Kepesertaan BPJS

(tulis 'Ya' pada Dosis I Dosis 2

kolom yang sesuai)
Umur Kelom Tanggal Tanggal
BPJS Non Merek Tanggal
No No. Ticket NIK Nama Penerima Vaksin JK Pekerjaan* (18-59 pok INSTANSI Alamat No. Hp BPJS Screenin Pemberia KET
Non Angg Vaksin*** No. Batch No seri Pemberian No. Batch No Seri
tahun) Umur PBI g n
PBI ota Vaksinasi
Vaksinasi

1 N-247D4C20 '3601046212830001 Elah Nurhayati, Amd.Keb P NAKES 08/01/1983 PUSKESMAS CIKEUSIK Kp.Muara dua ds.Cikiruhwetan.Kec Ci '087780538983 √ SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
2 P-BSGWMQFJ '3601045201990001 FITRI PUJIAWATI P NAKES 1/12/1999 PUSKESMAS CIKEUSIK Kp.Benger ds.Nanggala '083812150536 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
3 P-BT215L4X '3601042001980003 ADIT BAEHAKI L NAKES 20/01/1998 PUSKESMAS CIKEUSIK Kp.Umbulan .Ds Umbulan '08381313127 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
4 P-BTOR70PE '3601045707980004 SITI MARDIANTI P NAKES 17/07/1998 PUSKESMAS CIKEUSIK Kp.Sukaratu Ds Nanggala '082297668800 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
5 P-BWVD8YTQ '36013404070910001 ANGGA PERMANA L NAKES 04/10/1991 PUSKESMAS CIKEUSIK Kp.Cikeusik Ds.Cikeusik '085777313731 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
6 P-BWX9M1E7 '3201225704920003 NURICA APRIANI P NAKES 17/04/1992 PUSKESMAS CIKEUSIK Kp.Cikeusik Ds.Cikeusik '085716359342 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
7 S-8DB28AF0 '108076905910001 MEIKE PRAMUDITA PUTRI P NAKES 29/05/1991 PUSKESMAS CIKEUSIK Cikeusik SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
8 P-BYN5ZONS '3601044810950001 NUNUNG MUSIYANI SAFITRIP NAKES 08/10/1995 PUSKESMAS CIKEUSIK Kp.Kendal ds Nanggala '087750222280 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
9 P-BYQKUBST '3601044107880078 ELA FADILAH JUITA SARI P NAKES 16/12/1989 PUSKESMAS CIKEUSIK Kp.Benger ds.Nanggala '085694445171 √ SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
10 S-743FFDD3 '3601044910850003 MIMIN SUSILAWATI P NAKES 23/02/1984 PUSKESMAS CIKEUSIK Kp.Benger ds.Nanggala '081212361432 √ SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
11 S-1E3CD3F2 '3601041804520001 NURJAYA P CAL.HAJ 01/01/1952 CAL.HAJ Kp.Hunibera.Ds Cikiruhwetan ' SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
12 S-370E8164 '3601044902480001 SUTARSIH P CAL.HAJ 09/02/1948 CAL.HAJ Kp.Cikeusik Ds.Cikeusik SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
13 S-3C183479 '3601040107530197 MADRAWI L CAL.HAJ 15/07/1957 CAL.HAJ Kp.Sumberjaya.Ds Umbulan SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
14 S-3E8F2536 '3601042010590002 SUTRISNO L CAL.HAJ 20/10/1959 CAL.HAJ Kp.Batujaya Ds umbulan '082123554442 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
15 S-3F8418E6 '3601044806480002 MUNAH P CAL.HAJ 08/06/1948 CAL.HAJ Kp.Babakan Bandung Cikiruhwetan '081281168796 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
16 S-415E8712 '3601041005553331 JAMSU L CAL.HAJ 10/05/1955 CAL.HAJ Kp.Jatiwangi SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
17 S-8A32EABA '360108212800002 HERDI L GURU 02/12/1980 SDN 1 CIKADONGDONG Kp. Babakan Munjul '085215581060 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
18 S-42A88004 '3601046712840001 IIN HERAWATI P GURU 27/12/1984 SDN 2 CIKADONGDONG Kp.sampangjaha '085894373892 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
19 S-7CFFBD7C '3601040506860004 Ricky Nurdiansyah L GURU 05/06/1986 SDN 2 CIKADONGDONG KP. Cikeusik DS Cikeusik '085215786548 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
20 P-BF3XCYGT '3601046007900001 NURHAYATI P GURU 04/09/1992 SDN CURUGCIUNG 1 kp.Sinargintung '085211677150 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
21 S-0D4343BD '3601041304910001 Nurdin L GURU 13/04/1991 SDN CURUGCIUNG 1 Kp.kolelet Ds.Cikadongdong '085714776065 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
22 S-CCB3A93E '3601043811610001 OOY P GURU 18/11/1961 SDN 2 CURUGCIUNG Kp. Sinar gintung DS Curugciung '085697726683 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
23 S-48C242EC '3601084411630001 ENTIM FATIMAH P GURU 04/11/1968 SDN 2 CURUGCIUNG KP. Sodong Munjul '08212299606730 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
24 S-CB8F157A 360104070769000 Abdullah L GURU 01/02/1969 SDN 3 CURUGCIUNG KP SUKATANI 002/002 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
25 S-AFCAC3E8 '3601041505820002 ADI GUMILAR L GURU 15/05/1982 SDN 1 LEUWIBALANG Kp.Cikeuisk Ds.Cikeusik '085773224564 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
26 S-46708F30 "3601045408610001 TUSINEM P GURU 14/08/1961 SDN 1 LEUWIBALANG Kp. Sumber Jaya Ds. Lewibalang '085710972161 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
27 S-9D3484A7 '3601040406660001 TATANG L GURU 03/10/1996 SDN 1 LEUWIBALANG Kp.cilancar Ds Nanggala 085717347088 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
28 S-BF94C044 '3601040504820001 HILMAN SUHENDAR L GURU 05/04/1982 SDN 2 LEUWIBALANG Kp. Cikeusik DS Nanggala '082210358706 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
29 S-0E8DF6F7 3601044208870001 ROSITOH P GURU 06/02/1984 SDN 1 CIKEUSIK KP. Cikeusik DS Cikeusik '085778282449 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
30 S-341ACA74 '3601045507880005 Fifit Fitriani P GURU 15/07/1988 SDN 1 CIKEUSIK Kp.Cikeusik Ds.Cikeusik '087772756562 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
31 S-5638D985 '3601040808790001 AGUS AFFANDI L GURU 08/08/1979 SDN 1 CIKEUSIK Kp.Cikeusik Ds.Cikeusik '087709908307 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
32 S-732DB1A9 '3601042805840002 ASEP YONARDI L GURU 28/05/1984 SDN 1 CIKEUSIK Kp.Babakan Bandung Ds.Cikiruhweta '087773100028 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
33 S-DAE45F0A '360104480962001 YUBAEDAH P GURU 08/09/1962 SDN 3 CIKEUSIK KP. Cikeusik DS Cikeusik '085946623053 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
34 S-FE8DFCAD '3601044105860002 NURLAELA P GURU 14/07/1985 SDN 4 CIKEUSIK Kp,Ciririgi Ds Sukaseneng '087777700313 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
35 P-BI8XBNR2 '2103054204990002 DIAN EGITASARI P GURU 02/04/1999 SDN 4 CIKEUSIK Kp.Rahayu Jaya '082310245410 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
36 S-F687A463 '360104040590001 Karudin L GURU 04/05/1990 SDN 4 CIKEUSIK KP. Cikeusik ''085218940597 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
37 S-D73B9904 '3601044307860001 TRIANA SULISTYORINI P GURU 03/04/1986 SDN 4 CIKEUSIK KP. Cikeusik DS Cikeusik '081310996107 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
38 S-99E86237 '3601046709800001 ENTI SRIHATI P GURU 27/09/1980 SDN 5 CIKEUSIK KP. Cikeusik DS Cikeusik '085710509717 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
39 P-BUMXKU9Z '3601045902970004 RETNO FEBRIYANTO P L GURU 19/02/1997 SDN CIKEUSIK 5 Kp.Cikeusik Ds.Cikeusik '085718303368 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
40 S-505C4956 '3601046509800002 MURNAAH P GURU 16/01/1983 SDN 1 SUKASENENG DS Sukaseneng '085281456494 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
41 S-010A5743 '360104102760001 BENDI L GURU 01/02/1976 SDN 1 SUKASENENG ' SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
42 S-A917FF97 '3601042408690001 UNAJAYA L GURU 24/08/1969 SDN 2 SUKASENENG Kp.Ciririgi Ds.Sukaseneng '085998067443 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
43 S-C78B25B5 '3601044101810002 ENENG JUHETI P GURU 01/01/1981 SDN 2 SUKASENENG Kp.Cikeuisk.Ds.Cikeusik '081213984677 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
44 S-FB631E18 '3602214102790006 SUMIATI P GURU 01/02/1979 SDN 2 SUKASENENG Kp.pasirnangka '085889408894 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
45 P-BKRQCKUN '3601044310960004 DEDE RISANTI P GURU 03/10/1996 SDN 1 NANGGALA Kp.Benger ds.Nanggala '085693450229 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
46 S-13A6AC07 '3601044305790002 MAEMUNAH P GURU 03/05/1979 SDN 1 NANGGALA Kp.Tanjungsari Ds.nanggala '085794664102 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
47 P-BLUKYXM0 '3601045505940002 ATIAH P GURU 15/04/1994 SDN 1 NANGGALA Kp.Sukajaya Ds.Nanggala '081398491614 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
48 S-88F8E948 '360104504820005 Saroji L GURU 15/04/1982 SDN 1 NANGGALA Kp.nanggala Ds Nanggala '085693594166 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
49 S-AF510D5A '3601044612820001 Trinsani Hayati P GURU 06/12/1982 SDN 1 NANGGALA Kp.Kondang Ds nanggala '085283234383 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
50 S-B2B062E2 '36010407810006 ODIH SUNARDI L GURU 04/07/1981 SDN 1 NANGGALA KP. Nanggala DS Nanggala '085694442433 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
51 S-98DC7592 '3601040107880166 Joko Susanto L GURU 01/07/1988 SDN 2 NANGGALA Kp.Babakan Nangka Ds.Nanggala '085219830151 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
52 S-C70486DC '3601042403640001 YAYA SUBAGYA L GURU 24/03/1964 SDN 2 NANGGALA Kp.Cikeuisk.Ds.Cikeusik '081385014227 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
53 P-BLIVO4XN '3601044505900001 NUNUNG NURJANAH P GURU 12/09/1990 SDN 2 NANGGALA Kp.Benger ds.Nanggala '081511958967 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
54 P-BM6TC42S '3601044107970237 LINDA P GURU 05/08/1996 SDN 2 NANGGALA Kp.Sukaratu Ds Nanggala '085215203996 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
55 S-46EDEAFB '3601042206940002 Dodo Darusalam L GURU 22/06/1994 SDN 2 NANGGALA Kp.Sukaratu Ds Nanggala '082113371677 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
56 S-25BBCC1F '03601044707710000 MUTIYAH P GURU 07/07/1971 SDN 2 NANGGALA Kp.Sukaratu Ds Nanggala '082298712969 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
57 S-55C05461 '3601040107580112 AKHMAN KALIWANDA L GURU 25/03/1962 SDN 2 NANGGALA KP. Benger DS Nnaggala '085718078077 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
58 S-80824D53 '360104017580108 Sutarman L GURU 01/07/1958 SDN 3 NANGGALA KP. Benger DS Nnaggala '085792918408 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
59 S-EEC6E203 '3601040809680001 Romli L GURU 08/09/1968 SDN 3 NANGGALA Kp.sukajaya Ds.nanggala '085776712190 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
60 S-31A23C7A '3601024211870001 Iis Hisroh P GURU 02/11/1987 SDN 4 NANGGALA Kp.rancanaga Ds,Nanggala '08571947818051 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
61 P-BQBULVSC SARIKAH P GURU 07/07/1980 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
62 P-BU5PDW1M '3601045507800004 TUTI P GURU 16/04/1983 Kp.Cikeusik Ds.Cikeusik '085217377617 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
63 P-BW8CXRYW '3601042008950002 SUDIANA L UPT CIKEUS01/11/1994 Kp.Cikeusik Ds.Cikeusik '081298083023 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
64 S-1F3A2AC1 '3601042404710001 Konadi L GURU 24/04/1971 Kp.Cikeusik Ds.Cikeusik '085218721818 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
65 S-663A2D0D '3601042500810002 Irwan Kuswanto L GURU 25/08/1981 KP. Sinar gantung '085771917488 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
66 S-6CB039A8 '3601045705530001 SAEDAH P CAL.HAJ 20/12/1960 Cal HAJ Kp.Hunibera Ds Cikiruhwetan SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
67 S-8B84E053 '3601044204710001 Piah P GURU 02/04/1971 SDN CIKEUSIK Cikeusik '085215203937 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
68 S-AC9CDA40 '36010829099850001 NANA SURYANA L GURU 29/09/1985 SDN CIKEUSIK Kp. Pasanggaran '085939388141 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
69 S-B398B314 '3601040901880002 Nuk Bangkit Eko Putro L GURU 09/01/1988 SDN CIKEUSIK Kp. Cikeusik '085702134821 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818
70 S-E4C44A50 3601045206600001 Hj. SARPAH P GURU 12/06/1960 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818

Vaksin yang terpakai dosis 1 : 7 vial

Spuit : 70
Alkohol sweb : 70
Septi box :1
 Dosis I
Tanggal Dosis 2
Umur Kelom
Nama Penerima Merek Tanggal Pemberi Tanggal
No. Ticket NIK JK Pekerjaan* (18-59 pok INSTANSI Alamat No. Hp KET
Vaksin Vaksin*** Screening an No seri Pemberian No. Batch No Seri
tahun) Umur
Vaksina Vaksinasi
1 S-57FC0B7C 3601042408580001 SUROTO L GURU 24/08/1958 KP.Leuwibalang Ds.Leuwibalang '085880004180 si
SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
2 P-DJJX8JXN '3601040207700005 MUTOIN L GURU 20/03/1964 Cikeusik SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
3 S-88FF132B '360104700884000 Nurhaeni P GURU 30/08/1984 SDN 2 RANCASENENG Kp.Rancaseneng Ds Rancaseneng '085313357647 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
4 P-D33H3QLP '3601046511850002 ANI ANGGRAENI P GURU 25/11/1985 SDN 2 RANCASENENG Kp.Rancaseneng Ds.Rancaseneng '085319399998 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
5 S-8A404AF5 "3601040610840001 Edi Sunardi L GURU 06/10/1984 SDN 2 RANCASENENG Kp. Suka mulya '085773493442 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
6 S-A109C440 '3601041707820003 WAWAN GUNAWAN L GURU 17/07/1982 SDN 2 RANCASENENG Kp.Sukawaris.Ds.Sukawaris '085894432182 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
7 S-1BF31840 '3601041408710001 AMAN SUHERMAN L GURU 14/08/1971 SDN 1 UMBULAN Kp.Sukamulya Ds.Sukamulya '087783100233 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
8 S-0EE8652D '3601040107710036 AHMAD TOYO S L GURU 03/05/1971 SDN 2 UMBULAN Kp.Rancaseneng Ds.Rancaseneng '085695274274 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
9 P-D5XVN7S4 '3601044701760002 ETI ROHAETI SPD P GURU 09/02/1976 SDN 3 UMBULAN Kp. Babakan cibaliung '085214152639 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
10 S-718AD66C '3601042007730001 TATANG HIDAYAT L GURU 12/07/1973 SDN 3 UMBULAN KP. Gadel DS Umbulan '085213500292 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
11 S-4D1654E3 '3601040805680002 Uci Sauci L GURU 08/05/1968 SDN 3 UMBULAN Kp.Sukamulya Ds.Sukamulya '085886919799 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
12 S-CFC1A70A '3601045006790001 LILIS KUSNIAWATI P GURU 05/06/1979 SDN 3 UMBULAN Kp.Rancaseneng Ds.Rancaseneng SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
13 S-6B2CF61A '3601041406620002 WIRNA P GURU 14/06/1962 SDN 1 SUMURBATU DS Nanggala '085215761459 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
14 S-C0141A31 ''3601046002670001 SUTIYAH P GURU 20/02/1967 SDN 1 SUMURBATU Kp.sumurbatu Ds Sumurbatu '085214000641 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
15 P-DJV848C2 '3601044107850356 LAMSARI P GURU 23/01/1985 SDN 2 SUMURBATU Cikeusik '081295081451 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
16 S-D6D97CCE '3601044701840001 Darni Suhayati P GURU 07/01/1984 SDN 4 SUMURBATU Kp.Leuwigede Ds Sumurbatu '08770640912 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
17 P-DMBNVJ33 3601040107620005 AAN JAMALUDIN L GURU 06/07/1963 SDN 4 SUMURBATU SUMURBATU SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
18 S-FD1A6631 '3602215002870003 Siti Rodiah P GURU 10/02/1987 SDN 4 SUMURBATU Kp.Alas Roban '085284385566 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
19 P-DALPJDTE '3601030207800012 CECEP PRIATNA L GURU 26/07/1977 SDN 1 PARUNGKOKOSAKp.Parungkokosan Ds.Parungkokosan '08138483870 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
20 P-DGTKSICV '3607081982 enok herni P GURU 07/08/1982 SDN 1 PARUNGKOKOSAKp.Umbulan Ds Umbulan '083147334062 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
21 S-72117CC9 3601046612900003 DESTA WISMAYA P GURU 26/12/1990 SDN 2 PARUNGKOKOSAKp.Umbulan Ds Umbulan '081287709355 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
22 S-7B8DB11F '3601040107890169 Aam Muharom P GURU 01/07/1989 SDN 2 PARUNGKOKOSAKP. PARKOS 85770974445 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
23 S-836D19D7 '3601045708720002 HENI AGUSTINA P GURU 07/06/1971 SDN 2 PARUNGKOKOSAKp.Rancaseneng Ds.Rancaseneng '081906299316 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
24 S-CEB117D0 '3601041208930005 Ade Mulyanah L GURU 12/08/1993 SDN 2 PARUNGKOKOSAKP. PARKOS '085710512510 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
25 S-85B9359A "3601046005820002 IIS ROHAYATI P GURU 20/05/1982 SDN 1 SUKAMULYA Kp. Gadel DS Umbulan '085219188742 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
26 S-AF0B927A '3601040107640065 UTOY L GURU 12/08/1963 SDN 2 SUKAMULYA Kp.Sukamulya Ds.Sukamulya '085810408980 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
27 S-B12CED90 '3215055112950001 Monika SPd P GURU 11/12/1995 SDN 2 SUKAMULYA Cikeusik '085322087407 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
28 P-D4QEWJ4L '3601040509950005 ENDANG ARIPIN L GURU 05/09/1995 SDN 2 LEWIBALANG KP.Leuwibalang Ds.Leuwibalang '085714778024 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
29 P-D5OMMDYA '3601040904630001 SUHANDI L GURU 04/08/1968 SDN 2 LEWIBALANG KP.Lauwibalang Ds Leuwibalang '085714215433 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
30 P-DAWMYBCW'3601045212930003 SITI'AH P GURU 12/12/1993 SDN 2 LEUWIBALANG Kp.Umbulan,Ds Umbulan '0873215525 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
31 S-7FF7166B '3601040107940152 Eko Saputra L GURU 01/07/1994 SMK 5 PANDEGLANG Kp'.Tanjungjaya Ds Sumurbatu '085695157979 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
32 S-E1198562 '3601044107950664 Dede Corlina Apriani P GURU 01/07/1995 SMK 5 PANDEGLANG Cikeusik '08571579854 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
33 S-EF059079 '3601045203730001 SUBARIAH P GURU 12/06/1973 CAL.HAJ Kp.Umbulan Ds Umbulan '08577169031 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
34 S-FC6ACA03 '3601040112610001 SOHIBIN L GURU 10/12/1961 GURU Kp.Parungkokosan Ds.Parungkokosan '085775355874 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
35 N-201185A9 '3601044202910002 Elis Febriyani, Amd.K P NAKES 02/02/1991 PUSKESMAS CIKEUSIK Kp.Rancaseneng Ds Rancaseneng 85811439792 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
36 N-5EEC1C53 '3601047112860002 Sanimah, Amd.Keb P NAKES 31/12/1986 PUSKESMAS CIKEUSIK Kp.Cikeusik Ds Cikeusik '087772914464 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
37 N-8352ACC4 '3601046003780002 Eva Widayati KhoiriyaP NAKES 20/03/1978 PUSKESMAS CIKEUSIK Kp.Muara dua Ds,Cikiruhwetan '087772001611 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
38 P-DCQT9D1Z '3601045304980005 RITA AFRIYANI P NAKES 13/04/1998 PUSKESMAS CIKEUSIK KP. Cangkore '083896984946 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818
39 P-DCUTR9EN '3601045506960002 AIDILA FITRI RAMADP NAKES 15/06/1996 PUSKESMAS CIKEUSIK Kp.Kesur Ds nanggala ''085959369050 SARS-CoV-2 18/03/2021 18/03/202 '16127779132818

Vaksin yang terpakai dosis 1 : 4 vial

Spuit : 39
Alkohol sweb : 39
Septi box :1
 Kepesertaan
BPJS (tulis 'Ya'
Dosis I Dosis 2
pada kolom yang
Umur Kelo sesuai) Merek
Nama Penerima Tanggal
No No. Ticket NIK JK Pekerjaan* (18-59 mpok INSTANSI Alamat No. Hp BPJ BPJS Non Vaksin** Screening Tanggal Tanggal KET
Vaksin No
tahun) Umur S Non Angg * Pemberian No. Batch No seri Pemberian No. Batch
Seri
PBI PBI ota Vaksinasi Vaksinasi

1 N-01D7D03A 3601040704630000 Iing,SKM L PNS 58 PKM CIKEUSIK KP.CIKEUSIK RT/RW 01/01 DES.CIKEUSIK '87773806663 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

2 N-0CB85764 '3601046907890000 Irma Trisnawati,Amd Keb P PNS 32 PKM CIKEUSIK KP.MUARA DUA.RT/RW 03/01 DES CIKIR '81298990789 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

3 N-20F89E98 3601045602800003 Dewi Nurhayati,Amd Keb P PNS 41 PKM CIKEUSIK KP.KARANGKENCANA RT/RW 03/01 DES. '87711431666 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
4 N-228317CD 3601044107760070 Hj.Siti Rukmiati,S.ST P PNS 44 PKM CIKEUSIK KP.RANCASENENG.RT/RW 03/02 DES.R 08569363476 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

5 N-30D4ED6C 360104430986001 Neng Ita Realita,Amd Kep P PNS 35 PKM CIKEUSIK KP.BATUJAYA RT/RW 10/03 DES.UMBULA 08128021943 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

6 N-51D5CCD8 3601044310820004 Indarwati,Str.Keb P PNS 39 PKM CIKEUSIK KP.CIKUJANG RT/RW 01/01 DES TANJUN 085717372996 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
7 N-5C009A25 3202285401860001 Reni Wigiawati,Apt P PNS 35 PKM CIKEUSIK KP.SALAKOPI RT/RW 07/04 DES.LEMBU 087720820830 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
8 N-6B613F70 3601045604870001 Siti Asiah,Amd Keb P PNS 34 PKM CIKEUSIK KP.SUMURBATU 081385343629 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

9 N-6C94373C 36010201270586001 Angga Pratama Ramadhan L PNS 35 PKM CIKEUSIK KP.CIGINTUNG RT/RW 01/02 DES.GUNU 082213903967 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

Neneng Shofiyatul
10 N-885DF733 3601015701960001 Mardiah,SKM P PNS 25 PKM CIKEUSIK KP.SUMUR RT/RW 01/04 DES. SUMUR-S 085215849509 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

11 N-948FB224 36010451292001 Desi Susanti,Amd Keb P PNS 30 PKM CIKEUSIK KP.BATUJAYA RT/RW 11/03 DES UMBULA 082213486621 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
12 N-ACA56BDF 360104410192001 Ema Elmawati,Amd Keb P PNS 35 PKM CIKEUSIK KP.CIKUJANG RT/RW 01/01 DES TANJUN 085774689410 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

13 N-B40FE463 3601046401860002 Fitri Ulfah Faujiah,Amd Keb P PNS 36 PKM CIKEUSIK KP.CIJAMBU RT/RW 01/03 DES.SUKAWAR 087773161677 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

14 N-EAOEE343 3601044908670001 Aan Hasanah,Amd Kep P PNS 54 PKM CIKEUSIK KP.BABAKAN BANDUNG RT/RW 03/02 DE 087772691170 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
15 N-F46DO881 3601045609770002 Fitriani,S.ST P PNS 44 PKM CIKEUSIK KP.MUARADUA RT/RW 03/01 DES.CIKIR 087809374946 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
16 N-F494861B 3601044803890003 Suhati,Amd Keb P PNS 32 PKM CIKEUSIK KP.KARANGSAMBUNG RT/RW 01/04 DES. 085777151511 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
17 N-FD6EB964 3601044710870003 Linawati,Amd Keb P PNS 35 PKM CIKEUSIK KP.SITUPOTONG RT/RW 01/06 DES SUK 085930096262 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
18 3601130107690027 Mulyadi Kahar,Amd Kep L PNS 55 PKM CIKEUSIK KP.CIKEUSIK RT/RW 01/01 DES.CIKEUSIK 08129086114 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

Yuyun Yunengsih,S √
19 3601047001830001 Kep.Ners P PNS 39 PKM CIKEUSIK KP.BENGER RT/RW 04/01 DES.NANGGAL 082113222480 SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042

20 3601044410890002 Yayah Junayah,Amd Keb P PNS 32 PKM CIKEUSIK KP.CITARUM RT/RW 03/04 DES.CIKIRUH 085281592559 √ SINOVAC 1/26/2021 1/26/2021 202011042 11/2/2021 202011042
21 3601044107960224 IRAH RAHMAWATI P TKS 25 TAHUN PKM CIKEUSIK KP. SUMBERJAYA RT 005 RW 001 085694122485 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
22 3601046211970002 ROBIAH P TKS 23 TAHUN PKM CIKEUSIK KP. TANJUNGAN RT 002 RW 002 081586914296 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
23 3601046411920002 KARSINIH KARTIKA D P TKS 28 TAHUN PKM CIKEUSIK KP. RANCASENENG RT 006 RW 003 085889411031 √ 28-01-2021 28-01-2021 202011042 11/2/2021 2020111042
24 3601044107800031 AAN KUNAERIH P TKS 32 TAHUN PKM CIKEUSIK KP. TANJUNG JAYA RT 001 RW 004 081283773335 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
25 3601044303930001 SRI WULANDARI P TKS 27 TAHUN PKM CIKEUSIK KP KESUR RT 006 RW 003 085210919414 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
26 3601044205850001 N. ROHMAH P TKK 36 TAHUN PKM CIKEUSIK KP. CIKUJANG RT 001 RW 001 085697842874 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
27 3601047008880001 IDA FARIDA P TUKSUS 32 TAHUN PKM CIKEUSIK KP. CIKEUSIK RT 003 RW 001 082120538546 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
28 3601047008880001 EVA ANGGRAENI P TKS 24 TAHUN PKM CIKEUSIK KP. SITUPOTONG RT 002 RW 004 085718466053 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
29 3601046202960004 EKA RIKA F P TKS 25 TAHUN PKM CIKEUSIK KP. SUMURBATU RT 001 RW 001 085715470702 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
30 3601045903940001 DINI MARIANI P TKK 37 TAHUN PKM CIKEUSIK KP. BABAKAN BANDUNG RT 002 RW 002 085714783654 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
31 3601047101910002 HERNIAWATI P OB 31 TAHUN PKM CIKEUSIK KP. CIKEUSIK RT 002 RW 002 085719437061 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
32 3601044507930005 NENI HERAWATI P TKS 28 TAHUN PKM CIKEUSIK KP. SUKARATU RT 003 RW 006 085760607954 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
33 3601045203870002 SUYANTI P OB 34 TAHUN PKM CIKEUSIK KP. CIKEUSIK RT 004 RW 005 085212817706 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
34 3601045905920004 IMAS SUSANTI P TKS 29 TAHUN PKM CIKEUSIK KP. PARUNGKOKOSAN RT 003 RW 001 085774019285 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
35 3601045612930001 DINIYARA R P TKS 27 TAHUN PKM CIKEUSIK KP. CIKEUSIK RT 002 RW 001 082111043979 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
36 3601045905900002 MAESAROH P TKS 29 TAHUN PKM CIKEUSIK KP SUMURBATU RT 03 RW 01 085579947949 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
37 3601041206670003 BUDI HERMAWAN L PNS 54 TAHUN PKM CIKEUSIK KP RANCASENENG RT 010 RW 005 085710756969 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
38 36011601007830208 IRWAN F L TKS 27 TAHUN PKM CIKEUSIK KP KENDAL RT 003 RW 004 081210061810 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
39 3601044107050016 POPY RATULANGI P TKS 23 TAHUN PKM CIKEUSIK KP CURUGCIUNG RT 002 RW 001 085813109158 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
40 3601042709820002 ASEP S L TKK 39 TAHUN PKM CIKEUSIK KP BENGER RT 04 RW 01 0813828359530 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
41 3601040508970002 ALIYUDIN L SUPIR 22 TAHUN PKM CIKEUSIK KP CIKEUSIK RT 03 RW 05 08567599550 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
42 3601040707920001 DENI L SECURITY 28 TAHUN PKM CIKEUSIK KP. CIKEUSIK RT 001 RW 001 081382846702 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
43 3601270711910001 MASRUDIN L TKS 30 TAHUN PKM CIKEUSIK KP. CILANCAR RT 002 RW 003 085694440513 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
44 3601046010960002 ENTIN S P TKS 24 TAHUN PKM CIKEUSIK KP. KESUR RT 006 RW 003 082167020763 28-01-2021 28-01-2021 202011042 11/2/2021 202011042
45 3601046105830001 RATNA MELANI P TKK 37 TAHUN PKM CIKEUSIK KP. CIRIRIGI RT 005 RW 006 085215596672 √ 28-01-2021 28-01-2021 202011042 11/2/2021 202011042

single disis nakes

Vaksin yang terpakai dosis 1: 45 vial
Spuit : 45
Alkohol sweb : 45
Septi box :1

Vaksin yang terpakai dosis 2: 45 vial

Spuit : 45
Alkohol sweb : 45
Septi box :1
 Kepesertaan BPJS
(tulis 'Ya' pada Dosis I Dosis 2
kolom yang sesuai)
Umur Kelom Tanggal
Nama Penerima BPJS Non Merek Tanggal Tanggal
NO No. Ticket NIK JK Pekerjaan* (18-59 pok INSTANSI Alamat No. Hp BPJS No. Pemberia KET
Vaksin Non Angg Vaksin*** Screening Pemberian No seri No. Batch No Seri
tahun) Umur PBI Batch n
PBI ota Vaksinasi
Vaksinasi

1 P-IMCFXILQ 3601045503610001 PATIMAH P CALON HAJI 60 KP.PEMATANG BUAH SUMURBATU - SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114
2 S-A3CC4882 3601041210580001 RASITA L CALON HAJI 63 KP.PEMATANG BUAH SUMURBATU - SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114
3 P-IKIQ81ZF 3601041307840001 YAYAN L UMROH 34 KP.SUKARENDAH DS.SUKAWARIS 085817457418 SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114
4 S-E5B84E27 3601045302520001 SAWINAH P UMROH 68 KP.LEMAHSUGIH DS.SUKAWARIS 085817457418 SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114
5 P-IJ679KVI 3601045104930004 WARTINAH RAHMI P NAKES 28 KP.CIKARET DESA.SUKAMULYA 081381043606 SARS-CoV-2 26/03/2021 26/03/2021 '24000821
'16127781522114
6 P-IO9VX90B 3601044107630040 SITI AISAH P LANSIA 58 KP.PEMATANGBUAH 006/004 DS.SUMURBATU - SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114
7 P-ILXBRMFO 3601040701780002 DAWUD L 37 KP.CANGKORE 002/001 DS.RANCASENENG 085891152634 SARS-CoV-2 26/03/2021 26/03/2021 24000821
PEL.PUBLIK '16127781522114
8 S-B971A807 3601040607640002 KUSNADI L 57 KP.BENGER 004/001 DS.NANGGALA 085773225988 SARS-CoV-2 26/03/2021 26/03/2021 24000821
PEL.PUBLIK '16127781522114
9 P-IPPGZ7SG 3601044107660134 DARKEM P 54 KP PENDEY RW 02 RT 002 DS.UMBULAN 085817984630 SARS-CoV-2 26/03/2021 26/03/2021 24000821
PEL.PUBLIK '16127781522114
3601045105010005
10 P-IPZRB7CK DIAN MUTNIAWATI P 20 KP PENDEY RW 02 RT 002 DS.UMBULAN 085817984630 SARS-CoV-2 26/03/2021 26/03/2021 24000821
PEL.PUBLIK '16127781522114
085779161352
11 P-IQCFRSVH 3601044412930002 DWI RIFANTI NF P 26 KP CIKEUSIK SARS-CoV-2 26/03/2021 26/03/2021 24000821
PEL.PUBLIK '16127781522114
12 P-IQSSXT9D 3601044405840002 ADE SUGIANTI P 37 KP. SUKARENDAH DS.SUKAWARIS 08159820763 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK
13 P-IQI7CIJJ 3601045604960004 ENDAH APRIYANTI P 25 KP SINAPEUL RW 02 RT 003 085243881689 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK
EVA TRESNA
14 P-IQYYTE8O 3601046512990001 P 22 KP.CIBULUH 085889514238 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
RAHAYU PEL.PUBLIK
15 P-IRJGJVG0 3601044508810002 MIRA DIANA P 40 KP CIKEUSIK 0877723258208 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK
16 P-IRR67KXZ 3601046210950002 SARTI P 24 KP.MURUY 002/004 DS.CIKADONGDONG 085892820260 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK
17 P-IU3CRTPM 3601044305850002 ADE ROHAYATI P 36 KP CIKEUSIK KALER 002/005 085779054211 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK
085779054211
18 P-IU84DA6T 3601041212920002 YOPI ISKANDAR L 29 KAMPUNG CIKEUSIK RW 05 RT 003 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK
19 P-IWA2ZZL6 3601040103970001 RAIS L 22 KAMPUNG BATUBANTAR RW 01 RT 002 081295096743 SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
PEL.PUBLIK

Vaksin yang terpakai dosis 1 : 2 vial

Spuit : 19
Alkohol sweb : 19
Septi box :1
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
Umur sesuai) Merek
Nama Penerima Kelomp Tanggal Tanggal Tanggal
NO No. Ticket NIK JK Pekerjaan* (18-59 INSTANSI Alamat No. Hp BPJS BPJS Non Vaksin** Screening KET
Vaksin ok Umur Pemberian No. Batch No seri Pemberian No. Batch No Seri
tahun) PBI Non PBI Anggota *
Vaksinasi Vaksinasi

1 S-14F26B61 3601046107540001 BAI JAMHARI GAPAR P 67 KP BABAKAN BANDUNG 087879148917 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
2 S-36EE9030 3601040104590003 USMAN B ATIP L 62 KP BABAKAN BANDUNG, 001/002 087879148917 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
3 S-BC3AAE13 3601040306400001 SAMUAN/RASID L 81 KP CIKEUSIK 003/005 085694440513 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
4 S-3AIA969F 3601040107430082 CASDA L 78 KP SUKASENENG 002/003 082311540318 SINOVAC 3/25/2021 3/25/2021 24000821

5 S-E463485A 3601044210470002 SUTIAH P 74 KP SUKASENENG 001/003 082311540318 SINOVAC 3/25/2021 3/25/2021 24000821

6 S-4638CDF2 3601041010580002 KARSA IRYANA L 63 KP SUMURBATU 001/001 085695148563 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
7 S-BC7BDD89 3601044112300002 AMEYAH P 91 KP HUNIBERA 003/003 085217249290 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
8 S-IC7DE861 3601041706590001 MULYADI L 62 KP BENGER 085210852418 SINOVAC 3/25/2021 3/25/2021 24000821

9 S-F43F785B 3601046510560001 ARNASIH P 65 KP MALANGSARI 083890404806 SINOVAC 3/25/2021 3/25/2021 24000821

CAL.HAJ
10 S-12E9FEBF 3601040107630364 MISTARI L 62 KP UMBULAN 085817984630 SINOVAC 3/25/2021 3/25/2021 24000821

11 P-HICRMZSU 3601040201730003 HAMDANI L 47 KP SUKASENENG 002/003 085216176803 SINOVAC 3/25/2021 3/25/2021 24000821

12 3601044107730417 ANI P 48 KP CIRIGI 087772740152 SINOVAC 3/25/2021 3/25/2021 24000821

P-HIXLQHFS CAL.HAJ
13 P-HJMI1AQ 3601042611680002 RUMAN P 57 KP CIRIGI 004/006 087772740152 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
14 P-HMIUI1AQ 3601040606750002 SYARIF L 46 KP SUKASENENG 001/003 085780460227 SINOVAC 3/25/2021 3/25/2021 24000821

15 S-AA4AC9A2 3601046001680003 UUM UMIYAH P 53 KP BABAKAN BANDUNG 081281168796 SINOVAC 3/25/2021 3/25/2021 24000821
CAL.HAJ
16 3601041308670001 ENUR L 53 KP CIKEUSIK 004/005 085894824891 SINOVAC 3/25/2021 3/25/2021 24000821

17 P-HNS0KP0R 3601046010680002 HJ MARYATI SADELI P 53 KP BABAKAN SIMPANG 081219100662 SINOVAC 3/25/2021 3/25/2021 24000821

18 P-HYKK7DH6 3601044107890155 SUMI SUSILAWATI P 32 KP PEUNDEUY 082311626989 SINOVAC 3/25/2021 3/25/2021 24000821
PEL.PUBLIK
19 P-13VUAYXW 3601046505890001 LELI KHAERIYAH P 32 KP CIKAREO 002/002 081384839889 SINOVAC 3/25/2021 3/25/2021 24000821
NAKES PKM CIKEUSIK

Vaksin yang terpakai dosis 1 : 2 vial

Spuit : 19
Alkohol sweb : 19
Septi box :1
 Kepesertaan BPJS
(tulis 'Ya' pada Dosis I Dosis 2
kolom yang sesuai)
Nama Penerima Umur Kelomp BPJS Non Merek Tanggal Tanggal Tanggal
NO No. Ticket NIK JK Pekerjaan* INSTANSI Alamat No. Hp BPJS
Vaksin (18-59 tahun) ok Umur Non Angg Vaksin*** Screening Pemberian No. Batch No seri Pemberian No. Batch No Seri
PBI
PBI ota Vaksinasi Vaksinasi

1 P-LFXURQWK 3601042001900004 Ardin L NAKES 15/10/1990 PKM CIKEUSIK Kp.Situpotong Ds sukamulya '081511502481 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
2 N-BA73DC85 360104570590003 Rifka Fitri R P NAKES 17/05/1990 PKM CIKEUSIK kp.babkan Bandung ds.cikiruhwetan '082246746267 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
3 S-1EC5C108 '3601044104780005 Jujum Jumiati P NAKES 01/04/1978 PKM CIKEUSIK Kp.Hunibera ds Cikiruhwetan '085732997956 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
4 S-D6FCC3B3 3601045506630001 Samsiah P lansia '05-07-1958 kp.cikeusik Ds.Cikeusik '085694032256 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
5 S-AE558F2B 3601041811560'001 H. Iin Karsanoyadi L lansia '18-11-1956 Kp.Cikeusik Ds Cikeusik '085694032256 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
6 Y-00004IL8 3601040602730003 Endin Saprudin L GURU 06/02/1973 SDN 3 Tanjungan Kp.Tanjungan Ds Tanjungan '085694473563 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
7 P-LELFX59I '3601041103860003 Mubin L GURU 20/10/1985 SDN3 Tanjungan Kp pasir asem Ds tanjungan '085280307475 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
8 Q-6B6E17C9 3601040101910004 Dian Nurjaman L GURU '01-01-1991 SDN Tanjungan 3 Kp.Sumurbatu 03/01 Ds Sumurbatu '085782007333 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
9 S-6891FC74 3601045411930001 Reni Munawaroh P Guru '14-11-1993 SDN 2 Sukawaris Kp.Lemahsugih Ds.Sukawaris '085882901005 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
10 S-675CF94F 3601044107930044 Siti maemunah P GURU '21-06-1994 SDN 2 Sukawaris Kp.sinarjati,Ds Sukawaris '081219642626 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
11 S-3DE23786 '3601044804810001 Nanih misharyani P GURU 08/04/1981 SDN 1 cikeusik Kp.Cikeusik 01/01 Ds Cikeusik 085810134584 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
12 S-C9FD712C 3601046606860001 Siti maemanah P GURU 26/06/1986 MI Malangsari Kp.batujaya 11/003 Ds umbulan '085880490349 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
13 S-9127C1DB '3601045408850001 Yanti Susanti P GURU 14/08/1985 MI Malangsari Kp.Malangsari Ds Sukawaris '085894540853 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
14 S-A205FD57 3601040201830002 Abdul Hafid Y L GURU '02-01-1983 MI Malangsari Kp.Malangsari 02/04 Ds.Cikiruhwetan '081389607968 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
15 Q-66AFC194 3601042012010004 dede feri malikudin L GURU 03/10/1996 Kp. '085710502923 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
16 S-DAB6DBE0 3601046503830004 Yati P GURU '25-03-1983 Kp.Malangsari Ds Sukawaris '085715609783 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
17 S-E5FCC2F5 3601040107950046 Pijayudin L GURU 01/07/1995 kp.leuwigeda ds.sumurbatu '082213690002 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
18 S-0EEC2E52 3601042111870001 Derik Ismawan L GURU 21/11/1987 kp.babkan Bandung ds.cikiruhwetan '081585715450 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
19 P-LQWDDHAB 3601044206840001 Elis Ratnasari P GURU 02/06/1984 Kp.ci[punaga Ds.Tanjungan '085894271114 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
20 S-D781661E 3602010208830004 Edi L GURU '13-111984 Kp.Kondang Ds.Sukamanah '085770630874 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
21 S-4BEB7B43 '3601040501690003 Aang Hidayat L GURU '03-01-1964 Kp.hunibera Ds.Cikiruhwetan '082312009294 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
22 S-3AB7983D 3601045803700002 Warmawati P GURU 18/03/1970 Kp.Cikeusik Ds Cikeusik '085313196807 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
23 S-3C4E0F48 '3601042606650001 Wawan Kosasih L Pel.Publik 26/06/1965 Kecamatan Kp.Umbulan 02/01 ds Umbulan '085319535476 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
24 S-DF2F17CB '3601041712660001 Aep L Pel.Publik 17/12/1966 Kecamatan Kp.Sumberjaya05/01 ds Umbulan '081380827777 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
25 S-B6DB761E '3601042911780001 Iyan Rubiyana L Pel.Publik 29/11/1978 kp.Leuwibalang DsLeuwibalang '082298166896 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
26 S-42D70937 3601040310830004 Ade Suhendi L Pel.Publik 26/02/1980 kecamatan Kp.Kadiri Ds cikiruhwetan '087773362426 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
27 P-LRI2NKEU 3601046204020001 Tika Aprianti P Pel.Publik 22/04/2002 kp.Leuwibalang DsLeuwibalang '081291683530 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
28 360104650484001 Tati Maryati P Pel.Publik '25-04-1984 Kp.Leuwibalang 01/01 Ds Leuwibalan '081584653372 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
29 S-36F8B3B9 '3601046804520003 Isem P umroh 28/04/1952 Kp.tanjungan Ds Tanjungan '085779170083 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810
30 P-LOT51S30 3601044107530005 Sanemah P umroh '01-07-1962 Kp.Balagung Ds.Sumurbatu '082310358370 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
31 P-LLK8FK4E 3601040202630003 H. Asmad L umroh '02-02-1963 Kp.Citarum Ds.Cikiruhwetan '085882906510 SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538
32 N-247D4C20 '3601046212830001 Elah Nurhayati, Amd.Ke P NAKES 08/01/1983 PUSKESMAS CIKEUSIKKp.Muara dua ds.Cikiruhwetan.Kec Cikeusik '087780538983 √ SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 '24000821 '16127778481518
33 P-BSGWMQFJ '3601045201990001 FITRI PUJIAWATI P NAKES 1/12/1999 PUSKESMAS CIKEUSIKKp.Benger ds.Nanggala '083812150536 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
34 P-BT215L4X '3601042001980003 ADIT BAEHAKI L NAKES 20/01/1998 PUSKESMAS CIKEUSIKKp.Umbulan .Ds Umbulan '08381313127 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
35 P-BTOR70PE '3601045707980004 SITI MARDIANTI P NAKES 17/07/1998 PUSKESMAS CIKEUSIKKp.Sukaratu Ds Nanggala '082297668800 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
36 P-BWVD8YTQ '36013404070910001 ANGGA PERMANA L NAKES 04/10/1991 PUSKESMAS CIKEUSIKKp.Cikeusik Ds.Cikeusik '085777313731 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
37 P-BWX9M1E7 '3201225704920003 NURICA APRIANI P NAKES 17/04/1992 PUSKESMAS CIKEUSIKKp.Cikeusik Ds.Cikeusik '085716359342 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
38 P-BYN5ZONS '3601044810950001 NUNUNG MUSIYANI SAP NAKES 08/10/1995 PUSKESMAS CIKEUSIKKp.Kendal ds Nanggala '087750222280 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
39 P-BYQKUBST '3601044107880078 ELA FADILAH JUITA SAP NAKES 16/12/1989 PUSKESMAS CIKEUSIKKp.Benger ds.Nanggala '085694445171 √ SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
40 S-743FFDD3 '3601044910850003 MIMIN SUSILAWATI P NAKES 23/02/1984 PUSKESMAS CIKEUSIKKp.Benger ds.Nanggala '081212361432 √ SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
41 S-42A88004 '3601046712840001 IIN HERAWATI P GURU 27/12/1984 SDN 2 CIKADONGDON Kp.sampangjaha '085894373892 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
42 S-7CFFBD7C '3601040506860004 Ricky Nurdiansyah L GURU 05/06/1986 SDN 2 CIKADONGDON KP. Cikeusik DS Cikeusik '085215786548 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
43 S-48C242EC '3601084411630001 ENTIM FATIMAH P GURU 04/11/1968 SDN 2 CURUGCIUNG KP. Sodong Munjul '08212299606730 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
44 S-AFCAC3E8 '3601041505820002 ADI GUMILAR L GURU 15/05/1982 SDN 1 LEUWIBALANG Kp.Cikeuisk Ds.Cikeusik '085773224564 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
45 S-46708F30 "3601045408610001 TUSINEM P GURU 14/08/1961 SDN 1 LEUWIBALANG Kp. Sumber Jaya Ds. Lewibalang '085710972161 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
46 S-9D3484A7 '3601040406660001 TATANG L GURU 03/10/1996 SDN 1 LEUWIBALANG Kp.cilancar Ds Nanggala 085717347088 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
47 S-BF94C044 '3601040504820001 HILMAN SUHENDAR L GURU 05/04/1982 SDN 2 LEUWIBALANG Kp. Cikeusik DS Nanggala '082210358706 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
48 S-0E8DF6F7 3601044208870001 ROSITOH P GURU 06/02/1984 SDN 1 CIKEUSIK KP. Cikeusik DS Cikeusik '085778282449 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
49 S-341ACA74 '3601045507880005 Fifit Fitriani P GURU 15/07/1988 SDN 1 CIKEUSIK Kp.Cikeusik Ds.Cikeusik '087772756562 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
50 S-5638D985 '3601040808790001 AGUS AFFANDI L GURU 08/08/1979 SDN 1 CIKEUSIK Kp.Cikeusik Ds.Cikeusik '087709908307 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
51 S-732DB1A9 '3601042805840002 ASEP YONARDI L GURU 28/05/1984 SDN 1 CIKEUSIK Kp.Babakan Bandung Ds.Cikiruhwetan '087773100028 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
52 S-DAE45F0A '360104480962001 YUBAEDAH P GURU 08/09/1962 SDN 3 CIKEUSIK KP. Cikeusik DS Cikeusik '085946623053 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
53 S-FE8DFCAD '3601044105860002 NURLAELA P GURU 14/07/1985 SDN 4 CIKEUSIK Kp,Ciririgi Ds Sukaseneng '087777700313 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
54 P-BI8XBNR2 '2103054204990002 DIAN EGITASARI P GURU 02/04/1999 SDN 4 CIKEUSIK Kp.Rahayu Jaya '082310245410 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
55 S-F687A463 '360104040590001 Karudin L GURU 04/05/1990 SDN 4 CIKEUSIK KP. Cikeusik ''085218940597 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
56 S-D73B9904 '3601044307860001 TRIANA SULISTYORINIP GURU 03/04/1986 SDN 4 CIKEUSIK KP. Cikeusik DS Cikeusik '081310996107 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
57 S-99E86237 '3601046709800001 ENTI SRIHATI P GURU 27/09/1980 SDN 5 CIKEUSIK KP. Cikeusik DS Cikeusik '085710509717 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
58 P-BUMXKU9Z '3601045902970004 RETNO FEBRIYANTO PL GURU 19/02/1997 SDN CIKEUSIK 5 Kp.Cikeusik Ds.Cikeusik '085718303368 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
59 S-505C4956 '3601046509800002 MURNAAH P GURU 16/01/1983 SDN 1 SUKASENENG DS Sukaseneng '085281456494 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
60 S-010A5743 '360104102760001 BENDI L GURU 01/02/1976 SDN 1 SUKASENENG ' SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
61 P-BKRQCKUN '3601044310960004 DEDE RISANTI P GURU 03/10/1996 SDN 1 NANGGALA Kp.Benger ds.Nanggala '085693450229 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
62 S-13A6AC07 '3601044305790002 MAEMUNAH P GURU 03/05/1979 SDN 1 NANGGALA Kp.Tanjungsari Ds.nanggala '085794664102 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
63 P-BLUKYXM0 '3601045505940002 ATIAH P GURU 15/04/1994 SDN 1 NANGGALA Kp.Sukajaya Ds.Nanggala '081398491614 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
64 S-88F8E948 '360104504820005 Saroji L GURU 15/04/1982 SDN 1 NANGGALA Kp.nanggala Ds Nanggala '085693594166 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
65 S-AF510D5A '3601044612820001 Trinsani Hayati P GURU 06/12/1982 SDN 1 NANGGALA Kp.Kondang Ds nanggala '085283234383 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
66 S-B2B062E2 '36010407810006 ODIH SUNARDI L GURU 04/07/1981 SDN 1 NANGGALA KP. Nanggala DS Nanggala '085694442433 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
67 S-98DC7592 '3601040107880166 Joko Susanto L GURU 01/07/1988 SDN 2 NANGGALA Kp.Babakan Nangka Ds.Nanggala '085219830151 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
68 P-BLIVO4XN '3601044505900001 NUNUNG NURJANAH P GURU 12/09/1990 SDN 2 NANGGALA Kp.Benger ds.Nanggala '081511958967 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
69 P-BM6TC42S '3601044107970237 LINDA P GURU 05/08/1996 SDN 2 NANGGALA Kp.Sukaratu Ds Nanggala '085215203996 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
70 S-46EDEAFB '3601042206940002 Dodo Darusalam L GURU 22/06/1994 SDN 2 NANGGALA Kp.Sukaratu Ds Nanggala '082113371677 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
71 S-25BBCC1F '03601044707710000 MUTIYAH P GURU 07/07/1971 SDN 2 NANGGALA Kp.Sukaratu Ds Nanggala '082298712969 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
72 S-55C05461 '3601040107580112 AKHMAN KALIWANDA L GURU 25/03/1962 SDN 2 NANGGALA KP. Benger DS Nnaggala '085718078077 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
73 S-EEC6E203 '3601040809680001 Romli L GURU 08/09/1968 SDN 3 NANGGALA Kp.sukajaya Ds.nanggala '085776712190 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
74 P-BQBULVSC SARIKAH P GURU 07/07/1980 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
75 P-BU5PDW1M '3601045507800004 TUTI P GURU 16/04/1983 Kp.Cikeusik Ds.Cikeusik '085217377617 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
76 S-8B84E053 '3601044204710001 Piah P GURU 02/04/1971 SDN CIKEUSIK Cikeusik '085215203937 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518
77 S-B398B314 '3601040901880002 Nuk Bangkit Eko Putro L GURU 09/01/1988 SDN CIKEUSIK Kp. Cikeusik '085702134821 SARS-CoV-2 16/03/2021 16/03/2021 24000821 '16127779132818 30/03/2021 24000821 '16127778481518

Dosis k2 Sebanyak : 46 orang

Vaksin yang terpakai dosis 1 : 8 vial
Spuit : 77
Alkohol sweb : 77
Septi box :1
KET
 Kepesertaan BPJS
(tulis 'Ya' pada kolom Dosis I Dosis 2
Umur yang sesuai)
Nama Penerima Kelompo BPJS Non Merek Tanggal Tanggal Tanggal
NO No. Ticket NIK JK Pekerjaan* (18-59 INSTANSI Alamat No. Hp BPJS No. KET
Vaksin k Umur Non Anggot Vaksin*** Screening Pemberian No seri Pemberian No. Batch No Seri
tahun) PBI Batch
PBI a Vaksinasi Vaksinasi

