FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI

Nama Puskesmas/Fasyankes/Pos : RSUD GANDUS

Kabupaten/Kota : PALEMBANG
Provinsi : SUMATERA SELATAN
Hari, Tanggal : SENIN, 27 SEPTEMBER 2021

Dosis I Dosis 2 Dosis 3

Jenis Umur
No No. Tiket NIK Nama Penerima Vaksin Kategori Sasaran Kelompok Umur Alamat No. Hp
Kelamin (18 sd ≥ 60 tahun)
Tanggal Pemberian Tanggal Pemberian Tanggal Pemberian
Merek Vaksin Merek Vaksin Merek Vaksin
Vaksinasi Vaksinasi Vaksinasi

1 1671122707700002 BASRUN LUBIS L C 51 46-59 JL. SOSIAL 082375577014 27-Sep-21 coronavac

P-BZOL1SVU
2 167112501730002 TEN ZUNAINAH P C 48 46-59 JL. SOSIAL 082375577014 27-Sep-21 coronavac
P-BNIORQI8
3 1671120307800003 SUKISWO L C 41 31-45 JL. SOSIAL 088274042508 27-Sep-21 coronavac
P-CMD6GAZZ
4 SAHRUL RAMADHAN L C 27 18-30 TASIKMAKLAYA 082345271200 27-Sep-21 coronavac
P-DRGPXREB 7371100704940006
5 1671140401730009 LAODE PUDO L C 48 46-59 PALEMBANG 082184172494 27-Sep-21 coronavac
P-D6HJSGKR
6 1671056602780004 NURASIAH P C 42 31-45 MAY SALIM 082175550880 27-Sep-21 coronavac
P-H1FNFVMH
7 181002804830002 SONI HARDADI L C 38 31-45 POLIGON 082186953223 27-Sep-21 coronavac
P-GI3O4POR
8 1671122909780001 MOH IRYANTO L C 43 31-45 PATRA SRIWIJAYA 081373422279 27-Sep-21 coronavac
P-CCH9DQDA
9 1810015512060002 CLAUDIA ERNANDA P C 14 12-17 POLIGON 089603699983 27-Sep-21 coronavac
P-GRBHID9I
10 1671121802080002 M FEBRI SURYANA L C 13 12-17 TAMAN ASRI GANDUS 082183942438 27-Sep-21 coronavac
P-DRGPXREB
11 1671076802990017 EFA DEPISA ARSI RONA P C 22 18-30 KAJANG BAYAN 081379650228 27-Sep-21 coronavac
P-D6HJSGKR
12 1671064401180007 NOVA ANGGRAINI L C 33 31-45 RAIDER 200 081367007877 27-Sep-21 coronavac
P-H1FNFVMH
13 1671122410720001 HAMDANI L C 49 46-59 PARTA SRIWIJAYA 081271172490 27-Sep-21 coronavac
P-GI3O4POR
14 1607105402060003 RESSA VALENTINA P C 15 12-17 BANYUASIN 083177143219 27-Sep-21 coronavac
P-CCH9DQDA
15 1604246912940001 POPY ALAN DESTARI P C 27 18-30 BPAJAR B ULAN 081367007877 27-Sep-21 coronavac
P-CMD6GAZZ
16 1671031605060002 M RIZKY ADITYA PRATAMA L C 15 12-17 KENTEN 081368200501 27-Sep-21 coronavac
P-DRGPXREB
17 1603031405930001 BENY RAKASIWI L C 28 18-30 DUSUN II 082123300793 27-Sep-21 coronavac
P-D6HJSGKR
18 1671062409740014 RAKHMAD WAHIDIN SHOBRY L C 47 46-59 BAMBANG UTOYO 082299162586 27-Sep-21 coronavac
P-H1FNFVMH
19 1671062109890002 ZAINAL AKBAR L C 32 31-45 BAMBANG UTOYO 081268226345 27-Sep-21 coronavac
P-GI3O4POR
20 1671061602930007 FEBRIANSYAH P C 27 18-30 BAMBANG UTOYO 082180396800 27-Sep-21 coronavac
P-BNIORQI8
21 1671061208890006 KIKI HAIRANGGA L C 32 31-45 BAMBANG UTOYO 088770006729 27-Sep-21 coronavac
P-CMD6GAZZ
22 1671143007020003 FAHRI FATURRAHMAN L C 19 18-30 PENGANTINGAN 082258548057 27-Sep-21 coronavac
P-DRGPXREB
23 1671061106010008 MUHAMMAD AINUN RIFAI L C 20 18-30 BAMBANG UTOYO 081278326762 27-Sep-21 coronavac
P-GI3O4POR
24 1671067005650005 ESSY NURAINI P C 57 46-59 BAMBANG UTOYO 081367297751 27-Sep-21 coronavac
P-CMD6GAZZ
25 1671062009870010 CHANDY TIAR L C 35 31-45 BAMBANG UTOYO 087723559777 27-Sep-21 coronavac
P-DRGPXREB
26 1671065207950006 YULIA WURI HANDAYANI P C 26 18-30 BAMBANG UTOYO 087723559777 27-Sep-21 coronavac
P-D6HJSGKR
27 1671062804660005 MUHAMMAD DWI TEGUH L C 56 46-59 BAMBANG UTOYO 081367297751 27-Sep-21 coronavac
P-H1FNFVMH
28 1607065003840004 JAMIA P C 34 31-45 TANJUNG KERANG 083176065546 27-Sep-21 coronavac
P-GI3O4POR
29 1671065306880006 HESTY KESUMA WULANDARI P C 33 31-45 BAMBANG UTOYO 085768089868 27-Sep-21 coronavac
P-BNIORQI8
30 1671015211810007 ATIK FATIMAH P C 39 31-45 STM MANSYUR 081274240581 27-Sep-21 coronavac
P-CMD6GAZZ
31 1671126704070001 AFRILIANI P C 14 12-17 PERUM GRIYA ASRI 085758062779 27-Sep-21 coronavac
P-DRGPXREB
32 1607104206060002 ABELLA FITRIA P C 15 12-17 KENTEN LAUT 089650887507 27-Sep-21 coronavac
P-H1FNFVMH
