FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI

Nama Puskesmas/Fasyankes/Pos : LIWUTO

Kabupaten/Kota : Baubau
Provinsi : Sulawesi Tenggara
Tanggal Pelaksanaan : 30 Juni 2021

Dosis I Dosis 2

Jenis Umur Keterangan

Kelompo Tanggal Nama/Jenis/Mer
No No. Tiket NIK Nama Penerima Vaksin Kela Pekerjaan* (18-59 No. Hp (Ditunda/Tidak
k Umur Screening ek Vaksin***
min tahun) Tanggal Tanggal Diberikan/Lanjut)
Pemberian No. Batch Pemberian No. Batch
Vaksinasi Vaksinasi

1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

1 P-2P6MM6YO 747206******0001 AL YUNUS ZAHABU L B 31 31-45 081340555942 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

2 P-2R9ON7KI 747205******0001 RINA P D 37 31-45 082194728518 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

3 P-2TOK5UHT 747205******0001 HASNAWATI P D 47 46-59 085145780402 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

4 P-2WAJQFJJ 747205******0003 WA APA P D 48 46-59 081244445770 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

5 P-2ZXLCWPD 747205******0001 WA RIHA P D 52 46-59 082194728518 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

6 P-3C0P6TPE 747202******0002 AHMAD ASRIL L D 22 18-30 085399021295 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

7 P-3FM8COE5 747205******0002 HUSRI L B 58 46-59 081259116317 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

8 P-3J73QVKN 747205******0002 SUTIA P D 54 46-59 082198629693 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

9 P-3N91WHCM 747205******0006 TATI P D 46 46-59 081524972961 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

10 P-3QFZ6WS3 747205******0001 HARNI P D 39 31-45 082195150220 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

11 P-3TCMWOCT 747205******0001 MARIANI P D 44 31-45 085281812756 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

12 P-41ONR1R7 747205******0001 NADIA NURFITRIANI EDI P D 21 18-30 085256853357 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

13 P-44PUF40G 747205******0003 HANIRU P B 51 46-59 081524972961 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

14 P-49X6RFL1 747205******0002 NARNI MATU P B 37 31-45 082259654378 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT
1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

15 P-4DP163TU 747205******0004 WA MBODO P D 58 46-59 082195183446 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

16 P-4O9V0YRO 747205******0001 MISRA P D 43 31-45 085756190128 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

17 P-4TJE7LOI 747205******0001 ROSNIA PANDE P D 39 31-45 082195195371 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

18 P-52RBNCDL 747205******0001 HAFIDA P D 35 31-45 082211390459 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

19 P-57RQ35Z6 747205******0001 SALIATI P D 40 31-45 081242478740 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

20 P-5H2WRU8U 747205******0004 WA TINI P D 46 46-59 082349862832 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

21 P-5LDL6WLK 747205******0001 EDI SUARDIN L B 41 31-45 082349216536 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

22 P-5UDZE1RE 747205******0015 ILYAS L D 52 46-59 082271203897 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

23 P-5XZ1EK1M 747205******0001 MARIANI P D 38 31-45 081242839822 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

24 P-63899EUH 747205******0002 RAHMAT L D 19 18-30 085219463822 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

25 P-6AN6FL2U 747205******0001 AZAUDIN L D 47 46-59 081245679156 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

26 P-6IOTRMMC 730901******0002 ZAFIAH P B 55 46-59 085399085370 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

27 P-6NJV4K43 530705******0027 WA MINI P B 42 31-45 082195183446 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

28 P-70SFFQ3R 747205******0006 FATIMA P B 39 31-45 082193858137 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

29 P-7AUU1YIY 747205******0002 ARIANI P D 43 31-45 082394629934 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

30 P-7HC97IQZ 917102******0002 ARIMIN L D 37 31-45 081248861020 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

31 P-7L2VHUJN 927104******0002 SUPIANA P D 42 31-45 082386383022 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

32 P-7YHW3VCF 747205******0002 NURHAYATI P D 39 31-45 082219213141 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

33 P-8J12A7UV 747205******0002 MIDAWATI P D 36 31-45 082188010143 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

34 P-9CQF1RUT 747205******0002 WA ODE ANITA P D 34 31-45 081310620441 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

