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Jenis
No No. Tiket NIK Nama Penerima Vaksin
Kelamin
1 2 3 4 5
1
P-PY1FEQYW 3206120604800012 ADE ASIROH P
2
NIK TDK TERDAFTAR 3206134107630243 MARYAM P
3
P-RV9KA1SP 3206120711760001 ASEP Z MUTAKIN L
4
P-PWDGHVFI 3278055003720002 NINING P
5
P-DDX38SG5 3206124509970003 ILHAM SAEPUL MILAH L
6
P-NJILRN6N 3206124609000004 AI RANI P
7
FASKES LAIN 3278052002660002 GANDA L
8
P-2I6VW9XT 3206126708640002 MUMAY P
9
P-Q3MSTN2B 3206124305860005 USWATUN HASANAH P
10
P-60YWKCPI 3206121303750001 IYAN L
11
P-QADTIPFS 3206124511720003 ENTIN P
12
NIK TDK TERDAFTAR 3206124502000004 DISYA ALKIA NUR MEIDA P
13
NIK TDK TERDAFTAR 3206121708760002 AJU L
14
NIK TDK TERDAFTAR 3206121109020007 IPAN L
15
FASKES LAIN 3206120612010002 MISBAHUDIN L
16
P-FQ05XWU8 3206120707790005 SAHRIDIN L
17
P-7XF04786 3206124807790002 ROHANA L
18
P-3Q5RV4CE 3206125507970002 RIRIN NURAEINI P
19
P-PUDKWWPL 3206124209880005 IMAS RUSMIATI P
20
P-2IJ6G6WG 3206010107700032 ENDANG L
21
S-0824EEB5 3206120107530073 OTOH L
22
P-85UJRYUJ 3206121903830002 SAYAT L
24
NIK TDK TERDAFTAR 3206120403650002 SARIP L
25
P-JFGDIIZG 3206120107620028 ABDUL PATAH L
26
NIK TDK TERDAFTAR 3206126100500001 RIDA SOPWAN HAMID P
27
P-733CNVC8 3206120107650250 JAJAT L
28
NIK TDK TERDAFTAR 3206120107800966 NYANYANG L
29
P-OM3DY4XI 3206120407680001 ENGKOS KOSWARA L
30
P-QJIRAV40 3206124706800003 KEUIS P
31
NIK TDK TERDAFTAR 3206124204610002 ANIYAH P
32
P-7ZIX2F0Q 3206124110930001 RINA S. RIADI P
33
S-08BC8C5D 3206120107520126 SUEB L
34
NIK TDK TERDAFTAR 3206121807800022 DEDE RUSMANAH P
35
Q-001L9J7J 3206016307010002 SELVI P
36
NIK TDK TERDAFTAR 3206436050317001 DIDIK L
37
P-U49D09BL 3206124911020002 RATNA SARI P
38
NIK TDK TERDAFTAR 3206125880704001 MELA NORISA P
39
NIK TDK TERDAFTAR 3206124107700004 OMINAH P
40
P-4FKY2TRV 3206121102060001 RENO SANJAYA L
41
P-MOK0V9WK 3206121204890002 HASANUDIN L
42
NIK TDK TERDAFTAR 3206120107610112 KOIM L
43
P-R2PDOGP3 3206120107830082 ABDULLAH L
44
S-83DFC040 3206120107530062 HOTIMI L
45
VAKSIN GOTONG ROYO3206124105820002 YEYET P
46
P-6QKAM1DT 3206121007890008 ASEP RIDWAN L
47
P-RXQDNQ4A 3206161806930005 NURDIN L
48
P-U9QJ8HOL 3278071610870006 ALI SURYAMAN L
49
NIK TDK TERDAFTAR 3206124107450183 MIROH P
50
P-6APQUH06 3206121206680001 SURYANA L
51
S-E414D2CA 3206126703850001 RANI ANGGRAENI P
52
P-SMQ70JPB 3206124202940001 LIA NURLIANI P
53