33 1603064612960001 RANI PANDAN WANGI P C 24 18-30 RAIDER 200 081373460513 27-Sep-21 coronavac
P-BNIORQI8
34 1901085003940002 NOVI LINDA SARI P C 26 18-30 RAIDER 200 082280250500 27-Sep-21 coronavac
P-CMD6GAZZ
35 1671150306970001 M FERDI SAPUTRA L C 24 18-30 JL SWADAYA 081366602050 27-Sep-21 coronavac
P-BNIORQI8
36 1671041104870007 EKO SAPUTRA L C 38 31-45 JL. SRI JAYA NEGARA 085609885791 30-Aug-21 coronavac 27-Sep-21 coronavac
Z-0009ZYV1
37 1607110912970001 M RONI NURYADI L C 23 18-30 SEMUTUL 0895600458806 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
38 1671122805690001 TRI SUCAHYO L C 52 46-59 GRIYA ASRI 085346337061 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RCB6S
39 1671124308030001 KHOIRUNNISAK P C 18 18-30 JL. TPH SOFYAN KENAWAS 082183395767 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
40 1671086512840004 MARWATI P C 37 31-45 GARDENA HILL 089618510787 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
41 1671074408780008 NURRAYA P C 42 31-45 HBR MOTIK 082372725192 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R937I
42 1671136912690006 WARYUNI P C 53 46-59 GANDUS 089696361475 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
43 1671132802940006 ABDURRAHMAN L C 27 18-30 GANDUS 089696361475 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB1AQ
44 16711222404680002 SYAHRUL L C 23 18-30 PERUM GRIYA ASRI 082184992188 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000REIMJ
45 1671124402740003 NURHAYATI P C 46 46-59 PERUM GRIYA ASRI 082184992198 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RD632
46 1671086904850006 RAHMI HARYATI P C 36 31-45 SEMATANG 087721907304 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R9PTF
47 1671120204040002 M BAYU A L C 17 12-17 JL MUSI 082176558959 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RAKV8
48 3173023105820001 BUDI FIRMANSYAH L C 39 31-45 MUJAHIDIN 081273490585 30-Aug-21 coronavac 27-Sep-21 coronavac
Z-0009ZYV1
49 1671082507830010 ALFRED JULI KATIKUS L C 38 31-45 SEMATANG 089530727383 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
50 16711264100770001 ANDRIANI P C 43 31-45 MUSI 2 081278815652 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RCB6S
51 1671120707980011 PANGERAN MOH L C 22 18-30 POLIGON 081246510667 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
52 1671016207670002 ELMAWATI P C 54 46-59 PASAR ATOM 081279202020 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
53 1603030103010001 MARIO ANDREA L C 21 18-30 TEBAT AGUNG 081272350869 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R937I
54 167205540100001 WENI TRI WAHYUNI P C 21 18-30 PAGARALAM 081271046532 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
55 1671073105940013 TRI AJI RUSTANDI L C 27 18-30 SUNGAI SAHANG 0895636742802 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB1AQ
56 1671125901060002 MARSANDAH P C 16 12-17 GANDUS 083177224511 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000REIMJ
57 1601140106010008 M FAUZAN MUZAKKI L C 20 18-30 ANGKATAN 66 08117166737 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RD632
58 1007103005050003 RAHMAD AL FATTAH L C 16 12-17 PANGERAN AYIN 082182433046 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R9PTF
59 1671016610020005 SITI NURHALIZA P C 18 18-30 LEBAK MALANG 0895621655501 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RAKV8
60 1671122712010004 MAKMUR HENDRA SYAPUTRA L C 19 18-30 SUNGAI TENANG 087799039172 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
61 1671061907980010 ROBIYANSA L C 23 18-30 JL. MAYOR RUSLAN 082377897386 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
62 1671063010990008 DWI PRASTIO PUTRA L C 21 18-30 BAMBANG UTOYO 085758203621 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
63 1671044710650007 ROSLAINI FITAWATI P C 55 46-59 BUKIT BARU 085380002800 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RCB6S
