORONAVAC 08/10/2021 24006821
9 MAGDALENA H MAKASENDA P 13 S SUPRIADI 6 31B 089643522668 CORONAVAC 08/10/2021 24006821
10 3573045909820002 NINIK NIANA SS P 39 KLAYATAN I 49 05/12 081615044988 CORONAVAC 07/09/2021 2021081581 10/8/2021 24006821
11 3573055812910002 SITI NURKHOLISA P 30 S SUPRIADI 36 H 082141261407 CORONAVAC 08/10/2021 24006821
12 3573046906730002 ANDHIKA YUWANA L 48 S SUPRIADI 6 2348 09/06 CORONAVAC 12/09/2021 2021081581 10/12/2021 24006821
13 3573040811610004 ADI KAWURJAN L 66 S SUPRIADI VI 2373 10/06 CORONAVAC 08/10/2021 24006821
14 3524021406710001 SUYATNO L 50 TALUNREJO 085708589164 CORONAVAC 08/10/2021 24006821
15 3578160202870006 ANANG EFFENDY L 33 SAWAH 25 085233841628 CORONAVAC 08/10/2021 24006821
16 3573045608050005 DEVIAN NADYA SYAH PUTRI P 16 S SUPRIADI X 42 17/06 081232094521 CORONAVAC 08/10/2021 24006821
17 3507326807880003 ENI DWI ASTUTI P 33 SAWAH 25 01/01 082139373207 CORONAVAC 08/10/2021 24006821
18 3573040803850001 TRI ASMOROHADI L 36 S SUPRIADI X 19 18/06 081326028652 CORONAVAC 08/10/2021 24006821
19 3573044609900002 INDAH PUSPITASARI P 31 S SUPRIADI VI 2291 03/06 081318859347 CORONAVAC 08/10/2021 24006821
20 3573044409720004 SITI ROKAYAH P 49 S SUPRIADI VII 36 13/06 087759611440 CORONAVAC 08/10/2021 24006821
21 3573031101840005 IMAM NUR HASAN L 37 KEBALEN WETAN 081332009008 CORONAVAC 08/10/2021 24006821
22 3573042611050003 HILDHAN AINUNNIZAR L 15 S SUPRIADI IV 3 05/06 0895397114344 CORONAVAC 08/10/2021 24006821
23 3573040802680003 SUCIPTO L 53 DUSUN KRAJAN LOR 02/03 081225458941 CORONAVAC 08/10/2021 24006821
24 3573040705720004 SUGENG WAHYUDI L 49 S SUPRIADI VI 30 085830703319 CORONAVAC 08/10/2021 24006821
25 3573041201540006 ABDUL SUUD L 67 S SUPRIADI XI 32 06/04 082232798024 CORONAVAC 08/10/2021 24006821
26 3573041705750007 SUGIONO SUROSO L 46 S SUPRIADI X 20 15/06 081246019622 CORONAVAC 08/10/2021 24006821
27 3573046409050010 GALUH NARARYA WAHNINGYUN P 16 SIMPANG JANTI BARAT II 22 11/04 087762866656 CORONAVAC 08/10/2021 24006821
28 3573040306820007 TONI EKO FITRIANTO L 39 S SUPRIADI IV 43 06/06 085755474110 CORONAVAC 08/10/2021 24006821
29 3528055712030001 IRAWATI P 18 DUSUN KOLPOH 087844873206 CORONAVAC 08/10/2021 24006821
30 5207025511720002 TALHA P 43 PELABUHAN KETAPANG 082299775862 CORONAVAC 08/10/2021 24006821
 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