S-E522BA6C 3206126107520001 ONIK L
54
P-SRKUFLJU 3206120607750005 ADE JUAENI L
55
NIK TDK TERDAFTAR 3206121203780003 KUNDANG L
56
P-9TCRCP5D 3206126211090001 AGIT L
57
NIK TDK TERDAFTAR 3206120403650002 SARIP L
58
P-61FKMJR7 3206122007050004 RIAN HERMAWAN L
59
P-SOHHRHDD 3206124510780004 HENI P
60
P-6DZQE0X9 3206124510050001 RIDA NURSABILA P
61
P-JFGDIIZG 3206120107620028 ABDUL PATAH L
62
P-733CNVC8 3206120107650250 JAJAT L
63
P-7ZIX2F0Q 3206124110930001 RINA S. RIADI P
64
S-0ACEC2AC 3206124707300001 IBAH L
65
FASKES LAIN 3206121003000003 ABDUL ARI P
66
3206121207000004 FIKI ABDUL WAHAB L
67
3206121103020002 YOGA L
68
3206120204730002 ENGKUS KUSNAWAN L
69
Q-001L8ZVF 3206120503700002 HAER APANDI L
70
Q-001FIBD6 3206124704860002 MARYATI P
71
Q-001HU10F 3206126108630001 IKA SURTIKA P
72
Q-001HU5CB 3206124906930006 WIDA FITRIANI P
73
Q-001HU04N 3206120107620077 HAMID L
74
Q-001HTH3U 3206082712800002 SODIK L
75
Q-001JK1MT 3206124705010002 MILA AUDINA P
76
Q-001JYIUT 3206125807040001 MELA NORISA P
77
Q-001ATCG1 3206126110900001 AGIT L
78
Q-001JK1MT 3206124705010002 MIA AUDINA P
79
FASKES LAIN 3206121509050001 PUAD SAPUTRA L
80
P-FRWR0AMJ 3206125906960004 RAI NURSYIPA P
81
NIK TDK TERDAFTAR 3206120107740093 SUDIN L
82
FASKES LAIN 3206130805970004 UUS SUPRIANTO L
83
Q-001I7ITK 3206124703970004 SUSILAWATI P
84
Q-001HQGWS 3206124508960004 SARI P
85
Q-001G3XV4 3206125305770001 HALIMAH P
86
Q-001G8H11 3206124803770003 IKA P
87
Q-001G8F2J 3206124607840005 ANIH P
88
Q-001I5RE5 3206123012850003 RUSTANA ABDUL WAHAB L
89
Q-001HPVP8 3206124403860002 DEDEH P
90
Q-001G1S2B 3206124606800001 OHEN L
91
Q-001HRZWY 3202444202920003 YENI SRI MULYANI P
92
Q-001HQ1QQ 3206125104750001 JENAH JUHAENAH P
93
Q-001G8EM7 3206120101700019 MUMUS L
94
Q-001G8H0S 3206124601820001 UROH P
95
Q-001L9AF9 3206120107800134 USEP YUDIANA L
96
Q-001L9AFE 3206125203810003 NUNUNG P
97
Q-001FI8VL 3278052407690001 HADIS L
98
Q-001L00UB 3206121808840003 ASEP L
99
Q-001JM1Q7 3206120303700009 UMAR L
100
Q-001KMKU7 3202080608820009 BUDI SAPUTRA L
101
Q-001EYFVG 3206126104760001 NUNUNG NURJANAH P
102
Q-001EPTR5 3206120212080001 JEJEN A L
103
Q-001JM5Q0 3278054111700003 AMAH UMI P
104
Q-0027XQDC 3206126501030008 PIAH P
105
Q-001EPB6T 3206125608740001 CUCU P
106
Q-001EIW4N 3201140810940004 SDE RUSTANDI L
111
Q-001L9KFE 3206120107670089 KOSIDIN L
113
P-FGCQMHRN 3206124908690001 TITIN P
114
Q-0027XQCH 3206120107700082 SAEHUDIN L