35 P-9NN6FTBF 747205******0002 MARFIAH P D 36 31-45 082188010143 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

36 P-9RQ6VXAS 917102******0005 SALMATIA P D 38 31-45 082397620993 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

37 P-9ZJL4LR5 747205******0002 MURNIATI P D 51 46-59 085326025684 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

38 P-A36F6TQB 747205******0001 RATNA P D 32 31-45 085823801438 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

39 P-A8DBQDF8 747205******0002 ANIZA P D 42 31-45 08756211072 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

40 P-AHBDSZNN 747205******0002 ARIZA P D 36 31-45 081296146810 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

41 P-AKO62ARR 747205******0001 GUSRIN L B 38 31-45 085399505524 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT
1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

42 P-AOBQETZX 747205******0001 ZUMIATI P D 36 31-45 085399505524 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

43 P-AQI72JYA 730901******0001 RASJID MARINDA L D 59 46-59 082195758171 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

44 P-AUWHSEKU 747205******0001 SARNI P D 42 31-45 085394642680 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

45 P-AYR5VQ55 917102******0007 WAIMPO P D 48 46-59 082259978563 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

46 P-B2NFSJMV 747205******0001 WIRDASTUTI P D 45 31-45 081296146810 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

47 P-B69RLK6Y 747205******0001 WA ODE FARIDA P D 38 31-45 082399286414 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

48 P-CDANGTNS 747205******0001 NINGSIH P B 34 31-45 085241933664 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

49 P-CHLNNYV9 747205******0002 RIZKI FAYSAL L B 33 31-45 082293109988 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

50 P-CRCPU8R7 747205******0001 LA ODE SUHARDIN L B 45 31-45 082283043903 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

51 P-CSE14G6P 747202******0004 MAHENDRA DARWIN L D 22 18-30 082210188843 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

52 P-CU1AJYVJ 747206******0001 VIUS WAHYUDI L D 29 18-30 082291741592 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

53 P-CXIACYL5 747206******0002 SAHID FADILAH P D 21 18-30 082296009047 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

54 P-CYQ1N014 747202******0001 DZUL JALALI WAL IQRAM L B 24 18-30 085340489626 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

55 P-D74G696Q 747205******0001 WA SARNIA P D 42 31-45 082349494885 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

56 P-DAZL4EPY 747205******0006 NURMINA P D 36 31-45 085342211788 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

57 P-DBWGN4V8 747205******0001 WA AMBE P D 50 46-59 085342211788 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

58 P-DDE0K2VL 747101******0002 NURIATI P D 38 31-45 081245215134 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

59 P-DHVQQV6N 747205******0004 MARGARETA BB P D 42 31-45 085342400600 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

60 P-DJ6WQLDU 747205******0003 DARNIA P D 32 31-45 082346077185 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

61 P-DKFDMMT2 747202******0002 SEPRIATI LUMILING P D 42 31-45 082293101909 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

62 P-DLFZQPEU 747205******0001 MUH. SIDDIQ TAMLIHAN L B 24 18-30 081341021443 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

63 P-DNQHX5LI 740327******0001 WA ODE SITTI ZAHARIAH P D 48 46-59 082239660095 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

64 P-DPDWXL5M 747205******0001 SAHIMA P D 34 31-45 082237878615 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

65 P-DQN39YSG 747205******0002 WA ODE MAINGGA P D 43 31-45 082188720250 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

66 P-DROXCULH 747205******0002 DINDA APRILIANA P D 18 18-30 082257745608 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

67 P-DSYFFDSG 747202******0001 ANGGUN INDRIANI P D 18 18-30 082188720250 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

68 P-DUORBQRM 747205******0001 MUHAMMAD FADEL TANJUNG L D 23 18-30 082293421717 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT
1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

