Nama Puskesmas/Fasyankes/Pos : PUSKESMAS BEJI

Kabupaten/Kota : BATU
Provinsi : JAWA TIMUR
Tangga; Pelaporan : 28 DESEMBER 2021
Tempat Vaksinasi : MI AS SALAM
JUMLAH ONLINE MANUAL
154 147 7

Jeni
s
No No. Registrasi NIK Nama Penerima Vaksin
Kela
min
KLAS

1 ONLINE 3579030412140003 Ahmad Jihan Faridzi 1 L

2 ONLINE 3579030708140002 Alvaro Tristan 1 L
3 ONLINE 3579031607140001 Arjuna El Bahri Muhamzah 1 L
4 ONLINE 3579030310140001 Arjuna Wahyu Ghaisan R 1 L
5 ONLINE 3579015411140004 Davina Nadhifa Kurniawan 1 L
6 ONLINE 3579011011140001 Fachur Reza Rozikin 1 L
7 ONLINE 3573044509140001 Hannadya Lutfia Aslan 1 L
8 ONLINE 357903308140001 Jheva Gilby Leoneil Napungky 1 L
9 ONLINE 3579030812130001 Juandanda Fajar S 1 L
10 ONLINE 3579030412140001 M Zakki Danendra Albiansyah 1 L
11 ONLINE 35790356101400014 Miftakhul Jannah 1 L
12 ONLINE 3579030211140002 Muhammad Iqbal 1 L
13 ONLINE 3579030705140003 Muhammad Putra Adicandra 1 L
14 ONLINE 3509166810140001 Naira Anindya Binta 1 L
15 ONLINE 3579034205140003 Najwa Khaira Nazhifa 1 L
16 ONLINE 3579012409140001 Selomitha Diva Ananda 1 L
17 ONLINE 3579010505140003 Syafare Arsakha 1 L
18 ONLINE 3575026811140001 Nova Wahyu Kamelia 1 L
19 ONLINE 3579034202130002 Agsyna Alfia Harianti 2A L
20 ONLINE 3579030501130001 Alvara Kenzi Reska Athara 2A L
21 ONLINE 3579031104140002 Fakhri Zhafran Faqih Khairi 2A L
22 ONLINE 35071868121300002 Kayla Azzahra 2A L
23 ONLINE 3507141702140006 Mochammad Rizqi Zaidaan 2A L
24 ONLINE 3579031201140001 Muhammad Arfian Prasetyo 2A L
25 ONLINE 3579032704130003 Muhammad Rasyad Adi Candra 2A L
26 ONLINE 3579036512130002 Mutiara Adyodya Arumbi Putri Filter 2A L
27 ONLINE 3579031604140002 Rafi' Ghani Sakha 2A L
28 ONLINE 3573046212130001 Revita Karunia Dwi Lestari 2A L
29 ONLINE 3579032101130001 Syafiqul Husna Murod 2A L
30 ONLINE 3579034909130002 Yasmin Washilah 2A L
31 ONLINE 3505164503140003 Khenzima Ratu Dharma S 2A L
32 ONLINE 3579036310130001 Aisyah Ayu Kirana 2B P
33 ONLINE 3579030105130001 Arno Adinata 2B L
34 ONLINE 3579034206140003 Balqis Alisyah Nurroh Setyowati 2B P
35 ONLINE 3579032306130001 Keysa Alviano Refana 2B L
36 ONLINE 3579032402130002 Muhammad Raka Mahardika Firma 2B L
37 ONLINE 3515181408130003 Prinz Alrasqa Clearesta 2B L
38 ONLINE 3579030102140001 Putra Tegar Firmansyah Suyadi Ka 2B L
39 ONLINE 3579033006140003 Ramadhan Akmalul Furqon 2B L
40 ONLINE 3579032305130001 Reygan Putra Wildan Prasetyo 2B L
41 ONLINE 3579030309120001 Abith Ingga Hendra S 3A L
42 ONLINE 3579031506120001 Abiyu Firjatullah 3A L
43 ONLINE 3579016703130001 Aqila Diva Fahira 3A L
44 ONLINE 3579034202130001 Arrum Maulidia Zafirah 3A L
45 ONLINE 3573022611120001 Dhava Ardhilla Risqo 3A L
46 ONLINE 3579034402130002 Dzakirah Athaya Coulava Azmi 3A L
47 ONLINE 3579033012120001 Fakhriy Septian Nizar 3A L
48 ONLINE 3579036404120001 Friza Naydhika Keysa Aprilia 3A L
49 ONLINE 35790346041200001 Hanum Qurrota A'yun 3A L
50 ONLINE 3579032801130001 Kaesar Mova Syalendra 3A L
51 ONLINE 3579030903120002 Muhammad Afif Arrafi 3A L
52 ONLINE 3579010904130002 Muhammad Kahfi Al Barr 3A L
53 ONLINE 3579035603130002 Naf'an Nuraini Hamidah 3A L
54 ONLINE 3579032311120002 Rhays Bima Ananta 3A L
55 ONLINE 3579035207120002 Velanie Ayundia C 3A L
56 ONLINE 3579012211120006 Wildan Risqi Fayadan 3A L
57 ONLINE 3507276205120001 Dhakiyah Hifzha Al Iffah 3B L
58 ONLINE 3579021704130002 Excel Yuristio Mahardila 3B L
59 ONLINE 3579015305120002 Fahira Aulya Maharani 3B L
60 ONLINE 3579016605130002 Falisha Athahila Zefa 3B L
61 ONLINE 3579012311120001 Fatir Nur Firdaus 3B L
62 ONLINE 3579031507120004 Galih Anggoro Gautama 3B L
63 ONLINE 3579036702130001 Lailatul Karomah 3B L
64 ONLINE 3579031411120001 Lingga Yoga Amasta 3B L
65 ONLINE 3579032008120003 Marchello Egha Bintang P 3B L
66 ONLINE 3579030903120001 Najmudin Bahrul Mustofa 3B L
67 ONLINE 3579033007120003 Rahmat Hidayat R 3B L
68 ONLINE 3579031708120001 Romi Arsyavin Ramadani 3B L
69 ONLINE 3579034510120002 Vira Nur Aini 3B L
70 ONLINE 3579030502120002 Ahmad Riza Ibrahimmovic 4A L
71 ONLINE 3579030607120003 Atha Nur Ihsan 4A L
72 ONLINE 3507205606110001 Devi Kholifatu Naswa 4A L