31 3573046205010004 SELVIEA RIZKY SUNARKO PUTRI P 20 S SUPRIADI IV 7 05/06 085730128422 CORONAVAC 08/10/2021 24006821
32 3573043112610012 SUHARDJO L 59 S SUPRIADI 15/06 082143710536 CORONAVAC 08/10/2021 24006821
33 3573045004950001 SHEYLA APRILLIA SUNARKO P 26 S SUPRIADI IV 7 05/06 08530128422 CORONAVAC 08/10/2021 24006821
34 3573046208800002 SULIANI P 41 S SUPRIADI X 3 18/06 082139664476 CORONAVAC 08/10/2021 24006821
35 3573042212760002 ISA JUNAEDI ROCHIMIN L 45 S SUPRIADII II A 07/03 082251312865 CORONAVAC 08/10/2021 24006821
36 3573041010680005 SUKOCO HADI L 53 S SUPRIADI X 8A 18/06 081357524144 CORONAVAC 08/10/2021 24006821
37 3573045006850005 SELVY NUR MAYASARI P 36 S SUPRIADI IX KAV C 29 16/04 087735155553 CORONAVAC 08/10/2021 24006821
38 3573040808780010 AGUS PURWANTO L 43 S SUPRIADI VI 2311 004/06 089653183242 CORONAVAC 08/10/2021 24006821
39 3573042211840001 HADI WIJIONO L 37 S SUPRIADI X 247 15 14/06 085707032014 CORONAVAC 08/10/2021 24006821
40 3573044307600005 YULIATI KUSMIATI P 61 SUKUN GEMPOL 4 03/09 081233664062 CORONAVAC 08/10/2021 24006821
41 3507034112740001 TITIK LESTARI P 47 SUKUN GEMPOL 47 02/09 085755142844 CORONAVAC 08/10/2021 24006821
42 3573044303840011 TITIK HUMA P 37 SUKUN GEMPOL MARGA BHAKTI 33 09/10 087866760299 CORONAVAC 08/10/2021 24006821
43 3573034803040004 RIFDA NAFISA ASZAHRA P 17 MUHARTO VII 13 05/07 083831973387 CORONAVAC 08/10/2021 24006821
44 3573045804000002 HAPSARI TYAS WIDYANINGRUM P 20 S SUPRIADI IV 32 02/06 085859319914 CORONAVAC 08/10/2021 24006821
45 3573044902890002 WULAN ARIATININGSIH P 32 S SUPRIADI X 2458 14/06 085331398060 CORONAVAC 08/10/2021 24006821
46 3573041906030006 ADI SETIAWAN L 18 RANGKOK UTARA 29 05/12 0853151426948 CORONAVAC 08/10/2021 24006821
47 3573042010000003 RIVALDO OKI YULANDA L 20 S SUPRIADI X 33 16/06 083824936815 CORONAVAC 08/10/2021 24006821
48 3573043006880003 ANSHORI L 33 NGAGLIK IID 35 13/01 082139143930 CORONAVAC 08/10/2021 24006821
49 3573040311770002 SLAMET SETIYAWAN L 44 SERUNI 04/10 085787657582 CORONAVAC 08/10/2021 24006821
50 3573042204710003 DRAJAT L 50 GEMPOL MARGA BHAKTI 02/10 085815721532 CORONAVAC 08/10/2021 24006821
51 3573045404050001 DEWIND AFRILISKA SUWARNO L 16 S SUPRIADI X 2458 26 14/06 083866801557 CORONAVAC 08/10/2021 24006821
52 3573042012890003 SWISS HADI PRASETYO L 32 S SUPRIADI X 18/06 085606309356 CORONAVAC 08/10/2021 24006821
53 3573042101720002 DIDIK DWI CAHYONO L 49 S SUPRIADI X 14/06 083833302189 CORONAVAC 08/10/2021 24006821
54 3573042110040001 ADI MAS KUSUMA L 17 S SUPRIADI X 1 15/06 087828720649 CORONAVAC 08/10/2021 24006821
55 3573045509670002 KUSWINARTI P 54 S SURPIADI X 01 15/06 087808720644 CORONAVAC 08/10/2021 24006821
56 3573041801960005 YANUAR EKO HARIANTO L 25 S SUPRIADI 6 / 13 10/06 083850200878 CORONAVAC 08/10/2021 24006821
57 3573040808650003 MULYONO L 56 S SUPRIADI X 01 15/06 087828720649 CORONAVAC 08/10/2021 24006821
58 3507094808850001 ANTIS MUCHORIDA P 36 S SUPRIADI VIII 19 12/06 081357357025 CORONAVAC 08/10/2021 24006821
59 3573041412050002 DIMAS FARHAN DAMAL MAULANA L 16 IR RAIS IX 48 02/05 081341294178 CORONAVAC 08/10/2021 24006821
60 3573040605620005 EDY ERMIANTO L 59 S SUPRIADDI X 2474 14/06 085815518389 CORONAVAC 08/10/2021 24006821
61 3573044405740006 WINARTI P 47 S SUPRIADI 6 2322 04/06 081233668027 CORONAVAC 08/10/2021 24006821
62 3573047105880001 WAHYUNINGTYAS P 33 S SUPRIADI VI 23 08/06 088805862316 CORONAVAC 08/10/2021 24006821
63 3573040304800008 ANDI HARIONO L 41 S SUPRIADI XI 7 06/04 08560966696 CORONAVAC 08/10/2021 24006821
64 3573041109580004 PUJI HARTONO L 63 S SUPRIADI XI 7 06/04 085381116868 CORONAVAC 08/10/2021 24006821
65 3573035604850004 ANIK YULITA P 36 MUHARTO VII 5 01/07 088989458258 CORONAVAC 08/10/2021 24006821
66 3573044807780001 SUSMIATIN P 43 S SUPRIADI 18/06 085606335117 CORONAVAC 08/10/2021 24006821
67 3573032405800003 MOH FAUJI L 41 MUHARTO VII 5 01/07 088989458527 CORONAVAC 08/10/2021 24006821
68 3573041503580002 KUSMANADI L 63 KLAYATAN I 39 10/01 083112033365 CORONAVAC 08/10/2021 24006821
69 3573045506850007 MUSRIANI P 36 S SUPRIADI 78 10/04 081334156925 CORONAVAC 08/10/2021 24006821
 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

