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MAKLUMAT PENERIMA VAKSIN / VACCINEE DETAILS

Nama / Name
Sarah Binti Mohd Nizam
Warganegara / Nationality
Malaysian

MALAYSIA No. Kad Pengenalan / Identity No. No. Pasport / Passport No.
960119105642 _

SIJIL DIGITAL Tarikh Lahir / Date of Birth


19-Jan-1996
VAKSINASI COVID-19
DIGITAL CERTIFICATE for COVID-19 Kementerian Berkuasa / Authority Ministry
VACCINATION KEMENTERIAN KESIHATAN (MINISTRY OF HEALTH)
Negara Pengeluar / Issuing Country
MALAYSIA
Tarikh Dikeluarkan / Date Issued
12-Jan-2022
Page 1 of 2

MAKLUMAT VAKSINASI / VACCINATION DETAILS

Dose 1 of 2 Tarikh Divaksin / Date of Vaccination


21-Jul-2021
Pusat Pemberian Vaksin / Vaccination Center
Ideal Convention Centre Shah Alam
Nama Produk / Product name
COVID-19 Vaccine AstraZeneca Solution for Injection (TH)
Nama Umum / Common Name
AstraZeneca
Pengeluar / Manufacturer Jenis Vaksin / Vaccine Type
Siam Bioscience Co., Ltd. COVID-19 vaccine, non-replicating
viral vector
No. Lot / Batch No.
A1013

Dose 2 of 2 Tarikh Divaksin / Date of Vaccination


22-Sep-2021
Pusat Pemberian Vaksin / Vaccination Center
Ideal Convention Centre Shah Alam
Nama Produk / Product name
COVID-19 Vaccine AstraZeneca Solution for Injection (JP)
Nama Umum / Common Name
AstraZeneca
Pengeluar / Manufacturer Jenis Vaksin / Vaccine Type
Daiichi Sankyo Biotech Co., Ltd., COVID-19 vaccine, non-replicating
Japan viral vector
No. Lot / Batch No.
D004A
MAKLUMAT PENERIMA VAKSIN / VACCINEE DETAILS
Nama / Name
Sarah Binti Mohd Nizam
Warganegara / Nationality
Malaysian

MALAYSIA No. Kad Pengenalan / Identity No. No. Pasport / Passport No.
960119105642 _

SIJIL DIGITAL Tarikh Lahir / Date of Birth


19-Jan-1996
VAKSINASI COVID-19
DIGITAL CERTIFICATE for COVID-19 Kementerian Berkuasa / Authority Ministry
VACCINATION KEMENTERIAN KESIHATAN (MINISTRY OF HEALTH)
Negara Pengeluar / Issuing Country
MALAYSIA
Tarikh Dikeluarkan / Date Issued
12-Jan-2022
Page 2 of 2

MAKLUMAT VAKSINASI / VACCINATION DETAILS

Booster Dose Tarikh Divaksin / Date of Vaccination


10-Jan-2022
Pusat Pemberian Vaksin / Vaccination Center
PPV Offsite Dewan Kompleks Sukan Majlis Perbandaran Kuala Langat
Nama Produk / Product name
COVID-19 Vaccine AstraZeneca Solution for Injection (TH)
Nama Umum / Common Name
AstraZeneca
Pengeluar / Manufacturer Jenis Vaksin / Vaccine Type
Siam Bioscience Co., Ltd. COVID-19 vaccine, non-replicating
viral vector
No. Lot / Batch No.
A1085

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