73 ONLINE 3579032101120002 Farhan Lutfan Nahar Hamid 4A L
74 ONLINE 3579036211110001 Gadis Akhlaqul Jannah 4A L
75 ONLINE 3579012806120001 Muhammad Azril Akbar Maulana 4A L
76 ONLINE 3514222602120001 Muhammad Daffa Ferdiansyah 4A L
77 ONLINE 3579031711110001 Muhammad Ferbriansyah Dwi W 4A L
78 ONLINE 3579032503120001 Naufal Zainnurofi'i 4A L
79 ONLINE 3579032506110001 Putra Yensan Suyadi 4A L
80 ONLINE 3753041911110003 Rifki Dion Putra Pratama 4A L
81 ONLINE 3579014408110001 Zaahirah Ziadatul 4A L
82 ONLINE 3579036603120002 Zaskiya Anggelita S 4A L
83 ONLINE 3579032906110002 Zidtra Zidane Ananta 4A L
84 ONLINE 3579030606110001 A'an Ibnu Agil Kusniantok 4B L
85 ONLINE 3579036807110002 Al Ulyatun Nisa' 4B L
86 ONLINE 3579035103120004 Alzazahra Nasya Virginia A. P. 4B L
87 ONLINE 3509126805120001 Betananda Miftarizqi Nuriza 4B L
88 ONLINE 3579035601120001 Javelyn Anandya Putri 4B L
89 ONLINE 5204190710110001 Khairul Fikri 4B L
90 ONLINE 3579032501120001 Mahesa Davino Arga Tirta 4B L
91 ONLINE 3579030403120002 Mochamad Raka Sidqi B. 4B L
92 ONLINE 3579032408110001 Mukhammad Fatkhur R. 4B L
93 ONLINE Nathania Juniandhistya 4B L
94 ONLINE 3579036208110003 Noura Nafiisa Ratih Salsabila 4B L
95 ONLINE 3579036912110001 Nur Alfi Anisatul Qoiryah 4B L
96 ONLINE 3579035501120001 Queensha Atifa Fardania 4B L
97 ONLINE 3579016905120001 Renata Azzahra Yuwono 4B L
98 ONLINE 3579036610110001 Sasmita Fais Oktavia 4B L
99 ONLINE 3579030607120002 Yusron Rizky Syahrul M. 4B L
100 ONLINE 6271036003110004 Zahra Salsabela 4B L
101 ONLINE 3507236502120002 Zahwa Aqila Malik fauzan 4B L
102 ONLINE 3579032411110002 Zaidan Adly Muzakky 4B L
103 ONLINE 3579032810100002 Abdul Haris Maulana Alfarizi 5 L
104 ONLINE 3579037004110001 Adinda Nafisha Nurussyifa 5 L
105 ONLINE 3579030106100001 Ahmad Faizi Ahsanul Khuluqi 5 L
106 ONLINE 3579030410100002 Ahmad Luthfi Hakim 5 L
107 ONLINE 3579030609110001 Ahmad Syifa'ul Qolbi 5 L
108 ONLINE 3579035104110001 Aisyah Rahma Aulia Putri 5 L
109 ONLINE 3579034312090001 Angel Hasna Salsabilah Murod 5 L
110 ONLINE 3579030904110001 Azizul Eka Nurmaulana 5 L
111 ONLINE 3507140208100001 Hilbram El-dzikro 5 L
112 ONLINE 3579035209100003 Lailatus Sa'adah 5 L
113 ONLINE 3579031002070237 Mochammad Farhan Firmansyah 5 L
114 ONLINE 3579030701110002 Mokhammad Irfan Bachdim 5 L
115 ONLINE 3579031707100003 Muhammad Akbar Al-Ayyubi 5 L
116 ONLINE 3579036012100003 Nabila Thalita Zahra 5 L
117 ONLINE 3579034507100001 Nayla Shafa Az Zahra 5 L
118 ONLINE 3579032002100002 Nico Albian Zulfan 5 L
119 ONLINE 3579030201110002 Noah Ilham Rizky Firmansyah 5 L
120 ONLINE 3579032207100003 Ridwan Alamsyah 5 L
121 ONLINE 3579032509100001 Septyan Raditya Sendy Dwi Saputra 5 L
122 ONLINE 3579032701110001 Wildansyah Gemilang 5 L
123 ONLINE 3573041011090022 Ramayla Hayyuqo Yumi 5 L
124 ONLINE 3579016904090004 Alleena Avryliassaida 6A L
125 ONLINE 3579032802100001 Ashabul Fallah 6A L
126 ONLINE 6402062607090002 Irsad Abi Juliano 6A L
127 ONLINE 3573034812090002 Keysa Putri R 6A L
128 ONLINE 3578215905100002 Mabelina Aisyah 6A L
129 ONLINE 3275045302100003 Nasyabea Shafa Aulia 6A L
130 ONLINE 3579033112090004 Nazril Gibran Akbar 6A L
131 ONLINE 3579016207100001 Qeisya Rachel F 6A L
132 ONLINE 3579033108100001 Rahmad Rizky A R 6A L
133 ONLINE 3579032609090002 Ramadani Putra H 6A L
134 ONLINE 3579011304100001 Kevin Aditya Saputra 6A L
135 ONLINE 3579034301090002 Ardy Regita Pramesty 6B L
136 ONLINE 3507294403100002 Dhea Putri Andriani 6B L
137 ONLINE 3579036904100002 Firsty Adzilla Vanessya 6B L
138 ONLINE 3579032702100001 Gibran Alvin Maulana 6B L
139 ONLINE 3579016604100001 Inayatur Rosyidah 6B L
140 ONLINE 3579030808090002 Irsyad Akmalul Farhan 6B L
141 ONLINE 3579031206090002 Junior Alfareza 6B L
142 ONLINE 3579035703100002 Kanaia Pradipta Laksmi 6B L
143 ONLINE 3579031611090001 Muhammad Syahdan Amirul H 6B L
144 ONLINE 3579012506090002 Refaldhi Anugrah Dwi Angga 6B L
145 ONLINE 3579034404100002 Safa Aprilia Andara Riyadi 6B L
146 ONLINE 3579011202100003 Wildan Dwi Nur Fathur R 6B L
147 ONLINE 3579030412090001 Zibran Hafidz Ardiansa 6B L
 148 MANUAL L
149 MANUAL L
150 MANUAL L
151 MANUAL L
152 MANUAL L
153 MANUAL L
154 MANUAL L