115
Z-000D2B51 3206124706600005 MUJIBAH L
116
Q-001BGPYI 3206121702980004 DANI RAMDANI L
117
Z-000DP0FI 3206127010580001 HOLIAH P
118
Q-001L9J7C 3206125010690002 ITOH P
119
Q-001L9J7S 3206120402730004 UDAN L
120
Q-001FI9H6 3206122705800001 IWAN L
121
Q-001FIBD0 3206124107640087 HOLISAH P
122
Q-001HPZ9E 3206125203680001 RORO L
123
Q-001L9J6E 3206124510630001 ICAH P
124
Q-001G1KK7 3206124107580105 ENGKAR P
125
Z-0005XM8X 3206125205700001 KOMARIAH P
126
Z-000D27I9 3206124107600193 AAN P
127
Q-001L9J6H 3206125907670002 IKOH P
128
Q-001I7IS3 3206125007760001 CUCU MUDRIKAH P
129
Q-001HS6YU 3206124107660010 ENTIN P
130
Q-001I5RKR 3206120107860007 USUP L
131
Z-000D8S9X 3206122108990002 WINDA NURWANTI P
132
Q-001G8KBW 3206126408670002 TATI NURHAYATI P
133
Q-001LRWAI 3206121012950001 RIKI SUBAGJA L
134
Q-001E8LWQ 3206124107950095 DINI PERMATASARI P
135
Q-001HS6YQ 3206126010810001 TITA P
139 DANI L
P-E5THRWJL 3206121302920007
140 RENI P
P-2K825XCE 3206124504840002
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
FORMAT P
TINGK
: Puskesmas Sodonghilir
: TASIKMALAYA
: JAWA BARAT
Umur
Pekerjaan* Tanggal Lahir (18 sd ≥ 60 Kelompok Umur
tahun)
6 7 8 9
1/4/1957
7/1/1963
11/7/1976
3/10/1972
9/8/2000
9/6/2000
2/20/1966
6/4/1963
12/15/1988
3/13/1975
11/5/1972
5/31/2003
8/17/1976
9/11/2002
12/6/2001
7/7/1979
5/13/1988
7/5/1997
9/2/1988
7/1/1970
7/1/1953
3/19/1983
19-02-1976
3/4/1965
7/1/1962
10/5/1998
5/1/1967
8/18/1990
7/4/1968
6/7/1984
6/5/1968
3/17/1996
7/1/1952
8/18/1978
7/23/2001
3/5/1984
11/9/2002
18-41-2004
11/29/1970
2/11/2006
4/12/1989
7/1/1961
2/15/1985
7/1/1953
5/1/1982
7/10/1989
6/18/1993
10/16/1987
7/10/1960
6/12/1968
4/27/1985
2/2/1994
7/21/1952
7/6/1954
3/12/1978
11/18/2009
3/4/1965
7/20/2005
10/5/1978
10/5/2005
7/1/1962
5/10/1967
5/17/1996
7/7/1958
9/5/2000
7/12/2000
3/11/2002
4/2/1975
3/5/1970
4/7/1986
8/21/1970
2/21/1993
7/1/1962
8/4/1987
7/2/2004
1/18/2004
11/18/2009
7/2/2001
9/15/2005
5/2/2000
6/5/1975
5/8/1997
3/7/1997
8/5/1996
5/13/1977
3/8/1977
7/6/1984
12/30/1985
3/4/1986
6/6/1980
2/2/1992
7/2/1975
1/1/1970
1/6/1982
7/1/1980
123-03-1981
24-07-1969
18-08-1985
03-03-1970
06-08-1982
10-06-1977
13-04-2003
01-11-1970
05-01-2003
16-08-1974
08-10-1994
07-07-1957
10-11-1957
27-06-1945
28-08-1958
7/1/1967
24-04-1992
09-08-1969
2/1/1970
6/7/1960
2/17/1998
1/30/1958
10/10/1969
2/4/1973
5/27/1980
3/18/1957
3/12/1968
10/5/1963
7/1/1958
5/12/1970