1 S-604DD555 3601040604660001 m roji L GURU 4/6/1966 SDN TANJUNGAN 1 ;EMAH SUGIH 085772842119 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418556808
2 S-1C8EEDC4 3601040107710031 UPI S L GURU 6/10/1964 SDN TANJUNGAN 1 CITARUM SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
3 S-D92C3A75 3601042612570001 engkos kosasih L GURU 9/8/1963 SDN TANJUNGAN 3 SITUPOTONG 085717350249 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418556808
4 S-73FB4F26 3601041407100001 ade andri L GURU 1/14/1971 SDN TANJUNGAN 4 PARUNGKOKOSAN 085717350249 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418556808
5 S-88143E64 3601042612570001 engkus L GURU 5/10/1962 SDN CIKIRUHWETAN 1 KADIRI 085217293330 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418556808
6 S-F1AB91F8 3601044806850004 SUKARSIH P GURU 7/4/1981 SDN CIKIRUHWETAN 2 CIKIRUHWETAN 082169909790 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
7 S-9AA6137A 3601044503800001 ATIKAH P GURU 3/5/1990 SDN CIKIRUHWETAN 3 CIKIRUHWETAN 085893310120 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
8 S-29361632 3601050906600002 AHYANI L GURU 9/5/1966 SDN CIKIRUHWETAN 3 MALINGPING 081283848786 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
9 Y-00004IM2 3601046809600004 ROSNIANI P GURU 9/28/1969 SDN SUKAWARIS 1 BABAKAN BANDUNG 08138303691 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
10 P-NVPN0NCN3601030406860002 UJANG SAMSI L GURU 6/3/1986 SDN SUKAWARIS 1 SUKAWARIS 0816234402 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
11 S-04D5677B 3601046204810002 HENI YULNIVIDA INDRP GURU 4/22/1981 SDN SUKAWARIS 2 SUKAWARIS 085210971212 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808
12 S-265A56BD 3601224607860003 MARPUAH P GURU 7/6/1986 SDN SUKAWARIS 2 CIKAREO 081281133869 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418580036
13 S-F1AB91F8 3601044107830104 SUKRIAH P GURU 1/15/1972 SDN SUKAWARIS 3 CITARUM 085813374254 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
14 Z-518C68D2 3601044701840001 DARNI SUHAYATI P GURU 8/2/1985 SDN SUMURBATU 4 SUMURBATU 08770640912 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
15 W-51FCB26F 3601045708720002 HENI AGUSTINA P GURU 8/7/1971 SDN UMBULAN 3 RANCASENENG 081906299316 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
16 W-50B68A3E 3601040107710036 AHMAD TOYO L GURU 5/3/1971 SDN RANCASENENG 1 RANCASENENG 085695274274 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
17 Z-F4529D7C 3601041304910001 NURDIN L GURU 8/20/1990 SDN CURUGCIUNG 1 KOLELET 085714776065 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418580036
18 S-F6D0662F 3601040708720002 saepudin L GURU 8/7/1972 SD NANGGALA 3 SUKAJAYA, NANGGALA085810134032 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418587384
19 S-910420D7 3671082904900003 RIESTO ATANTO L GURU 4/29/1990 MTSN 6 PANDEGLANG TANGERANG 085899812454 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418580036
20 S-DC1A0914 3208091406910004 YOGI SAGITA L GURU 6/14/1991 MTSN 6 PANDEGLANG PANDEGLANG 081282626324 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
21 S-146E30D3 3602142210950002 AHMAD KHOLIYI L GURU 10/22/1995 MTSN 6 PANDEGLANG CIKEUSIK 085215648781 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
22 S-04D5677B 3202275505910001 MEITI ST KANIA P GURU 5/15/1991 MTSN 6 PANDEGLANG CIKEUSIK 089684838471 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
23 S-F1CB0D5C 367114206960002 SITI ROSMALA P GURU 6/2/1996 MTSN 6 PANDEGLANG TANGERANG 085817181996 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418580036
24 P-NJISV0YA 3601140107810109 RUSDI L GURU 3/2/1981 MTSN 6 PANDEGLANG PASIR HUNI RT RW 018085213864138 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418587384
25 S-3EFFB5A5 3601041303580001 A SURYONO L GURU 3/13/1958 SMKN 5 PANDEGLANG SUKASENENG 085216272097 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418587384
26 S-4528F7D2 3601040801850001 ANDI GINANJAR L GURU 1/8/1985 SMKN PARUNGSARI SUKASENENG 087771100661 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418587384
27 P-NUMUAHTB3601041504790002 MULYANA L GURU 4/15/1979 SMK ARKID MADANI UMBULAN 085732997972 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418587384
28 S-438097F7 3601044405800006 ENOK MUNAWAROH P GURU 5/9/1980 TK RANCASENENG UMBULAN 085288146554 SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418587384
29 S-91BA2526 3601040403690001 masdopi L GURU 3/4/1969 CAL HAJ BABAKAN BANDUNG 087772073531 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418587384
30 P-NENGDVRC3601040610760001 Ra'I Priatna L GURU 10/6/1976 CALON KADES BABAKAN BANDUNG 082111779687 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418587384
31 S-0F324407 3601040705570001 santarip L GURU 5/7/1957 CAL UMROH CIKUJANG BARAT 085882754336 SARS-CoV-2 01/04/2021 01/04/2021 24000821 16134418587384
32 S-8DB28AF0 '108076905910001 MEIKE PRAMUDITA PUP NAKES 29/05/1991 PUSKESMAS CIKEUSIK Cikeusik SARS-CoV-2 16/03/2021 16/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418587384
33 P-BF3XCYGT '3601046007900001 NURHAYATI P GURU 04/09/1992 SDN CURUGCIUNG 1 kp.Sinargintung '085211677150 SARS-CoV-2 16/03/2021 16/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418587384
34 S-0D4343BD '3601041304910001 Nurdin L GURU 13/04/1991 SDN CURUGCIUNG 1 '085714776065
Kp.kolelet Ds.Cikadongdong SARS-CoV-2 16/03/2021 16/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418587384
35 P-BW8CXRYW '3601042008950002 SUDIANA L UPT CIKEUSI01/11/1994 Kp.Cikeusik Ds.Cikeusik '081298083023 SARS-CoV-2 16/03/2021 16/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418587384
36 S-1F3A2AC1 '3601042404710001 Konadi L GURU 24/04/1971 Kp.Cikeusik Ds.Cikeusik '085218721818 SARS-CoV-2 16/03/2021 16/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
37 S-AC9CDA40 '36010829099850001NANA SURYANA L GURU 29/09/1985 SDN CIKEUSIK Kp. Pasanggaran '085939388141 SARS-CoV-2 16/03/2021 16/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
38 P-D33H3QLP '3601046511850002 ANI ANGGRAENI P GURU 25/11/1985 SDN 2 RANCASENENG Kp.Rancaseneng Ds.Ra '085319399998 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
39 S-8A404AF5 "3601040610840001 Edi Sunardi L GURU 06/10/1984 SDN 2 RANCASENENG Kp. Suka mulya '085773493442 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
40 S-A109C440 '3601041707820003 WAWAN GUNAWAN L GURU 17/07/1982 SDN 2 RANCASENENG Kp.Sukawaris.Ds.Sukawa '085894432182 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
41 S-1BF31840 '3601041408710001 AMAN SUHERMAN L GURU 14/08/1971 SDN 1 UMBULAN Kp.Sukamulya Ds.Sukam'087783100233 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
42 P-D5XVN7S4 '3601044701760002 ETI ROHAETI SPD P GURU 09/02/1976 SDN 3 UMBULAN Kp. Babakan cibaliung '085214152639 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
43 S-718AD66C '3601042007730001 TATANG HIDAYAT L GURU 12/07/1973 SDN 3 UMBULAN KP. Gadel DS Umbulan '085213500292 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
44 S-4D1654E3 '3601040805680002 Uci Sauci L GURU 08/05/1968 SDN 3 UMBULAN Kp.Sukamulya Ds.Sukam'085886919799 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
45 S-6B2CF61A '3601041406620002 WIRNA P GURU 14/06/1962 SDN 1 SUMURBATU DS Nanggala '085215761459 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
46 S-C0141A31 ''3601046002670001 SUTIYAH P GURU 20/02/1967 SDN 1 SUMURBATU Kp.sumurbatu Ds Sumur'085214000641 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418549008
47 P-DJV848C2 '3601044107850356 LAMSARI P GURU 23/01/1985 SDN 2 SUMURBATU Cikeusik '081295081451 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
48 P-DMBNVJ33 3601040107620005 AAN JAMALUDIN L GURU 06/07/1963 SDN 4 SUMURBATU SUMURBATU SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
49 S-FD1A6631 '3602215002870003 Siti Rodiah P GURU 10/02/1987 SDN 4 SUMURBATU Kp.Alas Roban '085284385566 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
50 S-7B8DB11F '3601040107890169 Aam Muharom P GURU 01/07/1989 SDN 2 PARUNGKOKOSAN KP. PARKOS 85770974445 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
51 S-85B9359A "3601046005820002 IIS ROHAYATI P GURU 20/05/1982 SDN 1 SUKAMULYA Kp. Gadel DS Umbulan '085219188742 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
52 S-AF0B927A '3601040107640065 UTOY L GURU 12/08/1963 SDN 2 SUKAMULYA Kp.Sukamulya Ds.Sukam'085810408980 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
53 S-B12CED90 '3215055112950001 Monika SPd P GURU 11/12/1995 SDN 2 SUKAMULYA Cikeusik '085322087407 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
54 P-D4QEWJ4L '3601040509950005 ENDANG ARIPIN L GURU 05/09/1995 SDN 2 LEWIBALANG KP.Leuwibalang Ds.Leuw'085714778024 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
55 P-D5OMMDYA'3601040904630001 SUHANDI L GURU 04/08/1968 SDN 2 LEWIBALANG KP.Lauwibalang Ds Leuw'085714215433 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
56 S-7FF7166B '3601040107940152 Eko Saputra L GURU 01/07/1994 SMK 5 PANDEGLANG Kp'.Tanjungjaya Ds Sum'085695157979 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16127459968252
57 S-E1198562 '3601044107950664 Dede Corlina Apriani P GURU 01/07/1995 SMK 5 PANDEGLANG Cikeusik '08571579854 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418568820
58 S-EF059079 '3601045203730001 SUBARIAH P GURU 12/06/1973 CAL.HAJ Kp.Umbulan Ds Umbulan'08577169031 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418568820
59 N-201185A9 '3601044202910002 Elis Febriyani, Amd.KebP NAKES 02/02/1991 PUSKESMAS CIKEUSIK Kp.Rancaseneng Ds Ra 85811439792 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418568820
60 N-5EEC1C53 '3601047112860002 Sanimah, Amd.Keb P NAKES 31/12/1986 PUSKESMAS CIKEUSIK Kp.Cikeusik Ds Cikeusik '087772914464 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418568820
61 P-DCUTR9EN'3601045506960002 AIDILA FITRI RAMADAP NAKES 15/06/1996 PUSKESMAS CIKEUSIK Kp.Kesur Ds nanggala ''085959369050 SARS-CoV-2 18/03/2021 18/03/2021 2.4E+07 '16127779132818 4/1/2021 24000821 16134418568820
Dosis k2 Sebanyak : 25 orang
Vaksin yang terpakai dosis 1 : 6 vial
Spuit : 56
Alkohol sweb : 56
Septi box :1
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur sesuai)
Nama Penerima Kelomp
NO No. Ticket NIK JK Pekerjaan* (18-59 INSTANSI Alamat No. Hp BPJS BPJS Non
Vaksin ok Umur
tahun) PBI Non PBI Anggota

1 S-3FED8F13 '3601040107600090 EMED L CAL. HAJI 65 KP.SITUPOTONG 003/004 DESA SUKAMULYA KEC CIKEUSIK 085813534226

2 S-222EA4CD 3601040608590001 KAMSUDIN L CAL. HAJI 62 KP. BENDUNGAN 001/002 DESA PARUNGKOKOSAN KEC CIKEUSIK 085691095753

3 P-SL7UNRZV 3601045208590001 APIPAH P CAL. HAJI 59 KP. SUMURBATU 001/001 DESA SUMURBATU KEC CIKEUSIK 085695148563

4 P-SLWB0M3P 3601044802680001 RUMSAH P CAL. HAJI 45 KP. CICADAS 002/003 DESA PARUNGKOKOSAN KEC CIKEUSIK 085695401377

5 P-SMJ6WLXY 3601040705640002 HALIMI L CAL. HAJI 57 KP. JAHA 003/005 DESA SUKASENEG KEC CIKEUSIK 081288482267

6 S-8DCAEE7C 3601045208600005 YATI P CAL. HAJI 61 KP. SITUPOTONG 003/004 DESA SUKAMULYA KEC CIKEUSIK 085813534226

7 S-B1ED6CF6 3601040107500066 SANAN L CAL. HAJI 71 KP.CILEUNGSIR 001/001 DESA SUKAMULYA KEC CIKEUSIK 085781086722

8 S-F6465719 3601044107560095 ICIH P CAL. HAJI 65 KP. CILEUNGSIR 001/001 DESA SUKAMULYA KEC CIKEUSIK 0856978717899

9 S-FB82F0D4 3601045203700001 MENENG P CAL. HAJI 51 KP.JAHA 03/05 DS.SUKASENENG 085217312236

10 P-SOQCP4MM 3601041002700001 MUKTAR L CAL.HAJI 51 KP.PARUNGKOKOSAN 01/01 DS.PARUNGKOKOSAN 085714688311

11 P-SPLU743U 3601045103760001 NANI P CAL.HAJI 45 KP.PARUNGKOKOSAN 01/01 DS.PARUNGKOKOSAN 085714688311

12 P-SQLIK3YFE '3601040107680116 SAI L CAL.HAJI 58 KP.PARUNGKOKOSAN 04/02 DS.PARUNGKOKOSAN 081381491734

13 P-SS4WP5PZ 3601044107760122 UMIN P CAL.HAJI 47 KP.PARUNGKOKOSAN 04/02 DS.PARUNGKOKOSAN 085282388684

14 S-47D0FBIA 3601041205950084 IKHTIAR FATUROHMAN L CAL.HAJI 26 KP.BALAGUNG 01/03 DS.SUMURBATU 085218362982

15 S-27FA65CO 3202265112860001 ASTRI MAYASARI P GURU 35 MTSN 6 PANDEGLANG KP. TANGKOLO 013/003 DESA PURWASERA KEC CIRACAP 081572993789

16 S-56CB1610 3324046704940002 VIGA APRILIANA SARI P GURU 27 MTSN 6 PANDEGLANG KP. MEZING LOR 004/001 DESA AMBARKETAWANG KEC GAMPING 085743466333

17 S-64884E2D 3211151902960002 MUHAMMAD RAMDLAN L GURU 25 MTSN 6 PANDEGLANG JL. CILENGKRANG 002/003 DESA PALASARI KEC CIBIRU 081224000275

18 S-B97FF076 3601044207750006 SITI ATIAH P GURU 43 MTSN 6 PANDEGLANG KP.CIKEUSIK 03/02 DS.CIKEUSIK 0819-1090-0296

19 S-947F6876 3601042201720001 ANANG SAHRONI, S.PD L GURU 49 MTSN 6 PANDEGLANG KP.CITARIK 03/02 DS.CIKEUSIK 087709856521

20 Y-00004IL3 3601040107670079 JAENUDIN L GURU 51 KORMIN DINDIK KEC.CIKEUSIK KP.CIKALUDAN 03/01 DS.CURUGCIUNG 085282598705

21 P-SQ4W2CMG 3601041507800003 DENI LISMAYADI L 42 KORMIN DINDIK KEC.CIKEUSIK KP.CIKEUSIK 02/01 DS.CIKEUSIK 087773090595

22 S-522FBC6B 3601274107350009 SARNI P GURU 48 SDN TANJUNGAN 3 KP.KUTAKARANG 03/05 DS.KUTAKARANG KEC.CIBITUNG 085711105376

23 S-0CF4FFF7 3601041506640002 KHOERUDIN L GURU 37 SMP ISLAM DARUSALAM CIKEUSIK KP.BUNGURGEDE 04/04 DS.CURUGCIUNG 085779161178

24 S-5E296C20 3604252307870001 ABDU SOMAD L GURU 34 SMP ISLAM DARUSALAM CIKEUSIK KP.SAMPANG JAHA 01/01 DS.GUNUNGBATU KEC.MUNJUL 083899530960

25 P-SWN19B7R 3601040107870172 SARIM L GURU 30 SMP ISLAM DARUSALAM CIKEUSIK KP.KUKULU 01/01 DS.CURUGCIUNG 08574393845

26 S-A4B80540 3601044107920132 NUNUNG P GURU 30 SMP ISLAM DARUSALAM CIKEUSIK KP.CURUGCIUNG 01/01 DS.CURUGCIUNG 08578014462

27 S-E5E82C90 3601040107850178 SALAMUN L GURU 34 SMP ISLAM DARUSALAM CIKEUSIK KP.CURUGCIUNG 01/01 DS.CURUGCIUNG 08568928423

28 S-8B314BA5 3601040810860001 ADE SUHARYANA L GURU 35 KP.SITUPOTONG 001/006 DESA SUKAMULYA KEC CIKEUSIK 087773747091
29 N-8352ACC4 '360104600378000Eva Widayati Khoiriyah P NAKES 20/03/1978 PUSKESMAS CIKEUSIK Kp.Muara dua Ds,Cikiruhwetan '087772001611 SARS-CoV-2
30 P-DCQT9D1Z '360104530498000RITA AFRIYANI P NAKES 13/04/1998 PUSKESMAS CIKEUSIK KP. Cangkore '083896984946 SARS-CoV-2
 Dosis I Dosis 2
Merek Tanggal
Vaksin** Screeni Tanggal Tanggal KET
* ng Pemberian No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi Vaksinasi

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SINOVAC 9/4/2021 9/4/2021 24000821

SARS-CoV-2
18/03/202118/03/2021 24000821'16127779132818 9/4/2021 24000821
SARS-CoV-2
18/03/202118/03/2021 24000821'16127779132818 9/4/2021 24000821
 NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601044501700001 SUARSIH P

2 S-VVCDE686 3601040611730002 SUHENDRA L

3 P-VFTTJDEY 3601046508760002 PITRI P

4 S-FC4D264 3601044801580001 SARMI P

5 S-BI0C169A 3601046705740002 ENI ROHAENI P

6 S-A9D9454B 3601046608930003 NUNUNG NURJANAH P

7 S-11E58E2A 3601040911630001 SUBARNAS L

8 S-003377BF 3601045202760001 SUMANAH L

9 P-VFBFXTTH 3601046508890001 SITI AISYAH P

10 S-54211C2A 3601044808790001 HETI SUHAETI P

11 S-A8B358FE 3601045004790002 ENTIN KARTINI P

12 S-B50F0A10 3601044107580191 RUSINAH P

13 W-CABED94E 3601045803700002 O. WORMAWATI P

14 W-069BBB6F 3601040602730003 ENDIN SAPRUDIN L

15
S-370E8164 '3601044902480001 SUTARSIH P
16
S-3C183479 '3601040107530197 MADRAWI L
17
S-3E8F2536 '3601042010590002 SUTRISNO L
18
S-CB8F157A
360104070769000 Abdullah L
19
S-CFC1A70A '3601045006790001 LILIS KUSNIAWATI P
20
P-LELFX59I '3601041103860003 Mubin L
21
Q-6B6E17C9 3601040101910004 Dian Nurjaman L
22
S-3DE23786 '3601044804810001 Nanih misharyani P
23
S-C9FD712C 3601046606860001 Siti maemanah P
24
S-9127C1DB '3601045408850001 Yanti Susanti P
25
S-A205FD57 3601040201830002 Abdul Hafid Y L
26
S-DAB6DBE0 3601046503830004 Yati P
27
S-265A56BD 3601224607860003 MARPUAH P
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI
ok Umur
tahun)

HAJI 51 THN

HAJI 48 THN

HAJI 45 THN

HAJI 63 THN

GURU 46 THN SDN Rancaseneng 1

GURU 28 THN MI MLNGSARI

GURU 58 THN SMP 1 Cikeusik

GURU 45 THN MTSN 6 Pandeglang

GURU 32 THN MTSN 6 Pandeglang

GURU 42 THN MTSN 6 Pandeglang

GURU 42 THN MTSN 6 Pandeglang

HAJI 61 THN

GURU 51 THN SD NANGGALA 2

GURU 48 THN SDN Tanjungan 3

CAL.HAJ 09/02/1948 CAL.HAJ

CAL.HAJ 15/07/1957 CAL.HAJ

CAL.HAJ 20/10/1959 CAL.HAJ

GURU 01/02/1969 SDN 3 CURUGCIUNG

GURU 05/06/1979 SDN 3 UMBULAN

GURU 20/10/1985 SDN3 Tanjungan

GURU '01-01-1991 SDN Tanjungan 3

GURU 08/04/1981 SDN 1 cikeusik

GURU 26/06/1986 MI Malangsari

GURU 14/08/1985 MI Malangsari

GURU '02-01-1983 MI Malangsari

GURU '25-03-1983
GURU 7/6/1986 SDN SUKAWARIS 2
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat No. Hp BPJS BPJS
PBI Non PBI

KP BATUJAYA 010/003 081776036854

KP PARKOS 003/004 0877725158371

KP PARKOS 003/004 0877725158371

KP BENDUNGAN

KP RANCASENENG 001/005 087773162500

KP BINUANGEUN 087772229004

KP CIKEUSIK 002/001 085283234417

KP BATUJAYA 002/003 087771287771

KP CIKEUSIK 001/001 085779561204

KP CIKEUSIK 002/001 083875371595

KP CIKEUSIK 001/001 085213226419

KP SUMBERJAYA 005/001

KP CIKEUSIK 085313196807

KP TANJUNGAN 002/005

Kp.Cikeusik Ds.Cikeusik

Kp.Sumberjaya.Ds Umbulan

Kp.Batujaya Ds umbulan '082123554442

KP SUKATANI 002/002

Kp.Rancaseneng Ds.Rancaseneng

Kp pasir asem Ds tanjungan '085280307475

Kp.Sumurbatu 03/01 Ds Sumurbatu '085782007333

085810134584
Kp.Cikeusik 01/01 Ds Cikeusik

Kp.batujaya 11/003 Ds umbulan '085880490349

Kp.Malangsari Ds Sukawaris '085894540853

Kp.Malangsari 02/04 Ds.Cikiruhwetan '081389607968

Kp.Malangsari Ds Sukawaris '085715609783

CIKAREO 081281133869
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Tanggal Tanggal
Non Merek Vaksin***
Screening Pemberian No. Batch
Anggota
Vaksinasi
SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021 4/14/2021 24000821

SINOVAC 4/14/2021

SINOVAC 4/14/2021

SINOVAC 4/14/2021

SARS-CoV-2 16/03/2021 16/03/2021 24000821

SARS-CoV-2 16/03/2021 16/03/2021 24000821

SARS-CoV-2 16/03/2021 16/03/2021 24000821

SARS-CoV-2 16/03/2021 16/03/2021 24000821

SARS-CoV-2 18/03/2021 18/03/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 3/30/2021 3/30/2021 24000821

SARS-CoV-2 01/04/2021 01/04/2021 24000821

 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
16127778694458

16127778694614

16127778694614

16127778694614

16127778694458

16127459969968

16127459969968

16127459969968

16127778694614

16127778694614

16127778694614

4/14/2021 24000821 16127778694458

4/14/2021 24000821 16127778694458

4/14/2021 24000821 16127778694458

'16127779132818 4/14/2021 24000821 16127778694458

'16127779132818 4/14/2021 24000821 16127778694458

'16127779132818 4/14/2021 24000821 16127778694458

'16127779132818 4/14/2021 24000821 16127778694458

'16127779132818 4/14/2021 24000821 16127778694458

'16127778488398 4/14/2021 24000821 16127778694458

'16127778683538 4/14/2021 24000821 16127459969968

'16127778488398 4/14/2021 24000821 16127778694458

'16127778474810 4/14/2021 24000821 16127459969968

'16127778474810 4/14/2021 24000821 16127459969968

'16127778683538 4/14/2021 24000821 16127459969968

'16127778488398 4/14/2021 24000821 16127459969968

16134418580036 4/14/2021 24000821 16127459969968

 Umur
Nama Penerima
No No. Ticket NIK JK Pekerjaan* (18-59
Vaksin
tahun)

1 P2XMFQ20L 3601047008890001 PUDIN L 10/12/1972

2 P-Z5EKNIM 3601044107670036 ATIAH P 1/7/1967
3 S-F2972ADE 3601046702570001 LILIS P 27/2/1957
4 3601044101570001 HJ HINDUN P 1/1/1957
5 S-1E3CD3F2 '3601041804520001NURJAYA P CAL.HAJ 01/01/1952
6 S-3F8418E6 '3601044806480002MUNAH P CAL.HAJ 08/06/1948
7 S-CCB3A93E '3601043811610001OOY P GURU 18/11/1961
8 S-A917FF97 '3601042408690001UNAJAYA L GURU 24/08/1969
9 S-C78B25B5 '3601044101810002ENENG JUHETI P GURU 01/01/1981
10 S-C70486DC '3601042403640001YAYA SUBAGYA L GURU 24/03/1964
11 S-663A2D0D '3601042500810002Irwan Kuswanto L GURU 25/08/1981
12 S-6CB039A8 '3601045705530001SAEDAH P CAL.HAJ 20/12/1960
13 S-E4C44A50 3601045206600001 Hj. SARPAH P GURU 12/06/1960
14 S-57FC0B7C 3601042408580001SUROTO L GURU 24/08/1958
15 P-DJJX8JXN '3601040207700005MUTOIN L GURU 20/03/1964
16 S-88FF132B '360104700884000 Nurhaeni P GURU 30/08/1984
17 P-IKIQ81ZF 3601041307840001 YAYAN L UMROH 34

18 S-E5B84E27 3601045302520001 SAWINAH P UMROH 68

19 P-IQCFRSVH 3601044412930002 DWI RIFANTI NF P 26

PEL.PUBLIK
20 P-IQSSXT9D 3601044405840002 ADE SUGIANTI P 37
PEL.PUBLIK

21 S-14F26B61 3601046107540001 BAI JAMHARI GAPAR P 67

CAL.HAJ
22 S-36EE9030 3601040104590003 USMAN B ATIP L 62
CAL.HAJ
23 S-BC3AAE13 3601040306400001 SAMUAN/RASID L 81
CAL.HAJ
24 S-4638CDF2 3601041010580002 KARSA IRYANA L 63
CAL.HAJ
25 S-BC7BDD89 3601044112300002 AMEYAH P 91
CAL.HAJ
26 S-F43F785B 3601046510560001 ARNASIH P 65
CAL.HAJ
27 3601044107730417 ANI P 48
P-HIXLQHFS CAL.HAJ
28 P-HJMI1AQ 3601042611680002 RUMAN P 57
CAL.HAJ
29 S-AA4AC9A2 3601046001680003 UUM UMIYAH P 53
CAL.HAJ
30 P-13VUAYXW 3601046505890001 LELI KHAERIYAH P 32
NAKES
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Kelomp
INSTANSI Alamat No. Hp BPJS BPJS
ok Umur
PBI Non PBI

CAL HAJI CIKEUSIK 085817457418

CAL HAJI CIKEUSIK 085814632160
CAL HAJI KP. HUNIBERA DESA CIWET 083841520717
LANSIA CIKEUSIK 083841520717
CAL.HAJ Kp.Hunibera.Ds Cikiruhwetan '
CAL.HAJ Kp.Babakan Bandung Cikiruhwetan '081281168796
SDN 2 CURUKp. Sinar gintung DS Curugciung '085697726683
SDN 2 SUKA Kp.Ciririgi Ds.Sukaseneng '085998067443
SDN 2 SUKA Kp.Cikeuisk.Ds.Cikeusik '081213984677
SDN 2 NANGKp.Cikeuisk.Ds.Cikeusik '081385014227
KP. Sinar gantung '085771917488
Cal HAJ Kp.Hunibera Ds Cikiruhwetan

KP.Leuwibalang Ds.Leuwibalang '085880004180

Cikeusik
SDN 2 RA Kp.Rancaseneng Ds Rancaseneng'085313357647
KP.SUKARENDAH DS.SUKAWARIS 085817457418

KP.LEMAHSUGIH DS.SUKAWARIS 085817457418

085779161352
KP CIKEUSIK

KP. SUKARENDAH DS.SUKAWARIS 08159820763

KP BABAKAN BANDUNG 087879148917

KP BABAKAN BANDUNG, 001/002 087879148917

KP CIKEUSIK 003/005 085694440513

KP SUMURBATU 001/001 085695148563

KP HUNIBERA 003/003 085217249290

KP MALANGSARI 083890404806

KP CIRIGI 087772740152

KP CIRIGI 004/006 087772740152

KP BABAKAN BANDUNG 081281168796

KP CIKAREO 002/002 081384839889

PKM CIKEU
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal
Merek Tanggal
Non Screenin Pemberia No.
Vaksin*** No seri Pemberian
Anggota g n Batch
Vaksinasi
Vaksinasi

SINOVAC 23/4/2021 23/4/2021 240001421 '16127779132818

SINOVAC 23/4/2021 23/4/2021 240001421 '16127779132818
SINOVAC 23/4/2021 23/4/2021 240001421 '16127779132818
SINOVAC 23/4/2021 23/4/2021 240001421 '16127779132818
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-216/03/2021 16/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-218/03/2021 18/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-218/03/2021 18/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-218/03/2021 18/03/2021 2.4E+07 '1612777913281823/4/2021
SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114 23/4/2021
SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114 23/4/2021
SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114 23/4/2021
SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802
23/4/2021

SINOVAC 3/25/2021 3/25/2021 24000821

23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
SINOVAC 3/25/2021 3/25/2021 24000821
23/4/2021
Dosis 2

KET
No. Batch No Seri

240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818
240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

'16127779132818
240001421

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818

240001421 '16127779132818
NO No. Ticket NIK Nama Penerima Vaksin JK Pekerjaan*

1 360104070270000 Acep Sunarya L GURU

2 S-AC133B79 360104030172000 Eman Suparman L GURU
3 '360104010788015Eep Saepullah L PEL.PUBLIK
4 P-DALPJDTE '360103020780001CECEP PRIATNA L GURU
5 S-72117CC9 360104661290000DESTA WISMAYA P GURU
6 P-DAWMYBCW'360104521293000SITI'AH P GURU
7 P-IPPGZ7SG 3601044107660134 DARKEM P PEL.PUBLIK
3601045105010005
8 P-IPZRB7CK DIAN MUTNIAWATI P PEL.PUBLIK
9 P-IQI7CIJJ 3601045604960004 ENDAH APRIYANTI P PEL.PUBLIK
10 P-IQYYTE8O 3601046512990001 EVA TRESNA RAHAYU P PEL.PUBLIK
11 P-IRJGJVG0 3601044508810002 MIRA DIANA P PEL.PUBLIK
12 P-IU3CRTPM 3601044305850002 ADE ROHAYATI P PEL.PUBLIK
13 P-IU84DA6T 3601041212920002 YOPI ISKANDAR L PEL.PUBLIK
14 P-IWA2ZZL6 3601040103970001 RAIS L PEL.PUBLIK
15 S-12E9FEBF 3601040107630364 MISTARI L
16 P-HYKK7DH6 3601044107890155 SUMI SUSILAWATI P PEL.PUBLIK
 Umur Kelompo
INSTANSI Alamat
(18-59 tahun) k Umur

2/7/1970 MTSN 6 Pandeglang Cikeusik

1/3/1972 SDN 5 Cikeusik Kp.Karangsambung 01/04 Ds.Cikeusik

7/5/1989 Nanggala

26/07/1977 SDN 1 PARUNGKOKOSANKp.Parungkokosan Ds.Parungkokosan

26/12/1990 SDN 2 PARUNGKOKOSANKp.Umbulan Ds Umbulan
12/12/1993 SDN 2 LEUWIBALANG Kp.Umbulan,Ds Umbulan
54 KP PENDEY RW 02 RT 002 DS.UMBULAN
20 KP PENDEY RW 02 RT 002 DS.UMBULAN
25 KP SINAPEUL RW 02 RT 003
22 KP.CIBULUH
40 KP CIKEUSIK
36 KP CIKEUSIK KALER 002/005
29 KAMPUNG CIKEUSIK RW 05 RT 003
22 KAMPUNG BATUBANTAR RW 01 RT 002
62 KP UMBULAN
32 KP PEUNDEUY
 Kepesertaan BPJS (tulis 'Ya'
Dosis I
pada kolom yang sesuai)
Merek Tanggal Tanggal
No. Hp BPJS Non
BPJS PBI Vaksin*** Screening Pemberian
Non PBI Anggota
Vaksinasi
081911145245 SARS-CoV-2 4/24/2021 4/24/2021
081297374663 SARS-CoV-2 4/24/2021 4/24/2021
085695393554 SARS-CoV-2 4/24/2021 4/24/2021
'08138483870 SARS-CoV-218/03/2021 18/03/2021
'081287709355 SARS-CoV-218/03/2021 18/03/2021
'0873215525 SARS-CoV-218/03/2021 18/03/2021
085817984630 SARS-CoV-2 26/03/2021 26/03/2021
085817984630 SARS-CoV-2 26/03/2021 26/03/2021
085243881689 SARS-CoV-2 26/03/2021 26/03/2021
085889514238 SARS-CoV-2 26/03/2021 26/03/2021
0877723258208 SARS-CoV-2 26/03/2021 26/03/2021
085779054211 SARS-CoV-2 26/03/2021 26/03/2021
085779054211
SARS-CoV-2 26/03/2021 26/03/2021
081295096743 SARS-CoV-2 26/03/2021 26/03/2021
085817984630 SINOVAC 3/25/2021 3/25/2021
082311626989 SINOVAC 3/25/2021 3/25/2021
Dosis I Dosis 2
Tanggal KET
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

24000821 16127459968876
24000821 16127459968876
24000821 16127459968876
24000821 '16127779132818 4/24/2021 24000821 16127459968876
24000821 '16127779132818 4/24/2021 24000821 16127459968876
24000821 '16127779132818 4/24/2021 24000821 16127459968876
24000821 '16127781522114 4/24/2021 24000821 16127459968876
24000821 '16127781522114 4/24/2021 24000821 16127459968876
24000821 '16127778489802 4/24/2021 24000821 16127459968876
24000821 '16127778489802 4/24/2021 24000821 16127459968876
24000821 '16127778489802 4/24/2021 24000821 16127459968876
24000821 '16127778489802 4/24/2021 24000821 16127459968876
24000821 '16127778489802 4/24/2021 24000821 16127459968876
24000821 '16127778489802 4/24/2021 24000821 16127459968876
24000821 4/24/2021 24000821 16127459968876
24000821 4/24/2021 24000821 16127459968876
NO No. Ticket NIK Nama Penerima Vaksin JK

1 ZAB7BC472 3202112810004 RIZAL DANIAL RINALY L

2 S-F819DC45 3601041901720002 PIPIN L

3 S-C653D93 3601046012780001 KHUMAEROH L

4 P-5QAAWNMT 3601045002740001 EROH ROHMAYATI P

5 S-09425D80 3602215012910005 RUSNIATI P

6 S-4EFD563 3601041205750003 SUTISNA SENJAYA, ST L

7 W-29203539 3601040910670001 NURYADI L

8 P-8CUOKPFT 3601040910670001 DIAR KARANG SARI P

9 S-8C3B722B 3602210906720001 MAMAN SUTIANA L

10 3601047007010001 DEBBY DELIYANA YANTI P

11 P-6CVODBSW 3601040507790001 ENDIH SAHRUDIN L

12 S-AE554BFC 3601041704400002 H. SADE L

13 S-2CBE6B16 3601046101490001 HJ SAWIYAH P

14 S-415E8712 '3601041005553331 JAMSU L

15 S-FC6ACA03 '3601040112610001 SOHIBIN L
16 P-IJ679KVI 3601045104930004 WARTINAH RAHMI P

17 P-ILXBRMFO 3601040701780002 DAWUD L

18 S-B971A807 3601040607640002 KUSNADI L

19 S-IC7DE861 3601041706590001 MULYADI L

20 3601041308670001 ENUR L

21 P-HNS0KP0R 3601046010680002 HJ MARYATI SADELI P

22 P-LFXURQWK 3601042001900004 Ardin L

23 N-BA73DC85 360104570590003 Rifka Fitri R P
24 S-1EC5C108 '3601044104780005 Jujum Jumiati P
25 S-D6FCC3B3 3601045506630001 Samsiah P
26 S-AE558F2B 3601041811560'001 H. Iin Karsanoyadi L
27 S-E5FCC2F5 3601040107950046 Pijayudin L
28 S-0EEC2E52 3601042111870001 Derik Ismawan L
29 P-LQWDDHAB 3601044206840001 Elis Ratnasari P
30 S-D781661E 3602010208830004 Edi L
31 S-3C4E0F48 '3601042606650001 Wawan Kosasih L
32 S-DF2F17CB '3601041712660001 Aep L
33 S-B6DB761E '3601042911780001 Iyan Rubiyana L
34 S-42D70937 3601040310830004 Ade Suhendi L
35 P-LRI2NKEU 3601046204020001 Tika Aprianti P
36 S-36F8B3B9 '3601046804520003 Isem P
37 P-LOT51S30 3601044107530005 Sanemah P
38 P-LLK8FK4E 3601040202630003 H. Asmad L
39 S-88143E64 3601042612570001 engkus L

40 S-F1AB91F8 3601044806850004 SUKARSIH P

41 S-9AA6137A 3601044503800001 ATIKAH P

42 Y-00004IM2 3601046809600004 ROSNIANI P

43 P-NVPN0NCN 3601030406860002 UJANG SAMSI L

44 S-04D5677B 3601046204810002 HENI YULNIVIDA INDRIANIP

45 S-910420D7 3671082904900003 RIESTO ATANTO L

46 S-DC1A0914 3208091406910004 YOGI SAGITA L

47 S-146E30D3 3602142210950002 AHMAD KHOLIYI L

48 S-04D5677B 3202275505910001 MEITI ST KANIA P

49 S-F1CB0D5C 367114206960002 SITI ROSMALA P

50 P-NJISV0YA 3601140107810109 RUSDI L

51 S-91BA2526 3601040403690001 masdopi L

52 P-NENGDVRC 3601040610760001 Ra'I Priatna L

53 S-0F324407 3601040705570001 santarip L

54 S-27FA65CO 3202265112860001 ASTRI MAYASARI P

55 S-64884E2D 3211151902960002 MUHAMMAD RAMDLAN L

56 S-947F6876 3601042201720001 ANANG SAHRONI, S.PD L
 Kelom
Umur
Pekerjaan* pok INSTANSI
(18-59 tahun)
Umur

GURU 21-12-1981 SDN CIKEUSIK 1

GURU 19-01-1972 MTSN 4 MUNJUL

GURU 20-02-1978 SDN CIWET 1

GURU 10-02-1974 SDN SUKAWARIS 1

GURU 10-12-1991 MTSN 6 CIKEUSIK

GURU 12-05-1975 MTSN 6 CIKEUSIK

GURU 09-10-1967

GURU 15-10-1984 SDN SUKAWARIS 1

PEL. PUBLIK 09-06-1972 KEAMATAN

PEL. PUBLIK 30-07-2001

PEL. PUBLIK 05-06-1980 SEKDES

LANSIA 05-06-1935 CAL UMROH

LANSIA 05-08-1942 CAL UMROH

CAL.HAJ 10/05/1955 CAL.HAJ

GURU 10/12/1961 GURU

NAKES 28

37
PEL.PUBLIK
57
PEL.PUBLIK
62

53

53

NAKES 15/10/1990 PKM CIKEUSIK

NAKES 17/05/1990 PKM CIKEUSIK

NAKES 01/04/1978

lansia '05-07-1958

lansia '18-11-1956
GURU 01/07/1995

GURU 21/11/1987

GURU 02/06/1984

GURU '13-111984

Pel.Publik 26/06/1965 Kecamatan

Pel.Publik 17/12/1966 Kecamatan

Pel.Publik 29/11/1978

Pel.Publik 26/02/1980 kecamatan

Pel.Publik 22/04/2002

umroh 28/04/1952

umroh '01-07-1962

umroh '02-02-1963
GURU 5/10/1962 SDN CIKIRUHWETAN

GURU 7/4/1981 SDN CIKIRUHWETAN

GURU 3/5/1990 SDN CIKIRUHWETAN

GURU 9/28/1969 SDN SUKAWARIS 1

GURU 6/3/1986 SDN SUKAWARIS 1

GURU 4/22/1981 SDN SUKAWARIS 2

GURU 4/29/1990 MTSN 6 PANDEGLAN

GURU 6/14/1991 MTSN 6 PANDEGLAN

GURU 10/22/1995 MTSN 6 PANDEGLAN

GURU 5/15/1991 MTSN 6 PANDEGLAN

GURU 6/2/1996 MTSN 6 PANDEGLAN

GURU 3/2/1981 MTSN 6 PANDEGLAN

GURU 3/4/1969 CAL HAJ

GURU 10/6/1976 CALON KADES

GURU 5/7/1957 CAL UMROH

35 MTSN 6 PANDEGLANG
GURU
25 MTSN 6 PANDEGLANG
GURU
 49 MTSN 6 PANDEGLANG
GURU
 Kepesertaan BPJS
(tulis 'Ya' pada
kolom yangBPJsesuai)
Alamat No. Hp Non
BPJS S
Angg
PBI Non
ota
PBI

PURWASEDAR KEC. CIRACAP 085798163132

CIKEUSIK 01/01 081385745722

KP. SUKAWARIS DESA SUKAWARIS 081585721781

SUKAWARIS 085773883582

WANASALAM 083885621238

KP SINAR BAKTI DESA TANJUNGAN 085886124688

CIKEUSIK 085782266771

CIWET 081994117005

KATAPANG 085777218283

CIWET 083813538859

Cikeusik 083807493634

KP. MALANG SARI CIWET 085813294452

KP. MALANG SARI CIWET 085813294452

Kp.Jatiwangi
SARS-CoV-2

Kp.Parungkokosan Ds.Parungkokosan '085775355874 SARS-CoV-2

KP.CIKARET DESA.SUKAMULYA 081381043606

KP.CANGKORE 002/001 DS.RANCASENENG 085891152634

KP.BENGER 004/001 DS.NANGGALA 085773225988

KP BENGER 085210852418

KP CIKEUSIK 004/005 085894824891

KP BABAKAN SIMPANG 081219100662

Kp.Situpotong Ds sukamulya '081511502481 SARS-CoV-2

kp.babkan Bandung ds.cikiruhwetan '082246746267 SARS-CoV-2

Kp.Hunibera ds Cikiruhwetan '085732997956 SARS-CoV-2

kp.cikeusik Ds.Cikeusik '085694032256 SARS-CoV-2

Kp.Cikeusik Ds Cikeusik '085694032256 SARS-CoV-2

kp.leuwigeda ds.sumurbatu '082213690002 SARS-CoV-2

kp.babkan Bandung ds.cikiruhwetan '081585715450 SARS-CoV-2

Kp.ci[punaga Ds.Tanjungan '085894271114 SARS-CoV-2

Kp.Kondang Ds.Sukamanah '085770630874 SARS-CoV-2

Kp.Umbulan 02/01 ds Umbulan '085319535476 SARS-CoV-2

Kp.Sumberjaya05/01 ds Umbulan '081380827777 SARS-CoV-2

kp.Leuwibalang DsLeuwibalang '082298166896 SARS-CoV-2

Kp.Kadiri Ds cikiruhwetan '087773362426 SARS-CoV-2

kp.Leuwibalang DsLeuwibalang '081291683530 SARS-CoV-2

Kp.tanjungan Ds Tanjungan '085779170083 SARS-CoV-2

Kp.Balagung Ds.Sumurbatu '082310358370 SARS-CoV-2

Kp.Citarum Ds.Cikiruhwetan '085882906510 SARS-CoV-2

KADIRI 085217293330 SARS-CoV-2

CIKIRUHWETAN 082169909790 SARS-CoV-2

CIKIRUHWETAN 085893310120 SARS-CoV-2

BABAKAN BANDUNG 08138303691 SARS-CoV-2

SUKAWARIS 0816234402 SARS-CoV-2

SUKAWARIS 085210971212 SARS-CoV-2

TANGERANG 085899812454 SARS-CoV-2

PANDEGLANG 081282626324 SARS-CoV-2

CIKEUSIK 085215648781 SARS-CoV-2

CIKEUSIK 089684838471 SARS-CoV-2

TANGERANG 085817181996 SARS-CoV-2

PASIR HUNI RT RW 018/005 DESA PASIR KADU085213864138 SARS-CoV-2

BABAKAN BANDUNG 087772073531 SARS-CoV-2

BABAKAN BANDUNG 082111779687 SARS-CoV-2

CIKUJANG BARAT 085882754336 SARS-CoV-2

KP. TANGKOLO 013/003 DESA PURWASERA KEC C081572993789

JL. CILENGKRANG 002/003 DESA PALASARI KEC C081224000275

KP.CITARIK 03/02 DS.CIKEUSIK 087709856521
 Dosis I Dosis 2

Merek Tanggal Tanggal Tanggal

Vaksin*** Screening Pemberian No. Batch No seri Pemberian
Vaksinasi Vaksinasi

SINOVAC 03-05-2021 03-05-2021 24000821 16127778479506

SINOVAC 03-05-2021 03-05-2021 240001421 16127533014621
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 24000821 16127533014621
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SARS-CoV-216/03/2021 16/03/2021 24000821 '16127779132818 03-05-2021
SARS-CoV-218/03/2021 18/03/2021 24000821 '16127779132818 03-05-2021
SARS-CoV-2 26/03/2021 26/03/2021 '24000821
'16127781522114 03-05-2021
SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114 03-05-2021
SARS-CoV-2 26/03/2021 26/03/2021 24000821
'16127781522114 03-05-2021
SINOVAC 3/25/2021 3/25/2021 24000821
03-05-2021
SINOVAC 3/25/2021 3/25/2021 24000821
03-05-2021
SINOVAC 3/25/2021 3/25/2021 24000821
03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778474810 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538 03-05-2021
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778683538 03-05-2021
SARS-CoV-201/04/2021 01/04/2021 24000821 16134418556808 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418556808 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418556808 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418556808 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418556808 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418556808 03-05-2021
SARS-CoV-201/04/2021 01/04/2021 24000821 16134418580036 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418580036 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418580036 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418580036 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418580036 03-05-2021
SARS-CoV-24/1/2021 4/1/2021 24000821 16134418587384 03-05-2021
SARS-CoV-201/04/2021 01/04/2021 24000821 16134418587384 03-05-2021
SARS-CoV-201/04/2021 01/04/2021 24000821 16134418587384 03-05-2021
SARS-CoV-201/04/2021 01/04/2021 24000821 16134418587384 03-05-2021
SINOVAC 9/4/2021 9/4/2021 24000821
03-05-2021
SINOVAC 9/4/2021 9/4/2021 24000821
03-05-2021
SINOVAC 9/4/2021 9/4/2021 24000821
03-05-2021
Dosis 2

KET
No. Batch No Seri

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224
24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224

24000821 16127533013224
24000821 16127533013224
 Nama Penerima Umur Kelomp
No No. Ticket NIK JK Pekerjaan* INSTANSI Alamat No. Hp
Vaksin (18-59 tahun) ok Umur

1 S-71B1B070 3601040607720001 AJAT SUDRAJAT L GURU 7/6/1974 SDN C\IHARA TANJUNGAN 085882906450
2 P-FF39NTNH 3601044702730003 SUKNIAH P CALHAJ 2/7/1973 CIWET 083841520712
3 7 S-4C48C008 36041902780003 SAPRIA L GURU 2/19/1970 MTSN 6 PDG UMBULAN 081574883922
4 Z-437EC0BA 3601040107850237 SURYAMAN L GURU 11/4/1984 SMK 5 PDG UMBULAN 08158409997
5 S-D20A8753 3601046506820001 IRMA YULIANTI P GURU 6/25/1982 SMPN 2 CKS UMBULAN 081574883922
6 S-73FB4F26 3601041407100001 ade andri L GURU 1/14/1971 SDN TANJUNGAN 4 PARUNGKOKOSAN 085717350249
7 P-NUMUAHTB 3601041504790002 MULYANA L GURU 4/15/1979 SMK ARKID MADANI UMBULAN 085732997972
8 S-438097F7 3601044405800006 ENOK MUNAWAROH P GURU 5/9/1980 TK RANCASENENG UMBULAN 085288146554
9 S-3FED8F13 '3601040107600090 EMED L CAL. HAJI 65 KP.SITUPOTONG 003/0085813534226

10 S-222EA4CD 3601040608590001 KAMSUDIN L CAL. HAJI 62 KP. BENDUNGAN 001/ 085691095753

11 P-SL7UNRZV 3601045208590001 APIPAH P CAL. HAJI 59 KP. SUMURBATU 001/0085695148563

12 P-SLWB0M3P 3601044802680001 RUMSAH P CAL. HAJI 45 KP. CICADAS 002/003 085695401377

13 P-SMJ6WLXY 3601040705640002 HALIMI L CAL. HAJI 57 KP. JAHA 003/005 DE 081288482267

14 S-8DCAEE7C 3601045208600005 YATI P CAL. HAJI 61 KP. SITUPOTONG 003/ 085813534226

15 S-B1ED6CF6 3601040107500066 SANAN L CAL. HAJI 71 KP.CILEUNGSIR 001/0 085781086722

16 S-F6465719 3601044107560095 ICIH P CAL. HAJI 65 KP. CILEUNGSIR 001/ 0856978717899

17 S-FB82F0D4 3601045203700001 MENENG P CAL. HAJI 51 KP.JAHA 03/05 DS.SU 085217312236

18 P-SOQCP4MM 3601041002700001 MUKTAR L CAL.HAJI 51 KP.PARUNGKOKOSAN 085714688311

19 P-SPLU743U 3601045103760001 NANI P CAL.HAJI 45 KP.PARUNGKOKOSAN 085714688311

20 P-SQLIK3YFE '3601040107680116 SAI L CAL.HAJI 58 KP.PARUNGKOKOSAN 081381491734

21 P-SS4WP5PZ 3601044107760122 UMIN P CAL.HAJI 47 KP.PARUNGKOKOSAN 085282388684

22 S-47D0FBIA 3601041205950084 IKHTIAR FATUROHMAN L CAL.HAJI 26 KP.BALAGUNG 01/03 085218362982

23 S-56CB1610 3324046704940002 VIGA APRILIANA SARI P GURU 27 MTSN 6 PANDEGLANG KP. MEZING LOR 004 085743466333

24 S-B97FF076 3601044207750006 SITI ATIAH P GURU 43 MTSN 6 PANDEGLANG KP.CIKEUSIK 03/02 DS 0819-1090-0296
25 P-SQ4W2CMG 3601041507800003 DENI LISMAYADI L 42 KORMIN DINDIK KEC.CIKKP.CIKEUSIK 02/01 DS 087773090595

26 S-8B314BA5 3601040810860001 ADE SUHARYANA L GURU 35 KP.SITUPOTONG 001/0087773747091

27 S-VVCDE686 3601040611730002 SUHENDRA L HAJI 48 THN KP PARKOS 003/004 0877725158371

28 P-VFTTJDEY 3601046508760002 PITRI P HAJI 45 THN KP PARKOS 003/004 0877725158371

29 S-FC4D264 3601044801580001 SARMI P HAJI 63 THN KP BENDUNGAN

30 S-BI0C169A 3601046705740002 ENI ROHAENI P GURU 46 THN SDN Rancaseneng 1 KP RANCASENENG 001087773162500

31 S-003377BF 3601045202760001 SUMANAH L GURU 45 THN MTSN 6 Pandeglang KP BATUJAYA 002/003 087771287771

32 P-VFBFXTTH 3601046508890001 SITI AISYAH P GURU 32 THN MTSN 6 Pandeglang KP CIKEUSIK 001/001 085779561204

33 S-54211C2A 3601044808790001 HETI SUHAETI P GURU 42 THN MTSN 6 Pandeglang KP CIKEUSIK 002/001 083875371595

34 S-A8B358FE 3601045004790002 ENTIN KARTINI P GURU 42 THN MTSN 6 Pandeglang KP CIKEUSIK 001/001 085213226419

35 P2XMFQ20L 3601047008890001 PUDIN L 10/12/1972 CAL HAJI CIKEUSIK 085817457418

36 P-Z5EKNIM 3601044107670036 ATIAH P 1/7/1967 CAL HAJI CIKEUSIK 085814632160

37 S-F2972ADE 3601046702570001 LILIS P 27/2/1957 CAL HAJI KP. HUNIBERA DESA C083841520717

38 3601040702700003 Acep Sunarya L GURU 2/7/1970 MTSN 6 Pandeglang Cikeusik 081911145245