***Merek Vaksin
A = Sinovac
B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

Kelompok Umur:
12-17 0
18-30 0
31-45 0
46-59 0
> 59 0
Total 0
Pekerjaan:
A = Petugas Medis dan Non Medis di Fa 0
B = LANSIA 0
C = PENDIDIK 0
D = PEDAGANG PASAR 0
E = TOKOH AGAMA 0
F = WAKIL RAKYAT 0
G = PEJABAT NEGARA 0
H = PEGAWAI PEMERINTAH 0
I = KEAMANAN 0
J = PELAYAN PUBLIK 0
K = TRANSPORTASI PUBLIK 0
L = ATLIT 0
M = WARTAWAN DAN PEKERJA MEDIA 0
N = PARIWISATA / PEKERJA HOTEL / 0
O = TNI 0
P = POLRI 0
Q = BUMN 0
R = BUMD 0
S = MASYARAKAT UMUM 0
T = REMAJA 0
U = ANAK 18
Total 0
 FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI

DI KOSONGI

Pekerjaan* Dosis I

Umur Kelom Merek

(18-59 pok No. Hp Vaksin*
Klasif tahun) Umur **
Pekerja Tanggal Tang Bula Tahu
ikasi
an Riil Lahir gal n n
Pcare

U PELAJAR 4/12/2014 8 6-11 085236617487 sinovac 28 12 2021

U PELAJAR 7/8/2014 8 6-11 085832739563 sinovac 28 12 2021
U PELAJAR 16/07/2014 #VALUE! ### 082139214901 sinovac 28 12 2021
U PELAJAR 3/10/2014 8 6-11 085100481201 sinovac 28 12 2021
U PELAJAR 5/11/2014 8 6-11 0881026090064 sinovac 28 12 2021
U PELAJAR 10/11/2014 7 6-11 085257740172 sinovac 28 12 2021
U PELAJAR 5/9/2014 8 6-11 087855948723 sinovac 28 12 2021
U PELAJAR 30/08/2014 #VALUE! ### 085755454487 sinovac 28 12 2021
U PELAJAR 8/12/2013 8 6-11 089601321734 sinovac 28 12 2021
U PELAJAR 4/12/2014 8 6-11 0895613456508 sinovac 28 12 2021
U PELAJAR 16/10/2014 #VALUE! ### 083845054426 sinovac 28 12 2021
U PELAJAR 2/11/2014 8 6-11 081329860113 sinovac 28 12 2021
U PELAJAR 7/5/2014 8 6-11 085855540624 sinovac 28 12 2021
U PELAJAR 28/10/2014 #VALUE! ### 085733978946 sinovac 28 12 2021
U PELAJAR 2/5/2014 8 6-11 081907009870 sinovac 28 12 2021
U PELAJAR 24/09/2014 #VALUE! ### 081259767900 sinovac 28 12 2021
U PELAJAR 5/5/2014 8 6-11 081392091637 sinovac 28 12 2021
U PELAJAR 28/11/2014 #VALUE! ### 0895339425125 sinovac 28 12 2021
U PELAJAR 2/2/2013 9 6-11 081252498227 sinovac 28 12 2021
U PELAJAR 5/1/2013 9 6-11 08999015803 sinovac 28 12 2021
U PELAJAR 11/4/2014 7 6-11 081238418867 sinovac 28 12 2021
U PELAJAR 28/12/2013 ### ### 089509329123 sinovac 28 12 2021
U PELAJAR 17/02/2014 ### ### 081230675252 sinovac 28 12 2021
U PELAJAR 12/1/2014 7 6-11 0895339425125 sinovac 28 12 2021
U PELAJAR 4/27/2013 9 6-11 085856332390 sinovac 28 12 2021
U PELAJAR 25/12/2013 ### ### 082142548653 sinovac 28 12 2021
U PELAJAR 16/04/2014 ### ### 081339508889 sinovac 28 12 2021
U PELAJAR 22/12/2013 ### ### 083133209972 sinovac 28 12 2021
U PELAJAR 21/01/2013 ### ### 083846429941 sinovac 28 12 2021
U PELAJAR 9/9/2013 8 6-11 085646780321 sinovac 28 12 2021
U PELAJAR 5/3/2014 8 6-11 081336520694 sinovac 28 12 2021
U PELAJAR 23/10/2013 ### ### 081231426647 sinovac 28 12 2021
U PELAJAR 1/5/2013 9 6-11 085736861508 sinovac 28 12 2021
U PELAJAR 2/6/2014 8 6-11 081252628237 sinovac 28 12 2021
U PELAJAR 23/06/2013 ### ### 085852665449 sinovac 28 12 2021
U PELAJAR 24/02/2013 ### ### 083848252487 sinovac 28 12 2021
U PELAJAR 14/08/2013 ### ### 085855341332 sinovac 28 12 2021
U PELAJAR 1/2/2014 8 6-11 08113590713 sinovac 28 12 2021
U PELAJAR 30/06/2014 ### ### 087865846204 sinovac 28 12 2021
U PELAJAR 23/05/2013 ### ### 085730613632 sinovac 28 12 2021
U PELAJAR 9/3/2012 9 6-11 085105110699 sinovac 28 12 2021
U PELAJAR 6/15/2012 10 6-11 085655437577 sinovac 28 12 2021
U PELAJAR 3/27/2013 9 6-11 085156041100 sinovac 28 12 2021
U PELAJAR 2/2/2013 9 6-11 083848770251 sinovac 28 12 2021
U PELAJAR 11/26/2012 9 6-11 085247733020 sinovac 28 12 2021
U PELAJAR 2/4/2013 9 6-11 089639018700 sinovac 28 12 2021
U PELAJAR 12/30/2012 9 6-11 089676873040 sinovac 28 12 2021
U PELAJAR 4/24/2012 10 6-11 85101390880 sinovac 28 12 2021
U PELAJAR 06/04/2012 10 6-11 08986314318 sinovac 28 12 2021
U PELAJAR 28/01/2013 ### ### 082140415277 sinovac 28 12 2021
U PELAJAR 3/9/2012 10 6-11 089615104804 sinovac 28 12 2021
U PELAJAR 09/04/2013 8 6-11 08986314318 sinovac 28 12 2021
U PELAJAR 16/03/2012 ### ### 08986314318 sinovac 28 12 2021
U PELAJAR 11/23/2012 9 6-11 082244605214 sinovac 28 12 2021
U PELAJAR 7/12/2012 10 6-11 089524603984 sinovac 28 12 2021
U PELAJAR 22/11/2012 ### ### 085645720411 sinovac 28 12 2021
U PELAJAR 5/22/2012 10 6-11 087783339550 sinovac 28 12 2021
U PELAJAR 4/17/2013 9 6-11 082232802150 sinovac 28 12 2021
U PELAJAR 5/13/2012 10 6-11 081235189708 sinovac 28 12 2021
U PELAJAR 5/26/2013 9 6-11 08982165817 sinovac 28 12 2021
U PELAJAR 11/23/2012 9 6-11 081336236698 sinovac 28 12 2021
U PELAJAR 15/07/2012 ### ### 085720400503 sinovac 28 12 2021
U PELAJAR 2/27/2013 9 6-11 081357143874 sinovac 28 12 2021
U PELAJAR 11/14/2012 9 6-11 082147825466 sinovac 28 12 2021
U PELAJAR 8/20/2012 9 6-11 082229175334 sinovac 28 12 2021
U PELAJAR 3/9/2012 10 6-11 087846176680 sinovac 28 12 2021
U PELAJAR 7/30/2012 9 6-11 083133209967 sinovac 28 12 2021
U PELAJAR 8/17/2012 9 6-11 083142937287 sinovac 28 12 2021