70 3573044610720003 RINI SETYOWATI P 49 S SUPRIADI X 19 16/06 083834539880 CORONAVAC 08/10/2021 24006821

71 3573046002910002 TETTY SUPRIHATININGSIH P 30 PROF M YAMIN VII 50 09/07 089681117026 CORONAVAC 08/10/2021 24006821
72 3573040209090002 BARUNA RAMADHAN AZRIEL AKBAR L 12 S SUPRIADI VI 2358 09/06 088803776323 CORONAVAC 08/10/2021 24006821
73 3318124911400001 BOINI P 80 S SUPRIADI XI 28 06/04 085161677181 CORONAVAC 08/10/2021 24006821
74 3573041312790004 ARIF TEGUH PRIHATIN L 42 S SUPRIADI VIII 3 13/06 082257747381 CORONAVAC 08/10/2021 24006821
75 3573045303550001 NGATMINAH P 56 S SUPRIADI X 2458 14/06 CORONAVAC 08/10/2021 24006821
76 3528050103890004 SAHRIL L 32 NGAGLIK IVB 47 02/09 081945599807 CORONAVAC 08/10/2021 24006821
77 3528055211870006 SUYYINAH P 26 NGAGLIK IVB 47 02/09 087859713262 CORONAVAC 08/10/2021 24006821
78 3573045507600004 ENI HARTUTIK P 57 S SUPRIADI X 17/06 CORONAVAC 08/10/2021 24006821
79 3573044609690007 WARSINI P 52 KEMANTREN III 31 04/13 081553329578 CORONAVAC 08/10/2021 24006821 10/8/2021 24006821
80 3573045404790015 SUNARNI P 42 IR RAIS XIV 49 02/05 083134858829 CORONAVAC 08/10/2021 24006821
81 3573045502600006 SEMI P 61 S SUPRIADI IV 5 05/06 082230246010 CORONAVAC 08/10/2021 24006821
82 3573042808660002 YUSEF WIDIONO MUHAMMAD WIDION L 56 S SUPRIADI IV 37 06/06 CORONAVAC 08/10/2021 24006821
83 3573045903500001 YOHANA PIATI P 71 SUKUN GEMPOL 15 CORONAVAC 08/10/2021 24006821
84 3573044711770007 NUR SOLICHAH P 43 S SUPRIADI VIIB 19 01/04 081359112769 CORONAVAC 08/10/2021 24006821
85 3573045507690002 ANDRIANI P 52 S SUPRIADI X 17/06 082331844778 CORONAVAC 08/10/2021 24006821
86 3573044101500001 TUMINEM P 71 S SUPRIADI IV 65 05/06 085330874271 CORONAVAC 08/10/2021 24006821
87 3573046910600001 WIJIYATI P 61 S SURPADI 6 2311 04/06 085704045028 CORONAVAC 08/10/2021 24006821
88 8205171903010001 ABDUL MANAF L 20 DUSUN MEKARJAYA 03/02 081292618970 CORONAVAC 07/09/2021 24202221 10/8/2021 24006821
89 8103011602950003 SILFESTER LAMERE L 26 KABIARAT 02/01 081248771817 CORONAVAC 08/10/2021 24006821
90 3201172707840009 LALAN SUHERLAN L 37 KP CIDAMAR 02/06 082131557047 CORONAVAC 08/10/2021 24006821
91 9101010110010003 SILVESTER STALLONE R L 20 GEMAPIRAH 04/07 081313062147 CORONAVAC 08/10/2021 24006821
92 3573041906880004 ALFAN ROSIDI L 33 NGAGLIK IVB 287 07/01 089528424358 CORONAVAC 08/10/2021 24006821
93 3573044105060002 NESTA DYAH FAMEILYA P 15 S SUPRIADI X 14/06 089615155477 CORONAVAC 08/10/2021 24006821
94 3573042308040002 MOCHAMMAD ROFIQ AMIN L 17 S SUPRIADI X 12 18/06 081334872794 CORONAVAC 08/10/2021 24006821
95 3573042402680001 SUGENG HARIADU L 53 S SUPRIADI II 151 8 06/04 08813234121 CORONAVAC 08/10/2021 24006821
96 3573041905720003 SUPRIYONO L 49 DSN ADILUWIH 07/02 081335362837 CORONAVAC 08/10/2021 24006821
97 3573043011720001 WAWAN KUSWANTO L 49 S SUPRIADI VI 04/06 081357880632 CORONAVAC 08/10/2021 24006821
98 3573045210000002 RIZKI ISLAMIAH P 21 S SUPRIADI VI 2387 07/06 081330748192 CORONAVAC 08/10/2021 24006821
99 3573040801740002 BAMBANG ISLAMIANTO L 47 KEMANTREN HAYAMWURUK 5 11/03 081358284772 CORONAVAC 08/10/2021 24006821
100 3573040407050001 RIFKI ADITYA PASLAH L 16 S SUPRIADI VI 2410 11/06 083834993266 CORONAVAC 08/10/2021 24006821
101 3573042912010001 ALFREDO ANDY PRADANA NATALIUS L 20 S SUPRIADI VI 16 08/06 085748948434
102 3573040201810005 SUHARDJONO L 40 GELATIK LUAR 12 081231662229 11/09/2021 10/8/2021
103 3573050205660001 MUJIONO L 55 MANDASIA DALAM 34 03/14 082187044322
104 3573043105670004 SUPRAPTO L 54 S SUPRIADI VI 18A 07/06 081331449316
105 3573042412070001 SATRIO PAMBUDI L 14 MERPATI SELATAN 1 01/08 085748281080 10/8/2021
106 3573046206840007 ANA P 37 PUTER SELATAN 30 0895376590202 29/08/2021 10/8/2021
107 3573042403040001 MUHAMMAD ARDIAN FERDYANSAYAH L 17 KLAYATAN II 08 01/01 085236159558
108 3507190511040002 HAYKAL MAS AGENG PANGESTU L 17 PERUM GRIYA TELAGA PERMAI 1-4 07/03 081939808408
109 3507230205730003 SUPARNO L 48 S SUPRIADI VI 2327 07/06 085259000069
110 3578065911810004 KHUSNUL HIDAYATI P 40 DSN NGINGRIM 11/03 081703002221
111 3573040508710009 TUMINO L 50 SUKUN GEMPOL 02/09 085645054468
112 3507191105090004 MUHAMMAD ASYRAF HAKIM L 12 PERUM GRIYA TELAGA PERMAI 1-4 07/03 081939808408
113 3573041207680002 SUKRI L 53 SUKUN GEMPOL 47 02/09 085780417486
114 3573043112670018 HARI PRISTIWANTO L 55 S SUPRIADI X 11 15/06 082331257117
115 3573041102840003 Ahmad ZAKI FAKUROQOBAH L 37 IR RAIS V 114 C 08/02 089685430032
116 3573041912530001 MURDIONO L 68 S SUPRIADI VI 2379 10/06 081232018326
117 3573044506090004 RISMA YUNIAR VIBRIANTI P 12 S SUPRIADI VI 13 10/06 0881036345081
 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

