HASIL KEGIATAN IMUNISASI BAYI

PUSKESMAS KREJENGAN
TAHUN 2019

JENIS ANTIGEN
JML SASARAN
NO BULAN HB 0 (0<24) JAM TOTAL HB 0 (1<7) HARI TOTAL BCG TOTAL POLIO1 TOTAL DPT/HB(1) TOTAL POLIO2 TOTAL
L P JML L % P % ABS % L % P % ABS % L % P % ABS % L % P % ABS % L % P % ABS % L % P % ABS %

1 JANUARI 10 11 21 0 0.0% 1 9.1% 1 4.8% 0 0.0% 0 0.0% 0 0.0% 2 20.0% 1 9.1% 3 14.3% 1 10.0% 1 9.1% 2 9.5% 1 10.0% 1 9.1% 2 9.5% 1 10.0% 1 9.1% 2 9.5%

2 PEBRUARI 10 11 21 1 10.0% 0.0% 1 4.8% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 18.2% 2 9.5% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%

3 MARET 10 11 21 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 10.0% 0 0.0% 1 4.8% 2 20.0% 2 18.2% 4 19.0% 2 20.0% 3 27.3% 5 23.8% 1 10.0% 1 9.1% 2 9.5%

4 APRIL 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

5 MEI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

6 JUNI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

7 JULI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

8 AGUSTUS 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

9 SEPTEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

10 OKTOBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

11 NOPEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

12 DESEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

JUMLAH 10 11 21 1 10.0% 1 9.1% 2 9.5% 0 0.0% 0 0.0% 0 0.0% 3 30.0% 3 27.3% 6 28.6% 3 30.0% 3 27.3% 6 28.6% 3 30.0% 4 36.4% 7 33.3% 2 20.0% 2 18.2% 4 19.0%
 HASIL KEGIATAN IMUNISASI BAYI

PUSKESMAS KREJENGAN
TAHUN 2019

JENIS ANTIGEN
JML SASARAN
NO BULAN DPT/HB(2) TOTAL POLIO3 TOTAL DPT/HB(3) TOTAL POLIO4 TOTAL MR TOTAL IPV TOTAL
L P JML L % P % ABS % L % P % ABS % L % P % ABS % L % P % ABS % L % P % ABS % L % P % ABS %

1 JANUARI 10 11 21 2 20.0% 1 9.1% 3 14.3% 1 10.0% 1 9.1% 2 9.5% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 10.0% 0 0.0% 1 4.8% 1 10.0% 1 9.1% 2 9.5%

2 PEBRUARI 10 11 21 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 3 30.0% 1 9.1% 4 19.0% 0 0.0% 0 0.0% 0 0.0%

3 MARET 10 11 21 1 10.0% 1 9.1% 2 9.5% 2 20.0% 1 9.1% 3 14.3% 2 20.0% 1 9.1% 3 14.3% 1 10.0% 1 9.1% 2 9.5% 0 0.0% 2 18.2% 2 9.5% 0 0.0% 0 0.0% 0 0.0%

4 APRIL 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

5 MEI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

6 JUNI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

7 JULI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

8 AGUSTUS 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

9 SEPTEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

10 OKTOBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

11 NOPEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

12 DESEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

JUMLAH 10 11 21 3 30.0% 2 18.2% 5 23.8% 3 30.0% 2 18.2% 5 23.8% 2 20.0% 1 9.1% 3 14.3% 1 10.0% 1 9.1% 2 9.5% 4 40.0% 3 27.3% 7 33.3% 1 10.0% 1 9.1% 2 9.5%

Mengetahui Probolinggo, 1 Pebruari 2012

Kepala Puskesmas Krejengan Koordinator Imunisasi,
 HASIL KEGIATAN IMUNISASI BATITA

PUSKESMAS KREJENGAN
TAHUN 2019

JENIS ANTIGEN
JML SASARAN
NO BULAN PENTA 4 TOTAL CAMPAK 2 TOTAL
L P JML L % P % ABS % L % P % ABS %
1 JANUARI 10 11 21 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 18.2% 2 9.5%

2 PEBRUARI 10 11 21 0 0.0% 0 0.0% 0 0.0% 1 10.0% 1 9.1% 2 9.5%

3 MARET 10 11 21 0 0.0% 3 27.3% 3 14.3% 0 0.0% 0 0.0% 0 0.0%

4 APRIL 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

5 MEI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

6 JUNI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

7 JULI 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

8 AGUSTUS 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

9 SEPTEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

10 OKTOBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

11 NOPEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

12 DESEMBER 10 11 21 0.0% 0.0% 0 0.0% 0.0% 0.0% 0 0.0%

JUMLAH 10 11 21 0 0.0% 3 27.3% 3 14.3% 1 10.0% 3 27.3% 4 19.0%

 LAPORAN IMUNISASI WUS KABUPATEN PROBOLINGGO
PUSKESMAS : KREJENGAN
TAHUN : 2019

STATUS T AWAL (SAAT PENDATAAN atau SAAT PERTAMA KALI DATANG) HASIL KEGIATAN IMUNISASI TT STATUS T WUS SAMPAI DENGAN BULAN
SAS INI
NO BULAN SAS WUS NON HAMIL HAMIL
BUMIL T5 NON HAMIL HAMIL
T2 PLUS T2 PLUS BUMIL T5
T-0 T-1 T-2 T-3 T-4 T5 ABS T-0 T-1 T-2 T-3 T-4 T5
ABS % ABS % T-1 T-2 T-3 T-4 T5 T-1 T-2 T-3 T-4 T5 KUM % KUM %
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