64 1671044612950002 VIUTY TIADITA P C 25 18-30 PERUM BSI 085273736610 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
65 1671123112710021 RIDUAN L C 50 46-59 KADIR TKR 085366198558 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
66 1671062202000007 MUHAMMAD ALFI HADI L C 21 18-30 BAMBANG UTOYO 08117827709 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
67 089606351159 ANDI ALFIN SAPUTRA L C 21 18-30 BAMBANG UTOYO 089606351159 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
68 1671126503790002 MARWATI P C 42 31-45 KADIR TKR 085266575336 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
69 1671060801940007 M IRSYAM FIRNANDO L C 27 18-30 BAMBANG UTOYO 082176502978 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RCB6S
70 1671150411990001 M AULIA ADITIA L C 22 18-30 TALANG KELAPA 08962784518 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RD632
 71 1671060809010005 RAHMAT TANTRI L C 20 18-30 BAMBANG UTOYO 087797764376 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
72 1671060711920006 HARDI L C 27 18-30 BAMBANG UTOYO 082176502978 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R937I
73 1671062008740007 DIDI SUMARYONO L C 42 31-45 BAMBANG UTOYO 085366883829 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
74 7402334508900004 ISMARYANTI P C 31 31-45 DISUN1 0853332060008 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB1AQ
75 1673060207730001 FERRY AGUSTIAN L C 45 31-45 GENTAYU 082186211333 30-Aug-21 27-Sep-21 coronavac
Q-000REIMJ
76 1673065912750002 DEASY SUTERI P C 46 46-59 RAPUTRAAN 081377591999 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RD632
77 1673062610010002 M FERDY PRATAMA L C 20 18-30 KEPUTRAAN 082196194554 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R9PTF
78 1673060511030002 M FADLY R L C 18 18-30 GENTAYU 081377703655 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RAKV8
79 1671125211660001 HELMIATY P C 55 46-59 JL SYAKYAKIRTI 081377730214 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
80 1671120210680001 SISWANTO P C 53 46-59 JL SYAKYAKIRTI 081368104443 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RB7W1
81 1671076808930009 MEGA LESTARI P C 28 18-30 JL SUKABANGUN 08578188515 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
82 1610074710000001 ROSIDA P C 21 18-30 MATARAM 083667021759 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000RCB6S
83 1671072212000011 M RAFLY RAMADHANI L C 20 18-30 S SUPARMAN 081373099931 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
84 1671132309930005 M NAINURIDHO L C 28 18-30 KERAMASAN 082378568700 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
85 1671131509000006 DIKY RAHMAD L C 21 18-30 MATARAM 083186728860 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
86 1671074407990003 ELSYE ANNISA P C 20 18-30 KEBUN BUNGA 081367700465 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
87 1671036808660002 MASNI P C 55 46-59 JL JAYA 085377256668 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
88 1671060412830005 M SAHBANI L C 37 31-45 BAMBANG UTOYO 082376828988 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R1P1F
89 1671031510610004 RIZAL IRMANSYAH L C 60 ≥60 JL JAYA 081377506500 30-Aug-21 coronavac 27-Sep-21 coronavac
Q-000R961X
90 1671052806650004 MUZAMMIL L C 56 46-59 MAY SALIM 081373270883 30-Aug-21 coronavac 27-Sep-21 coronavac
K-0000VSOK
Petunjuk Pengisian :
* Kategori Sasaran dikelompokkan menjadi:
A = SDM KESEHATAN
B = PETUGAS PUBLIK
C = MASYARAKAT UMUM DAN MASYARAKAT RENTAN
* Kelompok Umur (diwarnai kuning) merupakan kolom dengan formula yang tidak perlu diisi/dihapus
* Alamat : Dapat diisi hanya dengan asal kota sasaran maupun alamat lengkap
* Merek Vaksin : Dituliskan merek vaksin yang digunakan (Coronavac, AstraZeneca, Moderna, dll)

