DATA SASARAN VAKSINASI COVID / 19 PUSKESMAS GADINGREJO KOTA PASURUAN

Tanggal Pelayanan

Jenis
No No. Registrasi NIK Nama Penerima Vaksin
Kelamin

1 Q-0001D13H 3575012310900004 ACH ZAINUL

2 P-2VSDCNBS 3575010101730006 MOCHAMAD SAID
3 P-ACZBH4QM 3575014107630124 IKYANAH
4 P-0GHZDZNZ 3575010107830041 MUNIR
5 P-0ZLMCUTK 3514181708890006 ABDUL ROZIQ
6 P-17D1RKRP 3575015007790007 SULAMI
7 P-1IZ0ZDPB 3575015106830001 RENY ANGGRAINI
8 P-1WEGWV1B 3507092505850006 EKO APRI LESTARI
9 P-181SAF69 3575011505020005 MUHAMMAD HAMZAH ZAKARIA
10 P-1EWGH3XR 3575011405820001 M. HUSEN
11 P-2701XQ24 3514070509880001 MUHAMMAD JUFRI
12 P-2D6QT2X3 3575014205980003 AINUL YAQIN
13 P-2P84JJSE 3575015304750003 ASMAUL KHUSNA
14 P-2965CLJQ 3575010702950002 RAHMAD HIDAYAT
15 P-2G9PLB35 3514161002740001 KHOLILI
16 P-5FONMGA1 3575016507790004 YULIATI
17 P-4FZME78F 3575012410000001 MUKHAMMAD IGO FAURIZI
18 S-DA221205 3575013004860001 M. FALIHIN
19 P-5MLBPV8M 3575016101760001 CICIK MIRAWATI
20 P-7LJNAMMO 3575011405990001 MISBAKHUL MUNIR
21 P-8FJBENZ0 3575012710020002 YULFIAN AKHMAD NANDA SETIA
22 P-1UIY4OQN 3575014609720004 MAIMUNAH
23 P-0OH85O6J 3575016102840002 SUCI AMALIA
24 P-40L0WGPA 3575015608880001 FRISTA DWI AGUSTYAS
25 Z-000AXBCY : 3575010606510003 RB. ABD KADIR
26 Z-000B1DQB : 3575015010590001 ENOK WINATINI
27 Q-000VS4UI : 3517155910080001 EVELYNE GUSTIAN WIJAYA
28 Q-000X12VK : 3575011801060001 SHAHRUL HAJ
29 Q-000X20NH : 3575010101090001 MUHAMMAD ARDAN ARDIANSYA
30 Q-000YFC8Q : 3575012503070003 AYU RISKI MAULIDIAH
31 Q-0010GZMW : 3575010807090001 NAUFAL MIRZA MUHAMMAD
32 Q-00034J8X : 3575011504830005 JUMA'ALI
33 Q-000E9WGD : 3514152712970001 SUGENG IRAWAN
34 Q-000RATW1 : 3575014401770002 RINI HANDAYANI
35 Q-000RMPIW : 3575026402040001 LAILATUL MAGHFIROH
36 Q-000S7XHQ : 3575010608770002 ABD. AZIS
37 Q-000VX3M0 : 3514145110990001 PUTRI SUKMA HIDAYAH
38 Q-000XGL76 : 3575014712980001 NUR HAMIDA
39 S-04D4B02A : 3575011202480001 FATAH
40 S-D28196DC : 3575014107590112 SARANI
41 P-1IF6WO60 : 3575014205050003 KUSNUL KHOTIMAH
42 P-8PSBIYUT : 3575012206050001 MUKHAMMAD ZAKY
43 P-A57KCQS9 : 3575012402040004 MUHAMMAD ROYS ARIF ZAWAID
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 Kepesertaan BPJS (tulis 'Ya'
Pekerjaan Kelompok pada kolom yang sesuai)
Umur Alamat No. Hp
* Umur
BPJS PBI
31 UMUM SEBANI GADINGREJO 08573852184
50 RENTAN JL SLAMET RIYADI 3/3 GENTONG 08580695540
58 RENTAN JL BANDA GADINGREJO 08222897333
1 38 UMUM TAMBAAN 5/3 PANGGUNGREJO 08121633046
2 32 UMUM KEBONCANDI 3/3 GONDANGWETAN 08113777705
3 42 UMUM KETUG MLAGI 5/3 KARANG KETUG 08778041340
4 38 UMUM JL SLAMET RIYADI NO 35 08389215880
5 36 UMUM LEBAKSARI SELATAN 08121750960
6 19 UMUM JL SLAMET RIYADI 08953671674
7 40 UMUM JL HALMAHERA 08781903275
8 33 UMUM KENDANG UTARA WONOREJO 08121633887
9 22 UMUM JL HANGTUAH 08384905443
10 46 UMUM JL SLAMET RIYADI 3/3 GENTONG 08580695540