118 3573047105930001 SAKINAH P 28 IR RAIS V 114 C 08/02 089685430032

119 3573040504840001 MOCHAMMAD ANTONI L 37 S SUPRIADI X 38 16/06 085273574243
120 3507016804010002 APRIANI SRI WAHYUNINGSIH P 20 DUSUN KALISANGKRAH 26/06 082331770352
121 3573025712930004 FIDIA NURJANA P 27 S SUPRIADI VII 69 05/02 082232379649
122 3573045812760001 PUDJIATI P 45 RAJAWALI 10/07 0895333500004
123 3507014809900001 SEPTYA DWI PALUPI P 31 SIDODADI VII 34/06 089646383282
124 3573042412790002 RUDI SANTOSO L 51 S SUPRIADI X 34 16/06 083834226239
125 3578154802880001 DEVY AYULIA FEBUYANTI P 33 GEMPOL 45 02/09 082139929604
126 3573021401830006 MURDIONO L 38 S SUPRIADI VI 2305 03/06 085755229431
127 3573041208550004 SUTARTO L 66 S SUPRIADI 6 30 10/06
128 3573046812830011 FENIA RIDEWANA P 37 S SUPRIADI IV 49 06/06 088289452807
129 3573042802880002 EKO ARI WITDIANTO L 33 GEMPOL 45 02/09 085655540655
130 7371052512030003 ALIF ABDI NEGORO L 18 SIMP JANTI BARAT PRM JANTI REGENCY KAV 86 083834567328 06/09/2021 10/8/2021
131 3573042206030002 MOCHAMMAD JAMALUDIN L 18 S SUPRIADI 14 01/06 089524596257
132 3573045408620001 SAMINI P 59 S SUPRIADI X 19 18/06 082335334905
133 3573045802870013 BUDI ATIADJASARI L 34 SUKUN 12/4 083129314463 07/09/2021 10/8/2021
134 3573040205150004 KARLENO ARDI SAPUTRA L 19 S SUPRIADI VI 15 08/06 081348565896
135 3573044703800011 WINARTI P 41 KLAYATAN I 10/01 0895412199060
136 3573040808640005 DJUWARNO L 57 NGAGLIK 4B 622 14/01 081333031815
137 3515021906820003 YUDI CAHYADI L 39 WONOKERTO LOR 05/01 082114392519
138 3573041507710002 AGUS PANTJIONO L 50 S SUPRIADI VIII 01 13/06 081234492790
139 3573040105800009 DANIEL L 41 NGAGLIK II 348 08/01 081334156927
140 3573040204620008 SUPRAYOGI L 59 JANTI BARAT 21 B 11/04 081234434462
141 3573041304010001 ABIL BRAHMASTYA SYURA L 20 S SUPRIADI GG MASJID ABDULLAH 34 01/06 083832502741 10/09/2021 10/8/2021
142 3573041409690001 IMAM GHOZALI L 52 S SUPRIADI VI 7 01/06 085731840799
143 3573021706910003 MOCH CHAMDANI L 30 SUKUN 03/04 085880560754
144 3573022310820004 CHOIRUL SOLEH L 39 KLAYATAN II 9A 15/12 0817389334
145 3573042807700002 ERY SURYADI L 51 S SUPRIADI IV 49 06/06 081259418997
146 3573040901520001 ARIADI L 69 JL. S. SUPRIADI X/26 081249592454 SINOVAC 08/10/2021 24006821
147 3573046105730001 MISTUN P 48 JL. JANTI UTARA V/39 087759753480 SINOVAC 08/10/2021 24006821
148 3573044109640001 SIOE FONG P 57 JL. LARWO E-18 081359294093 SINOVAC 08/10/2021 24006821
149 3573040104070007 ACHMAD HAMZAWI YAHYA L 14 JL. S. SUPRIADI VII/16 08311849998 SINOVAC 08/10/2021 24006821
150 3573045509420003 DIYAH P 79 JL. S. SUPRIADI IV/42 085231116823 SINOVAC 08/10/2021 24006821
151 3573046205810004 FITRI SAWITRI P 40 JL. S. SUPRIADI X/7 085608967836 SINOVAC 08/10/2021 24006821
152 3573046403700001 LILIK HENDRAWATI P 51 JL. S. SUPRIADI 4 NO 42 085231116823 SINOVAC 08/10/2021 24006821
153 3573042307610002 WASIS L 60 JL. S. SUPRIADI IV/58 083851047505 SINOVAC 08/10/2021 24006821
154 357304461670001 FARIDA P 54 JL. S. SUPRIADI X/24 081247341220 SINOVAC 08/10/2021 24006821
155 3573041407680006 KARLAN KARNOTO L 53 JL. S. SUPRIADI GG 6 NO 2287 0826394777 SINOVAC 08/10/2021 24006821
156 3573046702030003 DILLA RINDI FEBRIANTI P 18 JL. SUKUN GEMPOL 085655137201 SINOVAC 08/10/2021 24006821
157 3507306801540001 TARINI P 67 DSN TULUNGREJO 081332904852 SINOVAC 08/10/2021 24006821
158 3573045507930009 NIKE ARMILLA P 28 JL. TERS. TANJUNG PUTRA YUDHA 3/13 082150933402 SINOVAC 08/10/2021 24006821
159 3573045804760004 AFRILLA ZUNITA RACHMAWATI P 45 JL. S. SUPRIADI VI/2287 082226394777 SINOVAC 08/10/2021 24006821
160 3573040610790006 DIDIK SUGIANTO L 42 JL. S. SUPRIADI X/15 089613626801 SINOVAC 08/10/2021 24006821
161 3573047008040005 NESYA AULIA P 17 JL. S. SUPRIADI X/19 085771658564 SINOVAC 08/10/2021 24006821
162 3573045004720006 NGATMINAH P 49 JL. SUKUN GEMPOL 085791212082 SINOVAC 08/10/2021 24006821
163 3573046705090002 MAYANG AYODYA KIARA PUTRI P 12 JL. S. SUPRIADI VI/2287 082226394777 SINOVAC 08/10/2021 24006821
164 357302703640001 SUGITO L 57 JL. MERGAN KERAMAT 50 081239897097 SINOVAC 08/10/2021 24006821
165 3573042406880001 M. MAHRUS L 33 JL. S. SUPRIADI VII/36 081945339828 SINOVAC 08/10/2021 24006821
 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