U PELAJAR 10/5/2012 9 6-11 085645723945 sinovac 28 12 2021
U PELAJAR 2/5/2012 10 6-11 081276204371 sinovac 28 12 2021
U PELAJAR 7/6/2012 10 6-11 O89616931616 sinovac 28 12 2021
U PELAJAR 6/16/2011 11 6-11 082225315410 sinovac 28 12 2021
U PELAJAR 21/01/2012 ### ### 083845054426 sinovac 28 12 2021
U PELAJAR 22/10/2011 ### ### 083845054426 sinovac 28 12 2021
U PELAJAR 6/28/2012 10 6-11 0881026241194 sinovac 28 12 2021
U PELAJAR 26/02/2012 ### ### 083845054426 sinovac 28 12 2021
U PELAJAR 11/17/2011 10 6-11 081228757613 sinovac 28 12 2021
U PELAJAR 3/25/2012 10 6-11 8993452087 sinovac 28 12 2021
U PELAJAR 6/25/2011 11 6-11 08113590713 sinovac 28 12 2021
U PELAJAR 11/19/2011 10 6-11 083133209972 sinovac 28 12 2021
U PELAJAR 8/4/2011 10 6-11 081231141616 sinovac 28 12 2021
U PELAJAR 3/26/2012 10 6-11 085247733020 sinovac 28 12 2021
U PELAJAR 6/29/2011 11 6-11 082139161797 sinovac 28 12 2021
U PELAJAR 6/6/2021 1 0 082147815466 sinovac 28 12 2021
U PELAJAR 7/28/2011 10 6-11 085234104241 sinovac 28 12 2021
U PELAJAR 3/11/2012 10 6-11 81249820069 sinovac 28 12 2021
U PELAJAR 28/05/2012 ### ### 083834454526 sinovac 28 12 2021
U PELAJAR 1/16/2012 10 6-11 0881026896546 sinovac 28 12 2021
U PELAJAR 10/7/2011 10 6-11 082333208877 sinovac 28 12 2021
U PELAJAR 1/25/2012 10 6-11 085812338380 sinovac 28 12 2021
U PELAJAR 3/4/2012 10 6-11 081331429898 sinovac 28 12 2021
U PELAJAR 8/24/2011 10 6-11 085100552658 sinovac 28 12 2021
U PELAJAR 15/01/2012 ### ### 083834454526 sinovac 28 12 2021
U PELAJAR 8/22/2011 10 6-11 085855534916 sinovac 28 12 2021
U PELAJAR 12/29/2011 10 6-11 085230337227 sinovac 28 12 2021
U PELAJAR 1/15/2012 10 6-11 085749886616 sinovac 28 12 2021
U PELAJAR 29/05/2012 ### ### 083834454526 sinovac 28 12 2021
U PELAJAR 26/10/2012 ### ### 083834454526 sinovac 28 12 2021
U PELAJAR 06/07/2012 10 6-11 083834454526 sinovac 28 12 2021
U PELAJAR 3/20/2011 11 6-11 089512288926 sinovac 28 12 2021
U PELAJAR 2/25/2012 10 6-11 085103155709 sinovac 28 12 2021
U PELAJAR 11/24/2011 10 6-11 082143002327 sinovac 28 12 2021
U PELAJAR 10/28/2010 11 6-11 083851998316 sinovac 28 12 2021
U PELAJAR 4/30/2011 11 6-11 081333421123 sinovac 28 12 2021
U PELAJAR 6/1/2010 12 12-17 85331782132 sinovac 28 12 2021
U PELAJAR 10/4/2010 11 6-11 085108050520 sinovac 28 12 2021
U PELAJAR 9/6/2011 10 6-11 0895622202767 sinovac 28 12 2021
U PELAJAR 4/11/2011 11 6-11 082230468856 sinovac 28 12 2021
U PELAJAR 06/12/2009 13 12-17 '082257462448 sinovac 28 12 2021
U PELAJAR 4/9/2011 11 6-11 081252673207 sinovac 28 12 2021
U PELAJAR 8/2/2010 11 6-11 081230675252 sinovac 28 12 2021
U PELAJAR 9/12/2010 11 6-11 0895360599528 sinovac 28 12 2021
U PELAJAR 17/09/2010 ### ### '082257462448 sinovac 28 12 2021
U PELAJAR 1/7/2011 11 6-11 085816170775 sinovac 28 12 2021
U PELAJAR 7/17/2010 12 12-17 081252720797 sinovac 28 12 2021
U PELAJAR 20/02/2010 ### ### '082257462448 sinovac 28 12 2021
U PELAJAR 7/5/2010 12 12-17 085748549569 sinovac 28 12 2021
U PELAJAR 2/20/2010 12 12-17 085797948160 sinovac 28 12 2021
U PELAJAR 1/2/2011 11 6-11 081359158802 sinovac 28 12 2021
U PELAJAR 7/22/2010 11 6-11 081991287000 sinovac 28 12 2021
U PELAJAR 9/25/2010 11 6-11 085816177297 sinovac 28 12 2021
U PELAJAR 07/04/2011 11 6-11 '082257462448 sinovac 28 12 2021
U PELAJAR 8/18/2010 11 6-11 087855948723 sinovac 28 12 2021
U PELAJAR 29/04/2009 ### ### 085708265194 sinovac 28 12 2021
U PELAJAR 2/28/2010 12 12-17 082257182091 sinovac 28 12 2021
U PELAJAR 26/07/2009 ### ### 089686960849 sinovac 28 12 2021
U PELAJAR 12/8/2009 12 12-17 085648442748 sinovac 28 12 2021
U PELAJAR 5/19/2010 12 12-17 0858121217672 sinovac 28 12 2021
U PELAJAR 2/13/2010 12 12-17 083133320344 sinovac 28 12 2021
U PELAJAR 12/31/2009 12 12-17 082257226369 sinovac 28 12 2021
U PELAJAR 7/22/2010 11 6-11 081515616805 sinovac 28 12 2021
U PELAJAR 8/31/2010 11 6-11 083133320370 sinovac 28 12 2021
U PELAJAR 9/26/2009 12 12-17 081945778306 sinovac 28 12 2021
U PELAJAR 4/13/2010 12 12-17 081232290309 sinovac 28 12 2021
U PELAJAR 03/01/2009 13 12-17 085655541804 sinovac 28 12 2021
U PELAJAR 3/4/2010 12 12-17 085331740349 sinovac 28 12 2021
U PELAJAR 4/29/2010 12 12-17 083848018370 sinovac 28 12 2021
U PELAJAR 2/27/2010 12 12-17 081331996996 sinovac 28 12 2021
U PELAJAR 4/26/2010 12 12-17 085736218665 sinovac 28 12 2021
U PELAJAR 8/8/2009 12 12-17 089648494306 sinovac 28 12 2021
U PELAJAR 6/12/2009 13 12-17 0895331259184 sinovac 28 12 2021
U PELAJAR 3/17/2010 12 12-17 082334284080 sinovac 28 12 2021
U PELAJAR 11/16/2009 12 12-17 083856205172 sinovac 28 12 2021
U PELAJAR 6/25/2009 13 12-17 081235189708 sinovac 28 12 2021
U PELAJAR 4/4/2010 12 12-17 081335353495 sinovac 28 12 2021
U PELAJAR 2/12/2010 12 12-17 081331509329 sinovac 28 12 2021
U PELAJAR 12/4/2009 12 12-17 085852394027 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021
U PELAJAR 122 ≥60 sinovac 28 12 2021