39 S-AC133B79 3601040301720001 Eman Suparman L GURU 1/3/1972 SDN 5 Cikeusik Kp.Karangsambung 01/04
081297374663
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
sesuai) Merek Tanggal Tanggal Tanggal
BPJS BPJS Non No. No. KET
Vaksin*** Screening Pemberian No seri Pemberian No Seri
PBI Non PBI Anggota Batch Batch
Vaksinasi Vaksinasi
CoronaVac 5/22/2021 5/22/2021 24002221 16164644018174
CoronaVac 5/22/2021 5/22/2021 24002221 16164644018174
CoronaVac 5/22/2021 5/22/2021 24002221 16164644026442
CoronaVac 5/22/2021 5/22/2021 24002221 16164644026442 prof ds 1
CoronaVac 5/22/2021 5/22/2021 24002221 16164644026442
CoronaVac 01/04/2021 01/04/2021 24000821 16134418556808 5/22/2021 24002221 '16164643911782
CoronaVac 4/1/2021 4/1/2021 24000821 16134418587384 5/22/2021 24002221 '16164643911782
CoronaVac 4/1/2021 4/1/2021 24000821 16134418587384 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 16164644018174
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 9/4/2021 9/4/2021 24000821 5/22/2021 24002221 '16164643911782
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694614 5/22/2021 24002221 16164644028470
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694614 5/22/2021 24002221 16164644028470
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694614 5/22/2021 24002221 16164644018174
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694458 5/22/2021 24002221 '16164643911782
CoronaVac 4/14/2021 4/14/2021 24000821 16127459969968 5/22/2021 24002221 16164644018174
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694614 5/22/2021 24002221 16164644018174
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694614 5/22/2021 24002221 16164644018174
CoronaVac 4/14/2021 4/14/2021 24000821 16127778694614 5/22/2021 24002221 16164644018174
CoronaVac 23/4/2021 23/4/2021 240001421 '16127779132818 5/22/2021 24002221 '16164643911782
CoronaVac 23/4/2021 23/4/2021 240001421 '16127779132818 5/22/2021 24002221 '16164643911782
CoronaVac 23/4/2021 23/4/2021 240001421 '16127779132818 5/22/2021 24002221 16164644028470
CoronaVac 4/24/2021 4/24/2021 24000821 16127459968876 5/22/2021 24002221 '16164643911782
CoronaVac 4/24/2021 4/24/2021 24000821 16127459968876 5/22/2021 24002221 '16164643911782
 Nama Penerima Umur Kelomp
NO No. Ticket NIK JK Pekerjaan* INSTANSI
Vaksin (18-59 tahun) ok Umur

1 3601044205650003 P PEL. PUBLIK 10-05-1974

Q-2262BF7D YATI MARYATI
2 3602210110950002 L PEL. PUBLIK 12-04-1996 PLN
S-446E92D0 UNDA SEPIANA
3 3601045207960005 P GURU 12-04-1996 SMP ISLAM DARUSALAM CIKEUSIK
S-F583516C NANI YUNDRIANI
4 3601040604660001 m roji L GURU 4/6/1966 SDN TANJUNGAN 1
S-604DD555
5
S-F6D0662F 3601040708720002 saepudin L GURU 8/7/1972 SD NANGGALA 3
6 3601040801850001 ANDI GINANJAR L GURU 1/8/1985 SMKN PARUNGSARI
S-4528F7D2
7 Y-00004IL3 3601040107670079 JAENUDIN L 51 KORMIN DINDIK KEC.CIKEUSIK
GURU

8 S-0CF4FFF7 3601041506640002 KHOERUDIN L 37 SMP ISLAM DARUSALAM CIKEUSIK

GURU

9 S-5E296C20 3604252307870001 ABDU SOMAD L 34 SMP ISLAM DARUSALAM CIKEUSIK

GURU

10 P-SWN19B7R 3601040107870172 SARIM L 30 SMP ISLAM DARUSALAM CIKEUSIK

GURU

11 S-11E58E2A 3601040911630001 SUBARNAS L GURU 58 THN SMP 1 Cikeusik

12 Eep Saepullah
'3601040107880150 L PEL.PUBLIK 7/5/1989
13
ZAB7BC472 3202112810004 RIZAL DANIAL RINAL L GURU 21-12-1981 SDN CIKEUSIK 1
14 S-F819DC45 3601041901720002 PIPIN L 19-01-1972 MTSN 4 MUNJUL
GURU
15 3602215012910005 RUSNIATI P GURU 10-12-1991 MTSN 6 CIKEUSIK
S-09425D80
16 3601041205750003 SUTISNA SENJAYA, SL GURU 12-05-1975 MTSN 6 CIKEUSIK
S-4EFD563
17 3601040910670001 L GURU 09-10-1967
W-29203539 NURYADI
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
Alamat No. Hp BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
KP. CIWANDAN DESA CURUGCIUNG 085813109226 SINOVAC
16/04/2021 16/04/2021 24000821
KP SUKATANI DESA WANASALAM 085697240741 SINOVAC
02/06/2021 02/06/2021 24002221
KP. CURUGCIUNG 085691312855 SINOVAC 24000821
02/06/2021 02/06/2021
;EMAH SUGIH 085772842119 SARS-CoV-201/04/2021 01/04/2021 24000821

SARS-CoV-201/04/2021 01/04/2021 24000821

SUKAJAYA, NANGGALA 085810134032
SUKASENENG 087771100661 SARS-CoV-24/1/2021 4/1/2021 24000821

KP.CIKALUDAN 03/01 DS.CURUGCIUNG 085282598705 SINOVAC 9/4/2021 9/4/2021 24000821

KP.BUNGURGEDE 04/04 DS.CURUGCIUNG 085779161178 SINOVAC 9/4/2021 9/4/2021 24000821

KP.SAMPANG JAHA 01/01 DS.GUNUNGBATU KEC.MUNJUL 083899530960 SINOVAC 9/4/2021 9/4/2021 24000821

KP.KUKULU 01/01 DS.CURUGCIUNG 08574393845 SINOVAC 9/4/2021 9/4/2021 24000821

KP CIKEUSIK 002/001 085283234417 SINOVAC 4/14/2021 4/14/2021 24000821

Nanggala 085695393554 SARS-CoV-2

4/24/2021 4/24/2021 24000821

SINOVAC
PURWASEDAR KEC. CIRACAP 085798163132 03-05-2021 03-05-2021 24000821
CIKEUSIK 01/01 081385745722 SINOVAC
03-05-2021 03-05-2021 240001421
WANASALAM 083885621238 SINOVAC
03-05-2021 03-05-2021 240001421
KP SINAR BAKTI DESA TANJUNGAN 085886124688 SINOVAC
03-05-2021 03-05-2021 240001421
CIKEUSIK 085782266771 SINOVAC
03-05-2021 03-05-2021 240001421
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi

24000821 16127533015151 prof

02/06/2021

16164644017550
16127533015151

16134418556808 24000821 16127533015151

02/06/2021
16134418587384 24000821 16127533015151
02/06/2021
16134418587384 24000821 16127533015151
02/06/2021
24000821 16127533015151
02/06/2021
24000821 16127533015151
02/06/2021
24000821 16127533015151
02/06/2021
24000821 16127533015151
02/06/2021
16127459969968 24000821 16127533015151
02/06/2021
24000821 16127533015151
16127459968876 02/06/2021
24000821 16127533015151
16127778479506 02/06/2021
24000821 16127533015151
16127533014621 02/06/2021
24000821 16127533015151
16127533013224 02/06/2021
 24000821 16127533015151
16127533013224 02/06/2021
24000821 16127533015151
16127533013224 02/06/2021
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 P-7FYDRJ6H 3313025611960001 Nurul Wahidah P GURU

2 P-9WIHH2VH 3601042708780001 Endi Suhendi L GURU
3 S-75945056 3601086312950001 Iis Komalasari P GURU
4 P-AQ1UFTNO 3601040711750006 Sarnata L TU
5 P-AZK7DSHY 3601041704770003 Sarjuki Suryana L TU
6 P-CEB4IZ2J 3601040111880001 Aji Feri P. L GURU
7 S-F5754DE8 3601040312680001 M. Ridwan Syapei L GURU
8 S-35E179D3 3601042504990002 Dadan Firmansyah L GURU
9 Q-7680603C 3601040202980003 Endin L GURU
10 S-436F5ADA 3601040206840001 Rohman L GURU
11 S-8DCFE651 3601047011890001 Yeni Anggraeni P GURU
12 S-E138101A 36010448019500001 Herlina S. Nurantika P GURU
13 P-HSR46JY5 3601045101970002 Ena Nadia P GURU
14 S-CCDF7BBA 3601044503710003 Retni Suminar P GURU
15 P-KHW2UWBD 3601042208000002 Dicto khajar W. L
16 P-LVDPMNF2 3601044107870122 Nana Sujana L GURU
17 S-8863830F 3601040804950004 Gusti Wisnu R. L GURU
18 3313025611960001 NURUL KURNIAWATI P GURU
19 S-FB631E18 '3602214102790006 SUMIATI P GURU
20 S-D92C3A75 3601042612570001 engkos kosasih L GURU
21 3601047007010001 DEBBY DELIYANA YANTP PEL. PUBLIK
22 P-6CVODBSW 3601040507790001 ENDIH SAHRUDIN L PEL. PUBLIK
 Umur Kelomp
INSTANSI
(18-59 tahun) ok Umur

11/18/1996 SMK 14 PDG

3/9/1979 SMK 14 PDG
12/23/1995 SMK 14 PDG
11/7/1975 SMK 14 PDG
07/05/1875 SMK 14 PDG
11/10/1988 SMPN 1 Cikeusik
12/3/1968 SMPN 4 Cikeusik
4/20/1999 SMPN 4 Cikeusik
12/2/1998 SMPN 4 Cikeusik
2/6/1986 SMPN 4 Cikeusik
7/4/1989 SMPN 4 Cikeusik
1/8/1995 SMPN 4 Cikeusik
8/28/1997 SMPN 4 Cikeusik
3/5/1971 SMPN 3 Cikeusik
8/22/2000
4/24/1987 SMK 14 PDG
4/8/1995 SMK 14 PDG
4/8/1995
01/02/1979 SDN 2 SUKASENENG
9/8/1963 SDN TANJUNGAN 3
30-07-2001
05-06-1980 SEKDES
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Alamat No. Hp BPJS
PBI
Cikeusik 085925338965
Cikeusik 087709958555
Munjul 087875118317
Nanggala 085775156815
Curugciung 085697188485
Cikeusik 085710767999
Cikiruhwetan 081321163908
Cikeusik 085218335220
Nanggala 08153086539
Parungpanjang 085710525649
Nanggala 085762818223
Cikeusik 082125045195
Cikeusik 085780198542
Cikiruhwetan 085764547633
Cikiruhwetan 082121203808
Curugciung 081219687011
Nanggala 085891855844
Cikeusik '085925338965
Kp.pasirnangka '085889408894
SITUPOTONG 085717350249
CIWET 083813538859
Cikeusik 083807493634
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 24002221 16164644026130
coronaVac 6/7/2021 6/7/2021 24002221 16164644026130
SARS-CoV-216/03/2021 16/03/2021 24000821 '16127779132818
SARS-CoV-201/04/2021 01/04/2021 24000821 16134418556808
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

6/7/2021 2400821 16127532804496

6/7/2021 2400821 16127532804496
6/7/2021 2400821 16127532804496
6/7/2021 2400821 16127532804496
NO No. Ticket NIK Nama Penerima Vaksin

1 P-2B11HSCF 3601046401830002 LIA HASTUTI

2 S-92789576 3601043006690001 RADEN SURADIMAN
3 P-2FPGPTQ1 3601040107810160 ANDA
4 P-2JF9QGPF 3601045601830006 ASTI ANDRIANTINI
5 P-2L3GUZ06 3601040103990004 RUNDA
6 S-12C87E6A 3601031207850001 SARYANI
7 S-16D77F7C 3602080704820005 RIZKY MORA SOTARDUGA. H
8 S-CDSC8BE5 3601040510790001 DANURI
9 P-3P219RNA 36010413808750001 ABDUROHMAN
10 S-407D880D 360104490580001 SUHANAH
11 360104445508880001 SITI MUTMAINAH
12 S-E3C41371 3601040705860002 IWAN GUNAWAN
13 S-3DAAE357 3601045205770002 ENDAH HENDAYANI
14 S-512E0E90 3601044107730353 ROHMAN YATI
15 S-BBF27135 3602164506880003 PANCA YUNIA S
16 F-ASBFA3D 3601042702860001 VERI IKHSANUDIN
17 S-1AED4BEA 3601041006880004 ZEZEN ARZENI
18 S-DD4F3D0C 3601040602780002 ASEP MULYANA
19 S-SEDB1C23 3601044607860001 MARFU'AH
20 S-F0BF9827 3601031808780001 FIRMANSYAH
21 3601044607820002 ETIH
22 3601044301780002 HENI KUSMAWATI
23 S-DFB24DFC 3601043005680001 DEDI SETIADI
24 P-41UTKH0 3601046802960002 ERLA NH
25 S-BD23A9C1 3601041811870002 M. ILHAM, S.PD
26 S-EEA49D55 3602214511720001 SUWARSIH
27 P-5BFT3253 3601045106900006 NUR RODIAH
28 3601041705720001 SUHARTO
29 S-791B974B 3601081503950002 CEPI SUHENDRA
30 S-C6B53B5B 360201108790001 UJANG ABDUROHMAN
31 360104410790027 PUTRI RIZKI
32 P-5M9PCE9V 3601046901940002 ELIS SETYOWATI
33 S-FF848574 3601032507810001 ARKA
34 3601044706990005 EGA RAHMAWATI
35 S-CEB092D8 3601045411860001 MIMIN MIRAHWATI
36 S-7165349D 3601045905880001 ROSITA
37 P-5VFPUMUY 3601045112990006 EPITA SURYAWATI
38 S-A49A3E07 3601040607850005 NURYANI
39 S-DFE3310B 360104160872001 SAIDI
40 S-46B3D1EF 3601041508840004 WARNATA
41 P-6123HQQ3 3601040602870005 UDIN KOMARUDIN
42 S-093E0477 3601046405860001 IMAS SUSANTI
43 S-D04AB746 3601045606860001 YAYAT SUMYATI
44 S-74C2A102 3601084107890025 TITIN SITI PATIMAH
45 S-E09676A5 3601044507810005 TATI LESTARI
46 P-G3LBWLMJ 3601045604800002 ENDRAWATI
47 S-00ABAC5A 3601041503850002 SUKARDI
48 S-4BABE3BF 3601041603830004 NURJAEDI
49 S-F1074FIB 3601040107690024 SUANTA
50 S-962004C6 3601255006930002 RENI YUNIAWATI
51 S-7EE9DA55 3601044107740086 ROHATINI
52 P-6ALV56BE 3601040911860004 AMIN SUPYANI
53 3601041710740002 DASTA SUTRISNA
54 P-6FF34EHR 360104010701-268 AGI SUNARI
55 S-136D5D7B 3601046003870002 WITIN S
56 S-75EC3C87 3601044711740001 BETI HERAWATI
57 S-8F96970F 3601042008860001 RUKANDA
58 S-C7D683CD 3601040107810152 ASEP ROHIMAT S
59 S-4D32586B 3601044606730002 SAROH KUSNAWATI
60 3602164506880003 PANCA YUNIA
61 S-4BEB7B43 '3601040501690003 Aang Hidayat
62 S-29361632 3601050906600002 AHYANI
63 3601044101570001 HJ HINDUN
64 S-C653D93 3601046012780001 KHUMAEROH
65 S-AE554BFC 3601041704400002 H. SADE
66 S-2CBE6B16 3601046101490001 HJ SAWIYAH
67 7 S-4C48C008 36041902780003 SAPRIA
68 S-D20A8753 3601046506820001 IRMA YULIANTI
 Umur Kelomp
JK Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

P GURU 24-01-1983 SMPN 1 CIKEUSIK

L GURU 30-06-1969 SMPN 2 CIKEUSIK
L ODGJ 17-09-1983 ODGJ
P GURU 08-09-1983 SDN 2 UMBULAN
L PEL. PUBLIK 01-03-1999 PEL. PUBLIK
L GURU 12-07-1985 MTSN 6 PANDEGLANG
L GURU 07-04-1982 SMPN 2 CIKEUSIK
L GURU 05-10-1979 SMPN 2 CIKEUSIK
L MASYARAKAT UMUM13-08-1975 MASYARAKAT UMUM
P GURU 04-05-1985 MA DARUL HASAN
P GURU 05-10-1988 SMK 14 PANDEGLANG
L GURU 07-05-1986 SMPN 1 CIKEUSIK
P GURU 01-05-1977 SDN 3 CIWET
P GURU 02-03-1972 SDN 1 UMBULAN
P GURU 05-06-1988 SDN 3 CIWET
L GURU 14-09-1986 SDN 3 SUMUR BATU
L GURU 10-06-1988 MIS AT TORIQIYAH
L SATPAM 06-02-1978 SMAN 18 PANDEGLA
P GURU 09-02-1979 MTS HUNIBERA
L GURU 18-08-1978 MTSN 6 PANDEGLANG
P GURU 06-07-1982 SMPN 2 CIKEUSIK
P GURU 03-01-1978 SDN 3 CIWET
L GURU 30-05-1968 SMPN 1 CIKEUSIK
P GURU 28-02-1996 SDN 3 CIWET
L GURU 05-07-1988 SMPN 1 CIKEUSIK
P GURU 05-11-1972 SDN 3 CIWET
P GURU 11-06-1990 SDN 5 SUMUR BATU
L BALAI PENYULUH 17-05-1972 BALAI PENYULUH KB
L GURU 10-02-1996 SMPN 2 CIKEUSIK
L GURU 21-08-1974 SMPN 2 CIKEUSIK
P GURU 17-12-1997 SDN 5 SUMUR BATU
P GURU 28-01-1994 SDN 5 SUMUR BATU
L GURU 02-02-1982 MA DARUL HASAN CI
P GURU 07-06-1999 SDN 5 SUMUR BATU
P GURU 14-11-1986 MA DARUL HASAN CI
P GURU 28-08-1990 SDN 1 UMBULAN
 P PEL. PUBLIK 11-12-1999
L GURU 24-08-1985 SMPN 2 CIKEUSIK
L PEL. PUBLIK 23-04-1971
L GURU 15-08-1983 MTSN 6 CIKEUSIK
L GURU 10-05-1983 SDN 3 UMBULAN
P GURU 24-05-1986 MA DARUL HASAN
P GURU 03-03-1985 SMPN 2 CIKEUSIK
P GURU 09-09-1990 SDN 2 CURCI
P GURU 05-07-1981 SDN 2 SUKASENENG
P GURU 15-04-1980 SDN 3 CIKEUSIK
L GURU 11-11-1971 SDN SUKASENENG 2
L GURU 16-03-1993 SDN 1 CIKADONGDO
L GURU 30-03-1964 SDN 5 CIKEUSIK
P GURU 10-06-1963 SDN 2 CIKDONG
P GURU 20-02-1974 SDN CURCI 2
L GURU 09-11-1986 SDN 3 UMBULAN
L GURU 17-10-1974 SMPN 2 CIKEUSIK
L PEL. PUBLIK 26-03-2001
P GURU 20-03-1986 SDN 2 CIKDONG
P GURU 07-11-1974 SMPN 2 CIKEUSIK
L GURU 20-08-1986 MTS NURUL FALAH
L GURU 25-12-1981
P GURU 06-06-1973 SDN 4 CIKEUSIK
P 05/06/1988
L GURU '03-01-1964
L GURU 9/5/1966 SDN CIKIRUHWETAN 3
P 1/1/1957 LANSIA
L GURU 20-02-1978 SDN CIWET 1
L LANSIA 05-06-1935 CAL UMROH
P LANSIA 05-08-1942 CAL UMROH
L GURU 2/19/1970 MTSN 6 PDG
P GURU 6/25/1982 SMPN 2 CKS
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat No. Hp BPJS BPJS Non
PBI Non PBI Anggota

CIRIGI 083873694692
KP.BABAKAN BANDUNG DS CIWET 085773225861
SUKAMULYA 082258152607
SUKAWARIS 085281765087
CIBANGKONOL,, DS SUKAMULYA 081617499293
SUKAJADI, CIBALING 081210952211
085216929817
085693482221
KP. SUKAJADI DESA UMBULAN
KP. KUBANG PANCAL DESA CIKADONGDO 081398428632
KP SUKARATU DESA NANGGALA 082332912765
KP. CIKEUSIK DESA CIKEUSIK 085219708063
KP.HUNIBERA DESA CIWET
085693346668
KP. BABAKAN BANDUNG DESA CIW 082114790560
UR BATU 087871236788
KP. CIKEUSIK KALER DESA CIKEUS 085216619010
KP. CITARIK DESA CIKEUSIK 083898870076
KP. BABAKAN CIBALIUNG DESA R 081211557158
NDEGLANG 081318704708
KP. CITARIK DESA CIKEUSIK 081318704708
KP.BABAKAN BANDUNG DESA CIW 081285554441
085718886543
KP. BABAKAN BANDUNG DESA CIW 083802976996
KP. SUKASENENG DESA CIKEUSIK
KP. KUBANG LELE DESA WANASAL 085319216090
KP. TANJUNG JAYA DESA SUMURB 085817794430
KP. CILANCAR DESA NANGGALA 085770295133
KP.PESANGGRAHAN DESA PASAN 081284438082
KP. CEMPAKASARI DESA SUKARAJ 087772691175
KP. TANJUNG JAYA DESA SUMURB 085692045839
KP. SUKAWARIS DESA SUKAWARIS 081315286455
KP.KIBODAS DESA CIHANJUANG 085215512367
KP. TANJUNG JAYA DESA SUMUR 085693976638
KP. CIKEUSIK DESA CIKEUSIK 081382341934
KP. UMBULAN DESA UMBULAN 085782631409
KP. BABAKAN BANDUNG DESA CIW 081910941769
KP. UMBULAN DESA UMBULAN 085883381945
KP. PEMTANG SEMPUR DESA SUK 087779266490
KP. PEMATANG SEMPUR CIKEUSIK 081221222800
KP. UMBULAN DESA UMBULAN 085891372088
KP. CIKEUSIK DESA CIKEUSIK 083812911727
KP. UMBULAN DESA UMBULAN 085891255722
CURUGCIUNG 085715265906
CIKEUSIK 085280388990
CIKEUSIK 081383792666
CIKEUSIK 083808254038
CIKEUSIK 085311527362
RANCASENENG CIKEUSIK 085210027169
CIPAAS CIKDONG 085772394364
CIKALUDAN CURCI 085774964995
UMBULAN CKS 081283512383
RANCASENENG CIKEUSIK 085218008900
BABAKAN BANDUNG CIWET 085719062963
CIKDONG 085717130450
BABAKAN BANDUNG CIWET 085813720148
RANCASENENG CIKEUSIK 085691090127
SUKASENENG 085214150505
CIKEUSIK 085319411486
CIWET 081214790560
Kp.hunibera Ds.Cikiruhwetan '082312009294
MALINGPING 081283848786
CIKEUSIK 083841520717
KP. SUKAWARIS DESA SUKAWARIS081585721781
KP. MALANG SARI CIWET 085813294452
KP. MALANG SARI CIWET 085813294452
UMBULAN 081574883922
UMBULAN 081574883922
 Dosis I Dosis 2
Merek Tanggal Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri Pemberian
Vaksinasi Vaksinasi
SINOVAC 21-06-2021 21-06-2021 24002221 16164644021450
SINOVAC 21-06-2021 21-06-2021 24002221 16164644021450
SINOVAC 21-06-2021 21-06-2021 24002221 16164644021450
SINOVAC 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24000821 16127532807304
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
 CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
CORONAVAC 02/09/21 21/06/21 24003121
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '1612777868353821-06-2021
SARS-CoV-2 4/1/2021 4/1/2021 24000821 16134418556808 21-06-2021
SINOVAC 23/4/2021 23/4/2021 240001421 '16127779132818 21-06-2021
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224 21-06-2021
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224 21-06-2021
SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224 21-06-2021
CoronaVac 5/22/2021 5/22/2021 24002221 16164644026442 21-06-2021
CoronaVac 5/22/2021 5/22/2021 24002221 16164644026442 21-06-2021
Dosis 2

KET
No. Batch No Seri
24002221 16164644021450
24002221 16164644021450
24002221 16164644021450
24002221 16164644021450
24002221 16164644021450
24002221 16164644021450
24002221 16164644021450
24002221 16164644021450
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 P-FN6MBYTA 3601044706830002 ALPIAH P PUBLIK

2 P-HBEWS3KD 3601040109800004 OYO SUTOYO L GURU
3 P-J6F3VBZW 3601045106820002 SUMARTI P KADER
4 P-M3VNJSGN 3601044510820004 SUMYATI SULAETI P GURU
5 P-M4PMZGO9 3601045002860006 DINI YULIANTI P GURU
6 P-M5AUTMHO 3601086909690001 SITI AMINAH P GURU
7 P-M6JIJIXM 3601045906900003 MISNI P KADER
8 P-M7SI8MQW 3601044403950002 FITRI HANDAYANI P KADER
9 P-M9EO5QA7 3601044107870110 TITIN P KADER
10 P-MBDIJCDS 3601045005860002 ACIH P KADER
11 P-MBXMQZUF 3601044103800003 HENI P KADER
12 P-MDR2G7BN 3601046911860001 UUN K P KADER
13 P-MI4LJ6MS 3601041602720001 ASEP TATANG P GURU
14 P-MISZFP0P 3601045705770001 ETI JUMIATI P KADER
15 P-MJIRNJDL 3601044607760003 AAM SAMSIAH P KADES
16 P-MKVSQQF3 3601042209930001 M. REDI SEPTIANA L PRADES
17 P-MLP2WL5C 3601046803790002 UJU JUARSIH P GURU
18 P-MN75M5E0 360221011950002 UNDA SEPIANA L PLN
19 P-MYXNLMNX 3601044207860008 ENENG HARTATI P KADER
20 P-N9WAVMHJ 3601045603820001 SITI LILIS P KADER
21 P-NHQOG4MV 3601045512830001 ENTIN SURYATIN P KADER
22 P-NQQEYT6L 3601044903840001 TATI NINGRAT P KADER
23 P-NROIL00W 3601045311850001 MULYATI P KADER
24 P-NTFF39CX 3601044107740116 SITI AISAH P KADER
25 P-NWT4L2TT 3601045211660001 MIMIN SUMINAR P GURU
26 P-O3JPBYD1 3601041305760001 ROHANI L PNS
27 P-O71EVWEA 3601040107720088 KADRIAH DIDI E. L GURU
28 P-O7S5IRSX 3601044107830354 partinawati p kader
29 S-2919B42D 3601044609980005 erla nurazizah p GURU
30 S-293CF73C 3601046207770002 euis kartini p GURU
31 S-2A2B0D32 3601045203780003 sunariah p kader
32 S-4A3A63D6 3601044107860238 maryamah p kader
33 S-54A53BBA 3601040107970220 m. abdulah L PUBLIK
34 S-774D80FE 3601043011800001 idam L PUBLIK
35 S-A8A69D50 3601041703910001 rudi haryanto L GURU
36 S-C2FA6955 3601040309970001 DIKI SEPTIANA L PUBLIK
37 S-CD54E009 3601045609950001 ERMAWATI P KADER
38 S-CDD4197C 3601047005990001 MAYA LESTARI P PUBLIK
39 S-D14B5550 3601045510710002 ROHANIAH P KADES
40 Z-000123IW 3601045201670002 DEDEH P PUBLIK
41 3601046911860001 UUN KURNAESIH P
 Kepesertaan BPJS
'Ya' pada kolom y
Umur Kelomp
INSTANSI Alamat No. Hp BPJS
(18-59 tahun) ok Umur
PBI

6/7/1983 PUBLIK CIKEUSIK 082125045188

8/8/1980 guru CIKEUSIK 085313117522
6/11/1982 KADER SUKAMULYA 085697874691
05/101982 SMP 2 CKS SUMURBATU 085694956630
8/14/2001 SMP 2 CKS UMBULAN 085692729249
9/29/1969 SDN CURCI 3 MUNJUL 088293632543
6/19/1990 KADER CIKADONGDONG 085711943562
2/3/1995 KADER CIKADONGDONG 085888437244
10/7/1988 KADER UMBULAN 085280255980
5/10/1988 KADER UMBULAN 085211674967
11/9/1985 KADER SUKAMULYA 081511959161
4/3/1988 KADER SUKAMULYA 085773484819
5/2/1972 SMP 2 CKS UMBULAN 085694941713
5/17/1977 KADER CIKEUSIK 085694473876
7/6/1976 KADER CIKEUSIK 085694137248
9/22/1993 PRADES SUKASENENG 08157860280
3/28/1979 TK NANGGALA CIBALIUNG 083147213596
4/12/1996 PLN WANASALAM 085697240741
8/2/1984 KADER CIKEUSIK 085215739876
3/16/1982 KADER CIKEUSIK 085714790105
6/14/1979 KADER SUKASENENG
5/13/1983 KADER SUKASENENG 085695412791
3/1/1989 KADER SUKAMULYA 081213436207
4/29/1973 KADER SUKASENENG 085287821540
5/6/1965 SMP 3 CKS CIKEUSIK 085778185736
10/3/1976 TK NANGGALA NANGGALA 085736243228
6/12/1972 SMP 1 CKS UMBULAN 085691857859
11/5/1985 KADER SUKASENENG 085891153659
9/6/1988 sdn 3 sukawaris WANASALAM 083890673944
7/22/1977 sdn 3 sukawaris WANASALAM 081287120453
3/12/1978 KADER UMBULAN 082213486621
7/1/1986 KADER UMBULAN 085719423204
8/16/1996 PUBLIK UMBULAN 085710525716
3/14/1979 PUBLIK NANGGALA 081381926127
3/17/1991 SMP 1 CKS CIKEUSIK 085216922070
9/3/1997 PUBLIK NANGGALA 085883657215
11/23/1995 KADER SUKAMULYA 083841505933
5/30/1999 PUBLIK CIKEUSIK 085770136373
1/15/1971 KADES NANGGALA 085770136373
1/12/1967 PUBLIK CIKEUSIK 085770136373
03-04-1988 SUKAMULYA 08577348819
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch
Non PBI Anggota
Vaksinasi
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 8/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
coronaVac 6/28/2021 6/28/2021 24002221
CoronaVac 28-06-2021 28-06-2021 24002021
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
6/28/2021 24002221 16164643898366
16164643898366
16164643898366
16164643898366
16164643898366
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643903202
16164643900534
16164643900534
16164643900534
16164643900534
16164643900534
16164643900534
16164643900534
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 P-7Q0RFH3O 360104470398004 SRI LESTARI P

2 S-3DA93B98 3601046409750001 UPIT SUPRIATI P
3 P-BCS67F02 3601045112670001 EUIS NURHAYATI P
4 S-2F563196 3601046312820002 NENI NURHAENI P
5 Y-012ZNH89 3173060470000 HENDRY WIJAYA L
6 Y-013085UD 31730627003630002 TIOE HERMAN L
7 P-CDK40E5A 3601042502890001 TRIMO ARI PRAYUGO L
8 P-ELB42XV1 3601046412000002 FITRIYANTI P
9 S-02CC2296 3601045118843 SITI ROSINAH P
10 S-60EGF0DE 3601040701740001 DIDI SUHAEDI L
11 P-JKMX6O0P0 3601040309000008 FAHRY AL HAYYU F L
12 SEZF4E83A 3601046704890001 SITI HAWA P
13 S-8C81F0C7 3601045708750002 DARINIH P
14 P-MNUT21RR 360221500990005 SELI NURRANI P
15 P-002ZJEB0 3601040504990003 SAEPUDIN L
16 Q-0009B0H3 3601042810670001 ADE KURNIADI L

17 S-I5339A49 360104420690005 KARTINI P

18 S-28392511 3601044107920063 WIWI ANGGRAENI P

19 S-9773A6AE 3601046011970006 FELLA ATTAQI P

20 S-E7101867 360112430560001 RISTINI P

21 S-A372BB99 3601044107720089 YUYUN YUNENGSIH P

22 P-PELG52J7 120726231090002 M. RUSDI SIREGAR L

23 S-6E956B45 3601045203940004 IPAH SARIPAH P

24 P-PK0DZ 36010452040003 HADISAH P

25 P-PLN7OJ60 3601044311780001 HOLIAH P

26 S-52E6A017 360104010790158 SUBIYANI L

27 P-PMPFNATI 3601040904890002 ERWIN HERIYANTO L

28 P-PO0OUNU7 360104230990001 AINUN AZIZ L

29 S-239AB5F3 3601042403580 H. SARHANI L

30 P-PS0TB4MW 3601041907950001 SOLEH JATNIKO L

31 S-068B483E 3601046088500002 DALIM L

32 S-B5527CCA 360104520289000 NENIH MARTINAH P

33 P-PRTDKBZD 3601041002870004 AGUS KHAELANI L

34 P-PTJULMUU 360104074850002 IWAN RIDWANUDIN L

35 3601045012620002 DANI RAMDANI L

36 S-C88ADBEB 3601044212840001 SITI MUTIAH P

37 P-PW43U28V 3601040107010252 M.WANDI L

38 P-PYGMHCHM 36010 NANANG MULYANA L

39 P-Q0ED8PIK 3601042211000001 WIRO SUDIARTO L

40 P-Q28FGG3R 360104 NURHAELI L

41 P-Q4WG8SY5 3601041711890002 OTONG HAETAMI L

42 P-Q6H10Y5U 360 ELAH HASTUTI P

43 S-CDAB90DD 3601046105760001 N. IIS MURNASIH SAG P

44 P-Q9EARGAA 3601045207870006 YUSILAWATI P

45 P-Q3NR0TNV 360 RITA RISMAWATI P

46 P-Q8HDPO10 3601044310980002 EKA ERLIANTI P

47 P-Q9UPCQMN 3601045411980001 ETI P

48 P-QAW0GEV2 3601041103930000 ADE SURETNO L

49 P-QBSU5OEP 360104 SITI NURAENI P

50 P-QCR703I2 360104470160002 JUARIAH P

51 P-QDUJKL3M 3601041208890003 DAYAT HIDAYAT L

52 P-QDQXARS3 36010 MUHAMAD RIFA'I P

53 P-QFB9XI57 360104 ENDANG SUPARJI L

54 P-QERQ9LPY 3601042272350003 SAKAM L

55 P-QJ4BYVHN 3601042911927002 Riki REPANGGA L

56 P-QGMMRO9S 3601040607670004 ADE MULYANA L

57 P-QJL3KJTK 3601046907010002 IRMAYANTI P

58 P-QKWYMNV8 3601042703880001 TULUS MUCHLISIN P

59 Q-0009GVKY 3601045306960001 YUNI H P

60 P-QKQH6TQC 3601040107590017 UJANG ROHALI L

61 P-QLNY4IZP 360104481270001 TETI SUMiATI P

62 Y-0131HFWX 3173066650803003 YULIANTI HERMAN P

63 P-QMLDBWH4 3601045009960001 IJAH P

64 S-D663F38B 360114591291000 DESTI KOMALASARI P

65 P-1KHMQR3G 3601042303110002 ADWIN MARSELIO L

66 P-1MLMXG3M 3601040107790065 SUPYANI L

67 P-00Z2EWYW 3601343004840001 MUSA ARDAUS L

68 Q-0009GVF9 3601041301000002 DODI ARYA R L

69 P-3AH1LNIF 36010405 DARWIAH L

70 P-23VY1RRR 3601040107720085 TATA L

71 P-2HNTHSDB 3601044107730104 SRI WASTINAH P

72 P-2G79LD3V 3601041006720003 SUHARJA L

73 P-3VPENOHM 3601041301850002 IHAD SUHADA L

74 P-4LU1AICE RASiman L

75 P-3AA418DD 3601042106850004 SARNATA L

76 P-3UNAEVDC 3601040905800001 KANSARI L

77 P-33X3NWZ9 3601041212860003 ATMA L

78 P-QSOU2CP7 360104160460003 ARSA/ASRA L

79 S-FC787D86 3601041910890001 AGUS GUNAWAN L
80 S-EE84780B 3601040107920005 TOIP SUDARMADI L
81 S-A23746F4 3601040107760008 MASRI L
82 P-QOTEUK8H 3601046112990004 BAYU WAHYU AGUNG L
83 P-QNNKBXN0 3601040101850001 KUSMAN L
84 P-QRPYKIR1 3601044303990001 RESTI NURHASANAH P
85 36010402041890008 SUPARMAN L
86 360104581200001 DISA R P
87 S-849832D3 3601040307860002 KHOERUDIN L
88 S-31F9676B 360104591170008 EEN KOMALASARI L
89 S-256737F1 3601046103500001 FAUZAH P
90 P-QTYU211F 3601040108790002 TB RAHMAT H L
91 P-QWJDEQEI TB ROSADI RUSLAN L
92 P-QVQKS3L6 360104140590003 UJANG SAHRUL L
93 S-D83DCB9C 36010441604900003 MAHDI SUDRAJAT L
94 P-QTVDDL3G 3601041501610001 ABENG L
95 P-QPNG5E6S 3601040602930005 TATA L
96 P-QXTNRSMC 3601042105850001 RODIANSYAH L
97 P-R5J2JFS4 3601045004980004 NENG ENI P
98 AKMAR L
99 S-60E9F0DE 3210190210940001 DIDI RUSMADI L
100 P-R26AEQHC 360104017910046 ABDUL BASIT L
101 S-59B05C13 36010402038110003 USMAN SUPARMAN L
102 3601042507720002 MARDI L
103 3601040506780001 HARNA BIANTO L
104 S-9CA310F3 3601045306870003 IPAH PAUJIAH P
105 P-R7S5OGZU 3601040107780001 ASTIM L
106 P-QXFGVBMA 360104017760005 EMAN L
107 P-QYNTQV2C 3601044704820004 ELIS P
108 S-709E619D 3601040107800031 RAPI L
109 S-D7168E55 360113200480004 MUHAMAD HATTA L
110 Y-00004ILJ 3601042005870004 SARIPUDIN L
111 3601045511890001 MARLINA P
112 S-6E767403 3601040107910031 BAHTIAR RIFAI L
113 S-2D22B9A8 3601046103500001 WAWAN S L
114 P-R8BUL3MR 3601045104980006 NINA AGUSTINA P
115 P-REX1ACGV 3601040305910001 DEDE RAFIUDIN L
116 P-R9SG9OEX 360105111890001 AHMAD BADRU L
117 P-R9IK1ETT 3601046309980001 AYUNI P
118 P-RCVADBPJ 3601040502010002 ADI AHWANI L
119 P-RBVKCFLO 3601041210970004 DADAN SOPYAN L
120 P-RFWWVKAU 3601045507890001 SADIAH P
121 P-RG993P09 3601045504320002 KARINAH P
122 P-RHC76JA5 360104570070003 WASKINAH P
123 P-RI7BUEBJ 360104150770009 TALING L
124 P-RHSL96GN 3601044108010004 AYU KOMALASARI P
125 P-RJ2WNCBQ 360104640472002 YETTI SUDIYATI S.PD P
126 S-50C7DCD3 3601040107960038 DAUD FIRDAUS L
127 P-R6PO7YKA 360104200290001 M. JAMALUDIN L
128 P-RKBW663E 3601041002850003 JOJON JUHENI S.PD L
129 S-0A03C913 360104530450001 EUIS ISNAWATI P
130 Q-0009GV7J 3216021707960005 FIKRI MAULI UTOMI L
131 P-RMMZSUP3 3601042104910001 ASEP SUNANDAR L
132 P-RN6J7ZMZ 3601040203750005 UJER JAERUDIN L
133 S-3B5CF936 3601040803900001 DARNA L
134 P-RNDIMLFX 3204152703630001 ASEP SUPARMAN L
135 P-RNP1IJPO 3601042509890001 SUMANTA L
136 Q-0009GVFN ENDI ROHENDI L
137 S-11F8E75B '360104190370001 BAKRI ADI S L
138 P-ROR4ALRC 3601040110960009 DIKI SUNANDI L
139 P-RPCTLOT7 3601044605020001 KARMILA P
140 P-RPGFCSR2 3601046111740001 KOSASIH L
141 P-2KF6RU7Y 3601040908860002 EDI SUPRIYADI L
142 P-4PSYVNIX 3601041002680007 SUWARNO L
143 3601041507700032 TALING L
144 360104650484001 Tati Maryati P
145 S-71B1B070 3601040607720001 AJAT SUDRAJAT L
 Umur Kelompok
Pekerjaan* INSTANSI
(18-59 tahun) Umur

PEL.PUBLIK 07-05-1998

GURU 24-09-1975 MTS NURUL FALAH

11-12-1967

GURU 23-12-1982 SDN SUKASENENG 2

TAMBAK 04-07-2000

TAMBAK 27-03-1963

GURU 25-01-1989 SMPN 1 CIKEUSIK

24-12-2000

GURU 11-08-1988 MTS NURUL FALAH

GURU 30-04-1974 MTS NURUL FALAH

03-04-2000

GURU 27-04-1989 SMPN 1 CIKEUSIK

GURU 17-08-1975 MTSN NURUL FALAH

10-09-1999

05-04-1999
28-10-1967

GURU 02-06-1990 MTSN NURUL FALAH

GURU 13-03-1992 SMPN 2 CIKEUSIK

GURU 20-11-1997 MTSN NURUL FALAH

GURU 03-05-1964 SMPN 1 CIKEUSIK

GURU 02-02-1973 SDN SUKAMULYA 3

23-10-1994

14-07-1994

05-03-1969

03-11-1978

GURU 07-05-1989 MTS NURUL FALAH RCS

PRADES 20-08-1989 PRADES

23-05-1996

13-06-1958

11-07-1995
GURU 06-08-1985 SDN 2 CIWET

GURU 25-03-1988 SDN 3 CIWET

PRADES 10-02-1987 PRADES

PRADES 07-04-1985 PRADES

GURU 09-07-1984

GURU 12-12-1984 SDN 32 CIKDONG

29-07-2000

PRADES 02-04-1982 PRADES

22-11-2000

09-02-1985

PRADES 17-11-1989 PRADES

KADER 15-07-1993 KADER

GURU 21-05-1976 SMPN 1 CIKEUSIK

GURU 12-07-1987 SMPN 2 CIKEUSIK

KADER 07-06-1992 KADER

PRADES 28-05-1996 PRADES

PRADES 20-10-1995 PRADES

GURU 11-03-1993

10-08-2001

02-09-1969

PRADES 12-08-1989 PRADES CIKDONG

PRADES 13-11-1998 PRADES

17-07-1985

22-12-1995

18-05-1999

PRADES 17-06-1976 PRADES CIWET

29-07-2001

PRADES 03-06-1997 PRADES

PRADES 13-06-1996 PREDES CIWET

23-12-1965

08-12-1970

25-08-1963
PRADES 02-02-1997 PREDES CIWET
19-12-1991

06-03-2002

CAL KADES 08-11-1979 CAL KADES

30-04-1984

13-01-2000

05-03-1977

08-03-1972

20-03-1962

CAL KADES 10-06-1972 CAL KADES

17-08-1984

25-07-1980

21-06-1985

07-06-1981

12-12-1996

publik 16/04/1965 publik

publik 19/10/1989 publik

publik 04/05/1988 publik

publik 06/02/1975 publik

publik 01/12/1999 publik

publik 13/06/1986 publik

publik 03/03/1999 publik

publik 07/04/1987 publik

publik 18/12/2000 publik

publik 13/07/1986 publik

publik 15/03/1988 publik

publik 02/07/1996 publik

publik 12/03/1979 publik

publik 24/06/1987 publik

publik 08/02/1995 publik

publik 16/04/1990 publik

publik 15/11/1961 publik

publik 08/02/1993 publik

publik 21/05/1985 publik

publik 07/07/1998 publik

publik 01/07/1965 publik

publik 02/10/1994 publik

publik 26/05/1992 publik

publik 13/051981 publik

publik 25/07/1972 publik

publik 18/02/1987 publik

publik 13/06/1987 publik

publik 12/08/1974 publik

publik 10/12/1974 publik

publik 07/04/1982 publik

publik 22/11/1987 publik

publik 21/04/1981 publik

publik 20/05/1987 publik

publik 04/07/1994 publik

publik 21/04/1992 publik

publik 12/12/1982 publik

publik 11/04/1998 publik

publik 05/05/1991 publik

publik 11/11/1989 publik

publik 23/09/1998 publik

publik 05/02/1991 publik

publik 12/10/1997 publik

publik 15/07/1989 publik

publik 03/09/1983 publik

publik 17/09/1977 publik

publik 15/07/1970 publik

publik 01/08/2001 publik

GURU 24/04/1972 SMPN 1 CIKEUSIK

publik 02-10-1996 publik

publik 20-02-1989 publik

publik 10-02-1985 publik

publik 13-04-1985 publik

publik 17/07/1996 publik

publik 24/08/1990 publik

publik 11/04/1975 publik

publik 07/05/1989 publik

publik 27/03/1963 publik

publik 11/08/1989 publik

publik 17/12/1975 publik

publik 14/03/1974 publik

publik 01/10/1996 publik

publik 06/05/2002 publik

publik 01/11/1994 publik

publik 09/08/1986 publik

publik 10/02/1968 publik

15-07-1970
Pel.Publik '25-04-1984
GURU 7/6/1974 SDN C\IHARA
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Alamat No. Hp BPJS sesuai)
BPJS Non Merek Vaksin***
PBI Non PBI Anggota
CIKEUSIK 085210405671 SINOVAC

RANCASENENG 085782131421 SINOVAC

CIKEUSIK 085313197869 SINOVAC

CIKEUSIK 083874999426 SINOVAC

CIWET/JKT 082210287908 SINOVAC

CIWET/JKT 081285790275 SINOVAC

CIKEUSIK 083871333342 SINOVAC

CIWET 081908966363 SINOVAC

UMBULAN, CIKEUSIK 081585118843 SINOVAC

RANCASENENG 081282873433 SINOVAC

081280516159 SINOVAC

CIKEUSIK 081933836764 SINOVAC

RANCASENENG 081511407765 SINOVAC

BINUANGEN 087711169347 SINOVAC

UMBULAN '081210595119 SINOVAC

CIWET 08567331321 SINOVAC

NANGGALA 085210829889 SINOVAC

SUMURBATU 085887391436 SINOVAC

CIKEUSIK 085711059082 SINOVAC

081316674807 SINOVAC

SUKAENENG 085883441863 SINOVAC

CIKEUSIK 082312399266 SINOVAC

CIKEUSIK 083896259674 SINOVAC

KADIRI 085774685998 SINOVAC

CIWET 087773161677 SINOVAC

CIKEUSIK 085776131060 SINOVAC

KP.CIPAAS DESA CIKADONDONG 085882762225 SINOVAC

RANCASENENG 083812113389 SINOVAC

KP. KENDAL DESA CIKEUSIK KEC 082138304522 SINOVAC

KP. CIKAREO DESA SUKAWARIS 081222897132 SINOVAC

CIWET 081953516010 SINOVAC

CIWET 085782635792 SINOVAC

KP KOLELET DESA CIKADONGD 08569121293 SINOVAC

NANGGALA 081517430984 SINOVAC

KP SUMUR BATU DESA SUMURB 085714776851 SINOVAC

CIKADONGDONG 085691947858 SINOVAC

PEUNDEUY 081511870242 SINOVAC

KP. KIARA JANGKUNG DESA SU 085897845323 SINOVAC

KP. CILANCAR DESA NANGGALA 085210420223 SINOVAC

KP. CIPAAS DESA CIKADONGDO 085782266752 SINOVAC

CIKEUSIK 083878957799 SINOVAC

KP. CIRIRIGI DESA SUKASENENG 085719775300 SINOVAC

CIKEUSIK 081284804141 SINOVAC

CIWET 085210705235 SINOVAC

KP. CIRIRIGI DESA SUKASENENG 085716363966 SINOVAC

KP.CIPAAS DESA CIKADONDONG 085319143109 SINOVAC

KP. MURUY DESA CIKADONGDO 085817963393 SINOVAC

SUKAWARIS 085219322377 SINOVAC

CIKEUSIK 085210790104 SINOVAC

RANCASENENG 085219673277 SINOVAC

BABAKAN BANDUNG 081297517650 SINOVAC

KP. CIPAAS DESA CIKADONGDO 085883898310 SINOVAC

CIWET 085773883624 SINOVAC

SUMURBATU 085210532645 SINOVAC

CIKEUSIK 0818169076 SINOVAC

CIKADONGDONG 085774393903 SINOVAC

SUKA SENENG 085695271072 SINOVAC

CIWET 085894541105 SINOVAC

CIWET ;08569513776 SINOVAC

RANCASENENG 085219895865 SINOVAC

CIKADONGDONG 08558165467 SINOVAC

CIWET/JKT 081287298246 SINOVAC

CIWET 085930095559 SINOVAC

RANCASENENG 081319118320 SINOVAC

RANCASENENG 085770912174 SINOVAC

KP. BENGER DESA NANGGALA 085710750999 SINOVAC

KP KADIRI DESA CIWET 081585134039 SINOVAC

CIKEUSIK 081280270603 SINOVAC

RANCASENENG 085811439792 SINOVAC

SK MULYA 085813337385 SINOVAC

RANCSENENG 085779570639 SINOVAC

NANGGALA 085218581679 SINOVAC

SUKAWARIS 087773035661 SINOVAC

CIWET 087773993525 SINOVAC

LEUWIBALANG 085778390106 SINOVAC

BQTU BQNTQR LEUWIBALANG 085212667069 SINOVAC

RANCASENENG 085693645905 SINOVAC

SUMURBATU coronaVac

SUMURBATU 085211270603 coronaVac

RANCASENENG 085691137636 coronaVac

CIKEUSIK 081317538180 coronaVac

RANCASENENG 08558167399 coronaVac

SUKAWARIS 081282341415 coronaVac

CIKIRUHWETAN 082192684237 coronaVac

SUKAMULYA 085871073709 coronaVac

CIKIRUHWETAN 083806636951 coronaVac

SUKASENENG 082112679072 coronaVac

UMBULAN 085780302518 coronaVac

CIKIRUHWETAN 082312056402 coronaVac

SUKAMULYA 081511401751 coronaVac

SUKAMULYA 085714781984 coronaVac

SUKAMULYA 085718708211 coronaVac

CIKIRUHWETAN 08235893770 coronaVac

CIKEUSIK 08229776880 coronaVac

SUKAMULYA 085894816088 coronaVac

SUMURBATU 081287709199 coronaVac

CIKIRUHWETAN 085217136552 coronaVac

SUMURBATU coronaVac

RANCASENENG 083841249717 coronaVac

SUMURBATU 082114797324 coronaVac

CIKIRUHWETAN 081211621494 coronaVac

SUMURBATU 085650838241 coronaVac

SUMURBATU 081293320081 coronaVac

UMBULAN 085888755295 coronaVac

SUMURBATU 085782010333 coronaVac

SUMURBATU 085693392449 coronaVac

SUKASENENG 085773225928 coronaVac

SUKAWARIS 085890662346 coronaVac

CIKEUSIK 0819210481 coronaVac

SUKAWARIS coronaVac

SUKASENENG 085694587382 coronaVac

SUMURBATU 085214150670 coronaVac

CIKEUSIK 085778185531 coronaVac

RANCASENENG 085779097865 coronaVac

RANCASENENG 085719841325 coronaVac

NANGGALA 0857733765903 coronaVac

NANGGALA 085810142921 coronaVac

RANCASENENG 085210701023 coronaVac

RANCASENENG 082311047543 coronaVac

SUKASENENG 085694587302 coronaVac

SUKASENENG 085717237032 coronaVac

SUKASENENG 082312013182 coronaVac

SUKAMULYA 085779062100 coronaVac

RANCASENENG 085893307063 coronaVac

CIKEUSIK coronaVac

SUMUR BATU 085319141230 coronaVac

CIKEUSIK 085779072132 coronaVac

CIKEUSIK 085717544729 coronaVac

UMBULAN 085770620411 coronaVac

BABELAN 085695985574 coronaVac

TANJUNGAN 08157025499 coronaVac

CIKIRUHWETAN 085880665010 coronaVac

TANJUNGAN 085774013169 coronaVac

GARUT 081395454533 coronaVac

TANJUNGAN 085280307405 coronaVac

RANCASENENG coronaVac

RANCASENENG 08578046892 coronaVac

TANJUNGAN 085773757718 coronaVac

CIKEUSIK 082258640176 coronaVac

TANJUNGAN 085719131345 coronaVac

NANGGALA 085717893630 coronaVac

RANCASENENG 082111874883 coronaVac

SUKAMULYA 085779062100 CoronaVac
Kp.Leuwibalang 01/01 Ds Leuwi'081584653372 SARS-CoV-2
TANJUNGAN 085882906450 CoronaVac
 Dosis I Dosis 2
Tanggal Tanggal Tanggal
Screening Pemberian No. Batch No seri Pemberian
Vaksinasi Vaksinasi
29-06-2021 29-06-2021 24003121 16183002378405