166 3573025710040005 ESA FIDI OKTA RAMADHANI P 17 JL. BARENG RAYA II-N/33 089501597900 SINOVAC 08/10/2021 24006821
167 3573044512070001 SHERLY DZAKIYAH AZARIA P 14 JL. S. SUPRIADI VIII/15 085856586654 SINOVAC 08/10/2021 24006821
168 3573045707950004 HANIK ATUL MASRURO P 26 JL. S. SUPRIADI VIII/36 081945363306 SINOVAC 08/10/2021 24006821
169 3573040612440001 SUKUR L 37 JL. S. SUPRIADI IV/7 085730128422 SINOVAC 08/10/2021 24006821
170 3573042405070003 M. FAREL PAMUNGKAS L 14 JL. S. SUPRIADI IV/58 081703021163 SINOVAC 08/10/2021 24006821
171 3573042607030007 GIANT PAMUNGKAS L 18 JL. S. SUPRIADI IV/30 0858030703319 SINOVAC 08/10/2021 24006821
172 3573045802900002 SRI WAHYUNI P 31 JL. S. SUPRIADI IV/43 083848626918 SINOVAC 08/10/2021 24006821
173 3573041002910004 HEDAR FEBRIANTO L 30 JL. S. SUPRIADI IX/22 0895379104889 SINOVAC 08/10/2021 24006821
174 3573041406090003 PANJALU GURAT CHANDRA L 12 JL. SIMPANG JANTI BARAT II/22 08775906652 SINOVAC 08/10/2021 24006821
175 3573041308040004 PRADANA AGUS SETIAWAN L 17 JL. S. SUPRIADI X/8-A 081998445306 SINOVAC 08/10/2021 24006821
176 3516010104890001 MOH. GHUFRON L 32 JL. S. SUPRIADI X/6 082137741684 SINOVAC 08/10/2021 24006821
177 3573045912870009 GITA HANDAYANI P 34 JL. NGAGLIK II D/35 087859259852 SINOVAC 08/10/2021 24006821
178 3573044804090003 APRILITA AILEEN PUTRI INDIRA P 12 JL. S. SUPRIADI IX/65 081334965008 SINOVAC 08/10/2021 24006821
179 3573042008590004 DJULIONO L 62 JL. SIMPANG SUKUN 087869125536 SINOVAC 08/10/2021 24006821
180 3573045906900010 RULITA AYU SURYA PRATIWI L 21 DSN BARISAN 2/1 085707124217 SINOVAC 08/10/2021 24006821
181 3573035905050001 RAHAYU WILUJENG P 16 JL. KOL SUGIONO IB/27 088231172550 SINOVAC 08/10/2021 24006821
182 3573046807750004 NUNUK YULIANTI P 46 JL. SIMPANG SUKUN 49 08574284667 SINOVAC 08/10/2021 24006021
183 3573042409740001 M. ADIM L 47 JL. S. SUPRIADI IV/50 085755551274 SINOVAC 08/10/2021 24006821
184 3573044101710016 SINAP P 50 JL. SUKUN GEMPOL 087859259852 SINOVAC 08/10/2021 24006821
185 3507055206920003 YURIKE ADITIA P 29 JL. S. SUPRIADI VI/18 B 081357747253 SINOVAC 08/10/2021 24006821
186 3573045106030001 DEBRINA ARTATIKA SUWARNO P 18 JL. S. SUPRIADI X/2458-26 083866801557 SINOVAC 08/10/2021 24006821
187 3573044503040005 HAFSAH SHERAWALI AFRIANTI P 17 JL. S. SUPRIADI X/2458 087704793447 SINOVAC 08/10/2021 24006821
188 3573041104610001 PAIMAN L 60 JL. S. SUPRIADI 083834936815 SINOVAC 08/10/2021 24006821
189 3573041504860005 SETYOKO L 35 JL. S. SUPRIADI X/21 085334939382 SINOVAC 08/10/2021 24006821
190 3573041211840003 ATIM SANTOSO L 37 JL. S. SUPRIADI VIII/19 082140701800 SINOVAC 08/10/2021 24006821
191 3573040305050006 DWI WAHYU BAGUS SATRIO L 16 JL. KLAYATAM I/10 085707965280 SINOVAC 08/10/2021 24006821
192 3573046004870002 PRIWANTI P 34 JL. S. SUPRIADI X/15 085100435638 SINOVAC 08/10/2021 24006821
193 3573044411520004 WARSINI P 69 JL. S. SUPRIADI VIII/2423 082245908586 SINOVAC 08/10/2021 24006821
194 3573045410610001 ENDANG SRI UTAMI P 66 JL. S. SUPRIADI XI/7 085257823343 SINOVAC 08/10/2021 24006821
195 3573045102760001 FERY ELLVYANA P 45 JL. S. SUPRIADI X/14 085100435638 SINOVAC 08/10/2021 24006821
196 3573046404640004 ENDANG SUMARMI P 57 JL. PEL. TANJUNG PERAK 11 087873882006 SINOVAC 08/10/2021 24006821
197 3573046010810006 DWI ASIH KLIWANTI P 40 JL. S. SUPRIADI X/2458 087721959058 SINOVAC 08/10/2021 24006821
198 3573041908650001 SAIDI P 56 JL. S. SUPRIADI X 082331844778 SINOVAC 08/10/2021 24006821
199 3573044805010002 LOISE VALENCIA DELIAN. A P 20 JL. S. SUPRIADIVI/16 08574948434 SINOVAC 08/10/2021 24006821
200 1307114404950001 YOLLA YURIVA R P 26 KOTO TUO MUNGKA 082257288988 SINOVAC 08/10/2021 24006821
201 9101015007730006 ARSENIA DASMEDASE P 48 JL. GEMAHRIPAH 081313062147 SINOVAC 08/10/2021 24006821
202 3573045008070003 NADYA LAURA PUTRI P 14 JL. SIMPANG SUKUN TIMUR 081232175132 SINOVAC 08/10/2021 24006821
203 3573046112020003 DESY FITRIANA HARIADI P 19 JL. S. SUPRIADI XI/06 0881027514580 SINOVAC 08/10/2021 24006821
204 3573041111740007 HARIYANTO L 49 JL. S. SUPRIADI GG 9 NO 78 081334156925 SINOVAC 08/10/2021 24006821
205 3573041008570008 LUKIS WORO AMAN L 64 JL. JANTI BARAT 11 082232810057 SINOVAC 08/10/2021 24006821
206 3573045206400003 LOEBERFIRMANARTI P 81 JL. S. SUPRIADI VI/2365 081336701119 SINOVAC 08/10/2021 24006821
207 3573045712430001 SUDARMI P 78 JL. S. SUPRIADI IV/62 085330874271 SINOVAC 08/10/2021 24006821
208 3573041404730001 TOHARI L 48 JL. S. SUPRIADI IV/25 082233267770 SINOVAC 08/10/2021 24006821
209 3573041302570004 MUCHTAR L 64 JL. S. SUPRIADI X/38 081913009522 SINOVAC 08/10/2021 24006821
210 3573040102020011 LAXANDER FERNANDO L 19 JL. S. SUPRIADI X/19 083152686379 SINOVAC 08/10/2021 24006821
211 3573040609630003 MUTAKIN L 58 JL. KEMANTREN III/31 082232872249 SINOVAC 08/10/2021 24006821
212 3573046006590002 SRI SUKENI P 62 JL. S. SUPRIADI VI/2349 - SINOVAC 08/10/2021 24006821
213 3573040204900005 APRIAN SUSANTO L 31 JL. SUKUN GEMPOL 17 081231158764 SINOVAC 08/10/2021 24006821
 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