11 26 UMUM JL HANGTUAH IV 08113777705
12 47 UMUM JL SLAMET RIYADI 2/4 GENTONG 08531473978
13 42 UMUM JL HANGTUAH 1/4 GADINGREJO 08581503006
14 42 UMUM JL GATOT SUBROTO 1/5 KARANG KETUG 08384872573
15 35 UMUM JL HANGTUAH 4/3 GADINGREJO 08125981120
16 44 UMUM JL SEBANI 1/6 08113777705
17 22 UMUM JL GATOT SUBROTO 3/1 08561610683
18 19 UMUM JL GATOT SUBROTO 3/4 08561610683
19 49 UMUM JL HANGTUAH GADINGREJO 08384975411
20 37 UMUM KETUG MLAGI 5/3 KARANG KETUG 08113777705
21 33 UMUM JL SLAMET RIYADI 3/4 08123259161
1 70 LANSIA JL URIP SUMOHARJO 2/2 BUKIR 08123421238
2 61 LANSIA JL GATOT SUBROTO 08573645175
3 13 REMAJA DESA DARUREJO 08810263822
4 15 REMAJA JL. KYAI SEPUH GG. 21 08883085403
5 12 REMAJA JL SLAMET RIYADI 3/1 SEBANI 08314289066
6 14 REMAJA JL. HANGTUAH GG IV KELURAHAN GADING08581503006
7 12 REMAJA JL SLAMET RIYAID 2/1 SEBANI 08585964960
8 38 UMUM JL IRIAN JAYA NO 07 08575583351
9 24 UMUM MENDALAN 133 RT 2 RW 1 BANGIL 08585022405
10 44 UMUM JL IRIAN JAYA 1/2 GADINGRJEO 08565538177
11 17 UMUM JL DR WAHIDIN SH 5/2 PURWOREJO 08823173782
12 44 UMUM JL BANDA 3/3 GADINGREJO 08821790233
13 22 UMUM MENDALAN 133 BANGIL 08958042652
14 23 UMUM JL HANGTUAH 1/4 GADINGREJO 08384975411
1 73 LANSIA JL HANGTUAH 1/4 GADINGREJO 08113777705
2 62 LANSIA JL HALMAHERA GADINGREJO 08125946847
1 16 REMAJA JL HANGTUAH IV 08528085541
2 16 REMAJA JL KARYA BAKTI GENTONG 08785591405
1 17 UMUM JL KYAI SEPUH 1/6 08383340200
Kepesertaan BPJS (tulis 'Ya' Dosis I
pada kolom yang sesuai) Merek
Tanggal Screening Tanggal No. Tiket
BPJS Non Non Vaksin***
Pemberian No. Batch
PBI Anggota
Vaksinasi
Astrazeneca 6/8/2021 ABV6522
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
Astrazeneca 10/18/2021 A1076
BIOFARMA 9/16/2021 202108118H
BIOFARMA 9/18/2021 202108118H
BIOFARMA 9/9/2021 2021071371
BIOFARMA 9/13/2021 202108118H
BIOFARMA 9/13/2021 202108118H
BIOFARMA 9/15/2021 20210811H
BIOFARMA 9/20/2021 202108118H
BIOFARMA 6/17/2021 24001821
BIOFARMA 7/12/2021 24200421
BIOFARMA 8/30/2021 24202221
BIOFARMA 8/31/2021 24202221
BIOFARMA 9/1/2021 2021071371
BIOFARMA 9/10/2021 202108118H
BIOFARMA 9/14/2021 202108118H
BIOFARMA 10/18/2021 C202106115
BIOFARMA 10/18/2021 C202106115
BIOFARMA 10/18/2021 C202106115
BIOFARMA 10/18/2021 C202106115
BIOFARMA 10/18/2021 C202106115
 Keterang
Dosis 2 an
Tanggal (Lanjut/ NAMA INSTANSI
Pemberian No. Batch Tunda/
Vaksinasi Alasan)
10/18/2021 A1076

10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
10/18/2021 C202106115
 1 J-00000LHN351417****ZAHRATUL HUMAIDAH 15 0896038568REMAJA
2 J-0000C4EE351411****NAILY KHUSNIA 18 08819112062
3 J-0000OIP8 357503****INDAH MALIKHA 16 08880368229
4 J-0000OIQJ 357503****KHARISMATUL PUTRI KHAMDANA 16 0895385252252
5 J-0000OIQL 357502****FAWWAS ALDY NURRAMDHAN KAISAR 17 0821213123REMAJA
6 J-0000OIR9 357501****IBNU SADIDAN FIL IMAN 17 085815422341