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Dosis 2
KET
No. Batch No Seri
24003121 16182997316829
24003121 16183002366377
24003121 16183002374021
NO No. Ticket NIK Nama Penerima Vaksin JK

1 S-F6928AAA 3601040307630001 SUPRAPTO L

2 S-5EE25E2C 3601045506510001 HJ. DARSIH P
3 P-2VSND4X4 3601041012730000 YUDIN FIRMANSYAH L
4 P-35GJR7I5 3601041902820001 KUSEN L
5 S-4F01A8DF 3601044110840002 EEM SUHAEMAN P
6 S-DE5D0565 3601042309890001 YOGA SEPTIANA L
7 P-3GNA2NCL 3601040605840003 ENDING N L
8 P-3EGPJR8S 3601044107860062 ERTI ERNAWATI P
9 P-008VSQJO 3601042706000001 RIYAN L
10 P-2ARQ7XF9 3601045806860001 NURAISAH P
11 P-2CLQ7PMO3601042710970002 YOGA ADITIYA L
12 S-6D0EAE90 3601042207850002 ASEP YULIANA L
13 S-A0E4D957 360104620700002 IRMA MIRAWATI P
14 S-C84D6926 3175076510921001 ITA ROSITA P
15 S-904FDE23 3601044912800003 EEN ENDAWATI P
16 P-10TL5FFB 3601041901850001 HANAN RUSNANDI L

17 Q-000A5910 3601045102030002 NURKHOLISOH P

18 S-9479733D 3601044507870004 NANI HARYANI P

19 Q-000A5DQ6 3601045601620001 SUMARTI P
20 S-41E04423 3601045613770001 MASAMAH P

21 S-AAECFD28 3601045606880002 DEWI SUMINAR P

22 S-4445BDB5 3601046206860003 ENOK SUHARTINI P

23 P-424R81RL 3601044405680002 ENTOY P

24 P-1HWATZZA 3601042009780003 RASIM L

25 P-0TLEZ8X9 360104650001 ITA ROSITA P

26 P-367MC1OH 3601031308930002 HENDRI L
27 P-43HZRG1M 3601045708910001 TINEU AGUSTINA P
28 S-4A21687D 3601045606810001 SITI ROHMAH P
29 P-0UTD400H 3601047011830007 SITI ROHMAH BT H. HOLIL P
30 P-7H6C97Y5 360104150190003 ABDU LATIF L

31 P-2A0RZ4N8 3601045209980001 SINTA BELA P

32 P-3WAKT7MC3601040107680102 DEDE D L
33 3601046205420001 ENENG SETIAWATI P

34 P-3P50R33H 360104490760002 NURHAYATI P

35 P-3VVPKLBE 3601044107050017 GINA AGNIA P

36 P-4AEPV8R4 3601047003930002 SUMINAR P
37 S-6E55F10F 360134090570001 ARSUDIN L

38 P-0TQR3ITC 3601045102770006 MARSIH P

39 P-1OIDBB45 3601044107790166 PIAH P

40 Q-000A6EU5 36010454061770001 NUNUNG N P
41 P-2KKCH6HT 360104590884004 ELIS S P
42 Q-000A6H8T 3601045412990002 RITA RISMAYANTI P

43 P-0ROMAXNT3601045708890003 SUNIAH P

44 P-496149JS 3601045204830007 SITI P

45 P-33BXLIOC 3601135608980001 AINUN CHOIRUNNISA P
46 P-4IA8I5V4 3601042403990001 WIRANTO L

47 S-67E45F54 3601044310860003 IVIT VITRIAH P

48 P-4G0XI8KF 360104730003 SARI'AH P

49 P-4DSLB4ZB 3601040502830004 DARKA WARYANTO L

50 S-8624B72A 360104072930003 OBING L

51 P-4MQY7VNX360104150760006 SUGIRI L
52 S-4F4ADC45 360104410790059 ENDAH L P

53 P-4TJZXVEK 3601041007890006 AEP F L

54 P-4XA58BUL 3210102110870001 HENDRA SUPARNA L

55 S-F7F6CC14 3601034107850266 RENY ROHAENI P

56 S-BB06F088 3601041103900001 ATA L

57 P-56Z0JN71 3601045108730002 SUTINAH P
58 S-2E9824BB 3601044107890048 SITI ROKENAH P
59 P-5B57U1S8 3601045105020002 DAHLIA P
60 S-302C6245 3601045510930002 ERNAWATI P

61 S-70CEC0AD 3601042504910004 AGUS SYARIF L

62 S-AFAF503F 3601044907780001 CUCUM P

63 Q-000A78NY3601046603820003 NURALIAH P

64 P-5DGQS932 3601042602850002 ANDI SUANDI L

65 P-5M5JPBJW 3602215110000004 IRMA P

66 P-5LB8RP2G 3601044503880001 VENA M P
67 P-61IM4I4U 3601030107920110 SUHENDRI ANGGA L L

68 P-5OQBN5RP3601044107910070 SUMINIH P

69 S-9AFA42FB NANANG L
70 S-BDECE631 3601041109830003 DIDIN K L
71 P-5UPWZTEQ3602214206760003 YULAENI P
72 S-41C4B175 3601044906850003 SUMYATI P

73 S-10CD59DC 3601040704800003 EMAN SETIAWAN L

74 P-646R6KJM 3601041705960001 SUPARDI L

75 S-178CD1F6 360104010481005 HAMDANI L
76 S-35609063 3601041106940009 SARDI L

77 P-65EKRDD7 360104200750001 ENCEP S L

78 P-6CD8LT8K 3601045610960001 RENI I P

79 S-FD13C78F 36010140108800001 ABDUL AZIZ L

80 P-6GLSVXRE 3601044802800001 LILIS SUPANTI P

81 P-6MVNSC8C36010403090309900002 ABDUROCHIM L
82 P-6H78URGU 3671012101710007 SUMARSONO L

83 P-6POAVFVH 3601045711860001 MAMAY MARLIYAH P

84 P-6LQ9IVNQ 360104161090001 ANDRI H L

85 S-DC1BD0DF 3601045606890001 YULI S P

86 P-6W0XSIQL 3325090212900006 TONY BACHTIAR L

87 P-6W5GFBCZ3601046102090000 Sri MULYANI P
88 P-71PMHQ44 337110170995000 ARSAL C L
89 P-6Z6BVVEU 360104510770003 DEDEH K P
90 P-73A62XNE 3673052808920001 RIKI P L

91 S-9C1A2375 3601046404960001 SITI TIEN P

92 S-A7C26E29 3601044708680003 MUNAWAROH P

93 P-7AUFLU4Z 3601031706830001 WAWAN H L

94 S-3466CBC4 3601034107910194 MILAWATI P

95 P-7F1KO0D5 3601042606880002 ERRY FAIZA L

96 P-77WQ3UF4 3515110605920004 DIMAS PRAMBUDI L
97 P-7IOANBUN 3601044307920003 TATI H P

98 S-730AE5D6 3601042604930001 ABDUL LATIF L

99 P-7MF4IFAG 36010105950007 NURHALIM L

100 P-50MIPT45 3601045208950002 ISMA JIPAYANTI P
101 P-7R30GUVE 3601045009740005 SAMSIAH P
102 S-342D7E44 3601041303900002 KUSMAN EFENDI L

103 S-C4F0E61F 3601049512860001 JUMAH P

104 P-IRR67KXZ 3601046210950002 SARTI P

105 P-5QAAWNM3601045002740001 EROH ROHMAYATI P

106 S-8C3B722B 3602210906720001 MAMAN SUTIANA L
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

GURU 03-07-1963

LANSIA 20-09-1950
PEL. PUBLIK 10-12-1973
PEL. PUBLIK 10-09-1981

PEL. PUBLIK 08-05-1980

GURU 23-09-1989
PEL. PUBLIK 22-07-1982

PEL. PUBLIK 26-03-1987

PEL. PUBLIK 27-06-2000

PEL. PUBLIK 20-01-1987
PEL. PUBLIK 27-10-1997

GURU 22-07-1985 SDN 1 CIWET

GURU 22-07-1987 SDN 1 CIWET

PEL. PUBLIK 25-10-1992
GURU 09-12-1980 SDN 1 CIWET

GURU 15-07-1984 SDN 1 CIWET

PEL. PUBLIK 11-02-2003

GURU 05-07-1987 SDN 1 SUMUR

PEL. PUBLIK 03-01-1962

GURU 16-12-1976 SDN 1 SUMUR

GURU 16-06-1988 SDN 1 SUMUR
GURU 22-06-1986 SDN 3 CIWET
PEL. PUBLIK 04-05-1968

PEL PUBLIK 20-09-1978 PEL PUBLIK RT

GURU 06-06-1984 SDN 2 CIWET
PEL. PUBLIK 13-08-1993

PEL. PUBLIK 17-08-1991 SDN 1 CIWET

GURU 16-06-1981 SDN 1 RANCAS

PEL PUBLIK 06-07-1984

GURU 03-02-1990 SDN SUMUR BA

PRADES 18-06-1997 PRDES TANJUN
PRADES 23-11-1970 PRADES

KADER 28-09-1993 KADER

PEL. PUBLIK 10-03-1980

PEL. PUBLIK 31-05-2003

PEL PUBLIK 30-03-1995

GURU 09-05-1967 SDN SUKASENENG

PEL. PUBLIK 11-02-1997

KADER 26-08-1982 KADER DESA U

KADER 07-06-1977 KADER SUKAWA

KADER 18-04-1982 KADER UMBUL
PEL. PUBLIK 14-12-1996

PEL. PUBLIK 17-08-1989

KADER 12-04-1983 KADER TANJUN

GURU 16-08-1998 SDN SUKAWARI

MASY UMUM 10-08-1999 MASY UMUM

GURU 25-07-1981 TK CIWET
KADER 09-08-1973 KADER DESA S
05-02-1983

GURU 21-07-1990 SMPN 5 CIKEUS

21-02-1968
GURU 17-06-1993 SMPN 5 CIKEUS
NAKES 18-08-1988 PUSKESMAS CI

GURU 21-10-1987 SMPN 5 CIKEUS

23-03-1986

GURU 09-05-1989 SMPN 5 CIKEUS

KADER 07-11-1982 KADER RANCA
GURU 16-04-1990 SMPN 5 CIKEUS
11-05-2002
15-10-1993

GURU 25-04-1991 SMPN 5 CIKEUS

GURU 04-07-1977 SMPN 5 CIKEUS
26-03-1982

GURU 26-02-1985 SMPN 5 CIKEUS

11-10-2000

KADER 12-02-1987 KADER RANCA

01-02-1990

KADER 04-11-1993 KADER RANCA

09-05-1980

GURU 24-02-1985 SDN SUKAMULY

24-04-1976

GURU 27-11-1985 SDN SUMKAMUL

GURU 10-07-1983 SMPN 5 CIKEUS

17-05-1996

PRADES 07-10-1984 PRADES NANG

11-06-1994

PRADES 12-03-1993 PRADES PARKO

PLKB 16-10-1996 PLKB

GURU 06-02-1981

KADER 08-07-1982 KADER CURCI

PRADES 03-09-1990 PRADES RANC
TAMBAK UDA 21-01-1971 TAMBAK UDAN
17-11-1988

PLKB 16-10-1990 PLKB

GURU 16-05-1989 MTSN 6 CIKEUS

02-12-1990
01-04-1989
 12-09-1993
11-07-1972
28-08-1992

29-04-1996

07-08-1968
17-06-1983

02-01-1991

21-06-1986
06-05-1992
03-07-1992

26-04-1993

01-05-1995

GURU 12-08-1995 PAUD MUTIARA

10-09-1979
13-03-1990

02-07-1983
24
PEL.PUBLIK
GURU 10-02-1974 SDN SUKAWARI
PEL. PUBLIK 09-06-1972 KEAMATAN
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat No. Hp BPJS BPJS Non
PBI Non PBI Anggota

CIKEUSIK 081394437815

CIKEUSIK 085775667777
CIKEUSIK 085219677484
SUKASENENG 085717237032

CIKEUSIK 081299125546

CIKEUSIK 081905642922
BALAGUNG 085781237717

KP. RANCASENENG DESA RANCASENENG 08561501581

CIKEUSIK 081285222049
KP. PENDEY DESA UMBULAN 08561501581
BABAKAN BANDUNG 0877773779675

CIWET 082119771431

CIWET 081910825996
KP. PULO DESA JAKA SETIA 081511690419
CIWET 081585793293
KADIRI 085782635829

SUMUR BATU 082130940985

SUMUR BATU 085217129526

SUMUR BATU 082312236589
SUMUR BATU 085213725590

SUMUR BATU 082311384069

BABAKAN BANDUNG 081224379920

KP. KESUR DESA NANGGALA 085213872495

KP CILENGSIR DESA SUKAMULYA 08567874691

CIWET 08151763531
KP PANGLO DESA KEDUNG AKU 085883197597
CIWET 083871042441
SUKAWARIS 085882795642
KP KEDIRI DESA CIWET 081511865809
SUMUR BATU 085773226031

TANJUNGAN 085882495185

KP RANCASENENG DESA RANCASE 081316926209

TANJUNGAN 085283861981

CURUGCIUNG 081292459200

CURUGCIUNG 085779161203
KP SUKAJADI DESA UMBULAN 085692729270
KP CIEKEK DESA KARATON MALASARI 081510554401

RANCASENENG 085884911031

KP BARENGKOK DESA UMBULAN 081932715950

KP CIKAREO DESA SUKAWARIS 085717453746
KP SUMUR JAYA DESA UMBULAN 085695390117
CANGKORE 085695154736

KP. MATIUNG DESA TANJUNGAN 085777150923

KP CISEUREUH DESA TANJUNGAN 085771427457

MENES 081219687007
SUKAMULYA 081213437315

BABAKAN BANDUNG 081933832381

KP. CIKONCANG DESA SUKASENENG085219539426

RANCASENENG 085715264076

PARUNGKOKOSAN 085826102069
SUKASENENG 085219539426
KP SEMPUR DESA CIHANJUANG 08718052892

UMBULAN 085773527760
RANCASENENG 08571779139

SUKAJADI 085691035492

SUKAMULYA 085695665666
RANCASENENG 085694722856
RANCASENENG 085717791399
SUKASENENG 081318596176
CIKEUSIK 085778549022

TANJUNGAN 081586283995

PARUNGKOKOSAN 085891029495
CIWET 083899759343

KP KAIRI DESA CIWET 081574578392

NANGGALA 085781419733
RANCASENENG 085695393141
KP CIBODAS DESA CIHANJUANG KEC083813592818

RANCASENENG 0852121655305

PARUNGKOKOSAN 08153715668
SUKAMULYA 085885762298
NANGGALA 085691439867
SUKAMULYA 085710732813

PARUNGKOKOSAN 085718724696

KP SUKAJAYA DESA NANGGALA 085882817515

NANGGALA 085771292981
NANGGALA 085762187730

PARUNGKOKOSAN 085694522937

CIKEUSIK 085894496
KP KESUR DESA NANGGALA 082167013393

CURUGCIUNG 085782773255

RANCASENENG 085813198548
CIAKAR 081298570255

SUKATANI 081930000021
CIKEUSIK 08589044096

NANGGALA 085693993522

BATANG-JATENG 085190071237
CIKEUSIK 085282387738
KP MALANGSARI DESA CIWET 085241798886
CIWET 085214886676
CIKADONGDONG 08569388494

KP. CILANCAR DESA NANGGALA 085880007042

KP.BABAKAN BANDUNG DESACIWET085311036556

NANGGALA 085781529376

CIHANJUANG 083893307018

CIKEUSIK 081283773328
ALAM PESONA. SIDOARJO 085338407754
PARUNGKOKOSAN 085882760128

PARUNGKOKOSAN 081911980681

SAGA BALARAJA 081385067325

CIWET 085778988432
CIKEUSIK 085889297273
NANGGALA 081517844550

CIKEUSIK 085210708605
KP.MURUY 002/004 DS.CIKADONGDONG 085892820260

SUKAWARIS 085773883582
KATAPANG 085777218283
 Dosis I
Tanggal Tanggal
Merek Vaksin***
Screening Pemberian No. Batch No seri
Vaksinasi
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
 SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886

CoronaVac
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
 SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SARS-CoV-2 26/03/2021 26/03/2021 24000821 '16127778489802

SINOVAC 03-05-2021 03-05-2021 240001421 16127533013224

SINOVAC 03-05-2021 03-05-2021 24000821 16127533014621
 Dosis 2

Tanggal Pemberian KET

No. Batch No Seri
Vaksinasi
01-07-2021 24003921 16213341167886
01-07-2021 24003921 16213341167886
01-07-2021 24003921 16213341167886
 Jenis
No No. Registrasi NIK Nama Penerima Vaksin Pekerjaan*
Kelamin

1 3518123006720003 SUKARDI L PT RBB

2 1605181212840002 HERMANTONI L

3 32171208007940016 AJID L

4 3573031807750009 ROBERTUS L

5 3209391909890005 FRENGKI L

6 3201180211880005 UJANG SUNARYA L

7 3206061406760001 SUSANTO L

8 3672020705750002 SOFAN MUCHTADI L

9 3601070910840002 DEDE M ROHMAT L

10 3204250103980003 NANANG L

11 3601040107640038 SAHRI L

12 3209162310790004 ANTOK SUBANDRIYO L

13 3601072709990001 ASEP SUPRIATNA L

14 16AAEAC69538 XUE TIANDI L

15 3273221612660006 EDDY YESTHIETMI L

16 3601040402600003 TOHIR L

17 3601040504760001 H. ROID SAPUTRA L

18 3601040601940002 IMAN L

19 3601040612920001 AYUT L

20 3601040107750232 ADI SUARDI Y L

21 '3601040101000002 M HIDAYAT L
 Instansi
Kelompok
TGL LAHIR Alamat
Umur

6/30/1972 KP. DSN KENTONG 002/005 DS KEDUNGSOKO

12/12/1984 KP. TABA ANYAR 001/001 DS LEONG SELATAN

7/8/1994 KP CIPARI 002/002 DS CIPONGKOR

7/18/1975 KP PAYOLEBAR 019/000 DS JELUTUNG

9/19/1989 KP DUSUN NENGGALA INDAH DS SURANENGGALA

11/2/1988 KP LAME 003/004 DS SUKASARI

6/14/1976 KP MEKARJAYA 005/001 DS SINGAJAYA

5/7/1975 KP LINK CIWEDUS 003/002 DS CIWEUDUS

10/9/1984 KP CIKASO DS MUNJUL

3/1/1998 KP CISEKE DS

7/1/1964 KP CIPAAS DS CIKDONG

10/23/1979 KP BLOK GUNUNG DS PALIMANAN

9/27/1999 KP TARIKOLOT DS WANASALAM

11/30/1966 CINA

12/16/1966 JL BATU PERMATA KEC. BUAH BATU

2/4/1980 KP GUNUNG BATU DS CIKDONG

4/5/1976 KP CIKEUSIK DS CIKEUSIK

2/6/1990 KP GUNUNG BATU DS CIKDONG

9/10/1992 KP CIKADONGDONG

11/18/1975 KP CURUGCIUNG

8/4/2001 KEBON CAU

 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
Merek
sesuai) Tanggal Tanggal
No. Hp BPJS BPJS Non Vaksin** Screening
* Pemberian
PBI Non PBI Anggota
Vaksinasi
085784912307 SINOVAC 7/2/2021 7/2/2021

082378472609 SINOVAC 7/2/2021 7/2/2021

081222683648 SINOVAC 7/2/2021 7/2/2021

08123358183 SINOVAC 7/2/2021 7/2/2021

081258341819 SINOVAC 7/2/2021 7/2/2021

085691437228 SINOVAC 7/2/2021 7/2/2021

082384422999 SINOVAC 7/2/2021 7/2/2021

081314773777 SINOVAC 7/2/2021 7/2/2021

085216186330 SINOVAC 7/2/2021 7/2/2021

081218549053 SINOVAC 7/2/2021 7/2/2021

085313887650 SINOVAC 7/2/2021 7/2/2021

081264042243 SINOVAC 7/2/2021 7/2/2021

08312696390 SINOVAC 7/2/2021 7/2/2021

081289219966 SINOVAC 7/2/2021 7/2/2021

085247146992 SINOVAC 7/2/2021 7/2/2021

085691437246 SINOVAC 7/2/2021 7/2/2021

085732983350 SINOVAC 7/2/2021 7/2/2021

085219789722 SINOVAC 7/2/2021 7/2/2021

085691159086 SINOVAC 7/2/2021 7/2/2021

085886792224 SINOVAC 7/2/2021 7/2/2021

'085693636834 SINOVAC 7/2/2021 7/2/2021

Dosis I Dosis 2
Tanggal
No. Batch No seri Pemberian No. Batch No seri
Vaksinasi
24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003921 16213342034762

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413

24003121 1621334203413
 Keterangan
(Ditunda/Tidak
Diberikan/Lanjut)
 Jenis
No No. Registrasi NIK Nama Penerima Vaksin
Kelamin

1 3602160301880004 BADRUDIN L
2 P-17H1XT6Z 3601040107830313 JALALUDIN L
3 P-KHF09TV 3602010605810001 WAHYUDIN L
4 3602010204860003 MOHAMAD LOMRI L
5 P-1H0TQAQI 3601045012800002 ENJUN P
6 3601045005810005 LILIS P
7 3601045710920001 ARI P
8 3601044107780437 BEDAH P
9 P-1RUPW3RI 3601045011820005 ROHAYATI P
10 S-BC8D2E01 3601040101870003 CHEVY ARIJAL L
11 3601044202640001 RODIAH P
12 9271017005920002 LISI ANGGREANI P
13 P-21X416GR 3601045009920005 ENOK HASANAH P
14 P-25IBRK2T 3601045905960001 INAH P
15 P-28MYRQST 3601045110660001 CUCUM P
16 P-2BQRAFK4 3601045211800004 SURNAH P
17 P-2IND3NGK 7371071601920011 SULFIKAR L
18 P-2LAIZT2X 3325100408900005 SUGINANJAR L
19 P-2PXK25LJ 3525012412970001 IRFAN GUNAWAN L
20 P-3194W3XI 3602216506800004 SANAH P
21 P-3EQQQ6IN 3601040607910003 JARTI P
22 P-3HP9FI10 3512170703960001 NUR FUAD AL KAFI L
23 P-3KAW3YM1 3601044304860002 SAYANTI P
24 P-3NMP1RKR 3216081507940005 JOEL MICHAEL PATAR S L
25 P-3Q72JAPO 1405022909950003 RYAN DHARMAWAN L
26 P-3SHLOYQ9 3601045908890001 TUTI AWALIYAH P
27 P-3V1VNEW6 3601046301670001 MARTI P
28 P-3XKFMZIG 1308191905990001 BERLIAN RIFANDI L
29 P-416XAUWK 3575021907970005 IMAM NURUL FIRDAUS P
30 P-44IB3C3B 3601046005770001 SARNAH P
31 1871112910940003 AHMAD MAULANA S L
32 3322106205980002 VENY KRISDAYANTI P
33 P-491FRULO 3604091712960002 MAD FAUZI L
34 P-4GS0PNVF 1171035708980003 IMELDA SAGITA MARJA P
35 P-4LBDN1I3 3601044107910277 JUMSIH P
36 S-81E84843 3601046005550001 NARWATI P
37 P-4NMFPJXH 3325110109940006 VAUZUL ILHAM NUDIN L
38 P-4S4LSAQJ 3601044406910005 TITIN P
39 P-4UQVDJMI 3601041107770003 ABDUL ROSID L
40 P-S11TZMGC 3325011008980002 RAHMAD MULYANI L
41 P-58MK4RCL 3601044203790003 YATI P
42 P-5BUECHWR 3505113006830004 SAJULI L
43 P-5H7CBILF 3601044806860004 DILAH PELITA WATI P
44 S-C1B7EBCA 3601041907830004 IWAN HERMANSYAH L
45 P-5MA0OOYO 3602214502890008 ELIS P
46 P-5SKCQJAK 3601045604830003 NURHASANAH P
47 P-5PN0NNI5 3601044107730401 IIS AISAH P
48 P-5UPNB1CH 3601046806730001 RUMSINAH P
49 P-5XZSOVVD 3601044603780005 ETI P
50 P-61KKOCX3 3601045606790003 ROSMIYATI P
51 P-64KXTN4V 3601045201850002 NURDIANA P
52 P-67ET8S50 3601041410830001 MOH TOHARUDIN L
53 P-6AWFKEBY 3601044109780001 WIWIN P
54 P-6EVQA2QV 3329081504680005 SAKIM L
55 P-6HKDDKRO 3601174107900026 SITI SUHAENAH P
56 P-6KDK1MJG 3601045011800006 ENAH P
57 P-6MRLL62X 3601044910710001 ARNISAH P
58 P-6P2NAABQ 3601045912720002 JUHAERIAH P
59 P-6RCVTK5G 3601044307760002 MASITOH P
60 P-6V1K96ZH 3601045506750002 SOPIAH P
61 3601044805860003 SUNI P
62 3601044204760001 ISTIROKAH P
63 3601044107840223 ITA P
64 3601044702900002 SITI ROHMAH P
65 3601045904780003 ROLIPAH P
66 3601124107880082 MUTIA SARI P
67 3601040306750004 TONI FAHRUDIN L
68 3601044304780004 MURTI P
69 3601045210970008 ENTIN SUHARTINI P
70 3601045205760002 AISAH P
71 3601046401700001 RUKMI P
72 3601040107840168 SATRI L
73 3601045909660001 EHA P
74 3601042301880002 AHMAD KAELANI L
75 3601047012710001 IYAT P
76 3601044503630001 ANYAS P
77 3601044806850009 HUSEN L
78 3601041003920004 ALI PURNOM L
79 3601040808970001 DADAN AGUSTIAN L
80 3601042211870001 A WAHYU TIRTANA L
81 3601041506930003 IDRUS L
82 3601046503890001 DEDE NURASIH P
83 3601045001770003 EEN IDA FARIDA P
84 3601044107920178 N LISDA SETIAWARGI P
85 3601045605790001 NENENG BADRIAH P
86 3601041908820006 ROHAYATI P
87 3601044107810196 DAMINIH P
88 3601040812680000 IYUS L
89 3601045407300001 MASNAH P
90 3601045701630002 CAKRASIH P
91 3601047001920001 ENENG ROHENI P
92 360221478910004 NELLY P
93 3601045303580001 FATIMAH P
94 3601044107820176 UNAH P
95 3601041507830014 SUKDI L
96 3601046105860000 KOMARIAH P
97 3601046502000003 FENI FEBRIANTI P
98 3601042112600001 ASMAWI L
99 3601044603800007 LELA P
100 3601044601780006 KARTEMI P
101 3601040405940002 FIRAS FRASETYA L
 Kelomp
Pekerjaan* TGL LAHIR
ok Umur Instansi

SATPAM 4/2/1988
M.UMUM 4/8/1980
SATPAM 6/5/1981
M.UMUM 2/4/1986
M.UMUM 10/12/1980
M.UMUM 10/5/1981
M.UMUM 17/10/1982
M.UMUM 1/7/1978
M.UMUM 10/11/1982
M.UMUM 1/1/1987
M.UMUM 2/2/1964
TAMBAK 30/5/1992
M.UMUM 10/9/1992
TAMBAK 3/5/1997
M.UMUM 11/10/1986
M.UMUM 12/11/1969

TAMBAK 16/1/1992

M.UMUM 4/8/1990

M.UMUM 24/12/1997

M.UMUM 25/6/1980

M.UMUM 10/5/1990

PT PP I 7/5/1996
M.UMUM 3/4/1986

TAMBAK 15/07/1994

TAMBAK 29/9/1995

M.UMUM 8/9/1989

M.UMUM 23/1/1967

M.UMUM 19/5/1999

PT PPI 19/7/1997

M.UMUM 20/5/1977
TAMBAK 29/10/1994
TAMBAK PPI 22/5/1988

PT PPI 17/12/1996

M.UMUM 17/8/1998

M.UMUM 25/01/1991

LANSIA 20/5/1955
TAMBAK 1/9/1994

M.UMUM 4/6/1991

RT 11/7/1977

TAMBAK PPI 10/8/1998

M.UMUM 21/10/1979
TAMBAK PPI 30/6/1983

M.UMUM 8/6/1986

M.UMUM 17/10/1984

M.UMUM 5/2/1989

M.UMUM 16/4/1983

M.UMUM 1/7/1973

M.UMUM 28/6/1973

M.UMUM 6/3/1978
M.UMUM 16/6/1979

M.UMUM 12/1/1985
M.UMUM 4/5/1979
M.UMUM 16/8/1983

M.UMUM 15/4/1968

M.UMUM 1/7/1990

M.UMUM 10/11/1973

M.UMUM 9/10/1971

M.UMUM 19/12/1971

M.UMUM 3/7/1976

M.UMUM 15/6/1975

M.UMUM 8/5/1986

M.UMUM 2/4/1976

M.UMUM 1/7/1984
M.UMUM 23/10/1988

M.UMUM 19/4/1978

M.UMUM 7/10/1988

M.UMUM 3/6/1975

M.UMUM 3/4/1978

M.UMUM 12/10/1997

M.UMUM 12/5/1976
M.UMUM 24/1/1970

LINMAS 1/3/1982

M.UMUM 19/9/1966

M.UMUM 17/7/1987

M.UMUM 30/12/1971

M.UMUM 5/3/1963

M.UMUM 19/8/1982

M.UMUM 14/4/1991

M.UMUM 8/8/1997

M.UMUM 12/9/1986

M.UMUM 15/6/1993

M.UMUM 25/3/1989

M.UMUM 10/1/1977

M.UMUM 27/11/1991

M.UMUM 16/5/1979

M.UMUM 8/5/1985

M.UMUM 1/7/1981

M. UMUM 8/12/1968
M. UMUM 14-07-1948
M. UMUM 17-01-1963
M. UMUM 8/2/1991
M. UMUM 7/8/1991
M. UMUM 13-03-1958
M. UMUM 8/1/1982
M. UMUM 15-07-1983
M. UMUM 21-05-1986
M. UMUM 25-02-2000
M. UMUM 21-12-1960
M. UMUM 6/3/1980
M. UMUM 6/1/1978
M. UMUM 04-05-1994
 Alamat No. Hp

KP. GARUNG SABRANG 004/001 DS CIHUJAN 08567173216

KP MALANGSARI 003/004 DS CIKURUHWETAN 085217038458
KP KONDANG 023/005 DS KADUJAJAR 085776895165
KP CISEEL 012/002 DS SUKARAJA 085960531808
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085893645813
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085893645813
KP CIBARAHMI 005/004 DS CIKURUHWETAN 081617450658
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085893645813
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085893645813
KP BABAKAN BANDUNG 002/002 DS CIKURUHWETAN 085930382929
KP HUNIBERA 005/003 DS CIKURUHWETAN 085893645813
ALAM PESONA 1 BLOK M SIDOREJO 081299125683
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085714786451
KP MALANGSARI 002/004 DS CIKURUHWETAN 085216040669
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085893645813
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085891152906
JL DG REGGE II NO 5 DS RAPPOKALLING 082315684604
DUKUH KEDUNGLANGGAR DS SIBERUK 082326135866
SEMBUNGAN KIDUL 005/02 DS SEMBUNGAN KIDUL 085234322571
KP BABAKAN BANDUNG 002/002 DS CIKURUHWETAN 085715264150
KP MALANGSARI 002/004 DS CIKURUHWETAN 083110005183

KP KEMBANGSAMBI 007/004 DS PASIR PUTIH 082190266866

KP CIBARAHMI 005/004 DS CIKURUHWETAN 081617450658
KP TELAJUNG 002/001 DS TELAJUNG 081296566055
KP DUSUN SUMBERSOKO DS KESIUR 081238184628
KP HUNIBERA 002/008 DS CIKURUHWETAN 085218372716
KP BABAKAN SIMPANG 005/004 DS CIKURUHWETAN 081211312917
JORONG VIII SIMPANG DS LUBUAK LAYANG 085216364185
PERUM KEBONAGUNG MAS DS KEBONAGUNG 089692412148
KP BABAKAN BANDUNG 002/002 DS CIKURUHWETAN 085715264150
JL BUMI JAYA I NO 10 DS LABUHAN DALAM 085210829700
LINGK GARUNG 005/008 DS NGAMPIN 085713100044
KP SAMBILAWANG 004/007 DS CARENANG 081212452394
JL NILAM NO 23 DSN TGK JALARA 081368259701
KP CIBARAHMI 005/004 DS CIKURUHWETAN 089665313710
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085773810986
JL GAJAHMADA BOGORAN DS KAUMAN 08122563063
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085773810986
KP HUNIBERA 002/003 DS CIKURUHWETAN 085218372716
KP WONOTUNGGAL 006/001 DS WONOTUNGGAL 087717779331
KP BABAKAN BANDUNG 002/002 DS CIKURUHWETAN 0281295413784
DUSUN CAMPANG MUARA 001/004 DS TANJUNG AGUNG081995875324
KP HUNIBERA 001/003 FD CIKURUHWETAN 085218372716
KP BABAKAN BANDUNG 002/002 DS CIKURUHWETAN 081295413784
KP HUNIBERA 005/003 DS CIKURUHWETAN 085218372716
KP HUNIBERA 001/003 FD CIKURUHWETAN 087773084523
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085773810986
KP MALANGSARI 002/004 DS CIKURUHWETAN 083110005183
KP MALANGSARI 002/004 DS CIKURUHWETAN 081314607830
KP HUNIBERA 002/003 DS CIKURUHWETAN 085694587774

KP HUNIBERA 005/003 DS CIKURUHWETAN 085213872716

KP CISEUREUH 001/004 DS TANJUNGAN 085773494749
KP CISEUREUH 001/004 DS TANJUNGAN 085774233312
KP CIKURUHWETAN 002/002 DS CIKURUHWETAN 02812954133784
KP MALANGSARI 002/004 DS CIKURUHWETAN 083110005183
KP CIBARAHMI 005/004 DS CIKURUHWETAN 085773647850
KP PASIR ASEM 003/004 DS CIKURUHWETAN 085773647850
KP HUNIBERA 001/003 FD CIKURUHWETAN 087773965343
KP HUNIBERA 003/003 DS CIKURUHWETAN
KP HUNIBERA 005/003 DS CIKURUHWETAN 85893400173
KP MALANGSARI 002/004 DS CIKURUHWETAN 082253572998
KP HUNIBERA 002/003 DS CIKURUHWETAN 081398897114
KP MALANGSARI 002/004 DS CIKURUHWETAN 081299120768
KP HUNIBERA 001/003 FD CIKURUHWETAN 082111031627
KP HUNIBERA 002/003 DS CIKURUHWETAN 081398897114
KP KADIRI 006/002 DS CIKURUHWETAN 085311114708
KP KADIRI 005/001 DS CIKURUHWETAN 081511534215
KP HUNIBERA 001/004 DS CIKURUHWETAN 082310247139
KP HUNIBERA 003/003 DS CIKURUHWETAN
KP HUNIBERA 005/003 DS CIKURUHWETAN
KP MALANGSARI 003/004 DS CIKURUHWETAN 081284189310
KP MALANGSARI 002/004 DS CIKURUHWETAN 081314607830
KP HUNIBERA 001/003 DS CIKURUHWETAN
KP HUNIBERA 001/003 DS CIKURUHWETAN 085717555965
KP HUNIBERA 001/003 DS CIKURUHWETAN 085862716209
KP HUNIBERA 003/003 DS CIKURUHWETAN 085217136552
KP BABAKAN BANDUNG 001/002 DS CIKURUHWETAN 085773238411
KP BATUJAYA 011/003 DS UMBULAN 081293853749
KP SUKASARI 013/005 DS SUMBERWARAS 085773751859
CURUGCIUNG 081617278626
KP MALANGSARI 002/004 DS CIKURUHWETAN
KP MUARA DUA 005/001 DS CIKURUHWETAN 082110991513
KP BABAKAN BANDUNG 003/002 DS CIKURUHWETAN 085212155381
KP KADIRI 005/002 DS CIKURUHWETAN 083804673771
KP BABAKAN BANDUNG 003/002 DS CIKURUHWETAN 085283861420
KP BABAKAN BANDUNG 001/002 DS CIKURUHWETAN 085773238411
KP MUARA DUA 001/001 DS CIKURUHWETAN 082110991513

KP HUNIBERA 002/003 DS CIKIRUHWETAN 085894175006

KP HUNIBERA 001/003 DS CIKIRUHWETAN 0858941750006
KP HUNIBERA 002/002 DS CIKIRUHWETAN
KP MALANGSARI 002/004 DS CIKIRUHWETAN 081284189310
KP BABAKAN BANDUNG 002/002 DS CIKIRUHWETAN 085693449272
KP MALANGSARI 003/004 DS CIKIRUHWETAN
KP MALANGSARI 003/004 DS CIKIRUHWETAN 085778251892
KP MUARA DUA 005/001 DS CIKIRUHWETAN 087788309704
KP.MUARA DUA 001/001 DES CIKIRUHWETAN 081297951923
KP.BABAKAN BANDUNG 002/002 DESA CIKIRUHWETAN 081574919500
KP. HUNIBERA 005/003 DESA CIKIRUHWETAN 085219991470
KP.CIBARAHMI 004/004 DESA CIKIRUHWETAN 085776846047
KP.CIBARAHMI 005/004 DESA CIKIRUHWETAN 085721569291
KP.B ABAKAM BANDUNG 002/002 DESA CIKIRUHWETAN 083870825354
Kepesertaan BPJS (tulis 'Ya'
Dosis I
pada kolom yang sesuai)
Tanggal Tanggal
BPJS Non Merek Vaksin*** Screening
BPJS PBI Pemberian
Non PBI Anggota
Vaksinasi
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
 SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
295413784 SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
2954133784 SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
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SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
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SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
SINOVAC 7/3/2021 7/3/2021
 Keteran
Dosis I Dosis 2 gan
(Ditunda
Tanggal /Tidak
No.
No. Batch No seri Pemberian No seri Diberika
Batch
Vaksinasi n/Lanjut
)
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16182847401436
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921 16213342034606
24003921
24003921
24003921
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24003921
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No No. Registrasi NIK Nama Penerima Vaksin

1 P-CJH1BGM4 3601044703800001 ANASIH

2 P-DCRV6103 3601045105920001 TATI HARYATI
3 P-DFNRXL6K 3601041806840003 SUHARTA
4 P-DHQ9MM6A 3601044107880104 YATI
5 P-DL23CTU1 2171031706899005 SUDIRMAN
6 Z-00065Z7V 3601044404850003 IMAS SITI MASITOH
7 P-D58254C2 3601040107930077 HENDRA HERMAWAN
8 P-DFEP6PHK 3601040107750067 H. SUMAJAYA
9 Q-000B6PH4 3601046011830001 ENENG UNAYAH
10 P-DNSUO9G7 217119350008910005 YENI ELFYANTI
11 P-DJWP0H4B 3601042611760001 ABIDIN
12 P-DQVIWFA6 3601041806870002 NURDIN
13 P-DLXKO12V 3210962022870005 RAHMA ALHIRA
14 P-DNTU1HOQ 3601044107820106 RODIAH
15 P-DURRVG6D 3601045805880001 IKA WIDIAWATI
16 Q-000B70BH 3601044407880001 DEWI PURNAMASARI
17 S-1A58FF88 3601044207890006 ENENG
18 Q-000B9994 3601044430500001 SAPRAH
19 P-ENQGO556 3601045602010001 DEFY FEBRIYAN
20 P-EYBB56RD 360104600860003 RATNA
21 P-E5NAEBN6 3601044210760001 MINI
22 Q-000B7T9O 360104403720001 TINI
23 P-E2BBBH80 3601045105820003 ENENG SRIYATI
24 P-G0EKRC5G 3601044107780232 IYAM
25 Q-000B88WZ 3601040309020032 BAYU KUSBIANTORO
26 P-ERR4QYCA 360104650881001 SARNAH
27 Q-000B7F2R 3601042904020001 YUSUF BAHTIAR
28 Q-000B7IEP 3601042304930005 SUHARTONO
29 P-EYBB56RD 3671076507680007 ROHAEMI
30 P-F78VDG0H 360104410786227 JAMINAH
31 P-FCB6WNAV 3601044808790003 IYUN
32 Q-000B7R66 3601041803880001 ASEP SASTRA KN
33 J-00001D4G 327204080682004 MOHAMAD AZHAR REZANI
34 P-FNJQM4K7 3601045101000002 MELINIA RAHAYU
35 P-F7U0UU43 3601044107770141 AMNAH
36 S-7BEF2339 3601045607720004 BADRIYAH SUFIYANI
37 P-FCUVBS7S 3601044201020003 INDY
38 P-FGQBGREM 3313021708700001 PARNO
39 P-FQA4AUA1 3601044107890196 ARTI
40 P-FTFQIJ5L 3601044408780003 UMAENAH
41 P-FTKD03L2 3601102202920001 ADI YANTO
42 S-62862BDE 3601045302590001 SAPRAH
43 P-G0Z4XNFR 3601044702910004 JASTI
44 P-G0LW5YHO 3601046210900001 LUSIANA O
45 P-G2XPKBP6 3601041403930003 SARNAMIN
46 P-G4O7DE5M TESSA RAMDHANI
47 P-FWDWAQ0A 3601041006720006 DANA MIHARJA
48 P-EKB0F1Q0 3601045107700001 IYUM
49 P-G579DCVF 3601040502930008 SURYA SAHRUDIN S.AP
50 P-G5HFYEQV 3601045205920002 TUTI SETIAWATI
51 Q-000B856F 3601045103860002 JUALIAH
52 P-DXMPRSCJ 3601046911810001 DEWI S
53 P-GA0RLUFH 3601044309010007 VIRNA FAZRIANI
54 P-GDI0VHFP 360104080200003 HENDI FIQRI
55 P-QEGA3PCL 3601045401850002 ROHATI
56 P-GJ6C3NLZ 3601044612890001 ELAH
57 P-G9PLYQ24 3601044207850022 LARIAH
58 S-7B58F7C9 36010452030700001 ETI MARYATI
59 P-GLQT2RRT 3601041005790001 SUPARTA
60 P-GNJSVQEQ 3601044107730223 ASMARIAH
61 P-GOKRMQHG 3601040309830001 JAJANG
62 P-GQX9IPOU 3674032605960011 YUDI A
63 P-GRIKNIQKI 3263107970078 HANDI NUGRAHA
64 S-6989762B 3601046306550001 WASTEM
65 Q-000BAUH3 360141206870001 ASEP SUDENDI
66 P-GMNE96D0 3601047007760001 YANAH
67 P-GQT07STU 3601041702010006 RUJLI
68 P-GUUHPAZ6 3601040201010004 DEDE ANDRIAN
69 P-GY776BFH 3320130303950010 AKBAR HARYADI
70 P-GZNIODBR 3601040107970034 M. DANI WAHYUDI
71 Q-000B9TJ5 3601044103700001 ISAH
72 S-A8321BCB 3601043004550001 EMAN SURYANA
73 Q-000B9TIG 361041901620001 ISMAIL
74 P-GVRB2ZKW 3601040301840001 ARIS
75 P-GXX3EZM2 3601044207780006 DASINIH
76 P-H2FCJVE1 3601045507750015 AENAH
77 P-02JD74DB 3601044707010006 DWI Y
78 P-0NODQEX6 3601041708720002 GANUNG B SALKA
79 S-6151084B 3601047103870001 DWI ROSITA
80 S-952F7C7E 3601044108940001 LINA N
81 P-H2K5D1B9 360104100969001 AGUS S
82 P-2PAJF5ZY 3601040606690001 SUPENDI
83 Z-50F20773 360104150670002 ADE I
84 P-4GHQ3UOD ANDI EKA
85 S-000282E8 3601044903920002 ROSTIANI
86 P-6ULH2HCI 3601045810740001 EEY
87 P-5H3KUKF9 360104491190004 SITI HERIKA
88 S-86C8999B 3601046403710001 LILIS
89 P-1UVLKB6X OOM
90 UMAMAH 3601044107700162 UMAMAH
91 P-6QOTG3NQ 3601040104960006 JAENAL A
92 P-A11MQ786 3601045907820001 KARMI
93 P-BJ9HDTSM 3601046108850004 AAN APANDI
94 S-7A93D428 3601042508600002 DEDI SUPRIADI
95 P-D4L657Q1 360104410767011 ANI ROHAYATI
96 P-CCRNF2VD 3601046505720002 TATI M
97 P-DBYWUU0X 3601046601000001 DETIA FAZRIN
98 P-FBGDDKFH 3601044208600001 ASMI
99 P-E0YMO7JW 3601044805900007 SITI NURJANAH
100 Q-000B96IY 3601024712800004 ANDRIYANTO
101 P-E0N7QXNJ 3601046208880001 INA ERLINA
102 P-H47MHJ9E 3601025005920002 ACEP SAEPUDIN
103 P-H4VLEJEK 3603111811850004 ANAS
104 P-FOXIHZ9E 3601044107990251 RATU AULIA
105 S-4950747B 3601040702790001 JUANTA WIHARJA
106 P-H5Z4SOVZ 360104410785013 HENI RUSMIATI
107 P-GLBRKWL6 3601041809650001 SUHERMAN
108 P-F8NH1IWC 3601044107810131 LILIS R
109 P-H6IGDS6F 360104061290002 SANUDIN
110 P-H79TD1R1 3601041008970006 AA SUPRIATNA
111 P-H6Y8CYXL 32760254016660004 RUSYATI
112 S-2810F066 3601040104630003 EDI SUPRIATNA
113 S-16FF0D61 3601041708430001 MAKDI
114 P-H7YZEJJB 3601043007930001 TARSONO
115 P-GIQTRE8A 3601044107750161 RASMI
116 P-H8NT4RXP 3601044101680003 AMIRAH
117 P-H9PAOP6B 3601944408980001 DIANA N
118 P-GR89O49K 3601046110020002 NURUL FIQOH
119 S-53D2A0CC 3601046511690001 MAEMUNAH
120 P-H77J2295 360171405650002 PULUNG SUHANDA
121 P-H4O6WA0A 3601044107700143 SAODAH
122 S-7C76CCF3 3601046704960001 MURSIPAH
123 P-HA4XATZB 3215140302850006 ENDANG HOERUDIN
124 P-HANT6FWS 3601041004760001 SIDIK
125 S-1C7FD2D2 36010461080003 SUKAESIH
126 P-HB34MQ5T 3601046502770001 RASIH
127 P-HBLKJTJO 3601045010830001 SUMIATI
128 P-H8OV7WCX 3601044109850001 MURSINAH
129 P-H9IE24QO 3601046011620001 DANAWATI
130 P-HAENA7EZ 3601045601800003 SANIMAH
131 '3601045203300001 ETI MARYATI
132 ITA ROSITA
133 AKBAR HARYADI
134 '3263107970078 HANDI NUGRAHA
135 '3601045810740001 EEY
136 S-CEB117D0 '3601041208930005 Ade Mulyanah
137 P-9WIHH2VH 3601042708780001 Endi Suhendi
138 S-75945056 3601086312950001 Iis Komalasari
139 P-AQ1UFTNO 3601040711750006 Sarnata
140 P-CEB4IZ2J 3601040111880001 Aji Feri P.
141 S-35E179D3 3601042504990002 Dadan Firmansyah
142 Q-7680603C 3601040202980003 Endin
143 S-436F5ADA 3601040206840001 Rohman
144 S-E138101A 36010448019500001 Herlina S. Nurantika
145 P-HSR46JY5 3601045101970002 Ena Nadia
146 3313025611960001 NURUL KURNIAWATI
 Jenis Kelompok
Pekerjaan* TGL LAHIR Alamat
Kelamin Umur Instansi

P 07-03-1980 CIKEUSIK
P 17-11-1992 CIKEUSIK
L 18-06-1984 CIKEUSIK
P 01-07-1988 CIKEUSIK
L 17-06-1989 SUMUR BATU
P 24-11-1985 CIWET
L 02-06-1993 CANGKORE
L 05-07-1974 CANGKORE
P 20-11-1983 CIKEUSIK
P 18-10-1991 SUMUR BATU
L 26-11-1976 CIKEUSIK
L 18-06-1987 CIKEUSIK
P 22-02-1987 PALU TIMUR
P 15-07-1982 CIKEUSIK
P 14-07-1987 CIKEUSIK
P 10-08-1987 CIWET
P 02-07-1989 CIKEUSIK
P 03-05-1973 CIKEUSIK
P 16-02-2001 SUMUR BATU
P 20-08-1986 CIKEUSIK
P 04-01-1973 CIKEUSIK
P 04-03-1972 CIKEUSIK
P 11-05-1982 CIKEUSIK
P 10-07-1978 CIKEUSIK
L 03-09-2002 SUKAMULYA
P 28-08-1982 CIKEUSIK
L 29-04-2002 SUKAMULYA
L 23-04-1993 RANCASENENG
P 25-07-1968 CIKEUSIK
P 01-07-1986 CIKEUSIK
P 08-08-1979 CIKEUSIK
L 18-03-1988 CIKEUSIK
L 08-06-1982 KP. CIKUJANG 2
P 11-01-2000 CIKEUSIK
P 20-10-1971 CIKEUSIK
P 16-07-1972 NANGGALA
P 02-01-2002 RANCASENENG
L 17-08-1970 KARANG ANYER
P 01-07-1989 CIKEUSIK
P 01-11-1946 UMBULAN
L 22-02-1992 CIKEUSIK
P 13-02-1959 CIKEUSIK
P 07-02-1991 CIKEUSIK
P 22-10-1990 CIKEUSIK
P 07-02-1994 CIWET
L 19-06-1985 CIWET
L 10-08-1972 CIWET
P 11-07-1970 CIKEUSIK
L 23-02-1993 SUKASENENG
P 12-05-1992 CIKEUSIK
P KADER 11-03-1986 KADER CIKEUSCIKEUSIK
P 17-03-1981 CIWET
P 03-09-2001 CIWET
L 08-02-2000 CIWET
P 14-01-1985 CIKEUSIK
P 06-12-1989 CIKEUSIK
P 02-07-1975 CIKEUSIK
P 14-03-1990 CIKEUSIK
L 10-05-1979 SUMUR BATU
P 10-07-1973 CIKEUSIK
L 03-09-1983 CIKEUSIK
L 26-05-1996 TANGSEL
L 06-02-1987 TASIK MALAYA
P 23-06-1955 RANCASENENG
P 12-06-1978 NANGGALA
P 30-07-1976 RANCASENENG
L 17-02-2001 SUKAWARIS
L 02-01-2001 SUKAWARIS
L 03-03-1995 KAB JEPAKA
L 03-07-1996 SUMUR BATU
P 01-03-1970 CIWET
L 30-04-1955 CIKEUSIK
L 19-01-1962 CIWET
L 03-01-1984 CIKEUSIK
P 02-07-1978 CIKEUSIK
P 15-07-1985 CIKEUSIK
P 07-07-19=2001 CURCI
L 27-08-1972 CIKEUSIK
P 31-03-1987 NANGGALA
P 18-01-1995 NANGGALA
L 10-09-1969 CIKEUSIK
L 06-06-1969 CIKEUSIK
L 15-06-1976 CIKEUSIK
L 05-05-1975 CIKEUSIK
P 08-09-1992 NANGGALA
L 18-10-1974 SUKAWARIS
P 09-11-1999 CIKEUSIK
P 24-03-1971 CIKEUSIK
P SUKAMULYA
P 06-09-1977 CIKEUSIK
L 19-06-1996 CIWET
P 23-05-1992 CIKEUSIK
L CAL KADES 04-02-1988 CAL KADES SUKAMULYA
L 25-08-1960 CURCI
P 10-05-1966 SUKAMULYA
P 25-05-1970 CURCI
P 26-01-2000 CURCI
P 21-03-1972 SUMUR BATU
P 08-05-1990 SUMUR BATU
L 17-12-1980 PASIR JAYA
P 11-03-1986 SUMUR BATU
L 22-12-1992 DESA KRAMAT JAYA
L 18-11-1985 SUKANAMAH
P 14-08-2000 CURCI
L 07-02-1979 UMBULAN
P 01-07-1985 CIKEUSIK
L 18-09-1965 SUKAMULYA
P 01-07-1981 CIKEUSIK
L 06-12-1990 RANCASENENG
L 10-08-1992 CIWET
P 14-01-1966 SUKASENENG
L 17-09-1959 CIKEUSIK
L 17-08-1943 RANCASENENG
L 30-07-1993 RANCASENENG
P 01-07-1975 CIKEUSIK
P 07-02-1969 CIKEUSIK
P 04-08-1999 CIKEUSIK
P 21-10-2002 CIWET
P 25-11-1969 SUMUR BATU
L 14-05-1965 CIKEUSIK
P 07-10-1968 UMBULAN
P 27-04-1996 CIKEUSIK
L 03-03-1985 KAB KARAWANG
L 07-02-1973 SUKAWARIS
P 07-09-1966 UMBULAN
P 24-05-1980 SUKASENENG
P 10-01-1983 Nanggala
P 01-09-1985 CIKEUSIK
P 20-11-1962 SUKASENENG
P 16-01-1980 SUKASENENG
P '14-03-1990 CIKEUSIK
P '08-09-2000 CIKEUSIK
L '03-03-1995 JEPARA
L '06-02-1987 TASIK MALAYA
 P '18-10-1974 SUKAWARIS
L GURU 12/08/1993 SDN 2 PARU KP. PARKOS
L GURU 3/9/1979 SMK 14 PDG Cikeusik
P GURU 12/23/1995 SMK 14 PDG Munjul
L TU 11/7/1975 SMK 14 PDG Nanggala
L GURU 11/10/1988 SMPN 1 CikeuCikeusik
L GURU 4/20/1999 SMPN 4 CikeuCikeusik
L GURU 12/2/1998 SMPN 4 CikeuNanggala
L GURU 2/6/1986 SMPN 4 CikeuParungpanjang
P GURU 1/8/1995 SMPN 4 CikeuCikeusik
P GURU 8/28/1997 SMPN 4 CikeuCikeusik
P GURU 4/8/1995 Cikeusik
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Merek Tanggal
No. Hp BPJS BPJS Non Vaksin*** Screening
PBI Non PBI Anggota