Kepesert Jumlah
BPJS PBI 0
BPJS Non 0
Non Anggo 0
Total 0

Pemberian Jumlah
Dosis 1 0
Dosis 2 0
Total 0
Dosis I Dosis 2
Keterang
an
Pulang
Sehat /
Tang Bula Tahu
No. Batch No Etiket No. Batch KIPI
gal n n

202109174M 25 01 2022 SEHAT

202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
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202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
202109174M 25 01 2022 SEHAT
Nama Puskesmas/Fasyankes/Pos : PUSKESMAS BEJI
Kabupaten/Kota : BATU
Provinsi : JAWA TIMUR
Tangga; Pelaporan : 25 JANUARI 2022
Tempat Vaksinasi : MI AS SALAM

Jeni
Nama Penerima Vaksin s
No No. Registrasi NIK
(SISWA) Kela
min
Kelas

1 3573054803140002 Almira Zahwa Qurotu 1 p

2 3579032912140002 Dzaki Abdi Maulana 1 L
3 3579032401140003 Genta Pamungkas Wijaya P 1 L
4 3579030506140001 Muhammad Sayid Al Hafidz 1 L
5 Nafi'ah Tsalitsa 1 L
6 Septy Aulia Azahra 1 L
7 3579016409140002 Zakia Septa Nirwana 1 L
8 3579036109130003 Anindita Callia Nathania 2A L
9 3579036604130001 Azka Hilmatul Aulia 2A L
10 3579036502140001 Gava Aila Zahran Setiawan 2A L
11 3579031712120001 Ibrahim Hafidz Alfarizy 2A L
12 3579011106130004 Muhammad Zaenal Arifin 2A L
13 Afifah Al Kaisah 2B P
14 3579030107130001 Afrizal Prayoga Santoso 2B L
15 3579036109130002 Anindya Callysta Nathania 2B P
16 3507272207130001 Elang Zidni Alfarizzi 2B L
17 3507226503140002 Fakhira Salwa Alqaida 2B P
18 3579011312130001 Muhammad Abdurohman Ozil 2B L
19 3579035904140001 Quronil Uyunil Aizza Zahra 2B P
20 3579016006130001 Relita Cici Ainun Aziza 2B P
21 3579034807130001 Rizky Ammaria Ramadhani 2B P
22 3579030608130001 Syahrehan Bagus Ramadhan 2B L
23 3579036310120001 Nabila Aisyah M 3A L
24 Muhammad Nazhif Yusuf Al Kadri 3A L
25 3579035511120003 Aqila Kamelia Fiannidin 3B L
26 3579037006120001 Atina Bilqis Hilyatul Izza 3B L
27 3573050506120006 Muhammad Arlan S K 3B L
28 3579030210110001 Arzian Roihanatu Asysyayu 4A L
29 3507270206120002 Baihaqi Royyan Nawawi 4A L
30 3579034911110002 Faiqah Naili Shafeera 4A L
31 3579035311110001 Hawa Miftahul Khabibah 4A L
32 3579032701120002 Moch. Aldiansyah Khoirul Anwar 4A L
33 3579011805120003 Muhammad Aqil Abdullah 4A L
34 3579015305120003 Safa Redina Putri 4A L
35 3507184703100001 Shifa Al Rohmah 4A L
36 3579030607120003 Azzahrah Nur 'Aini 4B L
37 3579034602120003 Hasibuan Alfatihah 4B L
38 3579036712110001 Mevia Naura Zalfa 4B L
39 Bintang Putra Pratama 5 L
40 3579034112100002 Desyana Nur Alisa 5 L
41 Ervina Dwi Rahmawati 5 L
42 3574054602110002 Gianti Queen Mustika 5 L
43 3579031308100007 Muhammad Abisha Ramadhan 5 L
44 3579015703110002 Rizki Nanda Fatimah 5 L
45 3579036907100002 Velina Isma Zenia 5 L
 46 3579014806100003 Zahrotus Shifa 5 L
47 3579031105100001 Syaifullah Ali 5 L
48 3507052307090006 Ahmad Rafkah Adittya 6A L
49 3579035301100001 Alzira Vita Damayanti 6A L
50 3579031707090002 Andhyka Deva P 6A L
51 357903032090003 Ferdy Wibby Saputra 6A L
52 3579032302100002 M Aldiansyah Aljabar 6A L
53 3579015110090003 Oktaviana Alya Risty 6A L
54 3573054406090003 Putri Aurora K M 6A L
55 3579036712080001 Sifani Desy Arimbi 6A L
56 3579035008090001 Sasmita Putri R P 6A L
57 Adam Cahya 6B L
58 3579035203100004 Divla Alzena Lailatul 6B L
59 3579030303100003 Maulana Akbar Raffa .A 6B L
60 3579016310090003 Elina Okta Via 6B L