1 JANUARI 245 23 11 11 1 1 1 0.4% 0 0.0 0 0 0 0 0 0 0.0% 0 0.0

2 PEBRUARI 245 23 NIHIL 0 0 0.0% 0 0.0 NIHIL 0 0.0% 0 0.0

3 MARET 245 23 NIHIL 0 1 2 2 0.8% 0 0.0 NIHIL 0 0.0% 0 0.0

4 APRIL 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

5 MEI 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

6 JUNI 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

7 JULI 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

8 AGUSTUS 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

9 SEPTEMBER 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

10 OKTOBER 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

11 NOPEMBER 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

12 DESEMBER 245 23 0 0 0.0% 0 0.0 0 0.0% 0 0.0

JUMLAH 245 23 0 0 0 0 0 11 11 0 2 3 0 0 0 3 1.2% 0 0.0 0 0 0 0 0 0 0 0 0 0 0 0.0% 0 0.0

5
 LAPORAN KIPI ( KEJADIAN IKUTAN PASCA IMUNISASI )

PUSKESMAS : KREJENGAN
TAHUN : 2019

IDENTITAS GEJALA YANG DIALAMI

JENIS PEMBERIAN TEMPAT PELY
NO NAMA ORANG JENIS VAKSIN NO BATCH EXP DATE TANGGAL IMUNISASI DEMAM BENGKAK MERAH MUNTAH LAIL-LAIN
NAMA ANAK KELAMIN TANGGAL LAHIR UMUR ALAMAT IMUNISASI IMUNISASI
TUA
L P JIKA YA DITANDAI P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

5
 Format : Imundaskap-Pusk
LAPORAN HASIL PENGHITUNGAN BAYI YANG TELAH MENDAPATKAN IMUNISASI DASAR LENGKAP
DI PROVINSI JAWA TIMUR, 2018
PUSKESMAS : KREJENGAN
KABUPATEN : PROBOLINGGO TAHUN : 2019

JUMLAH BAYI YG TELAH MENDAPAT IMUNISASI DASAR JUMLAH BAYI YG TELAH MENDAPAT IMUNISASI
JUMLAH BAYI KETERANGAN :
NO DESA/KELURAHAN LENGKAP PADA BULAN INI DASAR LENGKAP JANUARI - MARET
UCI /NON UCI
L P JML L P ABSOLUT % L P ABSOLUT %
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 JANUARI 10 11 21 1 0 1 4.8% 1 0 1 4.8%

2 PEBRUARI 10 11 21 2 4 6 28.6% 3 4 7 33.3%

3 MARET 10 11 21 0 0 0 0.0% 3 4 7 33.3%

4 APRIL 10 11 21 0 0.0% 3 4 7 33.3%

5 MEI 10 11 21 0 0.0% 3 4 7 33.3%

6 JUNI 10 11 21 0 0.0% 3 4 7 33.3%

7 JULI 10 11 21 0 0.0% 3 4 7 33.3%

8 AGUSTUS 10 11 21 0 0.0% 3 4 7 33.3%

9 SEPTEMBER 10 11 21 0 0.0% 3 4 7 33.3%

10 OKTOBER 10 11 21 0 0.0% 3 4 7 33.3%

11 NOPEMBER 10 11 21 0 0.0% 3 4 7 33.3%

12 DESEMBER 10 11 21 0 0.0% 3 4 7 33.3%

IMUNDASKAP SAMA DENGAN LAPORAN BAYI PARIPURNA

DATA SASARAN IPV
DESA
(DATA BAYI YANG BELUM MENDAPAT IPV, DAN BAYI SAMPAI DENGAN BULAN LAPORAN)
(DITAMBAHKAN TERUS SETIAP BULAN /BAYI BARU LAHIR)

TANGGAL
NO NAMA TANGGAL LAHIR NAMA ORANG TUA ALAMAT
PEMBERIAN

1 ABELIA MALIKA ASYIFA 18.11.2017 UMI MALIKA SEMAR 08.01.2019

2 ABDIR ROZIQ 30.06.2018 UMMI HOBIBAH KRAJAN 08.01.2019
3 BILQIS NAJWA KHUMAIROH 01.07.2018 YATI OKTAVIA PETTE
4 M ARGA 11.07.2018 BUANA KRAJAN
5 ALESHA NAUFALIN R 01.08.2018 IRA WINARSIH SEMAR
6 AHMAD FADHOL ILAHI J 07.09.2018 KHOLIFATUL I SEMAR
7 M RAFA ZAFRAN 11.10.2018 NUR FADILAH SEMAR
8 NOVA INAYAH 19.10.2018 MURSIDA SEMAR
9 MUSA 22.10.2018 LELA A KRAJAN
10 M HAFIDZ MAULIDI 19.11.2018 LULUK K SEMAR
11 HANA MIKAYLA K 29.12.2018 SUNARSIH PETTE
12 SITI FATIMAH 10.01.2091 UMI KULSUM KRAJAN
13 RAHMAT VIRENDRA BERYL RAFADA D 06.02.2019 AGUSTINA NI NGSIH PETTE
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