214 3573041505580008 SAMADY L 63 JL. TERS. TANJUNG PUTRA YUDHA V BLOK E-29 08123353898 SINOVAC 08/10/2021 24006821
215 3573045503920004 YUNITA P 29 JL. S. SUPRIADI 6 NO 2311 085704045028 SINOVAC 08/10/2021 24006821
216 3573045005580011 ENDANG SETYAWATI UTAMI P 63 JL. TERS. TANJUNG PUTRA YUDHA V BLOK E-29 082131931258 SINOVAC 08/10/2021 24006821
217 3573030207000001 FAHMI ABDILLAH L 21 JL. KOL SUGIONO IIIB/23 081334712354 SINOVAC 15/07/2021 24201321 10/8/2021 24006821
218 3573045003590002 SITI ARIANI P 62 JL. S. SUPRIADIIV/4 082139499445 SINOVAC 08/10/2021 24006821
219 3326151507940003 NURI SLAMET L 27 WULED TIRTO 083833302189 SINOVAC 08/10/2021 24006821
220 3573042606000005 ZIDAN ROCHMAD DEWANTORO L 21 JL. S. SUPRIADI X 0838333021089 SINOVAC 08/10/2021 24006821
221 3573042807550002 ABD. ROCHIM L 66 JL. S. SUPRIADI VIII/2417-24 08533107569 SINOVAC 08/10/2021 24006821
222 3514111607920001 M. EKO WAHYUDI L 29 JL. S. SUPRIADI VI/2321 082119063681 SINOVAC 08/10/2021 24006821
223 3573045908660001 DWI UTAMI P 55 JL. S. SUPRIADI X/17 081330911599 SINOVAC 08/10/2021 24006821
224 3507231906960002 IMOH. ILHAM YAMANI L 25 JL. BARAN 4/7 082131170718 SINOVAC 08/10/2021 24006821
225 3578161709840003 ACHMAD ALI ASSEGAF L 37 SUKUN 1/7 081314668242 SINOVAC 10/8/2021 24006821
226 3573057006750001 FATIMAH P 46 JL. MANDASIA DALAM 34 082187044322 SINOVAC 08/10/2021 24006821
227 3573045607820009 ANGGA SURYA NINGSIH P 39 JL. S. SUPRIADI IX A/31 081252129561 SINOVAC 08/10/2021 24006821
228 3573043103070011 MAHESA TARA ARBIANTO L 14 JL. S. SUPRIADIVII/33 083814019567 SINOVAC 08/10/2021 24006821
229 3573041402840002 ONY DICKY ABDILLA L 37 JL. S. SUPRIADI VI/35 085604703880 SINOVAC 08/10/2021 24006821
230 3573044705550002 SUGIYOWATI P 66 JL. S. SUPRIADI VI/2349 - SINOVAC 08/10/2021 24006821
231 3573041509970002 M. ALFINO A. L 24 JL. KLAYATAN II-08 0895630919689 SINOVAC 08/10/2021 24006821
232 3573040409670009 HERMANSYAH L 54 JL. S. SUPRIADI VI/18B 082341834394 SINOVAC 08/10/2021 24006821
233 3573046206710002 NINIK SUDARTI P 50 JL. S. SUPRIADI VI/18 A 085258287633 SINOVAC 08/10/2021 24006821
234 3573041408680009 SOEHARMADI L 53 JL. S. SUPRIADI X/34 081515126333 SINOVAC 08/10/2021 24006821
235 3573041609040003 SEFRI FIGRES P 17 JL. S. SUPRIADI X/2 08523867964 SINOVAC 08/10/2021 24006821
236 3573040101740028 NARKO WIJOYO L 47 JL. S. SUPRIADI X/2 082129146905 SINOVAC 08/10/2021 24006821
237 3573045710590004 ETI SULIANA P 62 JL. S. SUPRIADI IV/49 088289452807 SINOVAC 08/10/2021 24006821
238 3573041807000001 IRFAN FAUZI L 21 JL. SUKUN GEMPOL 23 089516186266 SINOVAC 08/10/2021 24006821
239 3573045201920006 OLIVIA YULIANTI P 29 JL. BANDULAN VI B / 882 B 0895397796777 SINOVAC 08/10/2021 24006821
240 3573042403040004 PATRICK FERDINAND DELIAN FIGO L 17 JL. S. SUPRIADI VI/16 085748948434 SINOVAC 08/10/2021 24006821
241 35730408110800001 MOH. LINGGAR SYAFIE L 12 JL. KEPUH III/14 C 085880560762 SINOVAC 08/10/2021 24006821
242 3573010102770006 AGUS SUNYOTO L 44 JL. A. YANI GG SATRIA 71 081232383394 SINOVAC 08/10/2021 24006821
243 3573046908940005 RADHITYA GITA RESTYAN P 27 JL. S. SUPRIADI VI/13 081615044966 SINOVAC 08/10/2021 24006821
244 3573046110670002 ENI RESTININGSIH P 54 JL. S. SUPRIADI VI/13 081615044966 SINOVAC 08/10/2021 24006821
245 3573044903940003 RIA INDRIYANI P 27 JL. SIMPANG MEGA MENDUNG IB/2 085707704955 SINOVAC 08/10/2021 24006821
246 3573044211800008 KUSTIWI ANGGRAINI P 40 JL. S. SUPRIADI VI/2327 081233950194 SINOVAC 08/10/2021 24006821
247 3573045502030005 AISYAH FEBRIANTI P 18 JL. S. SUPRIADI X/5 081939808408 SINOVAC 08/10/2021 24006821
248 3573041403040007 MARIO ILHAM LAKSAMANA P L 17 JL. S. SUPRIADI VI/2350 088200960230 SINOVAC 08/10/2021 24006821
249 3573040402740009 AGUS SUMARIONO L 47 JL. SIMPANG SUKUN TIMUR 40 08121785252 SINOVAC 10/8/2021 24006821
250 3573042512010005 RIVANDANI SURYA DARMAWAN L 20 JL. S. SUPRIADI VI/2322 A 085764928676 SINOVAC 08/10/2021 24006821
251 3573040709730002 M. ARIF L 48 JL. S. SUPRIADI GG MASJID ABULLAH 29 082132212941 SINOVAC 08/10/2021 24006821
252 3573042606050001 IZZAT MAULANA ABDILLAH L 16 JL. SIMPANG SUKUN TIMUR 40 08121785252 SINOVAC 08/10/2021 24006821
253 3573045508060002 ANNISA KHASANAH P 15 JL. S. SUPRIADI GG MASJID ABULLAH 19 085815365813 SINOVAC 08/10/2021 24006821
254 3573041802040006 FEBRIO YOGA PRATAMA L 17 JL. S. SUPRIADI VI/07 081393392064 SINOVAC 08/10/2021 24006821
255 3573040412710001 SOKEH L 50 JL. PEL. TANJUNG EMAS 081574535074 SINOVAC 08/10/2021 24006821
256 3573046004710001 RISTYO EMMI WINARTI P 50 JL. S. SUPRIADI X/10A 081249641055 SINOVAC 08/10/2021 24006821
257 3573044107590052 MISTIN P 62 JL. S. SUPRIADI X/15 082132257702 SINOVAC 08/10/2021 24006821
258 3573041105570002 ABDIL MALIK L 64 JL. S. SUPRIADI X/37 081333667683 SINOVAC 08/10/2021 24006821
259 3573044309620006 DJUMIATI P 59 JL. S. SUPRIADI 59 081259916744 SINOVAC 08/10/2021 24006821
260 3573040402740009 AGUS SUMARIONO L 47 JL. SIMPANG SUKUN TIMUR 40 08121785252 SINOVAC 08/10/2021 24006821
261 3573044110790002 SULIS SETYOWATI P 42 JL. S. SUPRIADI VIII/26 0878500006936 SINOVAC 08/10/2021 24006821
 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