7/1/1960
7/19/1967
7/10/1976
7/1/1966
7/1/1986
8/22/1999
8/24/1967
12/10/1995
4/2/1995
10/20/1981
7/3/2002
7/1/1967
5/20/1985
2/13/1992
4/5/1984
8/19/1998
7/16/1958
FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI
10 11 12 13 14
KP.CIKAWUNG HILIR
KP.CIKALONG HILIR
KP.CALENGKA
KP.CICALENGKA
KP.CALENGKA 081219116243
KP.CALENGKA 085351055665
KP.CICALENGKA
KP.CALENGKA
KP.CALENGKA
KP.CALENGKA
KP.CALENGKA
KP.CALENGKA
KP.CALENGKA 082132229247
KP.CALENGKA 082117600544
KP.CALENGKA 085315068771
KP.CALENGKA
KP.CIBIRU 085211013063
KP.CIBIRU 085892645239
KP.CIBIRU 082298268605
KP.CIKALONG POGOR'
KP.CIBIRU 082298268605
KP CISEUEUR
KP.BUJAL SARI
KP BUJAL SARI
KP.BUJAL SARI
KP.SINDANGHURIP 083840390815
KP.CIKALONG 083169139378
KP.BUJAL SARI 081318103956
KP.SINDANGHURIP
KP.SINDANGHURIP
KP.SUKAPARAN
KP.AKERTA 085771600147
KP.KUBANG
KP.CIKERTA 082128072250
KP.CIKERTA 085694057208
KP.CIKERTA 081297373894
KP.SINDANGHURIP
KP.SINDANGHURIP
KP.KADUBONGKOK 085321818737
KP.KADUBONGKOK 085872021183
KP.KADUBONGKOK 083147107047
KP.BUJALSARI
KP.KADUBONGKOK
KP.KADUBONGKOK
KP.BUJAL KULON
KP.BUJAL KULON
KP.SINDANGHURIP WRTAN
KP.BUJAL KULON
KP.BUJAL SARI
KP BUJAL SARI
KP.BUJAL SARI
KP.BUJAL SARI
KP.BUJAL SARI
KP BUJAL SARI
KP BUJAL SARI
KP.SINDANGHURIP
KP.SINDANGHURIP
KP.CIKERTA
KP.CIKERTA 085742235339
KP.SUKAPARAN
KP.SUKAPARAN 081462328279
KP.BUJAL SARI
KP.BUJALKULON
KP CALENGKA 085220108287
KP CALENGKA
KP CALENGKA
KP SAWAH BARU 082124605095
KP CALENGKA 081277979107
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CIPICUNG
KP CISEUEUR
KP CISEUEUR
KP BANTAR AGUNG
KP CISEUEUR
KP CISEUEUR
KP CISEUEUR
KP CISEUEUR
KP CISEUEUR
KP CISEUEUR
KP CISEUEUR
KP CIPICUNG
KP CISEUEUR
KP CISEUEUR
KP.SINDANGHURIP
KP CISEUEUR
KP CISEUEUR
KP.SINDANGHURIP
KP.SINDANGHURIP
KP.SINDANGHURIP
KP.SINDANGHURIP 083822795594
KP.SINDANGHURIP
KP.SINDANGHURIP
KP CIKALONG HILIR
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CALENGKA
KP CIKALONG HILIR
KP CIKALONG HILIR
KP CIKALONG
KP CIKALONG HILIR
KP.KADUBONGKOK 085314400401
KP.KADUBONGKOK 082321177448
KP.SINDANGHURIP
KP.SINDANGHURIP
KP SINDANG HURIP
KP CISEUEUR 82315345114
KP CISEUEUR 85317166282
KP CIPICUNG
KP CISEUEUR
KP CISEUEUR
KP CISEUEUR
Dosis I Dosis 2
Nama/Jenis/Merek Tanggal
Tanggal Screening Tanggal Pemberian
Vaksin*** No. Batch No. Serial Pemberian
Vaksinasi
Vaksinasi
15 16 17 18 19 20
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