***Merek Vaksin
A = Sinovac
B = Lainnya (Mohon disebutkan jenis vaksin yang diterima Puskesmas/Faskes)

Kelompok Umur:
12-17 1
18-30 0
31-45 0
46-59 0
> 59 0
Total 1
Pekerjaan:
A = Petugas Medis dan Non Medis di Fas 0
B = LANSIA 0
C = PENDIDIK 0
D = PEDAGANG PASAR 0
E = TOKOH AGAMA 0
F = WAKIL RAKYAT 0
G = PEJABAT NEGARA 0
H = PEGAWAI PEMERINTAH 0
I = KEAMANAN 0
J = PELAYAN PUBLIK 0
K = TRANSPORTASI PUBLIK 0
L = ATLIT 0
M = WARTAWAN DAN PEKERJA MEDIA 0
N = PARIWISATA / PEKERJA HOTEL / 0
O = TNI 0
P = POLRI 0
Q = BUMN 0
R = BUMD 0
S = MASYARAKAT UMUM 0
T = REMAJA 0
U = ANAK 37
Total 0
 FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19

TINGKAT PUSKESMAS/FASYANKES/POS VAKSINASI

17/12/2012
17/12/2012

DI KOSONGI

Pekerjaan* Dosis I

Umur Kelom Merek

(18-59 pok No. Hp Vaksin*
Klasif tahun) Umur **
Pekerjaa Tanggal Tang Bula Tahu
ikasi
n Riil Lahir gal n n
Pcare

U PELAJAR 8/3/2014 7 6-11 081218408252 SINOVAC

U PELAJAR 29/12/2014 #VALUE! ### 085259855175 SINOVAC
U PELAJAR 24/01/2014 #VALUE! ### 085720400503 SINOVAC
U PELAJAR 5/6/2014 8 6-11 081229644364 SINOVAC
U PELAJAR 27/11/2014 #VALUE! ### 0823 3167 7089 SINOVAC
U PELAJAR 03/11/2014 8 6-11 082135407636 SINOVAC
U PELAJAR 24/09/2014 #VALUE! ### 087828539143 SINOVAC

U PELAJAR 21/09/2013 ### ### 085855534906 SINOVAC

U PELAJAR 26/04/2013 ### ### 089617421305 SINOVAC

U PELAJAR 25/02/2014 ### ### 081803844991 SINOVAC

U PELAJAR 17/12/2012 ### ### 082132514413' SINOVAC

U PELAJAR 11/6/2013 8 6-11 083133320369 SINOVAC

U PELAJAR 20/08/2013 ### ### 0823 3167 7089 SINOVAC

U PELAJAR 1/7/2013 9 6-11 082301051134 SINOVAC

U PELAJAR 21/09/2013 ### ### 085855534916 SINOVAC

U PELAJAR 22/07/2013 ### ### 0857-3012-4559 SINOVAC

U PELAJAR 25/03/2014 ### ### 085745410651 SINOVAC

U PELAJAR 13/12/2013 ### ### 0895339425125 SINOVAC

U PELAJAR 11/04/2014 7 6-11 087865846204 SINOVAC

U PELAJAR 20/06/2013 ### ### 0895339425125 SINOVAC

U PELAJAR 08/07/2013 8 6-11 085236335999 SINOVAC

U PELAJAR 6/8/2013 9 6-11 085704439919 SINOVAC

U PELAJAR 10/23/2012 9 6-11 081280040313 SINOVAC
U PELAJAR 1/16/2013 9 6-11 089677235289 SINOVAC
U PELAJAR 15/11/2012 ### ### 085720400503 SINOVAC
U PELAJAR 6/30/2012 10 6-11 085859317220 SINOVAC
U PELAJAR 6/4/2012 10 6-11 081218408252 SINOVAC

U PELAJAR 10/2/2011 10 6-11 089676866080 SINOVAC

U PELAJAR 02/06/2012 10 6-11 083845054426 SINOVAC

U PELAJAR 11/9/2011 10 6-11 085234478909 SINOVAC

U PELAJAR 11/13/2011 10 6-11 081229644364 SINOVAC

U PELAJAR 1/27/2012 10 6-11 089616919922 SINOVAC

U PELAJAR 18/05/2012 ### ### 083845054426 SINOVAC

U PELAJAR 13/05/2012 ### ### 083845054426 SINOVAC

U PELAJAR 3/7/2010 12 12-17 0823 3167 7089 SINOVAC

U PELAJAR 24/10/2012 ### ### 083834454526 SINOVAC

U PELAJAR 1/12/2012 10 6-11 087754587720 SINOVAC

U PELAJAR 12/27/2011 10 6-11 083832723000 SINOVAC

U PELAJAR 26/01/2010 ### ### '082257462448 SINOVAC
U PELAJAR 12/1/2010 11 6-11 083185397393 SINOVAC
U PELAJAR 04/07/2012 10 6-11 '082257462448 SINOVAC
U PELAJAR 2/6/2011 11 6-11 081212513491 SINOVAC
U PELAJAR 03/08/2010 12 12-17 '082257462448 SINOVAC
U PELAJAR 3/17/2011 11 6-11 082337983440 SINOVAC
U PELAJAR 29/07/2010 ### ### '082257462448 SINOVAC
U PELAJAR 6/8/2010 12 12-17 085755534186 SINOVAC
U PELAJAR 5/11/2010 12 12-17 081357143874 SINOVAC
U PELAJAR 7/23/2009 12 12-17 085852656192 SINOVAC
U PELAJAR 1/13/2010 12 12-17 081249820069 SINOVAC
U PELAJAR 17/07/2012 ### ### 089686960849 SINOVAC
U PELAJAR 03/02/2010 12 12-17 089686960849 SINOVAC
U PELAJAR 23/02/2010 ### ### 089686960849 SINOVAC
U PELAJAR 10/11/2009 12 12-17 085712053592 SINOVAC
U PELAJAR 6/4/2009 13 12-17 081218408252 SINOVAC
U PELAJAR 27/12/2008 ### ### 089686960849 SINOVAC
U PELAJAR 8/10/2009 12 12-17 087756526507 SINOVAC
U PELAJAR 7/17/2009 13 12-17 085655541804 SINOVAC
U PELAJAR 3/12/2010 12 12-17 085704439919 SINOVAC
U PELAJAR 3/3/2010 12 12-17 08824229281 SINOVAC
U PELAJAR 10/23/2009 12 12-17 083194799745 SINOVAC