262 3573010606950002 VICKY FERNANDO L 26 JL. S. SUPRIADI VI/2309 081216709026 SINOVAC 10/8/2021 24006821
263 3573046306920002 SRI WAHYUNI P 29 JL. NGAGLIK IV B/220 081913464215 SINOVAC 10/8/2021 24006821
264 3573042112840004 EKO JOKO SULISTIYOTO L 37 SUKUN 12/4 082257293859 SINOVAC 08/10/2021 24006821
265 3573041406650002 MUGIONO L 56 JL. S. SUPRIADI VII/2420-17 088803222935 SINOVAC 08/10/2021 24006821
266 3573040504690002 SUYONO L 57 JL. S. SUPRIADI VI/23-6 081334164747 SINOVAC 08/10/2021 24006821
267 3507141404940001 M. RIZKY PRATAMA L 29 JL. SIDODADI 22/5 083834291386 SINOVAC 08/10/2021 24006821
268 3573045102060003 NABILA NAFISATA PRASETYANTI P 15 JL. S. SUPRIADI IV/62 085330874271 SINOVAC 08/10/2021 24006821
269 3573041606550006 SUPRIADI L 66 JL. S. SUPRIADI X/34 083834226239 SINOVAC 08/10/2021 24006821
270 3573045609090003 AMIRA NAZWA AULIA P 12 JL. S. SUPRIADI IX 083849285149 SINOVAC 08/10/2021 24006821
271 3573045404850007 LINA P 36 JL. S. SUPRIADI IX/12 085707736601 SINOVAC 08/10/2021 24006821
272 3573046805050002 KERIN DWI KRISTELA P 16 JL. S. SUPRIADI IV/58 085706837036 SINOVAC 08/10/2021 24006821
273 3573045810850001 OKTAVIA KRISNAWATI P 35 JL. S. SUPRIADI IV/58 085706837036 SINOVAC 08/10/2021 24006821
274 3573040808090001 MOCH DIKA VICKY FIRMANSYAH L 12 JL. S. SUPRIADI VI/2287/19 081330910484 SINOVAC 08/10/2021 24006821
275 3573045502770003 MISINI P 44 JL. S. SUPRIADI VI/15 083148565896 SINOVAC 08/10/2021 24006821
276 3573044802560001 SURITATIK P 65 JL. S. SUPRIADI 8/2420-18 083834226239 SINOVAC 08/10/2021 24006821
277 3573046106800005 WIDIARTI P 41 JL. S. SUPRIADI GG MASJID ABULLAH 34 085107043824 SINOVAC 08/10/2021 24006821
278 3573041101970003 M. YANUAR L 24 KEPUH 08859854609 SINOVAC 08/10/2021 24006821
279 3573041705650002 ENDRO SULIANTO L 56 JL. S. SUPRIADI IV/49 087867597257 SINOVAC 08/10/2021 24006821
280 3573041507040002 RIFQI PRASETYO L 17 JL. S. SUPRIADI IV/49 083841635775 SINOVAC 08/10/2021 24006821
281 3573044505710006 ELIS SULIATI P 50 JL. S. SUPRIADI IV/49 081902538508 SINOVAC 08/10/2021 2400681
282 3506176402850003 SITI MUNADIROH P 36 JL. CANGAK NO 2 083848066090 SINOVAC 08/10/2021 24006821
283 3573041603850001 INDRA SISWANTO L 36 SIMPANG SUKUN 09 089505488070 SINOVAC 08/10/2021 24006821
284 3573045404560005 SUDARIYAM P 65 JL. SUKUN GEMPOL 20 081555652021 SINOVAC 08/10/2021 24006821
285 3573046010980001 CINDY PRADINA P 22 JL. S. SUPRIADI VII/09 085852834056 SINOVAC 08/10/2021 24006821
286 3573041403080001 DENISE ACHMAD GIBRAN YULIANTO L 13 JL. KLAYATAN III/57 087859111014 SINOVAC 08/10/2021 24006821
287 3507250209920001 YOSEP SETYAWAN L 29 LAWANG 081232017928 SINOVAC 08/10/2021 24006821
288 3573041105090002 DAVINO ANDHERPATI WARDANA L 12 PERUM GADANG MANDIRI B-18 085891495896 SINOVAC 08/10/2021 24006821
289 3573041507780003 ANDIK INDRAWAN L 43 JL. PISANG CANDI BARAT 86 A 087864464544 SINOVAC 08/10/2021 24006821