7 J-0000OIRJ 351417****SHELFI ALIBIA PUTRI 15 08885062942
8 J-0000OISN357502****VANIA RAHMAWATI 16 085707220570
9 J-0000OIUQ357502****JIHAN HISANAH ZAKIYAH 15 088805192167
10 J-0000OIWF357503****RENATA AZ ZAHRO 17 089502357100
11 J-0000OIZZ 331714****SEKAR RINI WULANDARI 15 083848947237
12 J-0000OKKE357501****AKHMAD RIZKI AMINUDIN 17 0895366314896
13 J-0000OKSD357501****NANDA SAKINAH RAHMAWATI 17 085736406791
14 J-0000OKUE357501****AFIF DWI SHOFWAN 17 085784354313
15 J-0000OPU 351418****AGUS UMAR 17 085748616031
16 P-5SCMPS3 357501****WIDIA TANZILA 17 0882009257REMAJA
17 P-6F4PUH5Z351417****NADIYAH PUTRI NAURAH 17 0819089372REMAJA
18 P-6F631QZ 357501****AISYATUL LATHIFAH 17 0838313433REMAJA
19 P-7UQX5PO357501****ALIF YAHYA MUNIRUDDIN 18 0857554158MASYARAK
20 P-999QRCW357502****AMINIANTO PUTRA HAAFIZH 18 0878505329MASYARAK
21 P-A69CZXIP351418****NOVEN EKA RAHMADHANI 16 0813304485REMAJA
22 P-ANHYPY4357501****SAKDA HOIRUN NIKMA 17 0838317515REMAJA
23 P-B8GH45V357501****SAVANA MASKHURIN 17 0812180374REMAJA
24 P-BM5KZUN357502****NOWEL EUGENIO HONOCK SILAHOOIJ 16 0813358972REMAJA
25 P-C8FLOXIE 357501****ARMANDIAZ LUTHJAVIER AGERSAH 15 0852575138REMAJA
26 P-D0PXECZI357501****DAHLIA NASYWAA ERIANTI 17 0896797259REMAJA
27 P-DH6N8XKJ357502****FARIS THORIQUL FALAH 17 0895395042REMAJA
28 P-FPBDMUE357502****IFTITA AULIA PUTRI 17 0821522637REMAJA
29 P-G9ZXGP5 357503****ANINDYA PUTRI 16 0857845986REMAJA
30 P-GEOUVUC357501****NAURA ZALFA DESTIARAWATI 15 0812342112REMAJA
31 P-GXF3901X357503****MAWARDHANI AHMAD AZZAHRA 15 0812340809REMAJA
32 P-HJIGI9OS 357502****AZIZATUN NISWAH 15 0859546728REMAJA
33 P-HLCRDC6 357501****LU'ALIK TIVAL VERONIA 17 0822516843REMAJA
34 P-HMWYGA357501****JUROTUN NASIKHA 17 0878519335REMAJA
35 P-HOXHJB8 357502****VENI AGUSTINA 18 0852309174MASYARAK
36 P-HP5OKT2 351417****IKA NURUL AINI 17 0821310796REMAJA
37 P-HRVZEPU357503****ERNY NOVITA PUTRY 17 0857068022REMAJA
38 P-HSDJVLJ3 357502****EGA SILVIA WANESTI 16 0857061823REMAJA
39 P-HTAOTFL7357502****RIF'AT SAHLA PUTRI MAHIRA 16 0895364949REMAJA
40 P-HUG6ZPM357502****DIAN ATUROKHMAWATI 17 0821429222REMAJA
41 P-HWCI7MI357503****FERNANDA NUR AZZAHRA 16 0812367297REMAJA
42 P-HXXGADJ 357503****ATTARAYYA JAUHAR RULIANDI 16 0888506713REMAJA
43 P-HY5DHUV357502****MIFTA FARIDH HIDAYAT 15 0878758619REMAJA
44 P-HZJM5SU357501****NILAM ANDINI 18 0831564911MASYARAK
45 P-I1KB3HKT357501****WAHYU VENNY ADISTRIYA 17 0813287544REMAJA
46 P-I2ERDJXF 357502****SHELLA AMANIA 15 0819079420REMAJA
47 P-I718IBU1 357502****SITI NUR MUFIDAH 18 0822325739MASYARAK
48 P-IAP86R2V357503****NUR ANISAH 17 0881210781REMAJA
49 P-IB1GUMR351417****FATMAH TAZIKIYAH 18 0857301984MASYARAK
50 P-ICFNY7IU 351418****SHINTIA WATI DJINI MANTROS 17 0852130066REMAJA
51 P-IDQO2NG357502****AHMAD NAUFAL LAYLI 17 0858954322REMAJA
52 P-IJTCY0XQ 351423****GILANG PERMANA PUTRA 17 0895395044REMAJA
53 P-IKO685ZQ351418****KHOLIFATUS SA'DYA 18 0895366247MASYARAK