69 P-DXNDQDX4 747205******0001 SYURYANI P D 52 46-59 082188720250 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

70 P-DZTCW7HK 747205******0001 LA ODE MUH. TAWAKAL WANCI L D 24 18-30 082293845810 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

71 P-E1PAG88K 747205******0001 DEWI DAMAYANTI ASTUTI RUSLI P B 23 18-30 082334317042 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

72 P-ECBPIANX 747205******0001 WA MIMA P D 32 31-45 082253274308 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

73 P-EDT6MHG6 747205******0001 FITRIYANI P D 25 18-30 085244374041 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

74 P-EEVON5N1 747205******0001 WA SAE P D 34 31-45 085242315448 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

75 P-EFYIE9NV 747205******0005 MUTIANI P D 46 46-59 082349169673 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

76 P-EQ3S17PH 747206******0001 FITRI YANTI ADIALONA BAKIR P A 23 18-30 082394020019 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

77 P-EQZK1MXA 747206******0002 IRAWATI P A 24 18-30 082266469042 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

78 P-ESEW5E0L 747201******0004 LIA KARMILA P D 26 18-30 085242623521 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

79 P-ETPBC00U 740423******0001 WA ODE NELFIATI P A 27 18-30 085397309457 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

80 P-EV852PHH 747202******0001 YUSTINA SUNARTI P D 52 46-59 085241756647 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

81 P-EWE3M3CC 747201******0002 LA MILI L B 34 31-45 082167894108 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

82 P-EX855CGP 747202******0001 FIRMAN H L D 30 18-30 081230667804 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

83 P-EXYW9FKU 747201******0001 SARMILA P D 21 18-30 081242848002 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

84 P-EYSH8VBQ 747202******0001 SYAHRIL RASYAD GUNAWAN ABDULLAH L B 24 18-30 082331039660 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

85 P-EZJTKL4C 747206******0001 YUDI SAPUTRA L B 30 18-30 082396225790 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

86 P-F1PE69ND 747205******0003 ARSINA P D 30 18-30 082190844400 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

87 P-F3VGKWPZ 747205******0002 LITA FEBRIYANTI ALBUGIS P D 18 18-30 082249438445 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

88 Q-E1CDC36F 352001******0003 INDAH RATNA SARI P D 21 18-30 082287367959 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

89 S-0E209967 747202******0001 WAYAN ARYADI L D 61 LANSIA 085241756647 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

90 S-3812C164 747206******0001 ERNA P B 42 31-45 085299901237 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

91 S-3B5A075F 747205******0001 BASIA P D 42 31-45 085341687572 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

92 S-763FB43F 747202******0002 LA UJIA L D 74 LANSIA 082354870569 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

93 S-90A04B50 747206******0001 JAHALUDIN L D 31 31-45 082271105003 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

94 S-958E8D7D 747205******0002 LA SAUDI L B 61 LANSIA 081244445770 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

95 S-A588B1B7 747205******0001 RASNI P B 48 46-59 085241915215 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT
 1 2 3 4 5 6 7 8 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

96 S-D03D915B 737204******0002 DARMAYANTI P B 40 31-45 082192746087 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

97 S-E12BCC79 747205******0001 RUSMIATI P D 52 46-59 081242630320 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

98 S-E7EE337E 747205******0002 Dina P D 32 31-45 082397548071 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

99 W-70742D99 817101******0002 AMRAN L D 54 46-59 081381346181 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

100 Y-01325GRJ 317204******0018 LA ODE MUHLIS EFENDI L B 36 31-45 082348605185 30/06/2021 CORONAVAC 30/06/2021 24003721 LANJUT

1 1 1 1

Keterangan ***Merek Vaksin

* Pekerjaan dikelompokkan menjadi: A = Sinovac Mengetahui,
A = Petugas Medis dan Non Medis di Fasilitas Pelayanan KeB = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes) Kepala Puskesmas Liwuto
B = Petugas pelayanan publik yang berhadapan langsung dengan masyarakat
C = Administrator Pemerintahan
D = Lainnya
E = Tidak Bekerja
ALFIAH, AMK
NIP. 19670711 198903 2 016