Kepesertaa Jumlah
BPJS PBI 0
BPJS Non P 0
Non Anggot 0
Total 0

Pemberian Jumlah
Dosis 1 0
Dosis 2 0
Total 0
Dosis I Dosis 2
Keterang
an
Pulang
Sehat /
Tang Bula Tahu
No. Batch No Etiket No. Batch KIPI
gal n n
DAFTAR HADIR VAKSINASI SINOVAC DOSIS 2 SD/MI
HARI,TANGGAL : SELASA, 25 JANUARI 2022
NAMA SEKOLAH : MI AS SALAM
KELAS :1-6
NO NAMA SISWA KELAS TANGGAL VAKSINASI KETERANGAN
DOSIS 1 DOSIS 2
1 Ahmad Jihan Faridzi 1 12/28/2021
2 Alvaro Tristan 1 12/28/2021
3 Arjuna El Bahri Muhamzah 1 12/28/2021
4 Arjuna Wahyu Ghaisan R 1 12/28/2021
5 Davina Nadhifa Kurniawan 1 12/28/2021
6 Fachur Reza Rozikin 1 12/28/2021
7 Hannadya Lutfia Aslan 1 12/28/2021
8 Jheva Gilby Leoneil Napungky 1 12/28/2021
9 Juandanda Fajar S 1 12/28/2021
10 M Zakki Danendra Albiansyah 1 12/28/2021
11 Miftakhul Jannah 1 12/28/2021
12 Muhammad Iqbal 1 12/28/2021
13 Muhammad Putra Adicandra 1 12/28/2021
14 Naira Anindya Binta 1 12/28/2021
15 Najwa Khaira Nazhifa 1 12/28/2021
16 Selomitha Diva Ananda 1 12/28/2021
17 Syafare Arsakha 1 12/28/2021
18 Nova Wahyu Kamelia 1 12/28/2021
19 Agsyna Alfia Harianti 2A 12/28/2021
20 Alvara Kenzi Reska Athara 2A 12/28/2021
21 Fakhri Zhafran Faqih Khairi 2A 12/28/2021
22 Kayla Azzahra 2A 12/28/2021
23 Mochammad Rizqi Zaidaan 2A 12/28/2021
24 Muhammad Arfian Prasetyo 2A 12/28/2021
25 Muhammad Rasyad Adi Candra 2A 12/28/2021
26 Mutiara Adyodya Arumbi Putri Filter 2A 12/28/2021
27 Rafi' Ghani Sakha 2A 12/28/2021
28 Revita Karunia Dwi Lestari 2A 12/28/2021
29 Syafiqul Husna Murod 2A 12/28/2021
30 Yasmin Washilah 2A 12/28/2021
31 Khenzima Ratu Dharma S 2A 12/28/2021
32 Aisyah Ayu Kirana 2B 12/28/2021
33 Arno Adinata 2B 12/28/2021
34 Balqis Alisyah Nurroh Setyowati 2B 12/28/2021
35 Keysa Alviano Refana 2B 12/28/2021
36 Muhammad Raka Mahardika Firmansyah 2B 12/28/2021
37 Prinz Alrasqa Clearesta 2B 12/28/2021
38 Putra Tegar Firmansyah Suyadi Kaitman 2B 12/28/2021
39 Ramadhan Akmalul Furqon 2B 12/28/2021
40 Reygan Putra Wildan Prasetyo 2B 12/28/2021
41 Abith Ingga Hendra S 3A 12/28/2021
42 Abiyu Firjatullah 3A 12/28/2021
43 Aqila Diva Fahira 3A 12/28/2021
44 Arrum Maulidia Zafirah 3A 12/28/2021
45 Dhava Ardhilla Risqo 3A 12/28/2021
46 Dzakirah Athaya Coulava Azmi 3A 12/28/2021
47 Fakhriy Septian Nizar 3A 12/28/2021
48 Friza Naydhika Keysa Aprilia 3A 12/28/2021
49 Hanum Qurrota A'yun 3A 12/28/2021
50 Kaesar Mova Syalendra 3A 12/28/2021
51 Muhammad Afif Arrafi 3A 12/28/2021
52 Muhammad Kahfi Al Barr 3A 12/28/2021
53 Naf'an Nuraini Hamidah 3A 12/28/2021
54 Rhays Bima Ananta 3A 12/28/2021
55 Velanie Ayundia C 3A 12/28/2021
56 Wildan Risqi Fayadan 3A 12/28/2021
57 Dhakiyah Hifzha Al Iffah 3B 12/28/2021
58 Excel Yuristio Mahardila 3B 12/28/2021
59 Fahira Aulya Maharani 3B 12/28/2021
60 Falisha Athahila Zefa 3B 12/28/2021
61 Fatir Nur Firdaus 3B 12/28/2021
62 Galih Anggoro Gautama 3B 12/28/2021
63 Lailatul Karomah 3B 12/28/2021
64 Lingga Yoga Amasta 3B 12/28/2021
65 Marchello Egha Bintang P 3B 12/28/2021
66 Najmudin Bahrul Mustofa 3B 12/28/2021
67 Rahmat Hidayat R 3B 12/28/2021
68 Romi Arsyavin Ramadani 3B 12/28/2021
69 Vira Nur Aini 3B 12/28/2021
70 Ahmad Riza Ibrahimmovic 4A 12/28/2021
71 Atha Nur Ihsan 4A 12/28/2021
72 Devi Kholifatu Naswa 4A 12/28/2021
73 Farhan Lutfan Nahar Hamid 4A 12/28/2021
74 Gadis Akhlaqul Jannah 4A 12/28/2021
75 Muhammad Azril Akbar Maulana 4A 12/28/2021
76 Muhammad Daffa Ferdiansyah 4A 12/28/2021
77 Muhammad Ferbriansyah Dwi W 4A 12/28/2021
78 Naufal Zainnurofi'i 4A 12/28/2021
79 Putra Yensan Suyadi 4A 12/28/2021
80 Rifki Dion Putra Pratama 4A 12/28/2021
81 Zaahirah Ziadatul 4A 12/28/2021
82 Zaskiya Anggelita S 4A 12/28/2021
83 Zidtra Zidane Ananta 4A 12/28/2021
84 A'an Ibnu Agil Kusniantok 4B 12/28/2021
85 Al Ulyatun Nisa' 4B 12/28/2021
86 Alzazahra Nasya Virginia A. P. 4B 12/28/2021
 87 Betananda Miftarizqi Nuriza 4B 12/28/2021
88 Javelyn Anandya Putri 4B 12/28/2021
89 Khairul Fikri 4B 12/28/2021
90 Mahesa Davino Arga Tirta 4B 12/28/2021
91 Mochamad Raka Sidqi B. 4B 12/28/2021
92 Mukhammad Fatkhur R. 4B 12/28/2021
93 Nathania Juniandhistya 4B 12/28/2021
94 Noura Nafiisa Ratih Salsabila 4B 12/28/2021