085212817706 coronaVac 05-07-2021

081646061709 coronaVac 05-07-2021
087773622692 coronaVac 05-07-2021
coronaVac 05-07-2021
081268408266 coronaVac 05-07-2021
0877773871977 coronaVac 05-07-2021
081381043606 coronaVac 05-07-2021
087773284224 coronaVac 05-07-2021
085319358131 coronaVac 05-07-2021
087728080617 coronaVac 05-07-2021
085219991481 coronaVac 05-07-2021
085212817706 coronaVac 05-07-2021
08594548201 coronaVac 05-07-2021
085694473876 coronaVac 05-07-2021
08781413658 coronaVac 05-07-2021
081281988214 coronaVac 05-07-2021
coronaVac 05-07-2021
coronaVac 05-07-2021
081286012536 coronaVac 05-07-2021
coronaVac 05-07-2021
087871413658 coronaVac 05-07-2021
085697102541 coronaVac 05-07-2021
085722186531 coronaVac 05-07-2021
087771744746 coronaVac 05-07-2021
085217106072 coronaVac 05-07-2021
coronaVac 05-07-2021
085697435216 coronaVac 05-07-2021
081297823427 coronaVac 05-07-2021
085719067454 coronaVac 05-07-2021
coronaVac 05-07-2021
0858107133818 coronaVac 05-07-2021
087772215512 coronaVac 05-07-2021
082247572929 coronaVac 05-07-2021
081517860610 coronaVac 05-07-2021
085813294715 coronaVac 05-07-2021
081219054510 coronaVac 05-07-2021
085691390170 coronaVac 05-07-2021
085385412777 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
083892744231 coronaVac 05-07-2021
087721424277 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085217870026 coronaVac 05-07-2021
081221222800 coronaVac 05-07-2021
085692052395 coronaVac 05-07-2021
081382364949 coronaVac 05-07-2021
085217104870 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085693153899 coronaVac 05-07-2021
085819314081 coronaVac 05-07-2021
085718271323 coronaVac 05-07-2021
081282881515 coronaVac 05-07-2021
083871094487 coronaVac 05-07-2021
08771466981 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085882613015 coronaVac 05-07-2021
081646061009 coronaVac 05-07-2021
085217973362 coronaVac 05-07-2021
085213833699 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
083841579332 coronaVac 05-07-2021
085331432244 coronaVac 05-07-2021
081395953252 coronaVac 05-07-2021
085889411031 coronaVac 05-07-2021
085775237462 coronaVac 05-07-2021
085889411031 coronaVac 05-07-2021
081283763124 coronaVac 05-07-2021
081381381277 coronaVac 05-07-2021
082333884648 coronaVac 05-07-2021
0857117350218 coronaVac 05-07-2021
082130201476 coronaVac 05-07-2021
081280313860 coronaVac 05-07-2021
0852111701125 coronaVac 05-07-2021
085695469625 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
081211608726 coronaVac 05-07-2021
085211684910 coronaVac 05-07-2021
081517572171 coronaVac 05-07-2021
08567416949 coronaVac 05-07-2021
085214931828 coronaVac 05-07-2021
085217377640 coronaVac 05-07-2021
082310306773 coronaVac 05-07-2021
087709925341 coronaVac 05-07-2021
085282388665 coronaVac 05-07-2021
082320119972 coronaVac 05-07-2021
085693591915 coronaVac 05-07-2021
085313799656 coronaVac 05-07-2021
 coronaVac 05-07-2021
082122276924 coronaVac 05-07-2021
085714541239 coronaVac 05-07-2021
085212512322 coronaVac 05-07-2021
085774316211 coronaVac 05-07-2021
087871169711 coronaVac 05-07-2021
085711509338 coronaVac 05-07-2021
085890292173 coronaVac 05-07-2021
085890292173 coronaVac 05-07-2021
085775258722 coronaVac 05-07-2021
081219691745 coronaVac 05-07-2021
085281550345 coronaVac 05-07-2021
085215497630 coronaVac 05-07-2021
087772191824 coronaVac 05-07-2021
085693009249 coronaVac 05-07-2021
085819326316 coronaVac 05-07-2021
081574901779 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085782809389 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085780301817 coronaVac 05-07-2021
085897090869 coronaVac 05-07-2021
081283239929 coronaVac 05-07-2021
085219469554 coronaVac 05-07-2021
087773215525 coronaVac 05-07-2021
085619154749 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085218247848 coronaVac 05-07-2021
085710515554 coronaVac 05-07-2021
083898726167 coronaVac 05-07-2021
085226914761 coronaVac 05-07-2021
085779097961 coronaVac 05-07-2021
085717544900 coronaVac 05-07-2021
085771355220 coronaVac 05-07-2021
081219904079 coronaVac 05-07-2021
087878342481 coronaVac 05-07-2021
081808201484 coronaVac 05-07-2021
coronaVac 05-07-2021
085719436944 coronaVac 05-07-2021
085214025199 coronaVac 05-07-2021
085778182351 coronaVac 05-07-2021
085710515952 coronaVac 05-07-2021
'085217973362 coronaVac 05-07-2021
'081285222005 coronaVac 05-07-2021
'082333884648 coronaVac 05-07-2021
'081395953252 coronaVac 05-07-2021
'0823201199972 coronaVac 05-07-2021
'085710512510 SARS-CoV-2 18/03/2021
087709958555 coronaVac 6/7/2021
087875118317 coronaVac 6/7/2021
085775156815 coronaVac 6/7/2021
085710767999 coronaVac 6/7/2021
085218335220 coronaVac 6/7/2021
08153086539 coronaVac 6/7/2021
085710525649 coronaVac 6/7/2021
082125045195 coronaVac 6/7/2021
085780198542 coronaVac 6/7/2021
'085925338965 coronaVac 6/7/2021
 Dosis I Dosis 2
Tanggal Tanggal
Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342033826
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274 30/09/2021 24200121
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
05-07-2021 24003921 16213342037274
 05-07-2021 24003921 16213342037274
18/03/2021 24000821 '16127779132818 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 1612753804496 05-07-2021 24003921
6/7/2021 2400821 16127533023364 05-07-2021 24003921
6/7/2021 2400821 16127533023364 05-07-2021 24003921
6/7/2021 24002221 16164644026130 05-07-2021 24003921
Dosis 2 gan
(Ditunda
/Tidak
No seri Diberika
n/Lanjut
16219309680901
16213342034918
16213342034918
16213342034918
16213342034918
16213342034918
16213342037274
16213342034918
16213342034918
16213342034918
16213342034918
16213342037274
 Nama Penerima Jenis
No No. Registrasi NIK
Vaksin Kelamin

1 P-I0CFBC3Y 3601044109990002 TASMEN P

2 P-LN64JM4M 3601044107020165 ELAH SARI P
3 P-O0FBDK3R 3601040510620001 H. ACENG SUHERI L
4 P-N2YGT97N 360104230910001 ARDIANSYAH L
5 P-NZNCRHUD 3601044107720073 TUMI P
6 P-NZKOJHE5 3601041701960003 RUDI FAKHRULI L
7 S-C3FE1EF0 360104421600001 YATI NURHAYATI P
8 P-O1DQBZW9 3601044409900010 JUNAH P
9 P-O1V36LND 3601045208730001 MARTI P
10 P-O2JYDZIF 3601044201800008 ASIH P
11 P-O32GGG02 360104550750020 NANI NURAENI P
12 S-06E1CB25 3601046303860008 APRILIA WULANDARI P
13 S-BA3B3F91 3601040107930147 SUGIANTO L
14 S-070E884E 360104551297003 SRI WAHYUNI P
15 P-O5BZN6Z 3601044107030139 NASIAH P
16 P-O5AANQMT 3601045012950002 CACA P
17 P-O5DFEGVL 3601046311020004 SINDY PRIHATINI P
18 P-O6D58WFH 3601040509700001 SALEH B RAGIM L
19 Q-000CEQOQ 3601045404800002 SARNAMI P
20 P-O7MV5QOT 36010449110100021 TRIWI DIARTI P
21 P-O7MK3M10 3601041810980003 JAENAL L
22 P-O7ZU2PNQ 3601046202660001 ENOK MASTUNAH P
23 S-26C1232A 36010441078800032 ENANG L
24 P-OAROE10K 3601042010690001 DAMIN P
25 P-OAYZ8OLW 3601044702970002 SITI MUSFIROH P
26 P-OCBYPM1Z 36010428049700002 AMIN L
27 P-OCUCWGZG 3601044906860002 SARNITI P
28 P-OEOFOTF8 3601044304010003 SITI UUM P
29 P-ODBR1VIJ 3601044906820001 ROHAYATI P
30 P-ODOD822Z 360104630200000 FINA TRIMULYANI P
31 P-OEHC7OBJ 36010450010000001 DETI MUTMAINAH P
32 P-OFKMJGD6 3601042606020001 RIYAN GUNAWAN L
33 P-OGDM0GL3 3601041505880003 SUDARMAN L
34 P-OGD4G2I3 3601045808890001 NONIH P
35 P-OGI5IZUE 3601040408100001 RAMA RIO SAGITA L
36 P-OHSQ9K8K 320426251910002 MUHAMAD ABQI L
37 P-OHVLSHTK 3601041109820002 SUARTA L
38 WU YEYONG L
39 Z-0006GODI 3601040112520002 JAENUDIN L
40 P-OLRE63XO 36010412048700 ROSMAN L
41 P-OQHVZKY1 3601044911760003 RUMINIH P
42 P-ORK9AZVG 3601044107930230 MURSAH HAYATI P
43 P-OS6IAJI2 3601040708780001 ZAENNUDDIN L
44 P-OSWFT6GR 3601043011900001 YUDI ISMAIL L
45 P-OSWZ7EAR 3601041007900003 IBROHIM L
46 P-OQKJTJDC 3375040412910002 M. ZAINUDIN L
47 S-C94606DA 3601041210580001 ADE MADRONI L
48 P-OUK6DPL0 36010441076200007 ADE SURYANI P
49 P-OVF5UHCZ 3601046111780001 UMAMAH P
50 P-OUEDIGJ7 360104420503008 NITA A RAJANI P
51 P-OVV2H7KJ 3601042803020003 NAJMUDIN L
52 P-OWVGSWGJ 3601045208030004 ANISYA P
53 P-OXX8EVHM 3601045808020002 MELIAWATI P
54 S-4BD5284A 3601045208570001 MULYANAH P
55 P-P04X9XRZ 36010451022002 NENGSIH P
56 Q-000CLFV1 3601045308790001 CICIH P
57 P-PQQEMOL 3601046503060003 AGNIA P
58 P-P1UE1YLE 3601041903060002 AJIS KURNIAWAN L
59 Q-000CG8W4 3601040607030003 WADI FIRMANSYAH L
60 P-P4LDNHD2 3601044107700164 ATIH P
61 P-P3CKTDVM 3601046103650001 HJ. WASKEM P
62 Q-000CH8RE 3601046311030002 ICA FITRIYANI P
63 P-P5OS9DUZ 3601044108050002 TUBAGUS A L
64 P-P6AJNEXH 3601044611700001 SUTIAH P
65 P-PD5SO55 3601041311040001 INDRI YANA L
66 P-P97S6UN1 36010146205020006 EKA ALFIAH P
67 P-P7KAB53D 3601045111880001 DETI SUSILAWATI P
68 P-PAVLDBBW 3601041205030001 IMAN FIRMANSYAH L
69 P-PA0CB7D0 3601045111750002 SUMIYATI P
70 P-PB4UEZG4 3601040107710449 EMONG ASPAR L
71 P-PCVMWTCP 3271060505050009 RIVALDI L
72 P-PD248G10 6210020106840002 MUSTAFID L
73 P-PDLZQBQO 3601045501060006 DWI RAHMAYANI P
74 P-PDVI1WC8 3601044110040002 TITI N P
75 3601040905050002 ANGGA MAULANA L
76 P-PEWQ3MYW 3601041507020001 PITO PERMANA L
77 SITI NURAFIDAH P
78 P-PFYSII20 360201020280004 TATANG HIDAYAT L
79 P-PGEYNPZQ 3601041002060001 HAMID L
80 P-PGQYELVQ 3601046307040001 YULIYANTI P
81 S-26A6D2AE 332713070890002 TYASBMAHARDIKA L
82 S-2CAA9CFE 3601040211860001 PERI ISKANDAR L
83 P-PHVI0PS5 3601040506000001 DIKI KURNIAWAN L
84 P-PHZYS71N 3601045703870002 SITI NUR SYAMSIAH P
85 P-PIJSBT1N 3601041012950003 JONO L
86 P-PJ2FJLGA 3601041302880004 EDAH P
87 P-PIZUO7JZ 3601042604610001 MUSLIM L
88 Q-000CJUU2 3601044105990003 NABILA NOOR AZMI L
89 Q-000CGM9J 3601041208846003 ASEP SUPRIATNA L
90 P-PKXU4307 3601046207010001 SERLI M P
91 P-P26KJC1N 36020155053870007 ENIK ROHAENI P
92 '3601042010690001 DAMIN L
93 '3601044702970002 SITI MUSFIROH P
94 ANWAR L
95 3601040107710149 AMONG ASPAR L
96 S-6891FC74 3601045411930001 Reni Munawaroh P
97 S-F5754DE8 3601040312680001 M. Ridwan Syapei L
98 S-8DCFE651 3601047011890001 Yeni Anggraeni P
99 S-CCDF7BBA 3601044503710003 Retni Suminar P
 Kelompok
Pekerjaan* TGL LAHIR
Umur Instansi

01-09-1999
08-11-2002

23-02-1991
01-07-1972
03-01-1996
02-10-1960
04-02-1990
12-08-1973
02-01-1980
07-05-1990
23-04-1988
16-07-1993
15-12-1997
23-01-2003
10-12-1995
23-11-2002
28-03-1971
14-04-1980
10-10-2001
16-10-1999
21-04-1979
22-06-1988
20-10-1969
07-02-1997
01-03-1998
09-06-1986
03-04-2001
09-06-1982
23-02-2000
10-01-2000
26-06-2002
15-05-1988
18-08-1989
17-12-1994
25-10-1991
11-09-1987
PT RBB 25-08-1976 PT RBB
08-06-1952
12-04-1987
20-11-1981
08-06-1993
07-08-1978
30-11-1998
09-05-1982
04-12-1991
10-02-1958
01-07-1962
 02-05-2003
28-03-2002
12-08-2003
18-08-2002
12-08-1957
11-02-1977
13-08-1979
25-03-2006
19-03-2006
17-10-2005
01-07-1970
21-03-1965
23-11-2003
06-11-2006
06-11-1970
20-06-2003
22-05-2002
11-11-1989
12-06-2003
11-11-1975
08-03-1974
05-05-2005
01-06-1984
15-01-2006
01-10-2004
09-05-2005
16-07-2002
30-07-2005
02-02-1980
30-06-2006
23-07-2004
07-08-1990
02-11-1986
05-06-2000
17-03-1987
15-04-1995
04-12-1976
26-04-1961
01-05-1999
12-08-1984
22-07-2001
15-03-1987
'20-10-1969
'07-02-1997
'26-07-1996
08/03/1974 POLSEK
Guru '14-11-1993 SDN 2 Sukawaris
GURU 12/3/1968 SMPN 4 Cikeusik
GURU 7/4/1989 SMPN 4 Cikeusik
GURU 3/5/1971 SMPN 3 Cikeusik
 Kepesertaan BPJS (tulis 'Ya'
pada kolom yang sesuai)
Alamat No. Hp BPJS Non
BPJS PBI
Non PBI Anggota

SUKASENENG 082310972993
SUKASENENG 085773213259
KP.HUNIBERA DESA CIWET 085862716198
CIKEUSIK 085715912556
CIKEUSIK 085212817706
KP.HUNIBERA DESA CIWET 085892616773
KP.HUNIBERA DESA CIWET 087780560299
KP. BELENGGUNG DESA CIKEUSIK 081646061709
CIKEUSIK 08567188522
KP. BELENGGUNG DESA CIKEUSIK 081646061709
CIKEUSIK 085211458932
CIKEUSIK 085782134699
KP. MASJID DESA KERTAJAYA 082112815718
RANCASENENG 085887148575
KP. SUMBERJAYA DESA UMBULAN 085280899199
CIWET 081314490159
KP. PENDEY DESA UMBULAN 085770641435
CIKEUSIK 085773236597
CIKEUSIK 085694515661
CIKEUSIK 085773236597
SUKAWARIS 082113213086
CIWET 082128431771
NANGGALA 081299734588
CIKEUSIK 085216176782
RANCASENENG 085780766609
CIWET 085215835048
SUKAWARIS 0857760253339
CIKEUSIK 081334971300
CIKEUSIK 085711493840
CIKEUSIK 082111645495
CIKEUSIK 085695153321
CIKEUSIK 081383803497
CIKEUSIK 085697611710
CIKEUSIK 085697611710
NANGGALA 085739526641
CIHERANG 085214935934
NANGGALA 085609257500
CIKDONG 08228886789
SUKASENENG 081210502895
RANCASENENG 085892626649
CIKEUSIK 085216176782
LEUWIBALANG 085218924111
LEUWIBALANG 081511640002
CIWET 081511953074
UMBULAN 085817984630
BANYURIP AGENG 081238354886
CIWET 085215331533
CIKEUSIK 085211511367
CIKEUSIK 081646061709
CIWET 085697734512
CIKEUSIK 085694723675
RANCASENENG 082127005045
PARUNGKOKOSAN 08582747082
CIKEUSIK 085719437061
CIKEUSIK 081646061709
CIKEUSIK 081646061709
PARUNGKOKOSAN 25-03-2006
SUKAMULYA 085891580796
UMBULAN 081388138823
CIKEUSIK 081646061709
BATUJAYA 081316302310
SUMURBATU 085770973053
SUKAMULYA 085774963408
CIKEUSIK 81646061709
SUKAMULYA 085283233972
RANCASENENG 085714772505
CIKEUSIK 085774305399
NANGGALA 085782131750
CIKEUSIK 081646061709
CIWET 085894828289
CURUGCIUNG 08577444041
KUALA KURUN 082351849999
LEUWIBALANG 085697592213
CIKEUSIK 08558654606
SUKAMULYA 081584375321
CIKEUSIK 085694138203
CIKEUSIK 085718725018
CIKEUSIK 085774961500
SUKAMULYA 085894765977
NANGGALA 085697898640
CIKEUSIK 081297410568
TANJUNGAN 085717044871
NANGGALA 085212197062
TANJUNGAN 085892643373
CIKEUSIK 082286440092
CIKEUSIK 081646061709
CIKEUSIK 081646061709
BABAKAN BANDUNG 085778299761
CIWET 087879496222
CIWET 081113831105
CIKEUSIK 085691153755
SUKASENENG '085216176782
RANCASENENG '085780766609
SUKARALI '085871440183
KADIRI 085894828283
Kp.Lemahsugih Ds.Sukawaris '085882901005
Cikiruhwetan 081321163908
Nanggala 085762818223
Cikiruhwetan 085764547633
 Dosis I
Merek Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri
Vaksinasi
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644961818
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
CORONAVAC 06/09/21 08/07/21 24003121
SARS-CoV-2 3/30/2021 3/30/2021 24000821 '16127778488398
coronaVac 6/7/2021 6/7/2021 2400821 1612753804496
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
coronaVac 6/7/2021 6/7/2021 2400821 16127533023364
 Keterang
Dosis 2 an
Tanggal (Ditunda/
Pemberian No. Batch No seri Tidak
Vaksinasi Diberikan
/Lanjut)

29-09-2021 2021081541
08-07-2021 24002221 16164644959834
08-07-2021 24002221 16164644959834
08-07-2021 24002221 16164644959834
08-07-2021 24002221 16164644959834
 Jenis
No No. Registrasi NIK Nama Penerima Vaksin Pekerjaan*
Kelamin

1 Q-000DCHL5 3601047007840002 SAPINAH P

2 S-83CF18DB 3601044107830437 AAN MARYANI P
3 P-NFDO6Y4M 3601040104930002 AGUS SAPUTRA L
4 P-MADXML5 1301090304850001 RAMAN L
5 Q-000D4CUQ 1871101204650004 JOHAN EFENDI L
6 P-NV2O5PBN 3601044207650004 ISAH P
7 P-ONKKKPEF 5305032510900002 JHON BRIKMAR L
8 P-QAXC0EK1 3601044107720016 PARMANAH P
9 Q-000D4D4Y 1801132803800002 M. ADJIE AKBAR PRAMUDIA L
10 P-RANE5RUM 1806113008020003 RIZKI ANTONI L
11 S-BE276732 3601044706860002 IDA RAHMAWATI P
12 P-SOQPULQJ 3601062202980002 SAEPUL MUBAROK L
13 P-TEPA81PS 3601046509780009 HJ. RATIH HARDIANTI P
14 Q-000D4PC4 1802011205790011 PUJIANTO L
15 P-TLK5MATG 3601045402660002 SANIMAH P
16 Q-000D4CPX 1801131803770003 KHOIRUDIN L
17 P-TM3MKNXH 3601045810580001 TUNIAH P
18 P-TMD2MHG1 3601044109000005 SUHERNI P
19 LYI JINYAN P
20 REN HUEIN P
21 P-TMWQK2ON3601040107840171 SANA L
22 P-TNGJ0EVY 1803122205940001 ISMAN ISKANDAR L
23 Q-000DC64L 3601045507750016 ECIH SUKAESIH P
24 S-D5379700 3601040910630001 KOMARUDIN SPD L
25 S-A25BBCB5 3601045507810004 SITI MAYSAROH P
26 P-TQENQWF9 3601044210790001 DANESIH HINDAYANI P
27 S-A0AA70A8 3601040701980004 M. FAIDHONI. A L
28 P-TSVQTJR1 3601040107900315 RASMIN L
29 P-TTCFAXTX 3601040107650202 ATMA L
30 P-TST2AJ7S 3601044509870002 TATI MARYATI P
31 P-TTGHVKKR 3601040607010003 FAUKI L
32 P-TTWDA6A0 3601040507980008 BANTAN MAULANA HASBI L
33 P-TTU5QE4T 3601040612960001 ARDIAN NUR L
34 P-TU0JU8YL 3601045808970001 INDRI PRADIANA P
35 P-TVKMYHCM 3601046107760001 HARIAH P
36 P-TW8SVMGD 3601046103710001 ASIH P
37 S-42F2DD6F 3601047108960001 DIANA P
38 P-TZ1MFOS6 3601041812970001 MOH. IMRON TAUFIK L
39 P-TYNPYBG6 3601044711730001 EUIS SUMIATI P
40 P-U285TTM9 36010294802020001 ROHASIH P
41 P-U32GMHQK 3601041907020001 ALDI DULIANSYAH L
42 Q-000DCFEB 3601044710940001 TARMINIH P
43 P-U6V0S6XS 3601044107840132 MARIAM P
44 P-U7BXDWBP 3601044107820150 EVA P
45 P-U7JGZPTH 3172041309980009 M. ILHAM FIRDAUS L
46 P-U7S58QEO 3601045007920003 KARSIAH P
47 P-U9FZO5W6 3601040703830007 SUHELI L
 Kelom
TGL LAHIR pok Alamat No. Hp
Umur Instansi

30-09-1984 CIKEUSIK 085693542126

05-04-1981 CURUGCIUNG 085718078437
19-08-1989 CURUGCIUNG 085694574195
08-04-1985 CURUGCIUNG 08381708538
12-04-1965 RAJABASA RAYA 082283884854
02-07-1965 CIKEUSIK 085217377617
25-10-1990 HELERMAN 085281724678
15-07-1974 SUMURBATU 081268408266
28-03-1999 DUSUN IVA KEL. KARANG ANYAR KEC. JATI AGUNG 089602070767
30-08-2002 TANJUNG AGUNG 081388462842
07-08-1986 CIKEUSIK 083812700806
22-02-1998 CITEREUP 081317135445
25-09-1978 UMBULAN 081236764485
12-05-1979 DUSUN 1 085379850647
14-02-1966 CURUGCIUNG 085718078437
18-03-1977 DUSUN IV A KARANG ANYAR 08127243502
07-10-1982 CIKEUSIK 081261332373
01-09-12000 SUMURBATU 085603243296
14-03-1980 PT RBB 081276949196
19-12-1973 PT RBB 081276949196
04-04-1996 SUKASENENG 085770130952
22-05-1994 NANGGALA 082125348558
15-07-1975 CIKEUSIK 085814303346
09-10-1962 CIKEUSIK 083875371563
01-02-1980 BABAKAN BANDUNG 085777479460
02-10-1979 CIKEUSIK 085881751509
27-10-1998 RANCASENENG 082258142769
03-09-1981 RANCASENENG 085770972017
01-07-1965 UMBULAN 085695274162
05-09-1987 UMBULAN 085695274162
06-07-2001 CIWET 085697266339
05-07-1998 CIWET 083877712467
06-02-1996 CIKEUSIK 085893308110
28-09-1998 UMBULAN 089517289449
11-07-1976 CIKEUSIK 085217377617
21-03-1971 CIKEUSIK 085217377617
31-08-1996 CIGADUNG 083808889484
18-12-1997 CURUGCIUNG 085888394672
07-11-1973 CIKEUSIK 087773147000
04-07-2000 SUKARESMI 083871578237
19-07-2002 CIWET 085775401863
07-10-1994 RANCASENENG 085772495231
28-01-1987 CURUGCIUNG 085781953573
27-06-1985 CURUGCIUNG 085772394367
13-09-1998 CIMANUK 085939465237
10-07-1984 CURUGCIUNG 085772394367
07-03-1983 SUKAWARIS 082260102992
 Kepesertaan BPJS
(tulis 'Ya' pada Dosis I
kolom yang
BPJSsesuai)
Non Merek Tanggal Tanggal
BPJS
Non Anggo Vaksin*** Screening Pemberian No. Batch
PBI
PBI ta Vaksinasi
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
coronaVac 12-07-2021 12-07-2021 24003921
 Dosis 2 gan
(Ditunda
Tanggal /Tidak
No seri Pemberian No. Batch No seri Diberika
Vaksinasi n/Lanjut
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
16207156783663
NO No. Ticket NIK Nama Penerima Vaksin JK

1 P-WWRLGFCY 3601040405750001 NARTO EKA PRAYITNO L

2
Q-000EOGG8 36044107870136 TATA SUPRIATNA L
3
Y-0313W2B 3173070805800006 HANAPI L
4
P-WY5OWQA4 3601044107870096 RESITA P
5
P-WYPTMROF 36010417020300002 BAMBANG IRAWAN L
6 3211131412800004 HE YULING L
7
P-WZB4BHLL 3601044107830283 HASANAH P
8
P-WZWXUG9X 360104401740002 JUJU P
9
S-1FC4A2AB 3601110207820031 EMAN SYAEFUL ROHMAN L
10
P-X197CFSM 3601042808020003 SAHRUDIN L
11
J-00005QL5 1871051912750002 HERU IRAWAN L
12 P-X29PH1Y2 3601046311820002 UMAH P
13
Y-01317OIC 3173071909700011 ABDUL MADJID L
14 MA SHUJUN L
15
P-X3KBXANG 3212062409810001 WASNA L
16 ZHANG XIAOBIN L

17 LI GUOFU L

18 ZHANK QLAN L

19 MU. HUA L

20 P-X5VYPJBZ 3601044302790001 ERAH P

21 LIANG, XIANGFEI L
22 WANG, XIANYANG L
23 P-X6K8CWVQ360104410770011 ONIH ROSITA P

24 P-X7JXL0LW 3601060107830107 WAWAN L

25 P-X7PGEOEM3601045711830001 ARTISAH P

26 3601041105810002 SARMANI L

27 TINAH P
P-X8VHWCT2
28 P-XC4LCD58 3601044108810003 ASMAH L

29 P-XCNZWRDT3601045503830004 MUNTIAH P

30

31 P-XD8CPSMA3601040107020215 HAMID L

32 P-XE9PNWQP3601045012800006 ONIH P

33 P-XEOQVMRS3601041504840001 EYE SUTARYA L

34

35 3601040505720007 SURADI L
P-XFJKNEWR
36 P-XG9LRABV 3601020204990001 DONI KUSUMA L

37 P-XGSMVGTS3601045705900001 SARNITI P

38 P-XHHE8OG136010451089500002 MILA WATI P

39 120828410910007 AMRI L

40 Q-000ESSLM 3601040708830003 HABIB GUNAWAN L

41 P-XIO0I0JB 3601022109980002 KODIR L

42 3601045111860003 AMINAH P
P-XJES2PRG
43
P-XJGJW0CB 36010447880003 SARNI P
44 P-XJX90YY0 3601041007040008 REZA S L

45 P-XK1Y6THV 3601042611940001 GARA H L

46 P-XL0Y2LUF 3601046105030003 SITI MARYAM P

47 P-XLP4VT3W 3601292607020003 RIZKI PAULANA L

48 P-XMLQBB97 3601040107770068 DAYAT FIRDAUS L

49 P-XRCKTJIF 3210190202990081 FERRI IRAWAN L

50 P-XRQ05M8E 360104410701026 VINA N P

51 P-XSSQB40H 3601062203000002 ADI RAHMAT L

52 Y-0134ICPI 3175091907990004 NANDANG KUMAEDI L

53
360106220300002 ADI RAHMAT H L
54
3601041105810002 SARMANI L
55 3601044108810003 ASMAH P

56 36010447880003 SARNI P

57 3601044501700001 SUARSIH P

58 Q-0002TT9Z 36010425076400001 CARMAN HERMANSYAH L

59 Q-0002VTMU 3601042108700002 H. DURIYAT L

60 Q-0002VT1B 3601046710740001 LINA HADRIYANTI P

61 Q-0002TWY3 3601040405720003 DASIM L

62 Q-0002VU5U 36010452039600006 ERNA MARDIANA P

63 Q-0002TWY0 3601040107900073 M. ARIFIN L

64 3601040207940001 L
Q-0002VR2Y RAKIYAH
65 3601040107610035 L
Z-0000OTIX ETANG SOBARI, SE
66 Q-0002TAO9 3601040107290003 SUPRIATNA L

67 P-XDNJAHBC3601044604850005 SITI ECIH P

68
Q-0002TWY8 3601041101990003 DEDI HERMANTO L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

04-06-1975 KP. BATUJAYA DESA UMBULAN

07-05-1984 SUKASENENG

08-05-1980 JATI PULO

18-07-1986 TAINAN ALAM

17-02-2003 KP. BATUJAYA DESA UMBULAN

14-12-1980 PT RBB

01-07-1983 CURUGCIUNG

04-01-1974 CURUGCIUNG

01-04-1977 PERUMAHAN PONDOK POETRI GEULIS

28-08-2002 KP. CILANCAR DESA NANGGALA

19-12-1975 KEBON JERUK

23-11-1976 SUKASENENG

19-09-1970 DESA JATI PULO KEC. PALMERAH

06-12-1971 PT RBB

24-09-1981 KP. SUKASENENG DESA CIKEUSIK

16-04-1969 PT RBB

07-04-1970 PT RBB

28-02-1993 PT RBB

27-09-1981 PT RBB

03-02-1985 SUKASENENG-CIKEUSIK

01-11-1991 PT RBB
 08-08-1990 PT RBB
06-01-1980 RANCASENENG

12-11-1981 RANCASENENG

17-11-1983 SUKAMULYA

11-05-1981 SUKAMULYA

06-08-1975 SUKAMULYA

01-08-1982 SUKAMULYA

15-03-1983 SUKAMULYA

10-07-2002 CIWET

10-12-1979 CIWET

15-04-1984 RANCASENENG

05-05-1972 CIKEUSIK

09-09-2000 CIMANGGU

13-12-1986 CIKEUSIK

07-08-1995 CIKEUSIK

24-10-1991 CIKEUSIK

29-12-1981 CIWET

08-07-1999 CIMANGGU

07-12-1989 SUKAMULYA

07-07-1988 SUKAMULYA
10-07-2004 NANGGALA
REMAJA
26-11-1994 CIKEUSIK
 21-05-2003 SUMURBATU

26-07-2002 PERDANA

28-10-1977 NANGGALA

02-02-1989 KEL SINDANG HAJI KEC PALASA

17-04-2001 UMBULAN

22-03-2000 PANIMBANG

19-07-1999 SUMUR

22/03/2000 PANIMBANG

11-05-1981 CIKEUSIK
01-08-1982 SUKAMULYA

07-07-1988 SUKAMULYA

HAJI 51 THN KP BATUJAYA 010/003

25-07-1967 RANCASENENG

21-08-1970 RANCASENENG - CIKEUSIK

27-10-1974 RANCASENENG

04-05-1973 RANCASENENG

12-03-1996 RANCASENENG

05-03-1990 RANCASENENG

02-07-1995 RANCASENENG

05-06-1981 RANCASENENG

05-07-1982 RANCASENENG

06-04-1984 RANCASENENG

13-05-1993 RANCASENENG
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
No. Hp BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

085887771336 CoronaVac 15-07-2021 15-07-2021

CoronaVac
085212099398 15-07-2021 15-07-2021
CoronaVac
085694093781 15-07-2021 15-07-2021
CoronaVac
081703414544 15-07-2021 15-07-2021
CoronaVac
082312395322 15-07-2021 15-07-2021

085310896666 CoronaVac 15-07-2021 15-07-2021

CoronaVac
085871616846 15-07-2021 15-07-2021
CoronaVac
085880562581 15-07-2021 15-07-2021
CoronaVac
085692720355 15-07-2021 15-07-2021
CoronaVac
083873755437 15-07-2021 15-07-2021
CoronaVac
082182022200 15-07-2021 15-07-2021

085283444145 CoronaVac 15-07-2021 15-07-2021

CoronaVac
085213058490 15-07-2021 15-07-2021

0812808498280 CoronaVac 15-07-2021 15-07-2021

CoronaVac
082114615673 15-07-2021 15-07-2021
;081218026714 CoronaVac
15-07-2021 15-07-2021
081241643805 CoronaVac
15-07-2021 15-07-2021
081218026674 CoronaVac 15-07-2021 15-07-2021
082124070397 CoronaVac
15-07-2021 15-07-2021
085313199723 CoronaVac
15-07-2021 15-07-2021
081210826721 CoronaVac
15-07-2021 15-07-2021
081210826729 CoronaVac 15-07-2021 15-07-2021
081282773440 CoronaVac
15-07-2021 15-07-2021
085779570670 CoronaVac
15-07-2021 15-07-2021
081612175303 CoronaVac
15-07-2021 15-07-2021
081617125303 CoronaVac 15-07-2021 15-07-2021
081617125303 CoronaVac
15-07-2021 15-07-2021
081617125303 CoronaVac 15-07-2021 15-07-2021
081617125303 CoronaVac
15-07-2021 15-07-2021

085813107273 CoronaVac
15-07-2021 15-07-2021
083147334063 CoronaVac
15-07-2021 15-07-2021
085217413019 CoronaVac
15-07-2021 15-07-2021

085283233169 CoronaVac
15-07-2021 15-07-2021
085803690743 CoronaVac
15-07-2021 15-07-2021
081219681493 CoronaVac
15-07-2021 15-07-2021
085694608927 CoronaVac
15-07-2021 15-07-2021
085694608927 CoronaVac 15-07-2021 15-07-2021
087871517905 CoronaVac
15-07-2021 15-07-2021
085773212178 CoronaVac
15-07-2021 15-07-2021
081617125303 CoronaVac
15-07-2021 15-07-2021
CoronaVac 15-07-2021 15-07-2021
081617125303
081511407991 CoronaVac
15-07-2021 15-07-2021
085779161257 CoronaVac 15-07-2021 15-07-2021
085715794360 CoronaVac 15-07-2021 15-07-2021
085280251081 CoronaVac
15-07-2021 15-07-2021
085710316117 CoronaVac
15-07-2021 15-07-2021
085714771238 CoronaVac
15-07-2021 15-07-2021
085711826359 CoronaVac 15-07-2021 15-07-2021
087776129065 CoronaVac
15-07-2021 15-07-2021
085773550350 CoronaVac 15-07-2021 15-07-2021

087776129065 CORONAVAC 02/09/21 15/07/21

08167125303 CoronaVac 15-07-2021 15-07-2021

081617125303
CoronaVac 15-07-2021 15-07-2021
081617125303
CoronaVac 15-07-2021 15-07-2021
081776036854 SINOVAC 4/14/2021 4/14/2021

08159337339 CoronaVac

087772313444 CoronaVac

081248283337 CoronaVac

085319527759 CoronaVac

0852196558886 CoronaVac

085211269647 CoronaVac

081283262109 CoronaVac

085647591981 CoronaVac

087709973819 CoronaVac
16-06-2021 16-06-2021
085771493967 CoronaVac

CoronaVac
08588755107
Dosis I Dosis 2
Tanggal
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791
24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791
 24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003921 16207156781791

24003121

24003921

24003921

24003121
24000821 16127778694458
15-07-2021 15-07-2021 24003921

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

24001421 15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

15-07-2021 24003921 16207156781791

KET
 16207156781791

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES

VAKSIN1 DI POLRES
NO No. Ticket NIK Nama Penerima Vaksin JK

1 P-BOGSIJKR 360226308920001 SITI MAESAROH P

2 P-DEVNJC4S 1812023107960005 JULIAN ADE P L
3 P-DIOLE4H9 5203050105800008 MUHAMAD YUSUP L
4 P-DJ5WK4PI 3601042911990001 CANDRA KURNIAWAN L
5 P-DK7B08LQ 3517075701940001 INTAN RIZKI G P
6 P-DLJZP9IB 3324141012650001 TUGIMAN L
7 P-DNW6ZKGW 3601042508720005 KADINAH P
8 P-DPY0FAXW 3601046108080001 NOVITA ANGGRAENI P
9 J-0000BYUG 351720660590001 ARISKA DIAH R P
10 P-DT1W2N5I 3601044501890001 RAEFI L
11 P-DVE8BRSR 3601044202940003 YATI P
12 P-DWGCPIZ9 3601045004890004 ENUR P
13 P-DXWGOB6Q 3601040104780004 JUMIN L
14 P-E3BIDUOQ 3601045410980002 ULFATUL KHASANAH P
15 P-E5E3NTDA 3601044512930001 TIKAH P
16 P-E5V5OSQZ 3601062403970001 JAJA L
17
18 P-ECDMQCSI 3601045408750003 HEDAH P
19 P-E8JOZDSN 3601042801000001 SUGIANA L
20 G-0133GQFG 3601040911860004 AMIN SUPYANI L
21 Q-000IONWZ 3601040207000003 BAGAS PUDA A L
22 P-E13JQF8G 3601044102850003 SARMIMI P
23 P-E33YDBUT 3601041211800003 JAENAL L
24 3601042302680003 MAKSUM L
25
26 3601044611850001 SAAH P
27 3602215609900001 YENI F P
28 Q-000IP1PC 3601040207690003 PARDIMAN L
29 3601040203790002 TASWADI L
30 3172020311660003 DIDIN L
31 P-EVUMENSR 3601015304740002 MUSLIHATUN P
32 P-EYD1BRV4 3601040109890002 MURTA L
33 P-F00HNDPQ 3602215110820004 MUMUS M P
34 3601044107920202 SARTI P
35 LYU YUNFEI L
36 1806203001680002 SUDARTO L
37 3524061507850003 M.SUCIPTO L
38 7312047005990002 SRI PUNAMA SARI P
39 P-42PJS8DB 3217071610970004 ARDIANSYAH L
40 P-5CNNJKQG 3308212005000005 YUSUP IMAN L
41 S-9B4407B9 3601171201860001 SURYADINATA L
42 P-0B9N9JBE 1810021406710001 SUKIRAN L
43 P-3W3PHB0Z 3601040908740001 SUMAR L
44 P-3PRLLHGG 3601045803040001 HELDA DIANA P
45 P-2T1KMZDL 3316071904990001 MUHAMAD ALIM C L
46 3524061507850003 MOCHAMAD SUCIPTO L
47 Q-0009JNQR 3601046906950002 SURNITI P
48 W-00007664 3601040107690024 SUANTA L
49 P-2B11HSCF 3601046401830002 LIA HASTUTI P
50 S-92789576 3601043006690001 RADEN SURADIMAN L
51 S-16D77F7C 3602080704820005 RIZKY MORA SOTARDUGA. H L
52 S-CDSC8BE5 3601040510790001 DANURI L
53 S-407D880D 360104490580001 SUHANAH P
54 S-E3C41371 3601040705860002 IWAN GUNAWAN L
55 S-1AED4BEA 3601041006880004 ZEZEN ARZENI L
56 S-DD4F3D0C 3601040602780002 ASEP MULYANA L
57 3601044607820002 ETIH P
58 S-BD23A9C1 3601041811870002 M. ILHAM, S.PD L
59 S-FF848574 3601032507810001 ARKA L
60 S-7165349D 3601045905880001 ROSITA P
61 P-6123HQQ3 3601040602870005 UDIN KOMARUDIN L
62 S-74C2A102 3601084107890025 TITIN SITI PATIMAH P
63 S-E09676A5 3601044507810005 TATI LESTARI P
64 P-G3LBWLMJ 3601045604800002 ENDRAWATI P
65 3601041710740002 DASTA SUTRISNA L
66 S-8F96970F 3601042008860001 RUKANDA L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

13-08-1992 KP CILEUNGSIR DS SUKAMULYA

31-07-1996 DAYA MURNI LK V1 KEC TUMUJAJAR
01-05-1980 KP SUMBER AGUNG
28-11-1999 KP SUKARENDAH DS SUKAWARIS
17-01-1994 JL MERDEKA 001/001 DS MOJOWARNO
10-02-1965 PEGULON 005/002 DS PEGULON
25-08-1972 KP CILANCAR DS NANGGALA
21-08-2008 KP BATJUAYA
26-05-1995 DSN KEDUNG JAWA TIMUR
05-01-1989 KP GUNUNG BATU
02-02-1994 BABAKAN SABEULAH 002/002
10-04-1985 SUMURBATU
01-04-1978 BABAKAN WARU
14-10-1998 HUNIBERA
05-12-1993 LEBAK WARU
01-04-1995 TANJUNGSARI

14-08-1983 LEBAKWARU
28-01-2000 CIKAREO
09-11-1986 PENDEUY
24-10-1999 TANJUNGAN
01/2/1985 BABAKAN WARU DS.SUKAWARIS
11-10-1985 BABAKAN WARU DS.SUKAWARIS
23-02-1968 CIKAREO DESA.SUKAWARIS

06-11-1985 BABAKAN SABEULAH, DS.SUMURBATU

16-09-1990 BABAKAN BANDUNG DS.CIKIRUHWETAN
03-05-1968 CIKUJANG II 001/001 DS.TANJUNGAN
02-03-1979 BABAKAN BANDUNG DS.CIKIRUHWETAN
03-11-1966 DEPOK
13-04-1974 DUSUN TELAGANAK RT 002 RW 003
 01-09-1987 SUKAMULYA
11-10-1982 SETRA TIMUR
01-07-1992 CIHERANG DS.SUKAMULYA
16-09-1908 PT RBB
30-01-1968 PURWODADI
15-07-1985 LAMONGAN
30-05-1999 SULAWESI SELATAN
16-10-1997 GUNUNGMASIGIT, CIPATAT KEC.BANDUNG
20-05-2000 DUSUN KUWUNG DS.WINDUSARI
12-01-1986 JABODETABEK
12-03-1970 TEGAL SARI GEDUNG REJO
09-08-1974 PAMATANG SEMPUR DS.SUKASENENG
18-03-2004 PAMATANG SEMPUR DS.SUKASENENG
19-04-1999 DK.SINGGET, DS.BLEBOH
15/07/1985 POLSEK KEDUNGPIRING
29-06-1995 CANGKORE
30-03-1964 RANCASENENG 02/05 DS.RANCASENENG
GURU 24-01-1983 SMPN 1 CI CIRIGI
GURU 30-06-1969 SMPN 2 CI KP.BABAKAN BANDUNG DS CIWET
GURU 07-04-1982 SMPN 2 CIKEUSIK
GURU 05-10-1979 SMPN 2 CIKEUSIK
GURU 04-05-1985 MA DARULKP. KUBANG PANCAL DESA CIKADONGDONG
GURU 07-05-1986 SMPN 1 CI KP. CIKEUSIK DESA CIKEUSIK
GURU 10-06-1988 MIS AT T KP. CIKEUSIK KALER DESA CIKEUSIK
SATPAM 06-02-1978 SMAN 18 KP. CITARIK DESA CIKEUSIK
GURU 06-07-1982 SMPN 2 CKP. CITARIK DESA CIKEUSIK
GURU 05-07-1988 SMPN 1 CKP. SUKASENENG DESA CIKEUSIK
GURU 02-02-1982 MA DARUKP.KIBODAS DESA CIHANJUANG
GURU 28-08-1990 SDN 1 U KP. UMBULAN DESA UMBULAN
GURU 10-05-1983 SDN 3 U KP. UMBULAN DESA UMBULAN
GURU 09-09-1990 SDN 2 CUCURUGCIUNG
GURU 05-07-1981 SDN 2 S CIKEUSIK
GURU 15-04-1980 SDN 3 CI CIKEUSIK
GURU 17-10-1974 SMPN 2 CRANCASENENG CIKEUSIK
GURU 20-08-1986 MTS NURRANCASENENG CIKEUSIK
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
No. Hp BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi
081218596605 SINOVAC 7/22/2021 7/22/2021
082289344197 SINOVAC 7/22/2021 7/22/2021
081246334506 SINOVAC 7/22/2021 7/22/2021
085890701475 SINOVAC 7/22/2021 7/22/2021
082342238615 SINOVAC 7/22/2021 7/22/2021
081325434173 SINOVAC 7/22/2021 7/22/2021
083873755437 SINOVAC 7/22/2021 7/22/2021
085693150349 SINOVAC 7/22/2021 7/22/2021
081235930665 SINOVAC 7/22/2021 7/22/2021
085814868613 SINOVAC 7/22/2021 7/22/2021
085773220361 SINOVAC 7/22/2021 7/22/2021
085773220361 SINOVAC 7/22/2021 7/22/2021
085695285790 SINOVAC 7/22/2021 7/22/2021
085215597829 SINOVAC 7/22/2021 7/22/2021
085650806947 SINOVAC 7/22/2021 7/22/2021
081574834166 SINOVAC 7/22/2021 7/22/2021

085650838241 SINOVAC 7/22/2021 7/22/2021

085719784680 SINOVAC 7/22/2021 7/22/2021
081283512383 SINOVAC 7/22/2021 7/22/2021
085799335655 CoronaVac 22-07-2021 22-07-2021
085695285790 SINOVAC 7/22/2021 7/22/2021
085650806947 SINOVAC 7/22/2021 7/22/2021
085719784680 SINOVAC 7/22/2021 7/22/2021

085817561807 SINOVAC 7/22/2021 7/22/2021

082312466212 SINOVAC 7/22/2021 7/22/2021
0855-1786-628 SINOVAC 7/22/2021 7/22/2021
085880069299 SINOVAC 7/22/2021 7/22/2021
082213258146 SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
 081257715450 SINOVAC 7/22/2021 7/22/2021
087772691170 SINOVAC 7/22/2021 7/22/2021
081257715450 SINOVAC 7/22/2021 7/22/2021
081383608781 SINOVAC 7/22/2021 7/22/2021
082371350538 SINOVAC 7/22/2021 7/22/2021
085251641433 SINOVAC 7/22/2021 7/22/2021
082312882380 SINOVAC 7/22/2021 7/22/2021
085246039710 SINOVAC 7/22/2021 7/22/2021
085858659187 SINOVAC 7/22/2021 7/22/2021
083806502370 SINOVAC 7/22/2021 7/22/2021
081237148132 SINOVAC 7/22/2021 7/22/2021
0857-7956--3338 SINOVAC 7/22/2021 7/22/2021
085776130282 SINOVAC 7/22/2021 7/22/2021
082131228546 SINOVAC 7/22/2021 7/22/2021
085251641433 CORONAVAC 7/22/2021 22/07/21
085694377110 SINOVAC
085210027169 SINOVAC
083873694692 SINOVAC 21-06-2021 21-06-2021
085773225861 SINOVAC 21-06-2021 21-06-2021
085216929817 CoronaVac 21-06-2021 21-06-2021
085693482221 CoronaVac 21-06-2021 21-06-2021
081398428632 CoronaVac 21-06-2021 21-06-2021
085219708063 CoronaVac 21-06-2021 21-06-2021
085216619010 CoronaVac 21-06-2021 21-06-2021
083898870076 CoronaVac 21-06-2021 21-06-2021
081318704708 CoronaVac 21-06-2021 21-06-2021
CoronaVac 21-06-2021 21-06-2021
085215512367 CoronaVac 21-06-2021 21-06-2021
085782631409 CoronaVac 21-06-2021 21-06-2021
085891372088 CoronaVac 21-06-2021 21-06-2021
085715265906 CoronaVac 21-06-2021 21-06-2021
085280388990 CoronaVac 21-06-2021 21-06-2021
081383792666 CoronaVac 21-06-2021 21-06-2021
085218008900 CoronaVac 21-06-2021 21-06-2021
085691090127 CoronaVac 21-06-2021 21-06-2021
Dosis I Dosis 2
Tanggal KET
No.
No seri Pemberian No. Batch No Seri
Batch
Vaksinasi

24003121
24003121
22-07-2021 24003121 16182990738465
22-07-2021 24003121 16182990738465
24002221 16164644021450 22-07-2021 24003121 16182990738465
24002221 16164644021450 22-07-2021 24003121 16182990738465
24002221 16164644021450 22-07-2021 24003121 16182990738465
24002221 16164644021450 22-07-2021 24003121 16182990738465
24002221 16164644021450 22-07-2021 24003121 16182990738465
24002221 16164644021450 22-07-2021 24003121 16182990738465
24000821 16127532807304 22-07-2021 24003121 16182990738465
24000821 16127532807304 22-07-2021 24003121 16182990738465
24000821 16127532807304 22-07-2021 24003121 16182990738465
24000821 16127532807304 22-07-2021 24003121 16182990738465
24000821 16127532807304 22-07-2021 24003121 16182990738465
2.4E+07 16164644021450 22-07-2021 24003121 16182990738465
2.4E+07 16164644021450 22-07-2021 24003121 16182990738465
2.4E+07 16164644021450 22-07-2021 24003121 16182990738465
2.4E+07 16164644021450 22-07-2021 24003121 16182990738465
2.4E+07 16164644021450 22-07-2021 24003121 16182990738465
2.4E+07 16164644021450 26/07/2021 24003121 16182990738465
2.4E+07 16164644021450 22-07-2021 24003121 16182990738465
 Umur Kelomp
NO No. Ticket NIK Nama Penerima Vaksin JK Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