54 P-INJRTER6 357501****SULIANI HANDAYANI 17 0858154391REMAJA
55 P-INPUB2TZ357501****MUHAMMAD WILDAN KHUMAIDI 18 0895396005MASYARAK
56 P-IPNOQ6P 361414****NUR THOYYIBAH 18 0813590335MASYARAK
57 P-IQIOENTI 351423****AGNES YUNITA SARI 18 0838196669MASYARAK
58 P-IXCHTON 357502****AMANDA ISNAINI 16 0831461180REMAJA
59 P-J0Q9AM8351423****MAIMUNATU LAILATUL QODRIYAH 17 0895338131REMAJA
60 P-J0V79CIY 357501****WARDAH FEBRIANAS ULA 17 0812323331REMAJA
61 P-J4CNN08 351416****RIZZA NUR AFILLIA 18 0857849744MASYARAK
62 P-J6RP9TNL357502****FITRIA RAMDANI 15 0831153975REMAJA
63 P-J81R28KI 351418****KINANTI LINTANG AYU IFTITAH 18 0831196197MASYARAK
64 P-J94DYULX357502****M. BAHAUDIN 19 0858500639MASYARAK
65 P-J9ZVG5GS357502****MUCHAMMAD HAFMI FARIZ 18 0857557359MASYARAK
66 P-JAW96K9 357503****YASMIN SYAHADA 16 0813900139REMAJA
67 P-JBI62OY8 351418****RIZKY AJI MAULANA 16 0813281414REMAJA
68 P-JCIKATKJ 357501****TSABITAH PUTRI SALSABILA 17 0821455044REMAJA
69 P-JFG7J90Q351423****MUHAMAD ALDI KURNIAWAN 17 0838952572REMAJA
70 P-JVGXMSZ 357503****MUHAMMAD TAUFIK 18 0895322201MASYARAK
71 P-JWSS97U 357502****DEVAN BIMA'ANI FEBRIANSYAH 17 0881026839REMAJA
72 P-JX3K7LOP351418****AHMAD DANI NUGROHO 16 0877088884REMAJA
73 P-JY2K6YQ9351416****MUKHAMAD WILDAN BURHANUDDIN 17 0858071050REMAJA
74 P-JZZ348WY357501****SELFI 16 0838484607REMAJA
75 P-K1CJTJC7 351414****MUHAMMAD ROFIQ 18 0881978170MASYARAK
76 P-K2P3UDH351418****AKHMAD ULIL AZMI 18 0812598491MASYARAK
77 P-K41XDBS5351405****SOFI MAULANA 17 0857311905REMAJA
78 P-K5LYKZYB357503****ERLINDA NUR QIFTIA 16 0813590379REMAJA
79 P-K706BI0A357502****TRI BAKTI COBAN MULYO 17 0896030036REMAJA
80 P-KBCVDF1 351418****MUCHAMMAD ALI MURTADO 16 0857552869REMAJA
81 P-KC94L3D 351417****ADIS FIRMANSYAH 16 0858564057REMAJA
82 P-KCKXOJXS351417****M ALI IMRON 17 0838466824REMAJA
83 P-KDURT8V357503****ADELIA HUSNUL ABIDAT 18 0896996796MASYARAK
84 P-KE0CWDE357502****SANDY DWI ARYA 16 0812168723REMAJA
85 P-KFK61QEB357502****SAFINATUN NIJA 16 0896996036REMAJA
86 P-KGSGPA8 351407****M. ILHAM ALMARWAN 15 0812318815REMAJA
87 P-KIKCEJA2 640719****AHMAD ROMADHONI 16 0822316076REMAJA
88 P-LC41ASCL351312****ACHMAD RICKY A P 17 0813590322REMAJA
89 P-LD0PRZAF357404****MAHENDRA J. PURNOMO 17 0838357357REMAJA
90 P-LETKG2U 357503****NUR WAHYUNI 17 0838353531REMAJA
91 P-LFIO4LMF357502****MUHAMMAD SEPTIAN DWI S 17 0857306283REMAJA
92 P-LGC6DKT1357502****IRWAN MAULANA 17 0857842511REMAJA
93 P-LL7Z883F 357502****JAYANTI ISLAMIYAH 18 0889301212MASYARAK
94 P-LU5LF3W 321311****RIYANI 15 0821512708REMAJA
95 P-LUTMDZ6357503****FAIRY NUR ANJANI 17 0812384832REMAJA
96 P-LY0PTVSY357503****M BAIDILLAH 17 0821403493REMAJA
97 P-LZH8Y8O0357501****RAMADHANNIA ROUDHOTUL JANNAH 16 0851026766REMAJA
98 P-LZULKUM357502****DIANA WAHYUNI 17 0895080050REMAJA
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