3573041810960004 RISKI ANDIK IRWANZA L 27 JL. SUKUN GEMPOL II/02 085959524502 SINOVAC 9/30/2021 24006921 11/5/2021 24006921 DOSIS I RSIA PURI

3573040304800008 ANDI HARIONO L 41 JL.S.SUPRIADI XI/7 085609666696 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573045402720004 SUMIATI P 49 JL.JOHAN BARAT NO.3 082243417196 SINOVAC 10/22/2021 24202821 11/5/2021 24006921

3573040101470007 DJAMA'ALI L 74 JL RAYA KEPUH X/25 085101427414 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573042510620001 GUNTORO L 59 JL .KEMANTREN 03 II/13 082142042115 SINOVAC 9/30/2021 24202921 11/5/2021 24006921 DOSIS I PMI

3507214107050001 NURAINI JULAIHA M P 16 SITIREJO WAGIR VI/04 089683320033 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

31750628080310003 FARHAN KHOIR L 18 JATINEGARA CAKUNG VI/4 081939467661 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3507305510650001 WINARSIH P 56 JL MERGAN 50 III/11 082129137531 SINOVAC 10/1/2021 202107144 11/5/2021 24006921 DOSIS I DAMPIT

3507211302060001 WIDJI SUMANTRI L 15 SUKODADI WAGIR I/01 082132593190 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3175066707040006 AYU YULIYANTI P 17 JATINEGARA CAKUNG VI/4 085706331202 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3514211204030001 ROYKAN ABDUH L 18 081259470010 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573041705750007 SUGIONO SUROSO L 46 081246019622 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573041807000001 IRFAN FAUZI L 21 JL SUKUN GEMPOL 23 IV/09 0895161862666 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573020404030002 ACHMAD HABIBIE L 18 087756664477 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

 Dosis I Dosis 2
Umur Keterangan
No NIK Nama Penerima Vaksin L/P Alamat No. Hp Merek Vaksin Tanggal Tanggal
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

3573046108730007 YAYUK MARIA KRISTINA P 48 JL S. SUPRIADI IX A/47 085230354156 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573045809940008 MUTOH HAROH L 27 083194209122 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573045101800005 NINIK ANDAYANI P 41 JL KEMANTREN II/54 082257277727 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573044605510001 SIH RAHADJENG P 70 JL JANTI SELATAN VII/47 085704513726 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573041412680001 SYAMSUL HIVANSYAH L 53 JL KEMANTREN I/10 081331862729 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573046207600001 DJUMANING P 61 JL.S.SUPRIADI VII/09 081515575082 SINOVAC 04/10/2021 24202021 11/5/2021 24006921 DOSIS I DI TNI AU

3573041308040004 PRADANA AGUS SETIAWAN L 17 081998495306 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573040807910003 JOKO PURWINOTO L 30 JL. KEMANTREN II/54 081336729593 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573040409760009 SUBAKRI L 45 JL. KEMANTREN II/56 081249449590 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573046102050003 FEBRYANE INDRA ANGENTYAS P 16 JL. SIMP. JANTI BARAT 2/52 085755462976 SINOVAC 7/15/2021 24201421 11/5/2021 24006921 RSIA RUMKITBAN

3573040409020002 SEPTIAN ARDI P L 081348565896 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573011902890006 MOCH RUDI WAHANA L 32 JL. PULOSARI I-N/19 A 089697018261 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

3573046204040002 KARINA DWI RATNA P 17 JL. SUKUN GEMPOL NO 14 0085735613784 SINOVAC 08/10/2021 24006821 11/5/2021 24006921

35730410066840003 SUKARDI L 37 JL. KOL SUGIONO X/66 0895606633635 SINOVAC 08/10/2021 24006821 11/5/2021 24006921