1 P-G8NAJCE3 3601192908990003 AHMAD DIDI TURMUDI L 29-08-1999

2 P-GO9LRQV5 3601041404030002 GUNADI L 14-04-2003
3 P-GOYHRHSV 3601040207830008 EPI MULYANA L 02-07-1983
4 S-2C754E65 3601045111580003 SUNTIAH P 11-11-1958
5 P-GPX 3601046703000001 RITA AMINDII P 27-03-2000
6 P-GQ7ZRIBC 1802124707820007 ANIS ISTIQOMAH P 07-07-1982
7 P-GQLII5OZ 7310064911990001 DIAN TENTI A P 09-11-1999
8 P-GRSCO7STF 3512041303850001 BUDI SISWANTO L 13-03-1985
9 P-GRBDX1VB 3320061710030004 M ARDI L 17-10-2003
10 P-GSABPPYE 3515141203950002 ALFIN KURNIA L 12-03-1995
11 P-GSCIMNZG 1802122001010002 ARIA JUMANTORO L 20-01-2001
12 P-GTJ71G74 1801132506730004 DIDING SUPRIADI L 25-06-1973
13 P-GT5YF8Y7 1805271806800001 PANDOYO L 18-06-1980
14 Y-010FJ97N 3214116811850002 HINDUN NOVIANTI P 28-11-1985
15 Q-0008VL2Z 3601045705770001 ETI JUMAETI P 17-05-1977
16 P-GVS62NZR 3202082802010001 SOLEH BUDIMAN L 28-02-2001
17
18 P-GXTL33LM 3601044205980001 IA JUMIATI P 02-11-1990
19 S-E0E65AAC 3601040106500001 AMIN PRIATNA L 01-06-1950
20 P-GYW2OGO3 3601044107900059 DIAN P 01-07-1980
21 P-H0KBYAPW 1671062612840005 DESRIANG L 26-12-1984
22 P-H54RX5E7 3603180411760009 OHIM NUROHIM L 04-11-1976
23 P-H5FSNCGJ 3602030711690001 BUDI SUSANTO L 7/11/1969
24 P-H63N0K9S 3601064902030003 ANNISA S P 09-02-2003
25 P-H6JQHR2C 1802124708780007 ERNA NINGSIH P 23-11-1977
26 S-E6F5B70B 3601041205520001 M ARIP L 12-05-1952
27 P-H8XWDMZG 3601045008950009 SITI HASANAH P 10-08-1995
28 P-HA6HZTWU 3601045206000008 IMAS PRIHATINI P 13-06-2000
29 P-HA3FECYE 3601035107710001 ROHANAH P 11-07-1971
30 P-HB0VC5L1 3601044901990001 LAILA NURSAFITRI P 09-01-1999
31 P-HARN25XT 3214131709700001 EMAN SULAEMAN L 17-09-1970
32 Z-0007YUHP 3601041607970001 MUHAMAD SONI L 16-06-1994
33 P-HE9LU6IR 3601040102730006 KARTIM L 06-06-1974
34 Q-000JES6H 3601045006740001 PARIDAH P 10-06-1974
35 P-HGPVJYHP 3601045710730001 CICIH P 09-01-1970
36 P-HHXJAF5M 3601041509070001 MUHAMAD DAFFA R L 04-09-2007
37 P-HLKS0TRK 1002125010730010 MURTA FINGSIH L 10-10-1973
38 P-HMMZFAUB 33080607030006 ADI S L 07-07-2003
39 P-HNHZLNNO 3620062910020001 MIFTACHUL HUDA L 21-07-2002
40 P-HNCKTVHH 3308011808030001 ABID S L 18-08-2003
41 P-HNXMLHJB 33200619100320002 DIMAS F L 19-10-2003
42 P-HOINOJNA 3602211204960002 CECEP S L 29-04-1996
43 Z-0007YVDH 3173010412620006 DAVID L 04-12-1962
44 3601041509070001 M. DAFFA. R L 04-09-2007
45 Z-46B3IEF 3601041508840004 WARNATA L 15/08/1983
46 Q-0002G69X 3601046704010001 NANDA APRILIANTI P 27-04-2001
47 P-FN6MBYTA 3601044706830002 ALPIAH P PUBLIK 6/7/1983 PUBLIK
48 P-HBEWS3KD 3601040109800004 OYO SUTOYO L GURU 8/8/1980 guru
49 P-M5AUTMHO 3601086909690001 SITI AMINAH P GURU 9/29/1969 SDN CURC
50 P-M9EO5QA7 3601044107870110 TITIN P KADER 10/7/1988 KADER
51 P-MJIRNJDL 3601044607760003 AAM SAMSIAH P KADES 7/6/1976 KADER
52 P-MLP2WL5C 3601046803790002 UJU JUARSIH P GURU 3/28/1979 TK NANGG
53 P-MYXNLMNX 3601044207860008 ENENG HARTATI P KADER 8/2/1984 KADER
54 P-N9WAVMHJ 3601045603820001 SITI LILIS P KADER 3/16/1982 KADER
55 P-NQQEYT6L 3601044903840001 TATI NINGRAT P KADER 5/13/1983 KADER
56 P-NWT4L2TT 3601045211660001 MIMIN SUMINAR P GURU 5/6/1965 SMP 3 CK
57 P-O3JPBYD1 3601041305760001 ROHANI L PNS 10/3/1976 TK NANGG
58 P-O71EVWEA 3601040107720088 KADRIAH DIDI E. L GURU 6/12/1972 SMP 1 CK
59 S-774D80FE 3601043011800001 idam L PUBLIK 3/14/1979 PUBLIK
60 S-C2FA6955 3601040309970001 DIKI SEPTIANA L PUBLIK 9/3/1997 PUBLIK
61 S-CDD4197C 3601047005990001 MAYA LESTARI P PUBLIK 5/30/1999 PUBLIK
62 S-D14B5550 3601045510710002 ROHANIAH P KADES 1/15/1971 KADES
63 P-RPCTLOT7 3601044605020001 KARMILA P publik 06/05/2002 publik
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal
Merek
Alamat No. Hp BPJS BPJS Non Screeni Tanggal
Vaksin*** Pemberian No. Batch
PBI Non PBI Anggota ng
Vaksinasi

DS.CIKEUSIK KEC.CIKEUSIK 08581191-1955 SINOVAC 26/07/2021 24002221

KP RANCASENENG 085887771044 SINOVAC 26/07/2021 24002221
KP CIBULUH 081318377474 SINOVAC 26/07/2021 24002221
KP CIKEUSIK 085214724141 SINOVAC 26/07/2021 24002221
KP CIKEUSIK 083871139882 SINOVAC 26/07/2021 24002221
KP TENGAH LAMPUNG 082377044425 SINOVAC 26/07/2021 24002221
KP SAMALEWA 082343796369 SINOVAC 26/07/2021 24002221
KP PENGABETAN 001/001 085258298878 SINOVAC 26/07/2021 24002221
JEPARA 085540669564 SINOVAC 26/07/2021 24002221
GRIYA BAYANGKARA 085811550812 SINOVAC 26/07/2021 24002221
LAMPUNG TENGAH 085753012196 SINOVAC 26/07/2021 24002221
LAMPUNG TENGAH 08570710391 SINOVAC 26/07/2021 24002221
PRINGSEWO 085378279098 SINOVAC 26/07/2021 24002221
BODONG TIMUR 087880520247 SINOVAC 26/07/2021 24002221
KP CIKEUSIK 003/005 DS CIKEUSIK 085694473876 SINOVAC 26/07/2021 24002221
KP CICADAS 085794909248 SINOVAC 26/07/2021 24002221

KP CIKEUSIK 001/001 DS CIKEUSIK 085212265990 SINOVAC 26/07/2021 24002221

KP CIKEUSIK 085212265990 SINOVAC 26/07/2021 24002221
KP CIKEUSIK 083893313045 SINOVAC 26/07/2021 24002221
IUR TIMUR 081311784187 SINOVAC 26/07/2021 24002221
TANGGERANG 081586886281 SINOVAC 26/07/2021 24002221
BAYAH 085695212869 SINOVAC 26/07/2021 24002221
SUKAMAJU 081210596499 SINOVAC 26/07/2021 24002221
LAMPUNG TENGAH ;081286144272 SINOVAC 26/07/2021 24002221
KP CIKEUSK 085779561204 SINOVAC 26/07/2021 24002221
KP SUKALAKSANA 085782264240 SINOVAC 26/07/2021 24003121
KP SUKAWARIS 087887534922 SINOVAC 26/07/2021 24003121
KP CIBINGBIN 081287707230 SINOVAC 26/07/2021 24003121
KP SUKAWARIS 081806717334 SINOVAC 26/07/2021 24003121
JL JATI JAMBI 082311401445 SINOVAC 26/07/2021 24003121
SUKAWARIS 0858888951994 CoronaVac 26-07-202 26-07-2021 24003121
KP BABAKAN WARU 085866761684 SINOVAC 26/07/2021 24003121
LKP PEMATANG SEMPUR 085218230691 SINOVAC 26/07/2021 24003121
KP CIKUJANG 085772833556 SINOVAC 26/07/2021 24003121
KP CIKEUSIK 085694138651 SINOVAC 26/07/2021 24003121
LAMPUNG TENGAH 082375739892 SINOVAC 26/07/2021 24003121
MAGELANG 088225238469 SINOVAC 26/07/2021 24003121
JEPARA 085700146931 SINOVAC 26/07/2021 24003121
MAGELANG 088286094171 SINOVAC 26/07/2021 24003121
JEPARA 085900256471 SINOVAC 26/07/2021 24003121
WANASALAM 081610682122 SINOVAC 26/07/2021 24003121
JAKARTA BARAT 085218726888 SINOVAC 26/07/2021 24003121
CIKEUSIK 085694138651 CoronaVac 26-07-202 26-07-2021 24003121
KP PERMATANG SEMPUR DS CIKEUSIK 081221222800 SINOVAC
KP CIKEUSIK 081383696572 SINOVAC
CIKEUSIK 082125045188 coronaVac 6/28/2021 6/28/2021 24002221
CIKEUSIK 085313117522 coronaVac 6/28/2021 6/28/2021 24002221
MUNJUL 088293632543 coronaVac 6/28/2021 6/28/2021 24002221
UMBULAN 085280255980 coronaVac 6/28/2021 6/28/2021 24002221
CIKEUSIK 085694137248 coronaVac 6/28/2021 6/28/2021 24002221
CIBALIUNG 083147213596 coronaVac 6/28/2021 6/28/2021 24002221
CIKEUSIK 085215739876 coronaVac 6/28/2021 6/28/2021 24002221
CIKEUSIK 085714790105 coronaVac 6/28/2021 6/28/2021 24002221
SUKASENENG 085695412791 coronaVac 6/28/2021 6/28/2021 24002221
CIKEUSIK 085778185736 coronaVac 6/28/2021 6/28/2021 24002221
NANGGALA 085736243228 coronaVac 6/28/2021 6/28/2021 24002221
UMBULAN 085691857859 coronaVac 6/28/2021 6/28/2021 24002221
NANGGALA 081381926127 coronaVac 6/28/2021 6/28/2021 24002221
NANGGALA 085883657215 coronaVac 6/28/2021 6/28/2021 24002221
CIKEUSIK 085770136373 coronaVac 6/28/2021 6/28/2021 24002221
NANGGALA 085770136373 coronaVac 6/28/2021 6/28/2021 24002221

CIKEUSIK 082258640176 coronaVac 6/29/2021 6/29/2021 24003921

 Dosis 2

Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi

16183002360949
16183002360949
16183002370745
16183002370745
16183002370745
16183002370745
16183002370745 27-09-2021 24200121 16219343252570
16183002370745
16183002370745
16183002370745
16183002370745
16183002370745
16182990738465
16182990738465
16182990738465
16182990738465

16182990738465
16182990738465
16182990737841
16182990737841
16182990737841
16182990737841
16182990737841
16182990737841
16182990737841
16182990935789
16182990935789
16182990935789
16182990935789
16182990935789

16182990935789
16183002581969
16183002581969
16183002581969
16183002581969
16183002581969
16183002581969
16183002581969
16183002581969
16183002581969
16183002581969
 26/07/2021 24003121 16182990738465
26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 26/07/2021 24003121 16182990738465
16164643898366 22-07-2021 24003121
16164643903202 26/07/2021 24003121 16182990738465
16164643903202 26/07/2021 24003121 16182990738465
16164643903202 26/07/2021 24003121 16182990738465
16164643900534 26/07/2021 24003121 16182990738465
16164643900534 26/07/2021 24003121 16182990738465
16164643900534 26/07/2021 24003121 16182990738465
16164643900534 26/07/2021 24003121 16182990738465
16213341156810 26/07/2021 24003121 16182990738465
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 S-E492B29F 3601044404780001 WASTIJAH P

2 P-8D02E646 3601041006020001 SOLEHUDIN L
3 P-9HJH3HLQ 3601044101820002 HJ ANI P
4 P-AZODGPGQ 3601040710060002 M RAYA KUSUMA L
5 P-HZSOKKB1 3601045504040004 FITRIANI P
6 P-HOH5ISLZ 3601040108990007 HERI IRAWAN L
7 P-J0AGGOEJ 3601042108970003 ABDAN L
8 P-JSWLR51E 3601040711890005 ARSUDIN L
9 P-LVO5G93Q 3601045104070002 SITI KHANSA A P
10 P-LXVM9SZW 3601041104900005 ARMAN L
11 P-LYKG8HUD 3572010705710007 MOCH ARIF S L
12 P-LZZ372CU 3601042502070003 KARIS IRPANSYAH L
13 P-M19HGJPE 3601045205940007 TUTI P
NURRAMDAN
14 P-M2T8O2W9 3602260411020002 L
ROHMAN
15 P-M1AOD44M 3509131505850003 M JONI L
16 P-M2W9UBG83602190104020004 M YASIR L
17 P-M3NWRXF53602191710030001 ANGGIS L
18 P-M4EEAIJW 3603181006800024 JUNAEDI L
19 P-M5LG0H51 3602032405720001 SURYANTO L
20 P-M74GVOT 3601040107840163 SUNTAMA L
21 P-M7APV3HS 1801070310930004 SURDI L
22 P-MA3BQ87K 3601044504880001 RASTINI P
23 P-MA92DEGQ3601046907000004 AYU SUNAYAH P
24 P-MBTX5ZFT 3308152606030004 LUKMAN L
25 P-MD7VN8ZZ 3308052612020001 ANWAR FUADI L
26 P-MDYJ0SG0 1806180708010002 MASTHURIANSYAH L
27 P-MFB95WAJ 1806120406030006 ANDRE NUR AZIZ L
28 P-MGGFUHCJ1806182303030004 DIAN EFENDI P
29 P-MGXR1NNU1806180606020001 INDRI JAILANI P
30 P-MHT1XPOD3320060808030001 AGUS GUNAWAN L
31 P-MIGSYFDK 1806182312020003 INDRA S L
32 P-MJRDAIWH 3601040710920002 AAN L
33 P-MKKRDH36 3601041111030003 AMAK NOVALINO L
34 P-MLOXKOQB3604052808750001 AGUS WAHYUDI L
35 P-MLW1ATJW3601041903970003 M AMIN L
36 P-MMCM5AK73601046512710001 INA DAINA P
37 P-MMTXMTWH3320140806020002 M FENDY L
38 P-MN328VO5 3308061311030001 WAHID L
39 P-MNOM9CTP3604230404880002 AHMAD DONI L
40 P-MNCTR7Y1 3601120107830300 ERWAN L
41 P-MNJ4I3QJ 3601121810820001 KADRI A L
42 P-MNV0JWRP3601160107920089 HENDI SUPRIADI L
43 P-MO6OUB21 3317070608010002 M ABDUL; L
44 P-MOHX0GTY3601040502930002 DARNO L
45 3601045212800002 SITI P
46 Q-000K2E10 3602260411020002 NURAMDAN L
47 P-MOZQQZHE3601042304950003 NOVAL L
48 Z-0005RMK6 3601046103500001 FAUZAH P
49 Q-000A8GW0 7371101709930002 ARSAL CHALIL E L
50 Q-0009GVHB 360104470160002 JUARIAH P
51 Q-0009GV9X 3601040107590017 UJANG ROHALI L
52 Q-000A6OYX 3601042403990001 WIRANTO L
53 Q-0009GYL8 3602212002960004 SAMAN L
54 S-CEB092D8 3601045411860001 MIMIN MIRAHWATI P
55 P-M4PMZGO9 3601045002860006 DINI YULIANTI P
56 P-MKVSQQF3 3601042209930001 M. REDI SEPTIANA L
57 P-NHQOG4MV 3601045512830001 ENTIN SURYATIN P
58 S-54A53BBA 3601040107970220 m. abdulah L
59 P-7Q0RFH3O 360104470398004 SRI LESTARI P
60 P-BCS67F02 3601045112670001 EUIS NURHAYATI P
61 S-2F563196 3601046312820002 NENI NURHAENI P
62 Y-012ZNH89 3173060470000 HENDRY WIJAYA L
63 Y-013085UD 31730627003630002 TIOE HERMAN L
64 P-CDK40E5A 3601042502890001 TRIMO ARI PRAYUGO L
65 P-ELB42XV1 3601046412000002 FITRIYANTI P
66 P-JKMX6O0P0 3601040309000008 FAHRY AL HAYYU F L
67 SEZF4E83A 3601046704890001 SITI HAWA P
68 P-MNUT21RR 360221500990005 SELI NURRANI P
69 S-E7101867 360112430560001 RISTINI P

70 P-PK0DZ 36010452040003 HADISAH P

71 P-PLN7OJ60 3601044311780001 HOLIAH P

72 P-PS0TB4MW 3601041907950001 SOLEH JATNIKO L

73 P-PTJULMUU 360104074850002 IWAN RIDWANUDIN L

74 3601045012620002 DANI RAMDANI L

75 S-CDAB90DD 3601046105760001 N. IIS MURNASIH SAG P

76 P-QCR703I2 360104470160002 JUARIAH P

77 P-QKQH6TQC 3601040107590017 UJANG ROHALI L

78 Y-0131HFWX 3173066650803003 YULIANTI HERMAN P

79 P-QOTEUK8H 3601046112990004 BAYU WAHYU AGUNG L

80 S-849832D3 3601040307860002 KHOERUDIN L
81 P-QTVDDL3G 3601041501610001 ABENG L
82 3601042507720002 MARDI L
83 S-2D22B9A8 3601046103500001 WAWAN S L
84 P-R8BUL3MR 3601045104980006 NINA AGUSTINA P
85 P-REX1ACGV 3601040305910001 DEDE RAFIUDIN L
86 P-RHSL96GN 3601044108010004 AYU KOMALASARI P
87 P-4PSYVNIX 3601041002680007 SUWARNO L
88 S-F6928AAA 3601040307630001 SUPRAPTO L
89 P-35GJR7I5 3601041902820001 KUSEN L
90 S-DE5D0565 3601042309890001 YOGA SEPTIANA L
91 P-008VSQJO 3601042706000001 RIYAN L
92 S-6E55F10F 360134090570001 ARSUDIN L

93 P-0TQR3ITC 3601045102770006 MARSIH P

94 P-4DSLB4ZB 3601040502830004 DARKA WARYANTO L

95 P-4TJZXVEK 3601041007890006 AEP F L

96 P-4XA58BUL 3210102110870001 HENDRA SUPARNA L
97 S-F7F6CC14 3601034107850266 RENY ROHAENI P

98 S-BB06F088 3601041103900001 ATA L

99 S-2E9824BB 3601044107890048 SITI ROKENAH P

100 P-5B57U1S8 3601045105020002 DAHLIA P
101 S-302C6245 3601045510930002 ERNAWATI P
102 S-70CEC0AD 3601042504910004 AGUS SYARIF L

103 S-AFAF503F 3601044907780001 CUCUM P

104 S-BDECE631 3601041109830003 DIDIN K L

105 S-41C4B175 3601044906850003 SUMYATI P
106 P-6MVNSC8C 36010403090309900002 ABDUROCHIM L

107 P-6H78URGU 3671012101710007 SUMARSONO L

108 P-6W0XSIQL 3325090212900006 TONY BACHTIAR L

109 S-9C1A2375 3601046404960001 SITI TIEN P

110 P-7F1KO0D5 3601042606880002 ERRY FAIZA L

111 P-77WQ3UF4 3515110605920004 DIMAS PRAMBUDI L

112 3601046104000002 ELVIRA P
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

3/4/1978
6/7/2002
1/1/1982
10/7/2006
7/1/2000
8/1/1998
8/21/1997
11/7/1989
4/11/2007
4/11/1990
5/7/1971
2/25/2007
5/12/1994
11/4/2002
5/15/1985
5/14/2002
10/17/2003
6/10/1990
5/24/1972
7/1/1984
10/3/1993
4/5/1998
7/29/2000
6/26/2003
12/26/2002
8/7/2001
 6/4/2003
3/23/2003
6/6/2002
8/8/2003
12/23/2002
10/9/1988
11/3/2003
8/28/1975
3/10/1998
12/25/1971
6/8/2003
11/13/2003
4/4/1988
12/25/1985
18/10/19892
6/24/1989
8/6/2001
2/5/1993
10/07/1985
04-11-2002
7/16/1995
7/2/1946
9/17/1993
9/2/1969
12/23/1965
8/10/1999
2/20/1996
GURU 14-11-1986 MA DARU
GURU 8/14/2001 SMP 2 CK
PRADES 9/22/1993 PRADES
KADER 6/14/1979 KADER
PUBLIK 8/16/1996 PUBLIK

PEL.PUBLIK 07-05-1998

11-12-1967

GURU 23-12-1982 SDN SUKAS

TAMBAK 04-07-2000

TAMBAK 27-03-1963

GURU 25-01-1989 SMPN 1 CIK

24-12-2000

03-04-2000

GURU 27-04-1989 SMPN 1 CIK

10-09-1999

GURU 03-05-1964 SMPN 1 CIKEUSIK

05-03-1969

03-11-1978

11-07-1995

PRADES 07-04-1985 PRADES

GURU 09-07-1984

GURU 21-05-1976 SMPN 1 CIK

02-09-1969
23-12-1965

25-08-1963

publik 01/12/1999 publik

publik 13/07/1986 publik

publik 15/11/1961 publik

publik 25/07/1972 publik

publik 12/12/1982 publik

publik 11/04/1998 publik

publik 05/05/1991 publik

publik 01/08/2001 publik

publik 10/02/1968 publik

GURU 03-07-1963
PEL. PUBLIK 10-09-1981
GURU 23-09-1989

PEL. PUBLIK 27-06-2000

GURU 09-05-1967 SDN SUKAS

PEL. PUBLIK 11-02-1997

05-02-1983

NAKES 18-08-1988 PUSKESM

GURU 21-10-1987 SMPN 5 C
23-03-1986

GURU 09-05-1989 SMPN 5 C

GURU 16-04-1990 SMPN 5 C
11-05-2002
15-10-1993

GURU 25-04-1991 SMPN 5 C

GURU 04-07-1977 SMPN 5 C

GURU 24-02-1985 SDN SUK

GURU 27-11-1985 SDN SUM

PRADES 03-09-1990 PRADES

TAMBAK UDANG 21-01-1971 TAMBAK
02-12-1990
29-04-1996

21-06-1986

06-05-1992
01-01-2000
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat No. Hp BPJS BPJS Non
PBI Non PBI Anggota

KP SINAR GINTUNG 001/003 DS CURUGCIUNG 085697607114

SUKASENENG 085694617787
KP MUARA DUA 087788703424
KP CIKEUSIK 082310246932
UMBULAN 083899295587
SUMURBATU 085697744736
SUMURBATU 081282308122
CIKURUHWETAN 085711045287
UMBULAN 085773239659
SUMURBATU 082252954469
KARANGSARI 082340725064
LEBAK WARU 081311784192
SUKAMULYA 081280547808
SUKASENENG 085894196324
RAMBIPUJI 085231706321
CIBEBER 085888475830
SUKAMULYA 085246039710
SUKADAMAH 0895331863780
PASIR GOMBONG 081282875345
CIKEUSIK 081318704554
LAMPUNG SELATAN 081377865137
CIKEUSIK 085717275661
CIKEUSIK 087884832900
MAGELANG 085726001284
MAGELANG 08877709044
TALAGENING 087881443265
TANGGAMUS 087769078247
TANGGAMUS 082335418256
TANGGAMUS 081278408539
JEPARA 085200483883
TANGGAMUS 082182482281
SUKAMULYA 081280547808
CIKEUSIK 085782266800
RANCASENENG 083879024288
LEUWI BALANGF 085781944207
RANCASENENG 081219736959
JEPARA 085647262418
MAGELANG 085798027076
SERANG 083147256000
JAHA POJOK 081774977827
LABUAN 083893382648
KADUTUNDUN 081210288543
JAWA TENGAH 08569473132
SUKASENENG 083893644281
GUNUNG BATU 085772730281
SUKASENENG 085894196324
SUKAWARIS 082310769295
MALANGSARI 082312056402
CIWET 085241798886
RANCASENENG 085219673277
RANCASENENG 085219895865
CIKARET 081213437315
BOJONG KONENG 081297948175
KP. CIKEUSIK DESA CIKEUSIK 081382341934
UMBULAN 085692729249
SUKASENENG 08157860280
SUKASENENG
 UMBULAN 085710525716

CIKEUSIK 085210405671

CIKEUSIK 085313197869

CIKEUSIK 083874999426

CIWET/JKT 082210287908

CIWET/JKT 081285790275

CIKEUSIK 083871333342

CIWET 081908966363

081280516159

CIKEUSIK 081933836764

BINUANGEN 087711169347

SMPN 1 CIKEUSIK 081316674807

KADIRI 085774685998

CIWET 087773161677

KP. CIKAREO DESA SUKAWARIS 081222897132

NANGGALA 081517430984

KP SUMUR BATU DESA SUMURBATU 085714776851

CIKEUSIK 081284804141

RANCASENENG 085219673277
RANCASENENG 085219895865

CIWET/JKT 081287298246

RANCASENENG 08558167399

SUKASENENG 082112679072

CIKEUSIK 08229776880

SUMURBATU 085650838241

CIKEUSIK 085778185531

RANCASENENG 085779097865

RANCASENENG 085719841325

RANCASENENG 085893307063

RANCASENENG 082111874883
CIKEUSIK 081394437815
SUKASENENG 085717237032
CIKEUSIK 081905642922

CIKEUSIK 081285222049
KP CIEKEK DESA KARATON MALASARI 081510554401

RANCASENENG 085884911031

RANCASENENG 085715264076

UMBULAN 085773527760
RANCASENENG 08571779139
SUKAJADI 085691035492

SUKAMULYA 085695665666

RANCASENENG 085717791399
SUKASENENG 081318596176
CIKEUSIK 085778549022
TANJUNGAN 081586283995

PARUNGKOKOSAN 085891029495

SUKAMULYA 085885762298
SUKAMULYA 085710732813
RANCASENENG 085813198548

CIAKAR 081298570255

BATANG-JATENG 085190071237
KP. CILANCAR DESA NANGGALA 085880007042

CIKEUSIK 081283773328

ALAM PESONA. SIDOARJO 085338407754

MUARADUA 08314784303
 Dosis I Dosis 2
Merek Tanggal Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri Pemberian
Vaksinasi Vaksinasi
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
 SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
CORONAVAC 02/09/21 30/07/21 24003121
CoronaVac 28-07-2021 28-07-2021 24003121
SINOVAC 7/28/2021
SINOVAC 7/28/2021
SINOVAC 7/28/2021
SINOVAC 7/28/2021
SINOVAC 7/28/2021
SINOVAC 7/28/2021
SINOVAC 7/28/2021
CoronaVac 21-06-2021 21-06-2021 24002221 161646440 7/28/2021
coronaVac 6/28/2021 6/28/2021 24002221 161646438 7/28/2021
coronaVac 6/28/2021 6/28/2021 24002221 161646438 7/28/2021
coronaVac 6/28/2021 6/28/2021 24002221 161646438 7/28/2021
coronaVac 6/28/2021 8/28/2021 24002221 161646439 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002378 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24002221 16164643899 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24002221 16164643899 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24002221 16164643899 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24002221 16164643899 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002374 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002374 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002584 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002584 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002584 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002366377 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002366377 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002580565 7/28/2021
SINOVAC 29-06-2021 29-06-2021 24003121 16183002580565 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003921 16213341156 7/28/2021
coronaVac 6/29/2021 6/29/2021 24003921 16213341156 7/28/2021
 SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886 7/28/2021
CoronaVac 28-07-2021 28-07-2021 24004221 27-09-2021
Dosis 2
KET
No. Batch No Seri
24003121 16182997534589
24003121 16182997537413
24003121 16182997318233
24003121 16182990934697
24003121 16182990934697
24003121 16183002342461
24003121 16183002342461
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
24003121 16183002373865
 24003121 16183002373865
24003121 16183002373865
24003121 16183002373865

24003121 16183002373865

24003121 16183002373865
24003121 16183002373865

24003121 16183002373865

24003121 16183002373865
24003121 16183002373865

24003121 16183002373865
24003121 16183002373865

24003121 16183002373865

24003121 16183002373865
24003121 16183002373865
24003121 16183002373865

24003121 16183002373865

24003121 16183002373865
24003121 16183002373865
24003121 16183002373865

24003121 16183002373865

24003121 16183002373865
24003121 16183002373865

24003121 16183002373865
24003121 16183002373865
24005121 16219343252570
NO No. Ticket NIK Nama Penerima Vaksin JK

1 Q-000KLULH 3601042910790003 SURITA L

2 P-6LU7PVV0 3671021809780005 CARDIKI L
3 P-6OLA114K 361085901010002 KHOIRIAH P
4 Q-000KLX0M 360104107950129 SOIP L
5 P-6QDY18SI 360104600320001 TAMEN P
6 P-6T2SWHRZ 3601041904780002 DARMA L
7 P-6VEB5EQ4 36010441007838372 IDAH P
8 S-9D9D8581 3601044107530220 WARYI P
9 P-70LX3RQS 36010407100001 MAKAR L
10 S-55672BEC 360104691190004 YATI P
11 P-73WDFUU7 6108041609880003 HERMAN L
12 P-74M7H82I 360116230900001 SUPARDI L
13 P-7NROWFZF 360104600000008 UMSITI P
14 P-76LCK6LW 360228061100001 ARMAT L
15 P-79RUA05D 3602280506020002 REHAN L
16 Q-000KM5N8 3320086908010021 M. ADIFA L
17 P-7HLN0232 3601160610980001 TAUFIK H L
18 3601046901940001 MILA ISMU NURUL P
19 P-7DZQR7QB 3601040107940017 ADUNG L
20 P-7JWG5EVT 3601042802930002 SOBIANA L
21 P-7KZ1GPOF 360104690450002 MELDA SYIFA A P
22 3601040107990011 MILHANSAH L
23 P-7UTUEGCK 3601040701010011 FIRMANSYAH L
24 WASLAM L
25 360104540700006 INAH P
26 P-8CET411X 3601041202950002 EPI P
27 S-A675BD4C 360104540700006 INAH R P
28 P-8AOFDLQZ 360104410460002 SUHENAH P
29 P-82EPC4QJ 3601040107990011 MILHANSA L
30 P-8FUPGI47 180722220670001 BAMBANG L
31 P-8LQHWDEM 3308193010020003 NASICHIN L
32 P-8RE2VF4V 3601030106880001 SAROJI L
33 P-ILIN7NGD AMANDA PUTRI A P
34 Q-000KMRN2 3601046603050001 ANDINI D P
35 P-8JZG3BK0 360104630430003 TITIN P
36 3602140408220009 RUSDIANA P
37 P-8TRH1D3F 3601046302080001 NIKITA A P
38 P-945B7HND 36013290660001 ENDIN L
39 P-90G7DEHD 180106051000010 AANG J L
40 P-970LWE1O 3601040108880001 TB KUSNADI L
41 P-9DE2AOUS 3601044102900014 ANI P
42 P-9HSMKKRW 360104457890001 ARMI P
43 P-9FMK8606 2102035203830007 ELISAH L
44 P-9HMORNI1 3601044702960005 NOPIANA DEWI P
45 P-9AN1MEO6 3601045902670001 KUSIRI P
46 Q-000KN3CE 1804171507020002 RYAN A L
47 P-9KB7CNM3 360104026840002 USNAN L
48 P-9MHRGHVO 3601045704900005 BEDAH P
49 P-9NYEZC4D 360104010790037 JONI L
50 P-9NSKDWGH 3601042708020002 TB DARMA W L
51 P-9QROYT3M 3601041107890004 OHAM L
52 P-9TA27EQK 3601040106760006 EDI B IDRA L
53 P-9VIWLUSF 3601040703960003 RIO L
54 P-87KR9FDC 3601040405960006 HARUN L
55 P-9Z1JQS4X 3320081403020001 AMAR L
56 P-A03L1QP4 32108230470021 M SOFIAN A L
57 P-96OKPDJC 360214420850010 IIS N P
58 P-A4GXYUMJ SUROKEM L
59 P-A2K0H8HM M. NUR WAKHID L
60 P-A2TMIQD4 360103520970002 EEN ASIH S P
61 P-A5Q5JEV4 3601073002960001 MUKRIONO L
62 P-A4D42VB RIZKY BAGUS L
63 Y-0130VSKV 3175022108860010 HIDAYAT IHSAN L
64 P-A7RA2UWX RUDI S L
65 Y-0131013H 3175022710870004 ALBERT L
66 P-A68PDUKE 332011701030004 AMRUL L
67 Q-000KND6C M DICKY L
68 P-AA6W75T8 3622131903030001 M RUBI L
69 P-ABTW711L M RIZAL NUR KHOLIS L
70 P-ACU99HNW HENDRA DWI L
71 Q-000KNHUV 3602021406970002 ERI W L
72 P-AFHGG8CK FIRMAN A L
73 Q-000KNHS1 M. NAUFAL MUHAJI L
74 P-AD4RX4AO FIRMAN BIMA L
75 Q-0009B0GY 3601042309960001 AINUN AZIZ L
76 Q-000KNIHD AHMAD SUKAMIN L
77 P-AGAWRNIO 3601043107020001 JULIUS DAHSYAH L
78 P-AGVUJL4T 3601041808730007 RINTA L
79 P-AHB0ENJ2 7173051903760001 MARTHIN R L
80 P-AHXBTT6F 3601040401010004 FAHMI A L
81 P-AI00EOPV 360104107770035 WARSAD L
82 Q-000B98KL 3601044408980001 DIANA N P
83 Q-000B98MH 3601045609990001 MEGA SITI R P
84 Q-0002T8R4 3601040809810003 JUKARIH L
85 Q-000B96H5 3601045907820001 KARMI P
86 Q-0009GVCA 3601040502910032 ADI ACHWANI L
87 3601041907830004 IWAN H L
88 Q-000B7R35 3601040502930008 SURYA SAHRUDIN S.AP L
89 3602010204860003 M. ROMLI L
90 3209221306740005 ASEP MAHMUDIN L
91 1471110509810041 HASAN L
92 P-PYGMHCHM 36010 NANANG MULYANA L

93 P-1MLMXG3M 3601040107790065 SUPYANI L

94 P-RCVADBPJ 3601040502010002 ADI AHWANI L

95 P-RBVKCFLO 3601041210970004 DADAN SOPYAN L
96 S-5EE25E2C 3601045506510001 HJ. DARSIH P
97 P-2VSND4X4 3601041012730000 YUDIN FIRMANSYAH L
98 3602160301880004 BADRUDIN L
99 S-BC8D2E01 3601040101870003 CHEVY ARIJAL L
100 9271017005920002 LISI ANGGREANI P
101 P-25IBRK2T 3601045905960001 INAH P
102 P-2IND3NGK 7371071601920011 SULFIKAR L
103 P-2PXK25LJ 3525012412970001 IRFAN GUNAWAN L
104 P-3NMP1RKR 3216081507940005 JOEL MICHAEL PATAR S L
105 P-3Q72JAPO 1405022909950003 RYAN DHARMAWAN L
106 P-3XKFMZIG 1308191905990001 BERLIAN RIFANDI L
107 1871112910940003 AHMAD MAULANA S L
108 3322106205980002 VENY KRISDAYANTI P
109 P-4GS0PNVF 1171035708980003 IMELDA SAGITA MARJA P
110 P-4NMFPJXH 3325110109940006 VAUZUL ILHAM NUDIN L
111 P-67ET8S50 3601041410830001 MOH TOHARUDIN L
112 P-6AWFKEBY 3601044109780001 WIWIN P
113 3601040306750004 TONI FAHRUDIN L
114 P-6W5GFBCZ 3601046102090000 Sri MULYANI P
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

29-10-1979
18-09-1987
20-07-2002
05-06-1994
20-03-1982
19-04-1978
01-07-1983
01-07-1953
12-09-1963
29-11-1991
16-09-1987
27-09-2001
20-01-2000
01-11-2007
05-06-2002
29-08-2001
06-10-1998
29-01-1994
01-07-1995
28-02-1993
29-04-2005
07-06-1999
07-01-2001
60 TAHUN LANSIA
14-07-1960
15-09-1995
14-07-1960
01-06-1996
07-06-1999
22-04-1967
30-10-2002
01-06-1988
17-04-2003
26-03-2005
03-03-1970
04-06-1982
23-02-2008
29-06-1986
05-10-1990
07-11-1984
01-02-1990
05-07-1989
12-03-1989
07-02-1996
19-02-1967
15-06-2002
02-06-1984
17-04-1990
01-12-1979
27-09-2002
11-07-1989
01-06-1976
27-04-1996
04-05-1996
14-03-2002
23-09-1997
02-07-1985
18-07-2001
03-11-2002
12-02-1997
30-03-1996
30-08-2003
21-08-1996
19-10-2002
27-10-1987
17-01-2003
15-05-2003
19-03-2003
18-10-2003
11-09-2001
20-10-1997
17-12-1996
25-02-2003
01-05-2003
23-05-1996
18-05-1976
31-07-2001
18-08-1973
19-03-1976
04-01-2001
01-07-1977
04-08-1999
 16-09-1999
08-09-1981
23-05-1962
05-02-1991
17-10-1984
23-02-1999
02-04-1986
13-06-1974
05-09-1981

PRADES 02-04-1982 PRADES

CAL KADES 08-11-1979 CAL KADES

publik 05/02/1991 publik

publik 12/10/1997 publik

LANSIA 20-09-1950

PEL. PUBLIK 10-12-1973

SATPAM 4/2/1988
M.UMUM 1/1/1987
TAMBAK 30/5/1992
TAMBAK 3/5/1997
TAMBAK 16/1/1992

M.UMUM 24/12/1997

TAMBAK 15/07/1994

TAMBAK 29/9/1995

M.UMUM 19/5/1999

TAMBAK 29/10/1994
TAMBAK PPI 22/5/1988

M.UMUM 17/8/1998
TAMBAK 1/9/1994

M.UMUM 4/5/1979
M.UMUM 16/8/1983

M.UMUM 3/6/1975
01-04-1989
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat No. Hp BPJS BPJS Non
PBI Non PBI Anggota

PEMATANG SEMPUR, CIKEUSIK 081319912971

BABAKAN BANDUNG 081314198484
MUNJUL 085695022083
NANGGALA 085947050922
RANCASENENG 085781081982
SUKASENENG 082155500460
SUKASENENG 085774965042
PENDEY 087884605173
UMBULAN 08531396751
CIKEUSIK 085779198511
CIKEUSIK 085815365433
KP. TUNDUN 085692182896
BIDUR 085773498475
CIKAREO 085861642512
CIKAREO 085661642512
JEPARA 085875421908
JAYA MEKAR 083812568721
CIWET 085782381777
BIDUR 085773498475
SUMUR BATU 085888161463
BABAKAN BANDUNG 085718763263
SUMUR BATU
SUMUR BATU 085212748733
PAMATANG SEMPUR
BATUJAYA
CIKONCANG 083899245128
BATUJAYA
UMBULAN 085849601501
SUMUR BATU
JEPARA 082337156807
MAGELANG 085879274840
CIBALIUNG 081210625858
RANCASENENG 085780302140
CIKEUSIK 085691153801
PENDEUY 085311379311
RANGKASBITUNG 082213514391
RANCASENENG 085773763824
CIBALIUNG 085216809717
LAMPUNG SELATAN 083896494767
SUKAMULYA 085782766361
SUKAMULYA 085782766361
SUKAMULYA 08528365946
RIAU 085363404157
SUKAWARIS 081315543448
SUKASENENG 081284559992
SUKAHARJO 085780389980
PARKOS 085887242596
CIRIRIGI 081284559992
RANCASENENG 085882165248
SUKAMULYA 085778183058
SUKARATU 081522889411
CURUGCIUNG 08588255288
NANGGALA 085691137611
GADEL 085849601501
JEPARA 088229876545
MAJALENGKA 08991982014
RANGKASBITUNG 082213514391
TAMBAK
REMBANG 081343170815
CIBALIUNG 083841111474
CILACAP 081310274239
JEPARA 085643323505
JAKARTA TIMUR 085711038518
REMBANG 087822852869
JAKARTA TIMUR 081287276169
TAMBAK 0895397280533
TAMBAK 085878146558
REMBANG 087815932262
REMBANG 085926290229
JEPARA 085290478457
WARUNG HUNI 083815484913
TAMOHON 081213954017
TAMBAK 08975151000
TAMBAK 0895395229494
RANCASENENG 083812113389
TANJUNGAN 085710363805
NANGGALA 083898746405
PENDEUY 085710506264
WALOHAN SATU 081284888558
CIWET 085811462052
RANCASENENG 082177165325
CIKEUSIK 085710515554
CIKEUSIK 08577375846
RANCASENENG 085774802590
CIKEUSIK 085212512322
RANCASENENG 085210701023
CIWET 081295413784
SUKASENENG 085693153899
KP. CISEEL 085960531808
KAPETAKAN
PAYUNGSEKAKI
KP. KIARA JANGKUNG DESA SUKASENENG 085897845323

KP. BENGER DESA NANGGALA 085710750999

RANCASENENG 085210701023

RANCASENENG 082311047543

CIKEUSIK 085775667777

CIKEUSIK 085219677484
KP. GARUNG SABRANG 004/001 DS CIHUJAN 08567173216
KP BABAKAN BANDUNG 002/002 DS CIKURUH 085930382929
ALAM PESONA 1 BLOK M SIDOREJO 081299125683
KP MALANGSARI 002/004 DS CIKURUHWETAN 085216040669
JL DG REGGE II NO 5 DS RAPPOKALLIN 082315684604
SEMBUNGAN KIDUL 005/02 DS SEMBUN085234322571
KP TELAJUNG 002/001 DS TELAJUNG 081296566055
KP DUSUN SUMBERSOKO DS KESIUR 081238184628
JORONG VIII SIMPANG DS LUBUAK LAY 085216364185
JL BUMI JAYA I NO 10 DS LABUHAN DA 085210829700
LINGK GARUNG 005/008 DS NGAMPIN 085713100044
JL NILAM NO 23 DSN TGK JALARA 081368259701
JL GAJAHMADA BOGORAN DS KAUMAN 08122563063

KP CISEUREUH 001/004 DS TANJUNGAN085773494749

KP CISEUREUH 001/004 DS TANJUNGAN085774233312
KP KADIRI 005/001 DS CIKURUHWETAN 081511534215
CIKEUSIK 085282387738
 Dosis I
Merek Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
CoronaVac 29-06-2021 29-06-2021 24003121
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
CoronaVac 02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642

02-08-2021 02-08-2021 24003121 16183046076642

02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
 02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
SINOVAC 02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
02-08-2021 02-08-2021 24003121 16183046076642
05-07-2021 05-07-2021 24003921
 05-07-2021 05-07-2021 24003921

05-07-2021 05-07-2021 24003921

29-06-2021 29-06-2021 24003121
03-07-2021 03-07-2021 24003121
05-07-2021 05-07-2021 24003921
CoronaVac 03-07-2021 03-07-2021 03-07-2021

SINOVAC 29-06-2021 29-06-2021 24003121 16183002584777

SINOVAC 29-06-2021 29-06-2021 24003921 16213341156810

coronaVac 6/29/2021 6/29/2021 24003121 16183002580565

coronaVac 6/29/2021 6/29/2021 24003121 16183002580565

SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 01-07-2021 01-07-2021 24003921 16213341371762
SINOVAC 7/3/2021 7/3/2021 24003921 16213342034606
SINOVAC 7/3/2021 7/3/2021 24003921 16213342034606
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16213342034606
SINOVAC 7/3/2021 7/3/2021 24003921 16213342034606
SINOVAC 7/3/2021 7/3/2021 24003921 16213342034606
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16182847401436
SINOVAC 7/3/2021 7/3/2021 24003921 16213342034606
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642 DOSIS 1 POLRES PANDEGLANG
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642

02-08-2021 24003121 16183046076642

02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642
02-08-2021 24003121 16183046076642

02-08-2021 24003121 16183046076642

NO No. Ticket NIK Nama Penerima Vaksin JK

1 P-165TMOWU ROHMAN L
2 P-14EIW69B ANGGI L
3 P-1VM5TA3W '360104107710086 ARSID L
4 P-1TCAUDQK '3601045804030001 RINI A P
5 P-1VJZFXN7 '3601042111950001 RENDI RENALDI L
6 Z-0008MF9D 3601046603950002 RISKA P
7 P-2442GVL7 3601040107810146 NURYADI L
8 P-1YJLAWAU '3601045010060004 NESYA NUZULUL P
9 P-20U8R6BM 3601046511020002 SUCI RAHAYU P
10 Q-000L5UND 360104080240001 SUMINTA L
11 P-1JNL2POZ 3601041111000001 SURYANA L
12 P-1KAO0PK7 360104290590001 DASIMAN L
13 P-0N0J8MK0 '3601040101000025 WASNA L
14 P-1RJZFAKR '3601041910940002 JARMAN L
15 P-1MUCTFLH '3601044106040004 CUCU CAHYATI P
16 P-1RS7K1OR '360104090990015 AGUS SOPYAN L
17 P-249BS37H '3601041202800002 SUMARNA L
18 P-29CKZ4PP '3601042208040002 IRWAN AFANDI L
19 '3601040107700126 TATANG L
20 M. MARTIN L
21 '52101072807860001 PURWANTO L
22 '3601044802720003 YUNENGSIH P
23 360104080240001 SUMINTA L
24 '360129200930001 SUMAR L
25 '3601040107910243 NURJAYA L
26 '3601044404950001 INA HERLINA P
27 CASLIM L
28 BUNYANIN L
29 '3601041901010002 IWAN L
30 '3601032406790001 ASMIN L
31 Q-000L5D2D 3601044207020005 SONA P
32 Q-000L5UNL RASMADI L
33 Q-000L4Y5L 3601045703990004 DEWI RATNASARI P
34 '360104020180002 HELLAY L
35 SANURI L
36 Q-000L4YTI 3601045209000003 LOLA P
37 '3601040107900225 SAI'IN L
38 '3601044107010079 WISNU SAPUTRA L
39 Q-000L580I '360104580980005 SUHETI P
40 SITI ALSAH P
41 '3601040506970001 DIKI ISMUNANDAR L
42 KARMI P
43 AGUS L
44 '3601045504990001 SUCI TRISNAW P
45 NIRMALA P
46 EKA P
47 '3601041004000001 RIYAN WIJAYA L
48 Q-000L5W0C '3601041103010001 NABIL HAMID L
49 RIKIM H L
50 Q-000L3U6U 3601040107020125 WAHYU MAULANA L
51 CARMEN P
52 YUSIN L
53 AGUNG AJAT L
54 SUNAWATI P
55 SARAH P
56 EDIMAN L
57 DHANI KUSUMA L
58 '1807021103030003 DIMAS DWI MULYANA L
59 TUTI P
60 Q-000L55CR '3601046309900001 SITI HAFIFAH P
61 Q-000L3U20 '3601040107020126 LESMANA L
62 P-3IY9VCY6 360104590840002 TAMINAH P
63 '3601044503720002 KHODIJAH P
64 EEM P
65 Q-000L55FU '3601040207750005 BUHRI L
66 '3601045501790001 RUKMI P
67 '360104010760115 IRSAD L
68 '360104410778082 NURAISAH P
69 YENI P
70 '3601040604870004 WAKIR L
71 '3601044107000076 SUTRIANTIO P
72 RUSNI P
73 Q-000L50CZ 3601045003850007 MELAWATI P
74 '3601040107810208 HERMAN L
75 SUPRIADI L
76 '3601045603900001 SUTIAWATI P
77 '3601040101000025 WISNA L
78 K-0000ECHC 3601040201980002 HELLDY L
79 '3601041904780002 DARMA L
80 S-675CF94F 3601044107930044 Siti maemunah P
81 S-D7168E55 360113200480004 MUHAMAD HATTA L
82 Q-000A5910 3601045102030002 NURKHOLISOH P

83 S-4A21687D 3601045606810001 SITI ROHMAH P

84 S-8624B72A 360104072930003 OBING L

85 P-6GLSVXRE 3601044802800001 LILIS SUPANTI P
86 P-6POAVFVH 3601045711860001 MAMAY MARLIYAH P
87 P-7R30GUVE 3601045009740005 SAMSIAH P
88 3573031807750009 ROBERTUS L

89 3601072709990001 ASEP SUPRIATNA L

90 '3601040101000002 M HIDAYAT L
91 P-DFNRXL6K 3601041806840003 SUHARTA L
92 P-DL23CTU1 2171031706899005 SUDIRMAN L
93 Q-000B6PH4 3601046011830001 ENENG UNAYAH P
94 P-DNSUO9G7 217119350008910005 YENI ELFYANTI P
95 P-DLXKO12V 3210962022870005 RAHMA ALHIRA P
96 P-DNTU1HOQ 3601044107820106 RODIAH P
97 Q-000B9994 3601044430500001 SAPRAH P
98 P-ENQGO556 3601045602010001 DEFY FEBRIYAN P
99 Q-000B7T9O 360104403720001 TINI P
100 Q-000B88WZ 3601040309020032 BAYU KUSBIANTORO L
101 P-ERR4QYCA 360104650881001 SARNAH P
102 Q-000B7F2R 3601042904020001 YUSUF BAHTIAR L
103 P-EYBB56RD 3671076507680007 ROHAEMI P
104 Q-000B7R66 3601041803880001 ASEP SASTRA KN L
105 P-FNJQM4K7 3601045101000002 MELINIA RAHAYU P
106 P-F7U0UU43 3601044107770141 AMNAH P
107 S-62862BDE 3601045302590001 SAPRAH P
108 P-G5HFYEQV 3601045205920002 TUTI SETIAWATI P
109 Q-000B856F 3601045103860002 JUALIAH P
110 P-GOKRMQHG 3601040309830001 JAJANG L
111 P-GQX9IPOU 3674032605960011 YUDI A L
112 Q-000BAUH3 360141206870001 ASEP SUDENDI P
113 S-A8321BCB 3601043004550001 EMAN SURYANA L
114 P-GVRB2ZKW 3601040301840001 ARIS L
115 P-GXX3EZM2 3601044207780006 DASINIH P
116 P-02JD74DB 3601044707010006 DWI Y P
117 P-0NODQEX6 3601041708720002 GANUNG B SALKA L
118 P-H2K5D1B9 360104100969001 AGUS S L
119 P-2PAJF5ZY 3601040606690001 SUPENDI L
120 Z-50F20773 360104150670002 ADE I L
121 P-4GHQ3UOD ANDI EKA L
122 S-86C8999B 3601046403710001 LILIS P
123 UMAMAH 3601044107700162 UMAMAH P
124 S-7A93D428 3601042508600002 DEDI SUPRIADI L
125 P-CCRNF2VD 3601046505720002 TATI M P
126 S-2810F066 3601040104630003 EDI SUPRIATNA L
127 P-H8NT4RXP 3601044101680003 AMIRAH P
128 S-53D2A0CC 3601046511690001 MAEMUNAH P
129 P-HANT6FWS 3601041004760001 SIDIK L
130 P-HBLKJTJO 3601045010830001 SUMIATI P
131 P-I0CFBC3Y 3601044109990002 TASMEN P
132 P-LN64JM4M 3601044107020165 ELAH SARI P
133 S-06E1CB25 3601046303860008 APRILIA WULANDARI P
134 S-070E884E 360104551297003 SRI WAHYUNI P
135 P-O5BZN6Z 3601044107030139 NASIAH P
136 P-O5DFEGVL 3601046311020004 SINDY PRIHATINI P
137 P-O6D58WFH 3601040509700001 SALEH B RAGIM L
138 P-O7MV5QOT 36010449110100021 TRIWI DIARTI P
139 P-O7MK3M10 3601041810980003 JAENAL L
140 P-OCUCWGZG 3601044906860002 SARNITI P
141 P-OEOFOTF8 3601044304010003 SITI UUM P
142 P-ODBR1VIJ 3601044906820001 ROHAYATI P
143 P-ODOD822Z 360104630200000 FINA TRIMULYANI P
144 P-OEHC7OBJ 36010450010000001 DETI MUTMAINAH P
145 P-OFKMJGD6 3601042606020001 RIYAN GUNAWAN L
146 P-OHSQ9K8K 320426251910002 MUHAMAD ABQI L
147 WU YEYONG L
148 Z-0006GODI 3601040112520002 JAENUDIN L
149 P-OLRE63XO 36010412048700 ROSMAN L
150 P-OSWZ7EAR 3601041007900003 IBROHIM L
151 P-OUK6DPL0 36010441076200007 ADE SURYANI P
152 P-P1UE1YLE 3601041903060002 AJIS KURNIAWAN L
153 Q-000CG8W4 3601040607030003 WADI FIRMANSYAH L
154 Q-000CH8RE 3601046311030002 ICA FITRIYANI P
155 P-P5OS9DUZ 3601044108050002 TUBAGUS A L
156 P-P6AJNEXH 3601044611700001 SUTIAH P
157 P-PAVLDBBW 3601041205030001 IMAN FIRMANSYAH L
158 P-PA0CB7D0 3601045111750002 SUMIYATI P
159 P-PCVMWTCP 3271060505050009 RIVALDI L
160 P-PFYSII20 360201020280004 TATANG HIDAYAT L
161 P-PGEYNPZQ 3601041002060001 HAMID L
162 P-PHVI0PS5 3601040506000001 DIKI KURNIAWAN L
163 P-P26KJC1N 36020155053870007 ENIK ROHAENI P
164 '3601042010690001 DAMIN L
165 '3601044702970002 SITI MUSFIROH P
166 ANWAR L
167 '3601042303920001 RENDY RAMADHANI L
168 '3504102010930001 M BADI C L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