95 Nur Alfi Anisatul Qoiryah 4B 12/28/2021
96 Queensha Atifa Fardania 4B 12/28/2021
97 Renata Azzahra Yuwono 4B 12/28/2021
98 Sasmita Fais Oktavia 4B 12/28/2021
99 Yusron Rizky Syahrul M. 4B 12/28/2021
100 Zahra Salsabela 4B 12/28/2021
101 Zahwa Aqila Malik fauzan 4B 12/28/2021
102 Zaidan Adly Muzakky 4B 12/28/2021
103 Abdul Haris Maulana Alfarizi 5 12/28/2021
104 Adinda Nafisha Nurussyifa 5 12/28/2021
105 Ahmad Faizi Ahsanul Khuluqi 5 12/28/2021
106 Ahmad Luthfi Hakim 5 12/28/2021
107 Ahmad Syifa'ul Qolbi 5 12/28/2021
108 Aisyah Rahma Aulia Putri 5 12/28/2021
109 Angel Hasna Salsabilah Murod 5 12/28/2021
110 Azizul Eka Nurmaulana 5 12/28/2021
111 Hilbram El-dzikro 5 12/28/2021
112 Lailatus Sa'adah 5 12/28/2021
113 Mochammad Farhan Firmansyah 5 12/28/2021
114 Mokhammad Irfan Bachdim 5 12/28/2021
115 Muhammad Akbar Al-Ayyubi 5 12/28/2021
116 Nabila Thalita Zahra 5 12/28/2021
117 Nayla Shafa Az Zahra 5 12/28/2021
118 Nico Albian Zulfan 5 12/28/2021
119 Noah Ilham Rizky Firmansyah 5 12/28/2021
120 Ridwan Alamsyah 5 12/28/2021
121 Septyan Raditya Sendy Dwi Saputra 5 12/28/2021
122 Wildansyah Gemilang 5 12/28/2021
123 Ramayla Hayyuqo Yumi 5 12/28/2021
124 Alleena Avryliassaida 6A 12/28/2021
125 Ashabul Fallah 6A 12/28/2021
126 Irsad Abi Juliano 6A 12/28/2021
127 Keysa Putri R 6A 12/28/2021
128 Mabelina Aisyah 6A 12/28/2021
129 Nasyabea Shafa Aulia 6A 12/28/2021
130 Nazril Gibran Akbar 6A 12/28/2021
131 Qeisya Rachel F 6A 12/28/2021
132 Rahmad Rizky A R 6A 12/28/2021
133 Ramadani Putra H 6A 12/28/2021
134 Kevin Aditya Saputra 6A 12/28/2021
135 Ardy Regita Pramesty 6B 12/28/2021
136 Dhea Putri Andriani 6B 12/28/2021
137 Firsty Adzilla Vanessya 6B 12/28/2021
138 Gibran Alvin Maulana 6B 12/28/2021
139 Inayatur Rosyidah 6B 12/28/2021
140 Irsyad Akmalul Farhan 6B 12/28/2021
141 Junior Alfareza 6B 12/28/2021
142 Kanaia Pradipta Laksmi 6B 12/28/2021
143 Muhammad Syahdan Amirul H 6B 12/28/2021
144 Refaldhi Anugrah Dwi Angga 6B 12/28/2021
145 Safa Aprilia Andara Riyadi 6B 12/28/2021
146 Wildan Dwi Nur Fathur R 6B 12/28/2021
147 Zibran Hafidz Ardiansa 6B 12/28/2021
148 12/28/2021 MANUAL
149 12/28/2021 MANUAL
150 12/28/2021 MANUAL
151 12/28/2021 MANUAL
152 12/28/2021 MANUAL
153 12/28/2021 MANUAL
154 12/28/2021 MANUAL
JML SISWA : 154
DIVAKSIN :
TUNDA :
IJIN :
DAFTAR HADIR VAKSINASI SINOVAC DOSIS 2 SD/MI
HARI,TANGGAL : SELASA, 25 JANUARI 2022
NAMA SEKOLAH : MI AS SALAM
KELAS :1-6
NO NAMA SISWA KELAS TANGGAL VAKSINASI KETERANGAN
DOSIS 1 DOSIS 2
1 Almira Zahwa Qurotu 1
2 Dzaki Abdi Maulana 1
3 Genta Pamungkas Wijaya P 1
4 Muhammad Sayid Al Hafidz 1
5 Nafi'ah Tsalitsa 1
6 Septy Aulia Azahra 1
7 Zakia Septa Nirwana 1
8 Anindita Callia Nathania 2A
9 Azka Hilmatul Aulia 2A
10 Gava Aila Zahran Setiawan 2A
11 Ibrahim Hafidz Alfarizy 2A
12 Muhammad Zaenal Arifin 2A
13 Afifah Al Kaisah 2B
14 Afrizal Prayoga Santoso 2B
15 Anindya Callysta Nathania 2B
16 Elang Zidni Alfarizzi 2B
17 Fakhira Salwa Alqaida 2B
18 Muhammad Abdurohman Ozil 2B
19 Quronil Uyunil Aizza Zahra 2B
20 Relita Cici Ainun Aziza 2B
21 Rizky Ammaria Ramadhani 2B
22 Syahrehan Bagus Ramadhan 2B
23 Nabila Aisyah M 3A
24 Muhammad Nazhif Yusuf Al Kadri 3A
25 Aqila Kamelia Fiannidin 3B
26 Atina Bilqis Hilyatul Izza 3B
27 Muhammad Arlan S K 3B
28 Arzian Roihanatu Asysyayu 4A
29 Baihaqi Royyan Nawawi 4A
30 Faiqah Naili Shafeera 4A
31 Hawa Miftahul Khabibah 4A
32 Moch. Aldiansyah Khoirul Anwar 4A
33 Muhammad Aqil Abdullah 4A
34 Safa Redina Putri 4A
35 Shifa Al Rohmah 4A
36 Azzahrah Nur 'Aini 4B
37 Hasibuan Alfatihah 4B
38 Mevia Naura Zalfa 4B
39 Bintang Putra Pratama 5
40 Desyana Nur Alisa 5
41 Ervina Dwi Rahmawati 5
42 Gianti Queen Mustika 5
43 Muhammad Abisha Ramadhan 5
44 Rizki Nanda Fatimah 5
45 Velina Isma Zenia 5
46 Zahrotus Shifa 5
47 Syaifullah Ali 5
48 Ahmad Rafkah Adittya 6A
49 Alzira Vita Damayanti 6A
50 Andhyka Deva P 6A
51 Ferdy Wibby Saputra 6A
52 M Aldiansyah Aljabar 6A
53 Oktaviana Alya Risty 6A
54 Putri Aurora K M 6A
55 Sifani Desy Arimbi 6A
56 Sasmita Putri R P 6A
57 Adam Cahya 6B
58 Divla Alzena Lailatul 6B
59 Maulana Akbar Raffa .A 6B
60 Elina Okta Via 6B
JML SISWA : 60
DIVAKSIN :
TUNDA :
IJIN :