Kelompok Umur:
12-17 0
18-30 38
31-45 65
46-59 0
≥ 60 tahun 1
Total 90
Kategori Sasaran
A 0
B 0
C 90
Total 90
 FORMAT REKAPITULASI HARIAN PELAKS
TINGKAT KABUPATE
Nama Puskesmas/Fasyankes/Pos :
Kabupaten/Kota :
Provinsi :

Total Dosis I Tahap 1

(Semua Tahapan)
NO Tanggal Pelaksanaan Total Sasaran SDM Kesehatan

# % #

9/27/2021 90 35 38.89 0
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
TOTAL 90 35 38.89 0
IAN PELAKSANAAN VAKSINASI COVID-19
T KABUPATEN/KOTA

Penerima Vaksin Dosis 1

Tahap 1 Tahap 2 Tahap 3
Masyarakat Umum
SDM Kesehatan Lansia Pelayan Publik Remaja
dan Rentan

% # % # % # % # %

0.00 0 0.00 0 0.00 29 32.222222 6 6.666667

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0.00 0 0.00 0 0.00 29 32.222222 6 6.666667
 Penerima Vaksin Dosis 2
Total Dosis 2 Tahap 1 Tahap 2
(Semua Tahapan)
Masyarakat Umum
SDM Kesehatan Lansia Pelayan Publik
dan Rentan

# % # % # % # % #

55 61.11 0 0.00 1 1.11 0 0.00 51

0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
55 61.11 0 0.00 1 1.11 0 0.00 51
s2 Penerima Vaksin Dos
Total Dosis 3 Tahap 1 Tahap 2
(Semua Tahapan)
Masyarakat Umum
Remaja SDM Kesehatan Lansia
dan Rentan

% # % # % # % # %

56.666667 3 3.333333 0 0 0 0 0 0
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0!
56.666667 3 3.333333 0 0 0 0
 Penerima Vaksin Dosis 3 I
Tahap 2 Tahap 3
Masyarakat Umum Vaksin Covid 19 Biofarma
Pelayan Publik Remaja
dan Rentan

Jmlh Vial Jmlh

# % # % # % IP
Terpakai Diimunisasi

0 0 0 0 0 0 21 90 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
#DIV/0! #DIV/0! #DIV/0! 0 0 #DIV/0!
0 0 0 21 90 4.3
 Indeks Pemakaian Vaksin Berdasarkan Merek

Astra Zeneca Moderna Lain-lain

Jmlh Vial Jmlh Jmlh Vial Jmlh Jmlh Vial Jmlh

IP IP
Terpakai Diimunisasi Terpakai Diimunisasi Terpakai Diimunisasi

0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
0 0 #DIV/0! 0 0 #DIV/0! 0 0
ain-lain

IP

#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!