06-10-1983 NANGGALA
13-11-2002 CIKEUSIK
01-07-1971 NANGGALA
'18-04-2003 SUMURBATU
21-11-1995 CIKEUSIK
GURU 26-03-1995 NANGGALA
02-02-1981 CIKEUSIK
10-10-2006
25-11-2002 RANCASENENG
08-04-1978 UMBULAN
11/11/2000 NANGGALA
'18-02-1989 CIKEUSIK
'01-01-2000 CIKEUSIK
'19-10-1994 CIKEUSIK
'01-06-2004 SUMURBATU
'09-09-1999 SUKAWARIS
'12-02-1982 CIKEUSIK
'22-08-2004 CURCI
'01-07-1965 SUKASENENG
'10-10-1988 LPMBOK BAKAT
'28-10-1986 SEKOTONG BARAT
'08-02-1964 NANGGALA
'08-02-1974 NANGGALA
'06-07-1992 SUKARESMI
'20-08-1992 SUKASENENG
'29-07-1996 MALIMPING
'11-06-1989 UMBULAN
'01-07-1972 CICADAS
'20-02-2001 UMBULAN
'24-06-1979 CIBALIUNG
'21-03-2001 TANJUNGAN
'09-04-1976 CIKEUSIK
'17-03-1999 RANCASENENG
'02-10-1998 SUKAWARIS
'01-04-2000 RANCASENENG
'12-09-2000 CIKEUSIK
'02-06-1990 SUKASENENG
'30-06-2001 RANCASENENG
'18-08-1988 SUKAWARIS
'07-03-2003 PARKOS
'05-06-1997 SUKAWARIS
 '18-05-2005 SUKASENENG
'23-09-1999 SUMURBATU
'27-11-1999 CIKEUSIK
'05-12-2005 CIKEUSIK
'14-10-2005 SUKASENENG
'10-04-2000 SUKAWARIS
'11-03-2001 RANCASENENG
'27-12-2000 LAMPUNG
'27-11-2002 CIKEUSIK
'01-07-1989 SUKASENENG
'10-02-1981 SUMURBATU
'22-12-1998 SUKAWARIS
'16-03-1990 NANGGALA
'04-06-1966 NANGGALA
'12-12-1978 LAMANDAU
'09-11-2002 TULANG BAWANG
'11-03-2003 TAMBAK
'04-01-1991 SUKASENENG
'07-07-1993 SUKASENENG
'24-07-2001 CIKEUSIK
'19-07-1990 SUKASENENG
'05-03-1972 SUKASENENG
'03-10-1990 SUMURBATU
'05-08-1985 CIKEUSIK
'15-01-1979 CIKAREO
'01-05-1976 CIKEUSIK
'01-07-1982 CIKEUSIK
'04-07-1995 LAMANDAU
'06-04-1987 BATU AMPAR
'01-06-2000 RANCASENENG
'01-07-1988 SUKAJAYA
'10-03-1985 SUKAWARIS
'01-07-1981 SUKAJAYA
'29-09-1997 SUMURBATU
'16-03-1990 NANGGALA
'01-01-2000 CIKEUSIK
02-10-1998 SUKAWARIS
19-04-1978 SUKASENENG
GURU '21-06-1994 SDN 2 Sukawaris Kp.sinarjati,Ds Sukawar

publik 21/04/1981 publik CIKEUSIK

PEL. PUBLIK 11-02-2003 SUMUR BATU

GURU 16-06-1981 SDN 1 RANCASENEN SUKAWARIS

GURU 21-07-1990 SMPN 5 CIKEUSIK PARUNGKOKOSAN
KADER 08-07-1982 KADER CURCI CURUGCIUNG
17-11-1988 SUKATANI
10-09-1979 CIKEUSIK
7/18/1975 KP PAYOLEBAR 019/000

9/27/1999 KP TARIKOLOT DS WAN

8/4/2001 KEBON CAU

18-06-1984 CIKEUSIK
17-06-1989 SUMUR BATU
20-11-1983 CIKEUSIK
18-10-1991 SUMUR BATU
22-02-1987 PALU TIMUR
15-07-1982 CIKEUSIK
03-05-1973 CIKEUSIK
16-02-2001 SUMUR BATU
04-03-1972 CIKEUSIK
03-09-2002 SUKAMULYA
28-08-1982 CIKEUSIK
29-04-2002 SUKAMULYA
25-07-1968 CIKEUSIK
18-03-1988 CIKEUSIK
11-01-2000 CIKEUSIK
20-10-1971 CIKEUSIK
13-02-1959 CIKEUSIK
12-05-1992 CIKEUSIK
KADER 11-03-1986 KADER CIKEUSIK CIKEUSIK
03-09-1983 CIKEUSIK
26-05-1996 TANGSEL
12-06-1978 NANGGALA
30-04-1955 CIKEUSIK
03-01-1984 CIKEUSIK
02-07-1978 CIKEUSIK
07-07-19=2001 CURCI
27-08-1972 CIKEUSIK
10-09-1969 CIKEUSIK
06-06-1969 CIKEUSIK
15-06-1976 CIKEUSIK
05-05-1975 CIKEUSIK
24-03-1971 CIKEUSIK
06-09-1977 CIKEUSIK
25-08-1960 CURCI
 25-05-1970 CURCI
17-09-1959 CIKEUSIK
07-02-1969 CIKEUSIK
25-11-1969 SUMUR BATU
07-02-1973 SUKAWARIS
10-01-1983 Nanggala
01-09-1999 SUKASENENG
08-11-2002 SUKASENENG
23-04-1988 CIKEUSIK
15-12-1997 RANCASENENG
23-01-2003 KP. SUMBERJAYA DE
23-11-2002 KP. PENDEY DESA U
28-03-1971 CIKEUSIK
10-10-2001 CIKEUSIK
16-10-1999 SUKAWARIS
09-06-1986 SUKAWARIS
03-04-2001 CIKEUSIK
09-06-1982 CIKEUSIK
23-02-2000 CIKEUSIK
10-01-2000 CIKEUSIK
26-06-2002 CIKEUSIK
25-10-1991 CIHERANG
PT RBB 25-08-1976 PT RBB CIKDONG
08-06-1952 SUKASENENG
12-04-1987 RANCASENENG
09-05-1982 UMBULAN
01-07-1962 CIKEUSIK
19-03-2006 SUKAMULYA
17-10-2005 UMBULAN
23-11-2003 SUMURBATU
06-11-2006 SUKAMULYA
06-11-1970 CIKEUSIK
12-06-2003 NANGGALA
11-11-1975 CIKEUSIK
05-05-2005 CURUGCIUNG
02-02-1980 CIKEUSIK
30-06-2006 SUKAMULYA
05-06-2000 NANGGALA
15-03-1987 CIKEUSIK
'20-10-1969 SUKASENENG
'07-02-1997 RANCASENENG
'26-07-1996 SUKARALI
'23-03-1992 PANDEGLANG
'20-10-1993 TULUNG AGUNG
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Non Tanggal
No. Hp BPJS BPJS Merek Vaksin***
Anggot Screening
PBI Non PBI
a
085771355220 CoronaVac 05-08-2021
085281459518 CoronaVac 05-08-2021
085893304076 CoronaVac 05-08-2021
'085780400807 CoronaVac 05-08-2021
085313343332 CoronaVac 05-08-2021
085774222751 CoronaVac 05-08-2021
085216176781 CoronaVac 05-08-2021
085735581955 CoronaVac 05-08-2021
085778986738 CoronaVac 05-08-2021
081283773295 CoronaVac 05-08-2021
'085782131416 CoronaVac 05-08-2021
'085695153359 CoronaVac 05-08-2021
'085773765899 CoronaVac 05-08-2021
'082311446170 CoronaVac 05-08-2021
'083140579678 CoronaVac 05-08-2021
'085695360903 CoronaVac 05-08-2021
'085718779282 CoronaVac 05-08-2021
'085717828416 CoronaVac 05-08-2021
'081389496730 CoronaVac 05-08-2021
'085238317530 CoronaVac 05-08-2021
'085337671305 CoronaVac 05-08-2021
'081522889411 CoronaVac 05-08-2021
''085215596723 CoronaVac 05-08-2021
'081510585279 CoronaVac 05-08-2021
'085779161585 CoronaVac 05-08-2021
'085773210196 CoronaVac 05-08-2021
'085695045571 CoronaVac 05-08-2021
'087886643517 CoronaVac 05-08-2021
'081295089258 CoronaVac 05-08-2021
'085787044071 CoronaVac 05-08-2021
'081517297440 CoronaVac 05-08-2021
'082113852038 CoronaVac 05-08-2021
'085695148530 CoronaVac 05-08-2021
'085211850091 CoronaVac 05-08-2021
'08511870248 CoronaVac 05-08-2021
'085770973163 CoronaVac 05-08-2021
'085216239654 CoronaVac 05-08-2021
'085781085260 CoronaVac 05-08-2021
'0817777974961 CoronaVac 05-08-2021
'085884397294 CoronaVac 05-08-2021
''085692841149 CoronaVac 05-08-2021
'085217366187 CoronaVac 05-08-2021
'08531745325 CoronaVac 05-08-2021
'085779276148 CoronaVac 05-08-2021
'085692081943 CoronaVac 05-08-2021
''081398428633 CoronaVac 05-08-2021
''0895603415850 CoronaVac 05-08-2021
'085893307006 CoronaVac 05-08-2021
'085769168647 CoronaVac 05-08-2021
'085697188568 CoronaVac 05-08-2021
''085891581116 CoronaVac 05-08-2021
'082316217872 CoronaVac 05-08-2021
'081649077036 CoronaVac 05-08-2021
'0857575565595 CoronaVac 05-08-2021
'0857575565595 CoronaVac 05-08-2021
'0857575365595 CoronaVac 05-08-2021
'082289624504 CoronaVac 05-08-2021
'081373153913 CoronaVac 05-08-2021
'085894828757 CoronaVac 05-08-2021
'085693031870 CoronaVac 05-08-2021
''081313198665 CoronaVac 05-08-2021
'085281449160 CoronaVac 05-08-2021
'081286107718 CoronaVac 05-08-2021
CoronaVac 05-08-2021
'085695380751 CoronaVac 05-08-2021
'081574645184 CoronaVac 05-08-2021
'087788528179 CoronaVac 05-08-2021
''087788528179 CoronaVac 05-08-2021
'0858219330514 CoronaVac 05-08-2021
085821930514 CoronaVac 05-08-2021
'085714772505 CoronaVac 05-08-2021
'085778279579 CoronaVac 05-08-2021
''082157046909 CoronaVac 05-08-2021
CoronaVac 05-08-2021
'085691545969 CoronaVac 05-08-2021
'0857575565595 CoronaVac 05-08-2021
'085773765899 CoronaVac 05-08-2021
085211850091 CoronaVac 05-08-2021
082155500460 CoronaVac 02-08-2021
'081219642626 SARS-CoV-2 3/30/2021

0819210481 coronaVac 6/29/2021

082130940985 SINOVAC 01-07-2021
085882795642 SINOVAC 01-07-2021

085826102069 SINOVAC 01-07-2021

085782773255 SINOVAC 01-07-2021
081930000021 SINOVAC 01-07-2021
085889297273 SINOVAC 01-07-2021
08123358183 SINOVAC 7/2/2021

08312696390 SINOVAC 7/2/2021

'085693636834 SINOVAC 7/2/2021

087773622692 coronaVac 05-07-2021
081268408266 coronaVac 05-07-2021
085319358131 coronaVac 05-07-2021
087728080617 coronaVac 05-07-2021
08594548201 coronaVac 05-07-2021
085694473876 coronaVac 05-07-2021
coronaVac 05-07-2021
081286012536 coronaVac 05-07-2021
085697102541 coronaVac 05-07-2021
085217106072 coronaVac 05-07-2021
coronaVac 05-07-2021
085697435216 coronaVac 05-07-2021
085719067454 coronaVac 05-07-2021
087772215512 coronaVac 05-07-2021
081517860610 coronaVac 05-07-2021
085813294715 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
085819314081 coronaVac 05-07-2021
085718271323 coronaVac 05-07-2021
083841579332 coronaVac 05-07-2021
085331432244 coronaVac 05-07-2021
085775237462 coronaVac 05-07-2021
081280313860 coronaVac 05-07-2021
085695469625 coronaVac 05-07-2021
081646061709 coronaVac 05-07-2021
081211608726 coronaVac 05-07-2021
085211684910 coronaVac 05-07-2021
085214931828 coronaVac 05-07-2021
085217377640 coronaVac 05-07-2021
082310306773 coronaVac 05-07-2021
087709925341 coronaVac 05-07-2021
085313799656 coronaVac 05-07-2021
082122276924 coronaVac 05-07-2021
087871169711 coronaVac 05-07-2021
085890292173 coronaVac 05-07-2021
085219469554 coronaVac 05-07-2021
085218247848 coronaVac 05-07-2021
085226914761 coronaVac 05-07-2021
087878342481 coronaVac 05-07-2021
085719436944 coronaVac 05-07-2021
082310972993 coronaVac 08-07-2021
085773213259 coronaVac 08-07-2021
085782134699 coronaVac 08-07-2021
085887148575 coronaVac 08-07-2021
085280899199 coronaVac 08-07-2021
085770641435 coronaVac 08-07-2021
085773236597 coronaVac 08-07-2021
085773236597 coronaVac 08-07-2021
082113213086 coronaVac 08-07-2021
0857760253339 coronaVac 08-07-2021
081334971300 coronaVac 08-07-2021
085711493840 coronaVac 08-07-2021
082111645495 coronaVac 08-07-2021
085695153321 coronaVac 08-07-2021
081383803497 coronaVac 08-07-2021
085214935934 coronaVac 08-07-2021
08228886789 coronaVac 08-07-2021
081210502895 coronaVac 08-07-2021
085892626649 coronaVac 08-07-2021
085817984630 coronaVac 08-07-2021
085211511367 coronaVac 08-07-2021
085891580796 coronaVac 08-07-2021
081388138823 coronaVac 08-07-2021
085770973053 coronaVac 08-07-2021
085774963408 coronaVac 08-07-2021
81646061709 coronaVac 08-07-2021
085782131750 coronaVac 08-07-2021
081646061709 coronaVac 08-07-2021
08577444041 coronaVac 08-07-2021
085774961500 coronaVac 08-07-2021
085894765977 coronaVac 08-07-2021
085212197062 coronaVac 08-07-2021
085691153755 coronaVac 08-07-2021
'085216176782 coronaVac 08-07-2021
'085780766609 coronaVac 08-07-2021
'085871440183 coronaVac 08-07-2021
'085718388636 CoronaVac '30-06-2021
'082112010170 CoronaVac '14-06-2021
 Dosis I Dosis 2
Tanggal Tanggal
Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901 30-09-2021 24003121
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
 05-08-2021 24003121 16242626002901 30/09/2021 24200121
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901 27-09-2021 24200121
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121 16242626002901
05-08-2021 24003121
02-08-2021 24003121
3/30/2021 24000821 '16127778488398 '05-08-2021 24003121
6/29/2021 24003121 16183002580565 '05-08-2021 24003121
01-07-2021 24003921 16213341169290 05-08-2021 24003121

01-07-2021 24003921 16213341167886 '05-08-2021 24003121

01-07-2021 24003921 16213341167886 '05-08-2021 24003121

01-07-2021 24003921 16213341167886 '05-08-2021 24003121
01-07-2021 24003921 16213341167886 '05-08-2021 24003121
01-07-2021 24003921 16213341167886 '05-08-2021 24003121
7/2/2021 24003921 16213342034762 '05-08-2021 24003121
7/2/2021 24003121 1621334203413 '05-08-2021 24003121
7/2/2021 24003121 1621334203413 '05-08-2021 24003121
05-07-2021 24003921 16213342033826 '05-08-2021 24003121
05-07-2021 24003921 16213342033826 '05-08-2021 24003121
05-07-2021 24003921 16213342033826 '05-08-2021 24003121
05-07-2021 24003921 16213342033826 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
 05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
05-07-2021 24003921 16213342037274 '05-08-2021 24003121
08-07-2021 24002221 16164644963378 '05-08-2021 24003121
08-07-2021 24002221 16164644963378 '05-08-2021 24003121
08-07-2021 24002221 16164644961818 '05-08-2021 24003121
08-07-2021 24002221 16164644961818 ''05-08-2021 24003121
08-07-2021 24002221 16164644961818 ''05-08-2021 24003121
08-07-2021 24002221 16164644961818 '05-08-2021 24003121
08-07-2021 24002221 16164644961818 '05-08-2021 24003121
08-07-2021 24002221 16164644961818 05-08-2021 24003121
08-07-2021 24002221 16164644959834 05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 05-08-2021 24003121
08-07-2021 24002221 16164644959834 05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
08-07-2021 24002221 16164644959834 '05-08-2021 24003121
'30-06-2021 '24002921 05-08-2021 24003121
'14-06-2021 '24003221 '05-08-2021 '24003121
 KET
No Seri

16182997316829
16219309680901

16219343252570

16242626002901
16242626002901 dosis 1

16242626002901

16242626002901
16242626002901
16242626002901

16242626002901

16242626002901
16242626002901
16242626002901
D1 DI PKM MANIS JAYA
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901
16242626002901 D1 DI POLSEK
16242626002901 DI DI KEMAYORAN
16183002156885 D1 DI SUMBER GEMPOL
NO No. Ticket NIK Nama Penerima Vaksin

1 WANDI
2 RANGGA ANUGRAH
3 NENGSIH
4 P-HRUFWW5W 3601041112740001 MISTA
5 P-HYTMKPCM 3601044905990002 ENUNG FUADAH
6 P-HY81AOZ7 3601041010960006 ELIN SUHENDA
7 P-I31MV4AU 360123048000002 AYU MALINDA
8 P-I5HPESPC 3601044808720001 IPAH PUJIAH
9 P-I6WQ15DB 3602215504010005 PUTRI NUR FATIAH
10 P-I5HVL7ZD 3601042511020002 FITRI DIANI
11 P-I0IF0CU6 '3601045112680002 ARMAH
12 P-I8VLL57J 3601032504850001 SAEPUDIN
13 P-ICRH7YVE 3601040107950106 DASMIN
14 P-IBFE83CV 3601046010830001 ANIH
15 P-IF6AUCQC 3601046811030002 SITI NURSAEKAH
16 P-IGOKDT5N 3601046603890002 WALINAH ASIAH
17 P-IIOL8XKF 3374054701710005 OMSYAH DULHANAN
18 P-IHRL7R51 3601042510020002 DENI HERMAWAN
19 3601044505000003 KARTI
20 P-INARSW36 3601045812010002 ELSA FITRIA Z
21 P-IOFV3U8T 3601046504790001 ETI
22 P-ILSLQYYV 3601140806800003 FUAD ADE PUTRA
23 P-IKI6LGZ9 3601044107860224 SANIMAH
24 P-HUQP4KKGX '3601044407020000 CINDY AULIA R
25 P-IQDFEZA2 '3601045805750001 JUNAH
26 P-IUIBLWQA 360104041908040002 LEO SIPI
27 3601040104770002 RASWAN
28 P-IYQ6TUA1 36010444066930004 MIMIN
29 P-IZTYGC5S 3601045803780001 ELAH HAMDALAH
30 P-J1DHRUUA 3601045011790006 SANIAH
31 INEN
32 P-IZULCVCV 3601040104750007 MARHADI
33 P-J48JTR0V 3601041007010002 ASMARI
34 P-J6CIGYGV 3601041008860006 MAHPUDIN
35 P-J5WVB7PZ 3602261303800001 SARIP
36 P-J8Z7YLYK 3601046907930001 YUNI
37 P-J9E7A05S 3601041002830003 UMAR
38 Y-0136JDHT 3601042805050001 ELGA ARYO TRI PUTRA
39 360104410723001 ATMAH FATMAWATI
40 P-JABB3NY8 3601040910010005 INDRA MUZAKI
41 3601040404920002 DIDI SUHARTONO
42 S-459085B3 3601044107690056 HUJAEMAH
43 360104680930001 CARINIH
44 EVI PIRDAUS
45 3601045706040002 ASYIFA KIRANA
46 3601042109720001 KARSIM
47 3601041903780003 KASWA
48 3601041006830005 SARNATA
49 3601040107850039 ROHAENI
50 3601040912820003 ANDI ROSADI
51 3601040705850001 AMARYADI
52 3601041003720003 DASUKI
53 P-JJLGOT4W 3601044207820004 MASDIRAH
54 P-JVDCOGTD 3601040111810001 KARNO
55 3601045803780001 ELAH HAMDALAH
56 3601040104770002 RASWAN
57 3601044505000003 KARTI
58 3601040912820003 ANDI ROSADI
59 S-D663F38B 360114591291000 DESTI KOMALASARI

60 Q-0009GVF9 3601041301000002 DODI ARYA R

61 P-3VVPKLBE 3601044107050017 GINA AGNIA

62 Q-000A6H8T 3601045412990002 RITA RISMAYANTI
63 P-D58254C2 3601040107930077 HENDRA HERMAWAN
64 P-DFEP6PHK 3601040107750067 H. SUMAJAYA
65 Q-000B7IEP 3601042304930005 SUHARTONO
66 P-FOXIHZ9E 3601044107990251 RATU AULIA
67 P-N2YGT97N 360104230910001 ARDIANSYAH
68 Q-000CGM9J 3601041208846003 ASEP SUPRIATNA
69 P-TEPA81PS 3601046509780009 HJ. RATIH HARDIANTI
70 P-TQENQWF9 3601044210790001 DANESIH HINDAYANI
71 360144408050002 SINDI
72 3601042308910001 ARDIANSYAH
73 CARINIH
74 Q-000DHEMD 3601042210890001 TOTON
75 Q-000DHEQQ 3602274107980006 JUNAENI
76 3601045803780001 ELAH HAMDALAH
77 3601040104770002 RASWAN
78 P-IIE32I0U 3601044804040001 SITI ALISAH
 Umur Kelomp
JK Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

L 20-09-1999
L
P '16-04-1980
L 28-03-1985
P 30-03-1999
L 10-10-1996
P 02-10-2000
P 08-08-1972
P 15-04-2001
P 16-02-2001
P 11-12-1968
L 25-04-1985
L 22-12-2000
P 01-04-1982
P 28-11-2003
P 02-07-1990
P 07-01-1971
L 25-10-2002
P 05-05-2000
P 18-12-2001
P 25-04-1979
L 08-06-1980
P 01-09-1987
P 04-07-2002
P 02-12-1980
L 19-08-2004
L 01-04-1977
P 04-06-1993
P 18-03-1978
P 16-11-1991
P 01-01-2003
L 01-04-1986
L 01-07-2001
L 8/1/1986
L '18-04-1985
P 01-07-1993
L 07-08-1982
L 28-05-2005
P 24-04-1977
L 10-09-2001
 L 04-04-1992
P ODGJ 15-06-1966
P 28-09-1983
L 05-12-2001
P 17-06-2004
L 21-09-1972
L 19-03-1978
L 10-06-1983
P 01-07-1988
L 09-12-1982
L 07-05-1985
L 10-03-1972
P ODGJ 02-07-1982
L ODGJ 01-11-1981
P 18-03-1978 MASYARAKAT
L 01-04-1977 MASYARAKAT
P 05-05-2000
L 09-12-1982
P 19-12-1991

L 13-01-2000

P PEL. PUBLIK 31-05-2003

P PEL. PUBLIK 14-12-1996
L 02-06-1993
L 05-07-1974
L 23-04-1993
P 14-08-2000
L 23-02-1991
L 12-08-1984
P 25-09-1978
P 02-10-1979
P 04-08-2005
L 23-02-1991
P 09-07-1981
L 02-06-1994
L 01-07-1998
P 18-03-1978 MASYARAKAT
L 01-04-1977 MASYARAKAT
P 08-04-2004
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat No. Hp BPJS BPJS Non
PBI Non PBI Anggota
SUKASENENG 085781080007
OGAN KOMERING ULU SELATAN '085328485224
SUKAWARIS '081515728146
SUMURBATU 085722049158
CIWET 081931110757
NANGGALA 081585248155
CIWET 08828986107
CIKEUSIK 081382869232
CIWET 08788319037
CIWET 082258148948
CIKEUSIK 081296587385
SORONGAN, CIBALIUNG 085697663467
RANCASENENG 081314490453
SUMURBATU 085732997956
RANCASENENG 081286107549
CIKEUSIK 081287276072
UMBULAN 081319411818
CIKEUSIK 085210921120
SUKAMIULYA 085883000566
CIWET
SUKASENENG '082352237741
RANCASENENG 081511868419P
SUKASENENG 08381574605
SUMURBATU 085719680358
CIRIRIGI 085880005449
SUKASENENG 083872737009
CIKEUSIK 085710515553
TANJUNGAN 85693042501
CIWET 085893400185
SUKAMIULYA 081347233616
CIKEUSIK 083190229539
SUKAMIULYA 081347233616
SUMURBATU 085346806329
SUKAMIULYA 085719355945
SUKAMIULYA 085719355945
CIWET 081586571466
SUMURBATU '081586571466
CIKEUSIK 085214158415
SUMURBATU 085211564024
SUKASENENG 081574720996
UMBULAN 085280255695
CIKEUSIK 081210502898
SUKASENENG 084711046079
CIKEUSIK 081546891285
SUMURBATU 085773220378
SUKASENENG 083890674328
SUKASENENG 085711046079
SUMURBATU 083183038159
SUMURBATU 085718719605
SUKAMIULYA 085883000566
SUKASENENG 081349353049
SUKASENENG 083890674328
CIKEUSIK 085272417941
KIARA JANGKUNG, CIKEUSIK 085882501947
CIWET 085893400185
CIKEUSIK 085710515553
SUKAMULYA 085883000566
SUKAMULYA 085883000566
RANCASENENG 081319118320

CIKEUSIK 081280270603

CURUGCIUNG 085779161203
CANGKORE 085695154736
CANGKORE 081381043606
CANGKORE 087773284224
RANCASENENG 081297823427
CURCI 085819326316
CIKEUSIK 085715912556
CIWET 087879496222
UMBULAN 081236764485
CIKEUSIK 085881751509
SUKASENENG 081321841896
CIKEUSIK 085715912556
SUKASENENG 081511868381
BBKN SABELAH 085705574471
BBKN SABELAH 085705574471
CIWET 085893400185
CIKEUSIK 085710515553
SUKAMIULYA 085719024939
 Dosis I
Merek Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
SINOPAM '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
CoronaVac '09-08-2021 '09-08-2021 '24003121 16183002362789
SINOPAM '09-08-2021 '09-08-2021 '24003121 16183002362789
SINOPAM '09-08-2021 '09-08-2021 '24003121 16183002362789
SINOVAC 09-08-2021 09-08-2021 24200121
SINOVAC 09-08-2021 09-08-2021 24200121
CoronaVac 09-08-2021 09-08-2021 24003121
CoronaVac 09-08-2021 09-08-2021 24003121
SINOVAC 29-06-2021 29-06-2021 24003921 16213341156810
SINOVAC 29-06-2021 29-06-2021 24003921 16213341156810
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
coronaVac 05-07-2021 05-07-2021 24003921 16213342033826
coronaVac 05-07-2021 05-07-2021 24003921 16213342033826
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 08-07-2021 08-07-2021 24002221 16164644963378
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
CoronaVac 11-07-2021 11-07-2021 24003821
CoronaVac
CoronaVac
CoronaVac
CoronaVac 12-07-2021 12-07-2021 24200921
SINOVAC
SINOVAC
CoronaVac 16183002362789
 Dosis 2
Tanggal
Pemberian No. Batch No Seri
Vaksinasi
27-09-2021 24005121 16219343252570

27-09-2021 24005121 16219343252570

'09-08-2021 '24003121 16183002362789

'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121
'09-08-2021 '24003121 16183002362789
09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
'09-08-2021 '09-08-2021 '24003121
'09-08-2021 '24003121 16183002362789
'09-08-2021 '24003121 16183002362789
09-08-2021 24200121 16220778922592
09-08-2021 24200121 16220778922592
'09-08-2021 24200121 16220780299544
KET
D1 DI RSUD ADHYAKSA

KD1 KANTOR KES PELABUHAN 2

NO No. Ticket NIK Nama Penerima Vaksin JK

1 P-015TSHOB 360104107690070 DEDE S L

2 P-4NNYNIRE 3601044107740095 JUENI P
3 P-0G54N178 3601040102800015 ISNEN L
4 P-1UJV3X9K 3601040209950001 ROHMAN L
5 P-2CJUSM9R 3601040712680001 ISLI L
6 P-2RBQSYXS 3601040107780042 HEMI L
7 S-12CF874F 36010418025890002 SAUDIN L
8 P-2ITXL4GW 3601040103990003 DANA L
9 P-27H9N8LI 3601044407030001 SRI PUTRI ANJANI P
10 P-2R67JTPW 360104120000003 ANDRI P L
11 P-3YFFJT57 3601040107020071 DIAH SABNAYANTI P
12 P-3THGCK64 3601040906760004 ANDA SUHANDA L
13 P-4FSZIMYI 3601045502940001 UTIAH P
14 P-4T72EI0U 3601040101030010 CARSANA L
15 P-0WYJJ9KM 3601040101990007 NURJAYA DWI A L
16 P-2LQ0SWSD 3601041003810003 ADANG L
17 P-1MAO6U5I 3601042712010002 RIYAN HIDAYAT L
18 P-1PQY3J07 360104017880296 IRMAN L
19 P-30EIOCT1 C SURANDI L
20 P-193FFZ0O 3601041701920001 SODIK L
21 P-08AAMY2D 360104102850012 ADE L
22 P-0HXK4VJA 3212051808900002 SUNARTO L
23 P-1JOAC0LB 3601040704840005 KASPIN L
24 P-3NXWC0WC 3601041302990005 ARTA L
25 P-3QZM5F4F 3601046111890004 IMAS P
26 P-2FR82XVR 3601041206960001 SUMANTRI L
27 P-4DTUVQB3 3601040308760001 SANIM L
28 P-58Q8EHZW 3601042811700001 MUHIDIN L
29 P-59Z7GEQO 3601072007970001 WAHYU ROBI A L
30 P-4X9G9DQX 3601040107700036 IMI SUHAEMI L
31 P-4UW36MCQ 360104107870206 KARIM L
32 P-4VL41RS7 3601041006820002 ENDANG L
33 P-5EPBO7Z3 3601040102860011 ACE L
34 P-5EM9TBZ9 3601040107930062 IBIN SARBINI L
35 P-5OBXSKPG 3601040206020003 PENDI IRAWAN L
36 P-5N19XNGX 3601044309840001 EDAH P
37 P-5SAVUKVG 1806180508010002 AGUS PURWANTO L
38 P-5LJX7A2D 3601040702900005 YOMAN P M L
39 S-A6228156 360104290690003 DEVI SANJAYA L
40 P-69AHNSLI 1806181506010002 DEDE SAPUTRA L
41 P-1AT61W3W 3601042006060004 ALDI L
42 S-362C0071 3601040110750002 SARMANI L
43 P-7A0SPPLW 3671105702860006 KHOIRIYAH P
44 P-6NK0YX2A 3601043103980001 SUPRIYADI L
45 P-6I6GHEBA 3601040107780390 ASMIR L
46 SUPRIYADI L
47 P-8YRCYXOC 3329171110950004 M ILHAM L
48 3601042705040001 RIZKY PURNAMA L
49 3601045011040001 EPA NOPIANA P
50 RINI RIANI P
51 3601045811970002 MITA AMELIA P
52 3601041702020002 MUPTI L
53 ANI SUSILAWATI P
54 P-AFBB71O9 3601046607040002 PUTRI WAHYUN P
55 P-AJRR6WDC 3602285907040001 DELA NURALIA P
56 P-ACGQ5XU3 3602020906030007 SYARIF MALIK I L
57 P-7LJO6M01 3602210301060007 KHOERUL UMAM L
58 J-000003MI 3329032003970001 M RIKI SUBAGJA L
59 ROBI JAYA SENA L
60 P-AA9183JZ 3601045811970002 MITA AMELIA P
61 P-A92BRZPF 3601041702820002 MUPTI P
62 P-A0WTI52R 3320060602850002 SUNARTO L
63 S-56AB0196 3601040312900001 TUBAGUS JAYALANA L
64 P-AEMFABN 36010465110410001 RINI RIANI P
65 P-A41MXFKD 3601045309040001 WIDIA PUTRI P
66 P-AAOEMPV6 3601046412030001 ANNIS SUSIAWATI P
67 E-9ZDBU6Q3 3316102105000001 ERVA NOVIA BADUL NOVA P
68 P-AECPDUDQ 3601046805040001 IMELSA P
69 P-9SRKBSEL 3601010702920002 ASMAR L
70 P-ANVVAKTK 3601042705040001 RIZKY EKA PRATAMA L
71 P-9OKOY80L 3601045504050005 KRISTINA P
72 SUMARNI L
73 3601044107000209 TASSA ASTRI P
74 PIROH L
75 ANNISA FEBRIAN L
76 NAHDIA PIJRIATUL F P
77 FITRINI P
78 WAWAN L
79 SITI YULIASTI P
80 MURTI P
81 MAIN L
82 NINDA P
83 3601045011040001 EVA NOVIANA P
84 360104504000002 ISEU PUJAWATI P
85 3601045607970002 MEGA RIRIN P
86 WIDYA P
87 SYARIF WINARJA L
88 ANANTA RAHAYU L
89 RASWAN L
90 LUKI PRATAMA MARTIN L
91 360320107920068 DIATUL M L
92 3601042107820001 SUANI L
93 Z-000123IW 3601045201670002 DEDEH P
94 Q-0009B0H3 3601042810670001 ADE KURNIADI L

95 Q-0009GV7J 3216021707960005 FIKRI MAULI UTOMI L

96 Q-0009GVFN ENDI ROHENDI L
97 Q-000A5DQ6 3601045601620001 SUMARTI P
98 P-5BUECHWR 3505113006830004 SAJULI L
99 Z-00065Z7V 3601044404850003 IMAS SITI MASITOH P
100 Q-000B70BH 3601044407880001 DEWI PURNAMASARI P
101 Q-000B96IY 3601024712800004 ANDRIYANTO L
102 Q-000CEQOQ 3601045404800002 SARNAMI P
103 Q-000CLFV1 3601045308790001 CICIH P
104 P-PDLZQBQO 3601045501060006 DWI RAHMAYANI P
105 P-PDVI1WC8 3601044110040002 TITI N P
106 Q-000CJUU2 3601044105990003 NABILA NOOR AZMI L
107 Q-000DCHL5 3601047007840002 SAPINAH P
108 Q-000D4CUQ 1871101204650004 JOHAN EFENDI L
109 Q-000D4D4Y 1801132803800002 M. ADJIE AKBAR PRAMUDIA L
110 P-SOQPULQJ 3601062202980002 SAEPUL MUBAROK L
111 Q-000D4PC4 1802011205790011 PUJIANTO L
112 Q-000D4CPX 1801131803770003 KHOIRUDIN L
113 LYI JINYAN P
114 REN HUEIN P
115 Q-000DC64L 3601045507750016 ECIH SUKAESIH P
116 P-TSVQTJR1 3601040107900315 RASMIN L
117 P-TVKMYHCM 3601046107760001 HARIAH P
118 P-TW8SVMGD 3601046103710001 ASIH P
119 Q-000DCFEB 3601044710940001 TARMINIH P
120 Q-000EOGG8 36044107870136 TATA SUPRIATNA L
121 Q-000ESSLM 3601040708830003 HABIB GUNAWAN L
122 P-1N0ALDFA 3601045807010003 LIA PEBRIANTI P
123 Q-000B8GQM 3601045104730001 SUHALIAH L
124 Q-000B8GQJ 3601042007670001 SODIK L
125 SAENAH P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

05-05-1966 PERMATANG SEMPUR

25-04-1974 SUKASENENG
01-02-1980 SUMURBATU
02-09-1995 CIDAIMAH
30-06-1976 SUKAMULYA
01-04-1985 SUMURBATU
18-02-1959 CIKEUSIK
01-03-1999 SUKAMULYA
04-07-2003 SUKAMULYA
09-04-2000 SUKAWARIS
15-06-2002 RANCASENENG
08-06-1976 NANGGALA
15-02-1994 SUKASENENG
01-01-2003 RANCASENENG
01-01-1999 RANCASENENG
10-03-1981 SUMURBATU
27-12-2001 CIKEUSIK
01-07-1991 UMBULAN
24-04-2001 SUKASENENG
17-01-1991 SUKASENENG
05-06-1984 SUMURBATU
08-06-1993 UMBULAN
07-04-1992 UMBULAN
13-02-1999 TANJUNGAN
21-11-1989 UMBULAN
13-09-1998 TANJUNGAN
03-08-1976 SUKASENENG
28-11-1970 TANJUNGAN
20-07-1997 ANGSANA
05-03-1979 NANGGALA
01-07-1987 UMBULAN
10-06-1982 TANJUNGAN
1/2/1986 TANJUNGAN
25-07-1992 SUKAWARIS
 02-06-2002 TANJUNGAN
10-10-1985 NANGGALA
05-08-2001 DUSUN RAWA JADI
07-02-1990 NANGGALA
29-07-1996 CURCI
15-06-2001 KOTA AGUNG BARAT
20-06-2006 SUKASENENG
1/10/1975 CIKEUSIK
17-02-1986 CIKEUSIK
31-03-1998 RANCASENENG
01-07-1978 UMBULAN
25-05-2000 KOTA AGUNG BARAT
15-10-1995 PENDEY
27-05-2004 SUKASENENG
10-11-2004 CIKEUSIK
25-11-2003 CIKEUSIK
18-11-1997 UMBULAN
16-07-1981 UMBULAN
24-12-2003 SUKASENENG
26-07-2004 CURCI
19-07-2004 CIKONCANG
09-06-2003 WARUNG HUNI
03-01-2006 KATAPANG
20-03-1997 JENDRAL SUDIRMAN
03-01-2002 SUMURBATU
18-11-1997 UMBULAN
16-07-1981 SUMBERJAYA
06-02-1985 JEPARA
03-12-1990
25-11-2003 CIKEUSIK
13-09-2004 CIKEUSIK
24-12-2003 RANCASENENG
21-05-2000 TAMAN REJO
28-05-2004 CIKEUSIK
07-02-1992 UJUNG JAYA
27-05-2004 SUKASENENG
15-04-2005 CIKEUSIK
08-12-2005 PANGGARANGAN
 09-02-2003 CURCI
06-06-2006 SUMURBATU
03-02-2004 CIKEUSIK
;06-02-2003
20-06-2004 CIKEUSIK
15-08-1995
03-01-2002 UMBULAN
06-07-1975 SUMURBATU
01-07-1963
29-12-2005
10-11-2004 CIKEUSIK
05-04-2000
16-07-1997
19-06-2004 CIKEUSIK
01-05-1998
14-09-2004
17-08-2000
27-03-2003
20-04-1991
21-07-1982 MASYARAKAT TANJUNGAN
PUBLIK 1/12/1967 PUBLIK CIKEUSIK
28-10-1967 CIWET

publik 17/07/1996 publik BABELAN

publik 17/12/1975 publik RANCASENENG

PEL. PUBLIK 03-01-1962 SUMUR BATU

TAMBAK PPI 30/6/1983 DUSUN CAMPANG MUARA 001/00
24-11-1985 CIWET
10-08-1987 CIWET
17-12-1980 PASIR JAYA
14-04-1980 CIKEUSIK
13-08-1979 CIKEUSIK
15-01-2006 LEUWIBALANG
01-10-2004 CIKEUSIK
01-05-1999 BABAKAN BANDUNG
30-09-1984 CIKEUSIK
12-04-1965 RAJABASA RAYA
28-03-1999 DUSUN IVA KEL. KARANG ANYAR KEC.
22-02-1998 CITEREUP
12-05-1979 DUSUN 1
18-03-1977 DUSUN IV A KARANG ANYAR
14-03-1980 PT RBB
19-12-1973 PT RBB
15-07-1975 CIKEUSIK
03-09-1981 RANCASENENG
11-07-1976 CIKEUSIK
21-03-1971 CIKEUSIK
07-10-1994 RANCASENENG

07-05-1984 SUKASENENG
29-12-1981 CIWET
14-07-2002 CIKEUSIK
11-04-1973 CIKUJANG
20-07-1967 CIKUJANG BARAT
NANGGALA
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Merek Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening
PBI Non PBI Anggota

CoronaVac 12-08-2021
085312827766 CoronaVac 12-08-2021
08571130454582 CoronaVac 12-08-2021
085711804582 CoronaVac 12-08-2021
08766751897 CoronaVac 12-08-2021
085711304582 CoronaVac 12-08-2021
085279126839 CoronaVac 12-08-2021
085766751897 CoronaVac 12-08-2021
085691948036 CoronaVac 12-08-2021
083102453545 CoronaVac 12-08-2021
085710496935 CoronaVac 12-08-2021
085715496808 CoronaVac 12-08-2021
083819233781 CoronaVac 12-08-2021
085892626629 CoronaVac 12-08-2021
085695274136 CoronaVac 12-08-2021
082151320425 CoronaVac 12-08-2021
085693477211 CoronaVac 12-08-2021
085313704887 CoronaVac 12-08-2021
CoronaVac 12-08-2021
083819233381 CoronaVac 12-08-2021
0811304582 CoronaVac 12-08-2021
085650840776 CoronaVac 12-08-2021
085313704887 CoronaVac 12-08-2021
08151320425 CoronaVac 12-08-2021
085721272040 CoronaVac 12-08-2021
082151320425 CoronaVac 12-08-2021
085282338980 CoronaVac 12-08-2021
08134827165 CoronaVac 12-08-2021
08587208275 CoronaVac 12-08-2021
085773624156 CoronaVac 12-08-2021
0853313704887 CoronaVac 12-08-2021
081278551169 CoronaVac 12-08-2021
081278551169 CoronaVac 12-08-2021
081211640903 CoronaVac 12-08-2021
081278551169 CoronaVac 12-08-2021
085778519455 CoronaVac 12-08-2021
087818872694 CoronaVac 12-08-2021
085794663926 CoronaVac 12-08-2021
085313196752 CoronaVac 12-08-2021
087899616482 CoronaVac 12-08-2021
085714550785 CoronaVac 12-08-2021
08558711479 CoronaVac 12-08-2021
085840838887 CoronaVac 12-08-2021
085691437617 CoronaVac 12-08-2021
085650840776 CoronaVac 12-08-2021
087788649151 CoronaVac 12-08-2021
08572759668 CoronaVac 12-08-2021
085773491693 CoronaVac 12-08-2021
082113240195 CoronaVac 12-08-2021
085892378584 CoronaVac 12-08-2021
087774153761 CoronaVac 12-08-2021
081574578230 CoronaVac 12-08-2021
085694941731 CoronaVac 12-08-2021
085715407494 CoronaVac 12-08-2021
081586524431 CoronaVac 12-08-2021
08569443797 CoronaVac 12-08-2021
085778987180 CoronaVac 12-08-2021
081391627083 CoronaVac 12-08-2021
085694489242 CoronaVac 12-08-2021
087774153461 CoronaVac 12-08-2021
081574578230 CoronaVac 12-08-2021
082273936999 CoronaVac 12-08-2021
085777845921 CoronaVac 12-08-2021
085892378584 CoronaVac 12-08-2021
0857795687622 CoronaVac 12-08-2021
085694941731 CoronaVac 12-08-2021
081572228421 CoronaVac 12-08-2021
085783557958 CoronaVac 12-08-2021
081528158549 CoronaVac 12-08-2021
085773491693 CoronaVac 12-08-2021
085280514910 CoronaVac 12-08-2021
085893317787 CoronaVac 12-08-2021
081219604974 CoronaVac 12-08-2021
085861051686 CoronaVac 12-08-2021
085693542126 CoronaVac 12-08-2021
0859884017 CoronaVac 12-08-2021
085719069834 CoronaVac 12-08-2021
081278859870 CoronaVac 12-08-2021
085782555450 CoronaVac 12-08-2021
081282873518 CoronaVac 12-08-2021
085694608871 CoronaVac 12-08-2021
085218572625 CoronaVac 12-08-2021
082113240195 CoronaVac 12-08-2021
081285221717 CoronaVac 12-08-2021
081282349757 CoronaVac 12-08-2021
085779568762 CoronaVac 12-08-2021
085855707659 CoronaVac 12-08-2021
0815114124128 CoronaVac 12-08-2021
083804328040 CoronaVac 12-08-2021
083892646794 CoronaVac 12-08-2021
085604907124 CoronaVac 12-08-2021
085691863468 SINOVAC 12-08-2021
085770136373 coronaVac 6/28/2021
08567331321 SINOVAC 29-06-2021

085695985574 coronaVac 6/29/2021

coronaVac 6/29/2021
082312236589 SINOVAC 01-07-2021
081995875324 SINOVAC 7/3/2021
0877773871977 coronaVac 05-07-2021
081281988214 coronaVac 05-07-2021
085281550345 coronaVac 05-07-2021
085694515661 coronaVac 08-07-2021
081646061709 coronaVac 08-07-2021
085697592213 coronaVac 08-07-2021
08558654606 coronaVac 08-07-2021
085778299761 coronaVac 08-07-2021
085693542126 coronaVac 12-07-2021
082283884854 coronaVac 12-07-2021
089602070767 coronaVac 12-07-2021
081317135445 coronaVac 12-07-2021
085379850647 coronaVac 12-07-2021
08127243502 coronaVac 12-07-2021
081276949196 coronaVac 12-07-2021
081276949196 coronaVac 12-07-2021
085814303346 coronaVac 12-07-2021
085770972017 coronaVac 12-07-2021
085217377617 coronaVac 12-07-2021
085217377617 coronaVac 12-07-2021
085772495231 coronaVac 12-07-2021

085212099398 CoronaVac 15-07-2021

087871517905 CoronaVac 15-07-2021
081413472855 CoronaVac 13-07-2021
085776861104 CoronaVac 05-07-2021
085776861104 CoronaVac 05-07-2021
083873661413
 Dosis I Dosis 2
Tanggal Tanggal
Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764 04/10/2021 12/08/2021
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764 27-09-2021 24200121
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764 30/09/2021 24200121
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
 12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121 16219944745764
12-08-2021 24200121
6/28/2021 24002221 16164643900534 12-08-2021 24200121
29-06-2021 24002221 16164643899926 12-08-2021 24200121
6/29/2021 24003921 16213341156810 12-08-2021 24200121
6/29/2021 24003921 16213341156810 12-08-2021 24200121

01-07-2021 24003921 16213341169290 12-08-2021 24200121

7/3/2021 24003921 16213342034606 12-08-2021 24200121
05-07-2021 24003921 16213342033826 12-08-2021 24200121
05-07-2021 24003921 16213342037274 12-08-2021 24200121
05-07-2021 24003921 16213342037274 12-08-2021 24200121
08-07-2021 24002221 16164644961818 12-08-2021 24200121
08-07-2021 24002221 16164644959834 12-08-2021 24200121
08-07-2021 24002221 16164644959834 12-08-2021 24200121
08-07-2021 24002221 16164644959834 12-08-2021 24200121
08-07-2021 24002221 16164644959834 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121
12-07-2021 24003921 16207156783663 12-08-2021 24200121

15-07-2021 24003921 16207156781791 12-08-2021 24200121

15-07-2021 24003921 16207156781791 12-08-2021 24200121
13-07-2021 24003921 12-08-2021 24200121
05-07-2021 24200621 12-08-2021 24200121
05-07-2021 24200621 12-08-2021 24200121
12-08-2021 24200121
 KET
No Seri

24200121
16219343252570

16219309680901
16219944745764 DOSIS 1
16219944745764
16219944745764 dosis 1
16219944745764

16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764
16219944745764

16219944745764
16219944745764
16219944745764 D1 DI POLRES PDG
16219944745764 D1 DI RS ISKANDAR MUDA
16219944745764 D1 DI RS ISKANDAR MUDA
16219944745764 D1 JAKARTA
NO No. Ticket NIK Nama Penerima Vaksin JK

1 P-26CWAGI2 3601045711960002 TITI P

2 P-2GSU0B68 3601040107730191 SOLEMAN L
3 P-2ND6B1CPO 3601041507800016 ENDI SUTARJO L
4 DODO L
5 P-2UMEN4UT 3601044402760002 NURHAYANTO L
6 P-154BOH1V 3601045009790001 EMAH P
7 P-2ZIYQMF5 3601045008000004 SITI JUNARIAH P
8 P-35V439GV 3601042403930002 AHYANI L
9 P-3BQ9RDDQ 3601046311880001 KAMSAN L
10 P-3O201MQX 3601040904990002 ENTANG KURNIA L
11 P-3R78BVJ 3601044107750260 YATI P
12 P-3TNDMN6A 3601042003800001 AJUK L
13 P-3YIX94KI 3601042004800002 RUSDI L
14 P-3WJZRT8K 3601043007940002 JADMIKO ERYADI L
15 P-4B9UWRFM 3601040507810001 SANTA L
16 P-46VCNCIT 3601042006900003 SUPARMAN L
17 P-4I2L5ZIY 3601046103010001 NURASIH P
18 P-4IVVCDCRX 3601040306890001 SAMIN L
19 P-4G8ZQCOT 3601045106770003 SULASTRI P
20 S-E804BB6E 3601046710950003 SUPRIATI P
21 ESIH P
22 P-4SY8JUNS 360104107850260 YADI L
23 S-73B78200 3601044205600001 RASMINAH P
24 TB BASUKI RAHMAT L
25 ANISAH P
26 WARIH L
27 NENIH P
28 JUHRI L
29 RUSLIANA L
30 ATIAH P
31 NARSA L
32 LAELIAH P
33 RIJAL JAMAS E. N L
34 P-3LCALBSX 3601045105080001 RIRI P
35 NURKAMAL L
36 SINTYA DEVI P
37 ARMI P
38 WARYO L
39 TEDI SAPUTRA L
40 SANTIKA P
41 SITI SEPTI H P
42 DIDI SARMEDI L
43 SURHANI L
44 NIMAH P
45 ISA SUPENDI L
46 SAYU P
47 WASNI P
48 AJAT L
49 NOVIAN P
50 FAHRUL FAUZI L
51 36010401079200031 KIKI ABDUL RAHMAN L
52 HERMAN SUKARNO L
53 ESIH P
54 ANDINI P
55 AMIR L
56 RADI L
57 MAKHDUM ASMAWIY L
58 SAEPUL L
59 MAHFUDIN L
60 360104506920001 NENG DERI P
61 MAD USUP L
62 3601044107930029 SITI RUKIAH P
63 HERI SOPYANTI P
64 RISKA AULIA P
65 IMAM NUGRAHA L
66 ANIM L
67 DARSA L
68 AJI DARMAWAN L
69 SUKMA L
70 KURNAESIH P
71 KODIR L
72 MUSAROPAH P
73 DONI R L
74 DATUK L
75 MITA YULIANTI P
76 3602280405980001 ROHMAT L
77 EKA YULIAWATI P
78 NANDA ALANUARI P
79 3602160811970001 SARNA L
80 JAENI L
81 SUKESIH P
82 MILAWATI P
83 AMRI SETIAWAN S L
84 ARDI SAPUTRA L
85 3175092509760012 BOY SLAMER R L
86 SETJO BUDI L
87 UCI SUSILAWATI P
88 360104445508880001 SITI MUTMAINAH P
89 36010402041890008 SUPARMAN L
90 S-0A03C913 360104530450001 EUIS ISNAWATI P
91 S-41E04423 3601045613770001 MASAMAH P
92 P-E2BBBH80 3601045105820003 ENENG SRIYATI P
93 P-FWDWAQ0A 3601041006720006 DANA MIHARJA L
94 S-7C76CCF3 3601046704960001 MURSIPAH P
95 P-O7ZU2PNQ 3601046202660001 ENOK MASTUNAH P
96 P-OGDM0GL3 3601041505880003 SUDARMAN L
97 P-OGD4G2I3 3601045808890001 NONIH P
98 P-NFDO6Y4M 3601040104930002 AGUS SAPUTRA L
99 P-NV2O5PBN 3601044207650004 ISAH P
100 P-ONKKKPEF 5305032510900002 JHON BRIKMAR L
101 S-D5379700 3601040910630001 KOMARUDIN SPD L
102 P-TTU5QE4T 3601040612960001 ARDIAN NUR L
103 P-TU0JU8YL 3601045808970001 INDRI PRADIANA P
104 P-U285TTM9 36010294802020001 ROHASIH P
105 Y-0313W2B 3173070805800006 HANAPI L
106 P-WY5OWQA4 3601044107870096 RESITA P
107 P-WYPTMROF 36010417020300002 BAMBANG IRAWAN L
108 J-00005QL5 1871051912750002 HERU IRAWAN L
109 MA SHUJUN L
110 ZHANG XIAOBIN L

111 ZHANK QLAN L

112 LIANG, XIANGFEI L

113 WANG, XIANYANG L
114 P-X7PGEOEM 3601045711830001 ARTISAH P

115 P-XCNZWRDT 3601045503830004 MUNTIAH P

116 P-XD8CPSMA 3601040107020215 HAMID L

117 P-XE9PNWQP 3601045012800006 ONIH P

118 P-XG9LRABV 3601020204990001 DONI KUSUMA L

119 P-XJES2PRG 3601045111860003 AMINAH P
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

17-11-1996
07-04-1970
11-11-1982
ODGJ 17-03-1969
05-01-1990
10-09-1979
03-07-2002
24-03-1993
23-11-1988
09-04-1999
01-07-1975
20-03-1980
20-04-1980
30-07-1991
05-07-1981
20-06-1990
05-03-2002
03-06-1989
11-06-1977
27-10-1995
04-05-1995
02-03-1976
12-05-1960
13-01-2002
24-02-2003
05-10-1983
17-06-1975
10-05-1996
10-04-1984
15-08-2002
01-07-1985
16-03-2004
05-01-2004
11-05-2008
12-06-2003
08-09-2000
01-04-1979
02-03-1989
01-07-2005
30-12-1979
03-09-2000
 11-12-1986
11-04-1975
11-02-1996
15-05-1972
02-01-2006
27-08-2005
04-01-1990
24-05-2005
07-12-1997
05-01-1993
03-06-1986
04-05-1995
15-05-2006
01-07-1993
24-09-1990
08-11-1997
26-06-2000
17-05-2002
17-02-1991
04-08-1989
19-11-1993
12-07-1978
18-04-1997
08-08-1997
05-07-1988
03-07-1987
19-10-2001
26-05-1990
08-06-1982
08-07-1999
10-07-1970
09-09-2000
25-07-1997
02-07-1999
08-09-2001
06-02-1997
01-01-2002
08-11-1997
04-06-2003
02-08-1984
07-08-1995
24-10-1991
16-02-2002
25-09-1976
 01-06-1990
GURU 05-10-1988 SMK 14 PANDEGLA
publik 07/04/1987 publik

publik 13-04-1985 publik

GURU 16-12-1976 SDN 1 SUMUR B

11-05-1982
10-08-1972
27-04-1996
21-04-1979
15-05-1988
18-08-1989
19-08-1989
02-07-1965
25-10-1990
09-10-1962
06-02-1996
28-09-1998
04-07-2000

08-05-1980
18-07-1986

17-02-2003

19-12-1975
06-12-1971
16-04-1969

28-02-1993

01-11-1991

08-08-1990
17-11-1983

15-03-1983

10-07-2002
10-12-1979

09-09-2000
07-12-1989
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota
RANCASENENG 085710313192
CILEUNGSIR 085892625478
CIKEUSIK 081380500700
CIWET
RANCASENENG 085887771220
CILEUNGSIR 085892625478
SITUPOTONG 085624586521
SITUPOTONG 08562458621
80001 085766935442
SITUPOTONG 085782757884
SUKAMULYA 085778183058
SUKAMULYA 085773883490
085771287083
CIKEUSIK 085791137714
SITUPOTONG 085752338033
SITUPOTONG 085752328033
SITUPOTONG 085772859361
SITUPOTONG 085782265965
SUKAWARIS 08531370615
NANGGALA 085697188269
CIKEUSIK 081293290810
SUKAMULYA 081294477547
CIKEUSIK 081293290810
SUKAMULYA 081294477547
SUKAMULYA 085882501963
UMBULAN 085714776316
SUKAMULYA 085886486982
SUKAMULYA 08588946982
CIKEUSIK 081517712368
SUKAMULYA 085216246234
UMBULAN 085211674967
CANGKORE 085695267520
RANCASENENG 083151383630
CIWET 083856594005
UMBULAN 085694880466
UMBULAN 081219745021
SUKAMULYA 081617125303
UMBULAN 082310306847
OMEANG 085691857780
LEUWIDAMAR 081316927390
UMBULAN 085719016748
CURCI
CIKEUSIK 085718568944
PARKOS 085693645879
SUKAWARIS 082125045185
GENGGONG 085773898808
CIKEUSIK 08531381142
PARKOS 08572328033
CIKEUSIK 085886425249
BULUNGAN 087780035322
SUMURBATU 085717328050
CIKEUSIK 085212666899
CIKEUSIK 081293290810
CIKEUSIK 081511791421
UMBULAN 085849155226
CIKAREO 081272530658
TALANG MANGGA 085224890728
SITUPOTONG 085782394003
TAMBAK 082366950060
SUKAWARIS 08997069446
SUKARESIK 085219074183
SUMURBATU 081280578422
UMBULAN 085770147702
SUMURBATU 085782816158
KADUHEJO 089680558051
NANGGALA 085770147673
SUKAMULYA 081511992517
RANCASENENG 085774089428
CIKUJANG 085775141466
UMBULAN 082310918668
PS NANGKA 085773212178
082310918668
CIMANGGU 085863690743
SUKAMULYA 085861771697
SUMURBATU 081617541688
CIKAREO 082124567652
BODOR 085759231868
UMBULAN 081936678043
CIAPUS 085714550586
UMBULAN 085882844696
RANCASENENG 085930063294
CIKEUSIK 085694608927
CIKEUSIK 085694608927
MARGASARI 081279240283
CIRACAS 085289502116
PANDJA
SUKALAKSANA 085780022710
KP SUKARATU DESA NANGGALA 082332912765
SUKAMULYA 085871073709

UMBULAN 085770620411
SUMUR BATU 085213725590
CIKEUSIK 085722186531
CIWET 085217104870
CIKEUSIK 085771355220
CIWET 082128431771
CIKEUSIK 085697611710
CIKEUSIK 085697611710
CURUGCIUNG 085694574195
CIKEUSIK 085217377617
HELERMAN 085281724678
CIKEUSIK 083875371563
CIKEUSIK 085893308110
UMBULAN 089517289449
SUKARESMI 083871578237

JATI PULO 085694093781

TAINAN ALAM 081703414544

KP. BATUJAYA DESA UMBULAN 082312395322

KEBON JERUK 082182022200

PT RBB 0812808498280
PT RBB ;081218026714

PT RBB 081218026674

PT RBB 081210826721

PT RBB 081210826729
SUKAMULYA 081612175303

SUKAMULYA 081617125303

CIWET 085813107273
CIWET 083147334063

CIMANGGU 085803690743
SUKAMULYA 081617125303
 Dosis I
Tanggal Tanggal
Merek Vaksin***
Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732
CoronaVac
CoronaVac 19-07-2021 19-07-2021 24200921
CoronaVac 17-07-2021 17-07-2021 24201121
CoronaVac 23-06-2021 23-06-2021 24002021
CoronaVac 21-06-2021 21-06-2021 24002221 16164644021450
coronaVac 6/29/2021 6/29/2021 24003121 16183002580565

coronaVac 6/29/2021 6/29/2021 24003921 16213341156810

SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 08-07-2021 08-07-2021 24002221 16164644959834
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
 16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732 dosis 1

16-08-2021 24200121 16220780453732 dosis 1

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732

16-08-2021 24200121 16220780453732
16-08-2021 24200121 16220780453732
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601042107820001 SUANI L
2 3601041306860001 DENI AHYANI L
3 3601045001890007 NASIH P
4 3601046103670002 ANIH P
5 3601046803980001 EROH ROHAYATI P
6 3601046302970002 MUTMAINAH P
7 3209091808020003 RENDI RUSDIANTO L
8 1807030507930002 FATHUL MUSATQIM L
9 3503106505960002 IKA KARTIKA P
10 3215094505970006 RIRIN P
11 1810026504020003 INDAH MEGA LESTARI P
12 1608111305020001 RIYADI L
13 P-E3E0NB7P 3601100806910001 ROHMAN L
14 3601042104910001 ASEP SUNANDAR L
15 3601042509890001 SUMANTA L
16 3601040111740001 KOSASIH L
17 3601045204830007 SITI P
18 3601045703870002 SITI NURSYAMSIAH P
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

21-07-1982
21-03-1994
18-01-1989
21-03-1967
'28-05-1998
ODGJ '23-02-1997
PEL. PUBLIK 18-08-2002
05-04-1993
25-05-1996
05-08-1997
25-04-2002
13-05-2002
08-06-1991
24-08-1990
11-08-1989
01-11-1974
12-04-1983
17-08-1987
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota
TANJUNGAN 085691863468
TANJUNGAN 081511690531
TANJUNGAN 085697017899
TANJUNGAN 085779055286
TANJUNGAN 085771588347
SUKAWARIS
PANIMBANG 085886413682
BELIMBING SARI 085892614594
TANGGALEK 088214734871
KARAWANG 081280271020
PRINGSEWU LAMPUNG 0895704451605
TULANG BAWANG 082282418841
UMBULAN 085887747318
TANJUNGAN 081517025499
TANJUNGAN 085280307405
TANJUNGAN 085719131345
TANJUNGAN 085771427457
TANJUNGAN 085892643373
 Dosis I
Tanggal Tanggal
Merek Vaksin***
Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac 17-08-2021 17-08-2021 24200121 16220780453732
CoronaVac
CoronaVac
CoronaVac
CoronaVac
CoronaVac 16220780453732
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

17-08-2021 24200121 16220780453732

17-08-2021 24200121 16220780453732
17-08-2021 24200121 16220780453732
17-08-2021 24200121 16220780453732
17-08-2021 24200121 16220780453732
NO No. Ticket NIK Nama Penerima Vaksin JK

1 1808103005020007 DENI IRAWAN L

2 3601042609020002 M HADINTA L
3 3601040903030002 ULUNG PRAYOGA L
4 3601046609060001 RESTIANI ASTUTI P
5 360104410030007 LILIS P
6 3601041106360004 MUHDI L
7 3601044209980002 ANGGI W L
8 360104010640063 ATA L
9 360104500280004 ASWATI P
10 3601042101050003 AJI PANGESTU L
11 3601041507790001 ASMAR L
12 3601040107850003 SANIRUN L
13 3601040107800248 SAJA L
14 3601041403950004 SUMARNA L
15 3601042810020001 SUPANDI L
16 3601044911850001 RUMINIH P
17 3601040809820001 RIBUT L
18 3601041201730001 R, ENDAY L
19 3601045910950001 YETI PUSPITA P
20 3601044104990005 EVA P
21 3601045208020001 AYUNI D P
22 3601040702030003 FREDY H L
23 3601040901980001 TONI L
24 3601045710000001 LIA H P
25 3601040803010004 SUMAR A L
26 3601046303040003 IRMA AINI P
27 1602111001910002 EDI CANDRA L
28 3601041409850001 MARJA L
29 3601040107760228 MADI L
30 3601044508040002 IDA LAELA P
31 3601044811000002 SINTA P
32 3601044606010004 PINA L P
33 3601045107990003 SOPIAH P
34 3601044109040003 ROSIAH P
35 3601042108000001 ARIP L
36 3601041305980002 DIKMANSYAH L
37 3601044212010003 ROLANI P
38 360104010930132 SARMANI L
39 3601040107910132 SUPIANTO L
40 36010291408000012 ABU ROHIM L
41 3601045507750008 ITI CASWATI P
42 3601041302880006 BAKRI L
43 3601041611020001 YOGA R L
44 36010450000003 RITA. M P
45 360104010320001 UMAR L
46 P-Q0ED8PIK 3601042211000001 WIRO SUDIARTO L

47 P-6CD8LT8K 3601045610960001 RENI I P

48 P-6LQ9IVNQ 360104161090001 ANDRI H L

49 S-A0AA70A8 3601040701980004 M. FAIDHONI. A L
50 MU. HUA L
51 P-X6K8CWVQ 360104410770011 ONIH ROSITA P
52 P-BOGSIJKR 360226308920001 SITI MAESAROH P
53 P-DEVNJC4S 1812023107960005 JULIAN ADE P L
54 P-DJ5WK4PI 3601042911990001 CANDRA KURNIAWAN L
55 P-DLJZP9IB 3324141012650001 TUGIMAN L
56 P-E5V5OSQZ 3601062403970001 JAJA L
57 3601040203790002 TASWADI L
58 P-EVUMENSR 3601015304740002 MUSLIHATUN P
59 P-42PJS8DB 3217071610970004 ARDIANSYAH L
60 P-0B9N9JBE 1810021406710001 SUKIRAN L
61 P-3W3PHB0Z 3601040908740001 SUMAR L
62 P-3PRLLHGG 3601045803040001 HELDA DIANA P
63 3601044807020001 MILA P
64 3602091612010001 BAI NURHASANAH P
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

30-05-2002
26-09-2002
09-03-2003
26-09-2006
01-03-2003
11-06-1996
02-09-1998
01-07-1964
10-02-1968
21-01-2005
10-02-1988
01-07-1985
01-07-1980
14-03-1995
01-11-2001
09-11-1985
08-09-1982
10-05-1973
07-02-1995
10-04-1999
09-06-2002
07-02-2003
09-01-1998
17-10-2000
01-07-2002
23-03-2004
10-01-1991
14-09-1985
01-07-1976
05-08-2004
08-11-2000
06-06-2001
01-08-1999
24-05-2003
21-08-2000
13-05-1998
02-12-2001
01-07-1993
14-03-1987
14-08-2000
29-04-1968
 13-02-1988
16-11-2002
31-03-2002
01-02-1962
22-11-2000

PLKB 16-10-1996 PLKB

PLKB 16-10-1990 PLKB
27-10-1998
27-09-1981
06-01-1980

13-08-1992
31-07-1996
28-11-1999
10-02-1965
01-04-1995
02-03-1979
13-04-1974
16-10-1997
12-03-1970
09-08-1974
18-03-2004
04-07-2000
15-10-2000
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota
CIKEUSIK 085216810961
UMBULAN 085692729318
SUKASENENG 085774961404
NANGGALA 082125723676
NANGGALA 085212816396
SUKAMULYA 085888572484
SUKAMULYA 085881987242
SUKAMULYA 085861693441
SUKAMULYA 085861693441
SUKAMULYA 0858616693441
TANJUNGAN 085697592236
PARKOS 085695138663
PARKOS 081511863811
PARKOS 085719017060
PARKOS 085695138663
SUKAMULYA 085211641139
SUKAMULYA 085211641139
CIKEUSIK 085319076030
SUKAMULYA 08588290188
SUKAMULYA 085710765417
UMBULAN 081384852583
UMBULAN 083892392281
SUKASENENG 085819813266
SUKASENENG 085770971945
UMBULAN 085773236625
CIKEUSIK 085883507949
RANCASENENG 085210708073
CIKEUSIK 085695268429
UMBULAN 082311264796
SUKAWARIS 085694159844
SUKAWARIS 085877528061
SUKAWARIS 085283234518
UMBULAN 085287491857
SUKAMULYA 085894539255
NANGGALA 085694136884
NANGGALA 085881232262
CIKEUSIK 082312237097
NANGGALA 081289834184
CIKEUSIK 081289834184
SUKARESMI 083875881514
SUKASENENG 08589113659
UMBULAN 085691437503
UMBULAN 081388454677
SUKAMULYA 085711364890
UMBULAN 085716570354
KP. CILANCAR DESA NANGGALA 085210420223

CIKEUSIK 085894496

CIKEUSIK 08589044096
RANCASENENG 082258142769
PT RBB 082124070397
RANCASENENG 081282773440

KP CILEUNGSIR DS SUKAMULYA 081218596605

DAYA MURNI LK V1 KEC TUMUJAJ 082289344197
KP SUKARENDAH DS SUKAWARIS 085890701475
PEGULON 005/002 DS PEGULON 081325434173
TANJUNGSARI 081574834166
BABAKAN BANDUNG DS.CIKIRUHWET 085880069299
DUSUN TELAGANAK RT 002 RW 003
GUNUNGMASIGIT, CIPATAT KEC.BA 085246039710
TEGAL SARI GEDUNG REJO 081237148132
PAMATANG SEMPUR DS.SUKASENEN 0857-7956--3338
PAMATANG SEMPUR DS.SUKASENEN 085776130282
NANGGALA 085779059069
CIKEUSIK 08773520025
 Dosis I
Tanggal Tanggal
Merek Vaksin***
Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778364736
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220778369728
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780236268
CoronaVac 19-08-2021 19-08-2021 24200121 16220780245160
CoronaVac 19-08-2021 19-08-2021 24200121 16220780245160
CoronaVac 19-08-2021 19-08-2021 24200121 16220780245160
CoronaVac 19-08-2021 19-08-2021 24200121 16220780245160
CoronaVac 19-08-2021 19-08-2021 24200121 16220780245160
SINOVAC 29-06-2021 29-06-2021 24003121 16183002584777
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
SINOVAC 01-07-2021 01-07-2021 24003921 16213341167886
coronaVac 12-07-2021 12-07-2021 24003921 16207156783663
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
CoronaVac 15-07-2021 15-07-2021 24003921 16207156781791
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
CoronaVac 14-07-2021 14-07-2021 24200521
CoronaVac 22-07-2021 22-07-2021 24200921
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

27-09-2021 24200121 16219343252570

19-08-2021 24200121 16220780245160

19-08-2021 24200121 16220780236268

19-08-2021 24200121 16220780236268

19-08-2021 24200121 16220780245160

19-08-2021 24200121 16220780236268

19-08-2021 24200121 16220780236268

19-08-2021 24200121 16220780245160
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780245160
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780245160
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220780236268
19-08-2021 24200121 16220778364736 D1 DI JAKARTA
19-08-2021 24200121 16220780236268 D1 DI KODIM TANGGERANG
NO No. Ticket NIK Nama Penerima Vaksin JK

1 P-3KIGHRMA 360 1040107860075 Tarkim L

2 P-AJDZUF6E 3601041002900002 UJANG B TARKIM L
3 P-9KH6AISR 3601041605990002 HAIRIL ANWAR L
4 P-9HLXAUTK 3601041504780003 ADE SAPRUDIN L
5 P-A0QYAWZM 3601043011660001 MULYADI L
6 P-AR09QQAH 3601044307730007 USAH P
7 S-F0568EAB 3601044401930005 DIAN HARYANI P
8 P-AXQQ01IE 3601044611020001 WIDIYA LESTARI P
9 P-B4GJIKFB 3601044703000003 SITI SUTIRAH P
10 P-B7REV15R 3275094606990024 SITI JUBAIDAH P
11 P-B0SCRLUZ 3320113103010004 NA'IM AHMAD HA'IZ L
12 P-BAD1C3WK 3601041712000001 FAISAL RAMADHANI HAKIM L
13 P-ARNLLQF1 3601044401020001 ERSA P
14 P-ALYZQAPF 3601044503880005 SUHAYATI P
15 P-67YOK0TF 3601044603970002 RUMIYATI P
16 P-4V2KJN5U 1806286203010005 YOSYANI F P
17 P-M4HR56Z0 3602214103000001 RAGIL RAHMADILA A P
18 P-1ZIZN4QU 1801071504960002 RIAN HIDAYAT L
19 P-8L4VSPL2 3601046006970004 CUCU ELYASINTA P
20 P-A477687X 3601041612860002 HERI PURWADINATA L
21 P-CYAPAIJH 3602210506820010 WAWAN SUPARMAN L
22 P-CXS9X41P 3601046007830004 EMAH P
23 P-CXFKXCXI 3601042701940001 SAPTAJAYA L
24 P-CVBGYA3B 3601045401890001 MELa P
25 P-CWZI08BY 3601041112950005 NURIMAN FAJAR L
26 P-CUPH0YH2 3601046204810001 KURNIAH P
27 P-CSSGKQWH 3601041501990001 AGUS SUPRIYADI L
28 P-CRWSXLBL 3601044711020002 WINDA WIDIYANTI P
29 P-CQ6KWE6N 3601046502050001 VIVI ANGESTI SETIADI P
30 P-COGVGDNL 3601046707990004 LISDA DWI RAHAYU P
31 P-CN4ZIEAS 3601042510890002 DEDI HIDAYATULLAH L
32 P-CM3Q2FYM 1608113108930001 DWI KRISDIANTO L
33 P-CKAZD0ZX 3601041803660002 IDRIS L
34 Q-000CGSRH 3601041012990002 HASANUDIN L
35 P-CGBHH0OS 3601042012930001 DASEP AHMAD RIFAI L
36 P-CHZQUYNN 3601040112870001 MUHTADI ILAHI L
37 P-CJCABH4V 3320060202010001 ADITYA YUNA P L
38 P-AMLSN96T 3601045604910003 SITI SEWI P
39 P-AKPD2K1N 3601044305860001 SITI NU ASIAH P
40 P-AI2OFAMA 3601042604480001 ATO MARTANI L
41 P-AGMSFR5C 1905030110700002 HERMAN L
42 P-AF72A9M5 3601042910890001 IMAN AMRULLAH L
43 3601041703690001 dodo L
44 360104200890003 ZENI TAUFIK L
45 P-97QSZSCQ 3602210703690001 AHMAD ISKANDAR L
46 P-FNAPLAAP 3602261407520003 SITI NAJMIAH P
47 Q-000ASKK3 3601040107830313 Jalalaudin L
48 Q-0000AVCCR 3601045201850002 NURDIANA L
49 P-9ETHYE3L 3601041403950004 SUMARNA L
50 Q-000ASNKM 3601045005810005 LILIS L
51 Q-000AVCCV 3601045606790003 ROSMIATI P
52 Q-000ASNKU 3601045012800002 ENJUN P
53 Q-000AZGIT 3601047001920001 ENENG ROHENI P
54 W-00009TXZ 3601040203810003 USMAN SUPARMAN L
55 Q-000CKANK 3601043011980001 YUDI ISMAIL L
56 Q-000AZRIK 3601044107820176 UNAH P
57 Q-000B2GEV 3601046503890001 DEDE NURASIH P
58 Q-000B0CGS 3601044107810196 DAMINI P
59 Q-000IO2L7 3601045410980002 ULFATUL KHASANAH P
60 Q-000B02X9 3601044204760001 ISTIROKAH P
61 Q-000AXU1L 3601045904780003 ROLIPAH P
62 Z-0006566A 3601042112600001 ASMAWI L
63 Q-000B0GAE 3601044503630001 ANYAS P
64 Q-0009GVK7 3601045004980004 NENG ENI NURAENI P
65 Q-000B0BFY 3601040405940002 FIRAS FRASETYA A L
66 Q-000I2KGQ 1802080707830005 NANG SUPRIYATNA L
67 Q-0009GVEZ 3601041208890003 DAYAT HIDAYAT L
68 Q-0009GVFM 3601041711890002 OTONG HAETAMI L
69 Q-000IPGXR 3602215110820004 MUMUS MUSLIAWATI P
70 Q-000AW4WR 3329081504680005 SAKIM L
71 Q-0009GVGX 3601042703880001 TULUS MUCHLISIN L
72 Q-0000QUHI 3602214605920001 LILIS NURAENI P
73 Q-000AZJGT 3602214708910004 NELLY FRALILIA LEONA P
74 Q-000DCEMH 3601041907020001 ALDI JULIANSYAH L
75 Q-0009GVFK 3601041707860002 ENDANG SUPANJI L
76 Q-0009VGZ 3601042911920002 RIKI REPANGGA L
77 Q-000IPODF 1806203001680002 SUDARTO L
78 Q-0009GVKC 3601045009960001 IJAH P
79 Q-00012GDX 1802100806770007 AGUS HUSEIN P L
80 Q-00012LF5 1805270605720001 SARMAN L
81 Q-00092159 3601046207770002 EUIS KARTINI P
82 Q-000ASSNQ 3601044107780434 BEDAH P
83 G-0133LRPB 3601044711740001 BETI HERAWATI P
84 Q-000A597R 3601041901850001 HANAN HUSNANDI L
 Umur
Kelompok
Pekerjaan* (18-59 INSTANSI Alamat
Umur
tahun)

MASYARAKAT 14-10-1987 Cikiruhwetan

MASYARAKAT 10-02-1990 Cikiruhwetan
MASYARAKAT 20-04-2000 Cikiruhwetan
MASYARAKAT 15-04-1978 Cikiruhwetan
MASYARAKAT 30-11-1966 Cikiruhwetan
MASYARAKAT 03-07-1977 Cikiruhwetan
PENDIDIK 04-01-1993 Cikiruhwetan
MASYARAKAT 06-11-2002 Cikiruhwetan
MASYARAKAT 07-03-2000 Cikiruhwetan
MASYARAKAT 06-06-1999 Cikiruhwetan
MASYARAKAT 31-03-2001 DS. KRAPYAK
MASYARAKAT 17-12-2000 Cikiruhwetan
MASYARAKAT 22-01-2001 Cikiruhwetan
MASYARAKAT 05-03-1988 Cikiruhwetan
MASYARAKAT 18-06-1996 Cikiruhwetan
MASYARAKAT 22-03-2001 LENGKUKAI
MASYARAKAT 15-08-2000 MUARA
MASYARAKAT 15-04-1996 JAYAGIRI
MASYARAKAT 20-06-1997 Cikiruhwetan
MASYARAKAT 16-12-1985 Cikiruhwetan
MASYARAKAT 05-06-1982 Cikiruhwetan
MASYARAKAT 20-07-1983 Cikiruhwetan
MASYARAKAT 05-07-1993 Cikiruhwetan
MASYARAKAT 27-12-1988 Cikiruhwetan
MASYARAKAT 11-12-1992 Cikiruhwetan
MASYARAKAT 22-04-1981 Cikiruhwetan
MASYARAKAT 01-10-1999 Cikiruhwetan
MASYARAKAT 07-11-2002 Cikiruhwetan
MASYARAKAT 25-05-2005 Cikiruhwetan
MASYARAKAT 27-07-1999 Cikiruhwetan
MASYARAKAT 25-10-1989 Cikiruhwetan
MASYARAKAT 20-06-1995 TULANG BAWANG
MASYARAKAT 18-03-1966 Cikiruhwetan
MASYARAKAT 30-06-2002 Cikiruhwetan
MASYARAKAT 04-12-1993 Cikiruhwetan
MASYARAKAT 01-12-1987 Cikiruhwetan
MASYARAKAT 02-02-2001 JOBUKUTO
MASYARAKAT 16-04-1991 Cikiruhwetan
MASYARAKAT 03-05-1986 Cikiruhwetan
MASYARAKAT 11-05-1970 Cikiruhwetan
MASYARAKAT 01-10-1970 Cikiruhwetan
MASYARAKAT 19-08-1989 Cikiruhwetan
DISABILITAS MENTAL 17-03-1969 Cikiruhwetan
DISABILITAS MENTAL 20-08-1990 Cikiruhwetan
MASYARAKAT 7/3/1969 Cikiruhwetan
MASYARAKAT 14-02-1975 Cikiruhwetan
MASYARAKAT 04-08-1980 Cikiruhwetan
MASYARAKAT 12-01-1985 Cikiruhwetan
MASYARAKAT 14-03-1995 Cikiruhwetan
MASYARAKAT 10-05-1981 Cikiruhwetan
MASYARAKAT 16-06-1979 Cikiruhwetan
MASYARAKAT 10-12-1980 Cikiruhwetan
MASYARAKAT 08-09-1991 Cikiruhwetan
PENDIDIK 13-05-1981 Cikiruhwetan
MASYARAKAT 30-11-1998 Cikiruhwetan
MASYARAKAT 08-01-1982 Cikiruhwetan
MASYARAKAT 25-03-1989 Cikiruhwetan
MASYARAKAT 01-07-1981 Cikiruhwetan
MASYARAKAT 14-10-1998 Cikiruhwetan
MASYARAKAT 02-04-1997 Cikiruhwetan
MASYARAKAT 19-04-1978 Cikiruhwetan
LANSIA 01-05-1959 Cikiruhwetan
MASYARAKAT 05-03-1963 Cikiruhwetan
MASYARAKAT 07-04-1998 Cikiruhwetan
MASYARAKAT 04-05-1994 Cikiruhwetan
MASYARAKAT 07-07-1983 Cikiruhwetan
MASYARAKAT 12-08-1989 Cikiruhwetan
MASYARAKAT 17-11-1989 Cikiruhwetan
MASYARAKAT 11-10-1982 MUARA
MASYARAKAT 15-04-1968 SAWOJAJAR
MASYARAKAT 03-06-1997 Cikiruhwetan
MASYARAKAT 06-05-1992 WANASALAM
MASYARAKAT 07-08-1991 Cikiruhwetan
MASYARAKAT 19-07-2002 Cikiruhwetan
MASYARAKAT 17-07-1985 Cikiruhwetan
MASYARAKAT 18-05-1992 Cikiruhwetan
MASYARAKAT 30-01-1968 PURWODADI
MASYARAKAT 02-02-1997 Cikiruhwetan
MASYARAKAT 08-6-1977 LAMPUNG
MASYARAKAT 05-05-1972 LAMPUNG
PENDIDIK 22-07-1977 Cikiruhwetan
MASYARAKAT 01-07-1978 Cikiruhwetan
PENDIDIK 07-11-1974 Cikiruhwetan
PENDIDIK 15-07-1984 Cikiruhwetan
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Merek Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening
PBI Non PBI Anggota

- SINOVAC 19/08/2021
- SINOVAC 19/08/2021
0838-4138-6936 SINOVAC 19/08/2021
0812-9507-4877 SINOVAC 19/08/2021
0852-1167-7124 SINOVAC 19/08/2021
0857-8275-9260 SINOVAC 19/08/2021
0858-9057-0405 SINOVAC 19/08/2021
0857-1478-3244 SINOVAC 19/08/2021
0858-1145-9910 SINOVAC 19/08/2021
0856-9704-2129 SINOVAC 19/08/2021
0898-9374-611 SINOVAC 19/08/2021
0877-2190-8980 SINOVAC 19/08/2021
085795308371 SINOVAC 19/08/2021
085782759260 SINOVAC 19/08/2021
085546048371 SINOVAC 19/08/2021
085368312682 SINOVAC 19/08/2021
087872737744 SINOVAC 19/08/2021
085891005505 SINOVAC 19/08/2021
083890223344 SINOVAC 19/08/2021
081282294148 SINOVAC 19/08/2021
082113212490 SINOVAC 19/08/2021
085283868349 SINOVAC 19/08/2021
081315544340 SINOVAC 19/08/2021
082312006593 SINOVAC 19/08/2021
082130201498 SINOVAC 19/08/2021
085219991470 SINOVAC 19/08/2021
081903185398 SINOVAC 19/08/2021
081574914988 SINOVAC 19/08/2021
085773488248 SINOVAC 19/08/2021
081222549060 SINOVAC 19/08/2021
087773332223 SINOVAC 19/08/2021
083176436255 SINOVAC 19/08/2021
085332502517 SINOVAC 19/08/2021
087764771265 SINOVAC 19/08/2021
085773751939 SINOVAC 19/08/2021
0858-81630005 SINOVAC 19/08/2021
089666927640 SINOVAC 19/08/2021
0857-8275-9260 SINOVAC 19/08/2021
085211550153 SINOVAC 19/08/2021
082130940945 SINOVAC 19/08/2021
0818-0676-3642 SINOVAC 19/08/2021
0823-1021-5054 SINOVAC 19/08/2021
- SINOPHARM 19/08/2021
0857-1419-7414 SINOPHARM 19/08/2021
087772691170 SINOVAC 19/08/2021
082148815803 SINOVAC 19/08/2021
0852170389458 SINOVAC 19/08/2021
085213872716 SINOVAC 19/08/2021
0857-19017060 SINOVAC 19/08/2021
0858-9364-5813 SINOVAC 19/08/2021
0856-94587774 SINOVAC 19/08/2021
08589364813 SINOVAC 19/08/2021
081284189310 SINOVAC 19/08/2021
- SINOVAC 19/08/2021
081511953074 SINOVAC 19/08/2021
085779251892 SINOVAC 19/08/2021
082110991513 SINOVAC 19/08/2021
081398897115 SINOVAC 19/08/2021
085215597829 SINOVAC 19/08/2021
081398897114 SINOVAC 19/08/2021
081398897114 SINOVAC 19/08/2021
085219991470 SINOVAC 19/08/2021
0821713552 SINOVAC 19/08/2021
085217136552 SINOVAC 19/08/2021
08387082534 SINOVAC 19/08/2021
082186447257 SINOVAC 19/08/2021
081297517650 SINOVAC 19/08/2021
083878957799 SINOVAC 19/08/2021
087772691170 SINOVAC 19/08/2021
0812954133784 SINOVAC 19/08/2021
0858-9454-1105 SINOVAC 19/08/2021
0857-1077-3366 SINOVAC 19/08/2021
085693449272 SINOVAC 19/08/2021
0857-7540-1863 SINOVAC 19/08/2021
0857-7388-3624 SINOVAC 19/08/2021
0818-1690-76 SINOVAC 19/08/2021
0823-7135-0535 SINOVAC 19/08/2021
0859-3009-5559 SINOVAC 19/08/2021
0897-6124-242 SINOVAC 19/08/2021
0853-0835-4358 SINOVAC 19/08/2021
0812-8712-0453 SINOVAC 19/08/2021
0858-9364-813 SINOVAC 19/08/2021
0858-1372-0148 SINOVAC 19/08/2021
0857-8263-5829 SINOVAC 19/08/2021
 Dosis I Dosis 2

Tanggal Tanggal
No.
Pemberian No. Batch No seri Pemberian
Batch
Vaksinasi Vaksinasi

19/08/2021 24200121 16220780441704

19/08/2021 24200121 16220780441704
19/08/2021 24200121 16220780441704
19/08/2021 24200121 16220780441704
19/08/2021 24200121 16220780245472
19/08/2021 24200121 16220780245472
19/08/2021 24200121 16220780245472
19/08/2021 24200121 16220780245472
19/08/2021 24200121 16220780245472
19/08/2021 24200121 16220778354596
19/08/2021 24200121 16220778354596
19/08/2021 24200121 16220778354596
19/08/2021 24200121 16220778354596
19/08/2021 24200121 16220778354596
19/08/2021 24200121 16220780450908
19/08/2021 24200121 16220780450908
19/08/2021 24200121 16220780450908
19/08/2021 24200121 16220780450908
19/08/2021 24200121 16220780450908
19/08/2021 24200121 16220780450908
19/08/2021 24200121 16220780441080
19/08/2021 24200121 16220780441080
19/08/2021 24200121 16220780441080
19/08/2021 24200121 16220780441080
19/08/2021 24200121 16220780441080
19/08/2021 24200121 16220780441548
19/08/2021 24200121 16220780441548
19/08/2021 24200121 16220780441548
19/08/2021 24200121 16220780441548
19/08/2021 24200121 16220780441548
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220780442016
19/08/2021 24200121 16220778469884
19/08/2021 24200121 16220778469884
19/08/2021 24200121 16220778469884
19/08/2021 24200121 16220778469884
19/08/2021 24200121 16220778469884
19/08/2021 2021040436
19/08/2021 2021040436
19/08/2021 24200121 16220778469884
19/08/2021 24200121 16220778469884
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19/08/2021 24200121
19-08-2021 24200121
19-08-2021 24200121
19-08-2021 24200121
 KET
No Seri
16220780441704
16220778469884
16220778469884
16220778469884
16220778469884
16220778469884
16220780442016
16220780442016
16220780442016
16220780441548
16220780441548
16220780441548
16220780441548
16220780441548
16220780441080
16220780441080
16220780441080
16220780441080
16220780441080
16220780450908
16220780450908
16220780450908
16220780450908
16220778354596
16220778354596
16220778354596
16220778354596
16220778354596
16220780441704
16220780441704
16220780441704
16220780441704
16220780441704
16220780245472
16220780245472
16220780245472
16220780245472
16220780245472
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601040107800019 JATIM L
2 3601044107820160 CASTI P
3 3601044311870001 SUNARTI P
4 3601040408940002 JUANDI L
5 3601041608210001 ARDIN L
6 3601045908010002 GIETA DEVANY P
7 3601044605020002 RASITA L
8 3210094109910022 SANTI ANDRIANI P
9 3601041909990001 ALWAN MUSTOPA L
10 3601046006870002 SAROH P
11 3601040107830046 DARSO L
12 3602145303880009 NURAENI P
13 3601041807840003 YANI L
14 3601044107020119 AMANDA SULISTIAWATI P
15 3602182505870006 MISYANA L
16 3601042409920002 MUNIR L
17 3601041509030004 FERI KURNIAWAN L
18 3601040805810003 MAMAT L
19 3601040107900324 SARMAN L
20 1905062610080001 RIZAL L
21 1905064101870001 MARSAH P
22 3601040107540004 CAKAM L
23 3601040107850276 SANIIN L
24 3601041710940008 USRI L
25 1905061607840001 ISMAD L
26 3601041005800003 AGUS KOMALA L
27 3601046502770001 RASIH P
28 6104181803970002 YUDI SETIAWAN L
29 3601044412020004 NURHAYATI P
30 3601055703040001 SITI NURYATI P
31 3601045304040004 SITI SOFIA P
32 3601045408880001 MITA P
33 3601041501930004 BERI PERMANA L
34 3601045303760001 SARAH P
35 360104503980008 NISYAH P
36 33217076103020008 NOVI MARLIANI P
37 3601046309030004 NENG LAURA P
38 3601045503030002 RATNASARI P
39 3601041402130001 JULFIKAR L
40 33241415011980002 MUFLIH MULIA L
41 3374130205480005 BIMA FAJAR L
42 3601040101040004 SANDI L
43 3601042804030002 TARNA L
44 36010442055780003 WARTINIH P
45 3601046311000001 YESI ANDRIANI P
46 36010470010002 TINI NURBAETI P
47 3601046207010001 SERLI MARLINTON P
48 3601041010980001 ASEP L
49 3601044411980001 SITI ARUM P
50 3602211509020001 RIDWAN FIRDAUS L
51 LYU YUNFEI L
52 3602215609900001 YENI FAHRIANI P
53 3601044203640001 DEDEH ROHAENI P
54 3601045712020001 NURMALIA FAJRIANTI P
55 Q-0009GVKY 3601045306960001 YUNI H P
56 P-33X3NWZ9 3601041212860003 ATMA L
57 P-RFWWVKAU 3601045507890001 SADIAH P
360104540617700
58 Q-000A6EU5 NUNUNG N P
01
59 P-4G0XI8KF 360104730003 SARI'AH P
60 P-4MQY7VNX 360104150760006 SUGIRI L
360104510873000
61 P-56Z0JN71 SUTINAH P
2
360104660382000
62 Q-000A78NY NURALIAH P
3
360221511000000
63 P-5M5JPBJW IRMA P
4
64 P-7MF4IFAG 36010105950007 NURHALIM L
65 P-O1DQBZW9 3601044409900010 JUNAH P
66 P-OGI5IZUE 3601040408100001 RAMA RIO SAGITA L
360104570590000
67 P-XGSMVGTS SARNITI P
1
68 P-DK7B08LQ 3517075701940001 INTAN RIZKI G P
69 J-0000BYUG 351720660590001 ARISKA DIAH R P
360104020700000
70 Q-000IONWZ BAGAS PUDA A L
3
71 7312047005990002 SRI PUNAMA SARI P
72 P-5CNNJKQG 3308212005000005 YUSUP IMAN L
73 P-GO9LRQV5 3601041404030002 GUNADI L
74 P-GOYHRHSV 3601040207830008 EPI MULYANA L
75 S-2C754E65 3601045111580003 SUNTIAH P
76 P-GQ7ZRIBC 1802124707820007 ANIS ISTIQOMAH P
77 P-GQLII5OZ 7310064911990001 DIAN TENTI A P
332006171003000
78 P-GRBDX1VB M ARDI L
4
180113250673000
79 P-GTJ71G74 DIDING SUPRIADI L
4
360104420598000
80 P-GXTL33LM IA JUMIATI P
1
360104010650000
81 S-E0E65AAC AMIN PRIATNA L
1
360104120552000
82 S-E6F5B70B M ARIP L
1
360104490199000
83 P-HB0VC5L1 LAILA NURSAFITRI P
1
360104160797000
84 Z-0007YUHP MUHAMAD SONI L
1
85 P-HE9LU6IR 3601040102730006 KARTIM L
86 P-HMMZFAUB 33080607030006 ADI S L
330801180803000
87 P-HNCKTVHH ABID S L
1
88 3601045511890001 MARLINA P
 Umur
Kelompok
Pekerjaan* (18-59 INSTANSI Alamat
Umur
tahun)

MASYARAKAT 01-07-1980 SUMURBATU

MASYARAKAT 06-08-1980 CIKEUSIK
MASYARAKAT 03-01-1987 CIKEUSIK
MASYARAKAT 04-08-1994 SUKAMULYA
MASYARAKAT 01-07-1989 SUKAMULYA
MASYARAKAT 19-98-2001 SUKASENRNG
MASYARAKAT 06-05-2002 SUKASENENG
MASYARAKAT 01-09-1991 TANGERANG
MASYARAKAT 06-09-1999 CIKEUSIK
MASYARAKAT 20-06-1987 SUMURBATU
MASYARAKAT 01-07-1982 SUMURBATU
MASYARAKAT 13-03-1988 CITERAS
MASYARAKAT 18-07-1984 SUMURBATU
MASYARAKAT 19-01-2003 CIKEUSIK
MASYARAKAT 25-05-1987 KADUAGUNG
MASYARAKAT 24-09-1992 CIBALIUNG
MASYARAKAT 15-09-2003 SUKASENENG
MASYARAKAT 08-05-1981 CIKEUSIK
MASYARAKAT 01-07-1990 SUKASENENG
MASYARAKAT 28-10;2008 BANGKA BELITUNG
MASYARAKAT 01-01-1987 BANGKA BELITUNG
MASYARAKAT 01-07-1953 RANCASENENG
MASYARAKAT 15-07-1984 CIKEUSIK
MASYARAKAT 17-10-1994 SUMURBATU
MASYARAKAT 16-07-1984 AIR GANTANG
MASYARAKAT 14-05-1980 UMBULAN
MASYARAKAT 24-05-1980 CIKONCANG
MASYARAKAT 18--3-1997 MUARA PAWAN
MASYARAKAT 04-12-2002 TANJUNGAN
MASYARAKAT 17-03-21 CIGEULIS
MASYARAKAT 13-04-2004 RANCASENENG
MASYARAKAT 01-04-2003 NANGGALA
MASYARAKAT 15-01-1993 NANGGALA
MASYARAKAT 13-03-1976 CIKEUSIK
MASYARAKAT 10-03-1998 NANGGALA
MASYARAKAT 21-03-2002 CIKEUSIK
MASYARAKAT 23-09-2003 SUKASENENG
MASYARAKAT 15-03-2003 CIKEUSIK
MASYARAKAT 19-05-2003 CIKEUSIK
MASYARAKAT 15-01-1998 PORWEKERTO
MASYARAKAT 02-05-1998 SEMARANG
MASYARAKAT 01-01-2004 RANCASENENG
MASYARAKAT 28-04-2003 SUKASENENG
MASYARAKAT 02-05-1978 RANCASENENG
MASYARAKAT 23-11-2000 BABAKAN BANDUNG
MASYARAKAT 30-07-2001 HUNIBERA
MASYARAKAT 22-07-2001 CIKIRUHWETAN
MASYARAKAT 06-11-1999 UMBULAN
MASYARAKAT 09-04-1998 UMBULAN
MASYARAKAT 15-04-2002 LEBAK
MASYARAKAT 16-09-988 PT RBB
MASYARAKAT 16-09-1990 CIKIRUHWETAN
MASYARAKAT 03-04-1964 CIKEUSIK
MASYARAKAT 17-12-2002 NANGGALA
PRADES 13-06-1996 PREDES CI CIWET
12-12-1996 RANCASENENG

publik 15/07/1989 publik SUKASENENG

KADER 07-06-1977 KADER S KP CIKAREO DESA S
KADER 09-08-1973 KADER D KP. CIKONCANG DE
21-02-1968 SUKASENENG
KADER 07-11-1982 KADER R RANCASENENG
26-03-1982 CIWET
11-10-2000 NANGGALA
01-05-1995 SAGA BALARAJA
04-02-1990 KP. BELENGGUNG DESA CIK
17-12-1994 NANGGALA
13-12-1986 CIKEUSIK
17-01-1994 JL MERDEKA 001/00
26-05-1995 DSN KEDUNG JAWA T
24-10-1999 TANJUNGAN
30-05-1999 SULAWESI SELATAN
20-05-2000 DUSUN KUWUNG DS.W
14-04-2003 KP RANCASENENG
 02-07-1983 KP CIBULUH
11-11-1958 KP CIKEUSIK
07-07-1982 KP TENGAH LAMPUNG
09-11-1999 KP SAMALEWA
17-10-2003 JEPARA
25-06-1973 LAMPUNG TENGAH
02-11-1990 KP CIKEUSIK 001/001
01-06-1950 KP CIKEUSIK
12-05-1952 KP CIKEUSK
09-01-1999 KP SUKAWARIS
16-06-1994 SUKAWARIS
06-06-1974 KP BABAKAN WARU
07-07-2003 MAGELANG
18-08-2003 MAGELANG
MASYARAKAT 04-07-1994 SUKASENENG
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

081211641603 SINOVAC 23/08/21 23/08/21

082112308094 SINOVAC 23/08/21 23/08/21
085767449414 SINOVAC 23/08/21 23/08/21
085782221605 SINOVAC 23/08/21 23/08/21
085750308961 SINOVAC 23/08/21 23/08/21
081218302622 SINOVAC 23/08/21 23/08/21
085210993281 SINOVAC 23/08/21 23/08/21
081386118816 SINOVAC 23/08/27 23/08/21
085695149743 SINOVAC 23/08/21 23/08/21
085810134583 SINOVAC 23/08/21 23/08/21
085718719605 SINOVAC 23/08/21 23/08/21
08319336630 SINOVAC 23/08/21 23/08/21
085810134583 SINOVAC 23/08/21 23/08/21
081511750959 SINOVAC 23/08/21 23/08/21
083819336630 SINOVAC 23/08/21 23/08/21
085719474959 SINOVAC 23/08/21 23/08/21
081315543500 SINOVAC 23/08/21 23/08/21
083804395183 SINOVAC 23/08/21 23/08/21
082155500460 SINOVAC 23/08/21 23/08/21
085711036447 SINOVAC 23-08-21 23/08/21
085703151295 SINOVAC 23-08-21 23/08/21
085882165332 SINOVAC 23-08-21 23/08/21
081284923644 SINOVAC 23-08-21 23/08/21
085810134583 SINOVAC 23-08-21 23/08/21
082150065136 SINOVAC 23-08-21 23/08/21
087772770100 SINOVAC 23-08-27 23/08/21
0852194423928 SINOVAC 23-08-28 23/08/21
081385562639 SINOVAC 23-08-29 23/08/21
085719347841 SINOVAC 23-08-30 23/08/21
085778187836 SINOVAC 23-08-31 23/08/21
085695270515 SINOVAC 23-08-32 23/08/21
085280517291 SINOVAC 23-08-33 23/08/21
085609257500 SINOVAC 23-08-34 23/08/21
085715854289 SINOVAC 23-08-35 23/08/21
085694445383 SINOVAC 23-08-36 23/08/21
081511959181 SINOVAC 23-08-37 23/08/21
081390244095 SINOVAC 23-08-38 23/08/21
083691938627 SINOVAC 23-08-39 23/08/21
081286107602 SINOVAC 23-08-40 23/08/21
081227854700 SINOVAC 23-08-41 23/08/21
081804518657 SINOVAC 23-08-42 23/08/21
085717152175 SINOVAC 23-08-43 23/08/21
081213359327 SINOVAC 23-08-44 23/08/21
085352825636 SINOVAC 23-08-45 23/08/21
05773227346 SINOVAC 23-08-46 23/08/21
085697596595 SINOVAC 23-08-47 23/08/21
081113831105 SINOVAC 23-08-48 23/08/21
085157788276 SINOVAC 23-08-49 23/08/21
085888363303 SINOVAC 23-08-50 23/08/21
085210921191 SINOVAC 23-08-51 23/08/21
081383608781 SINOVAC 23-08-51 23/08/21
082312466212 SINOVAC 23-08-21 23/08/21
SINOVAC 23-08-21 23/08/21
085770621486 SINOVAC 23-08-21 23/08/21
;08569513776 SINOVAC 29-06-2021 29-06-2021
085693645905 SINOVAC 29-06-2021 29-06-2021
085694587302 coronaVac 6/29/2021 6/29/2021
085717453746 SINOVAC 01-07-2021 01-07-2021
085219539426 SINOVAC 01-07-2021 01-07-2021
085219539426 SINOVAC 01-07-2021 01-07-2021
085694722856 SINOVAC 01-07-2021 01-07-2021
083899759343 CoronaVac
085781419733 SINOVAC 01-07-2021 01-07-2021
081385067325 SINOVAC 01-07-2021 01-07-2021
081646061709 coronaVac 08-07-2021 08-07-2021
085739526641 coronaVac 08-07-2021 08-07-2021
081219681493 CoronaVac 15-07-2021 15-07-2021
082342238615 SINOVAC 7/22/2021 7/22/2021
081235930665 SINOVAC 7/22/2021 7/22/2021
085799335655 CoronaVac 22-07-2021 22-07-2021
082312882380 SINOVAC 7/22/2021 7/22/2021
085858659187 SINOVAC 7/22/2021 7/22/2021
085887771044 SINOVAC 26/07/2021
081318377474 SINOVAC 26/07/2021
085214724141 SINOVAC 26/07/2021
082377044425 SINOVAC 26/07/2021
082343796369 SINOVAC 26/07/2021
085540669564 SINOVAC 26/07/2021
08570710391 SINOVAC 26/07/2021
085212265990 SINOVAC 26/07/2021
085212265990 SINOVAC 26/07/2021
085779561204 SINOVAC 26/07/2021
081806717334 SINOVAC 26/07/2021
0858888951994 CoronaVac 26-07-2021 26-07-2021
085866761684 SINOVAC 26/07/2021
088225238469 SINOVAC 26/07/2021
088286094171 SINOVAC 26/07/2021
085694587382 SINOVAC
Dosis I Dosis 2
Tanggal
Pemberi KET
No. Batch No seri an No. Batch No Seri
Vaksina
si
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046520306
24003121 16183046514846
24003121 16183046514846
24003121 16183046514846
24003121 16183046514846
24003121 16183046514846
24003121 16183046514846
24003121 16183046514846 9/30/2021 24200121 162119303686689
24003121 16183046514846
2021040436
24003121 16183046514846
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046525298
24003121 16183046527326
24003121 16183046527326
24003121 16183046527326
24003121 16183046527326 27-09-202 24200121 16219343252570
24003121 16183046527326
24003121 16183046527326
24003121 16183046527326
24003121 16183046527326
24003121 16183046527326
24003121 16183046527326
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046524206
24003121 16183046527170
24003121 16183046527170
24003121 16183046527170
24003121 16183046527170
24003121 16183002580565 23-08-2021 24200121 16220780892388
24003921 16213341156810 23-08-21 24003121 16183046520306 DOSIS 2
24003121 16183002580565 23-08-2021 24003121 16183046520306 dosis 2
24003921 16213341167886 23-08-2021 '24200121 16220780892388
24003921 16213341167886 23-08-21 24003121 16183046520306
24003921 16213341167886 23-08-21 24003121 16220780892388
24003921 16213341167886 23-08-21 24003121 16183046520306
23-08-2021 '24200121 16220780881936
24003921 16213341167886 23-08-21 24003121 16183046520306
24003921 16213341167886 23-08-21 24003121 16220780881936
24002221 16164644963378 23-08-21 24003121 16183046520306
24002221 16164644959834 23-08-21 24003121 16220780881936
24003921 16207156781791 23-08-21 24003121 16183046520306
23-08-21 24003121 16220780881936
23-08-21 24003121 16183046520306
24003121 23-08-2021 '24200121 16220780890828
23-08-21 24003121 16220780890828
23-08-21 24003121 16220780890828
24002221 16183002360949 23-08-21 24003121 16220780890828
 24002221 16183002370745 23-08-21 24003121 16183046524206
24002221 16183002370745 23-08-21 24003121 16183046524206
24002221 16183002370745 23-08-21 24003121 16183046524206
24002221 16183002370745 23-08-21 24003121 16183046524206
24002221 16183002370745 23-08-21 24003121 16183046524206
24002221 16183002370745 23-08-21 24003121 16183046524206
24002221 16182990738465 23-08-21 24003121 16183046524206
24002221 16182990738465 23-08-21 24003121 16183046527170
24002221 16182990737841 .23-08-21 24003121 16183046527170 DOSIS 2
24003121 16182990935789 23-08-2021 '24200121 16220780890828
24003121 23-08-2021 '24200121 16220780890828
24003121 16182990935789 23-08-2021 '24200121 16220780892388
24003121 16183002581969 23-08-21 24003121 16220780890828
24003121 16183002581969 23-8-21 24003121 16220780892388
23-08-21 24003121 16183046514846
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045208350003 MAYA J P
2 3601044104320004 MILA A P
3 3601044304780001 SAMI P
4 3601045209780003 INA W P
5 3601045005020004 IPAT FATMAWATI P
6 3601045804950003 ENOK TUTI P
7 3601045506900009 BAINAH P
8 3601044110010002 TINI P
9 3601045006750003 KUS ANISAH P
10 3601044108550002 DESIH P
11 3601042104840001 AMIR L
12 3601044606790002 EMAH SAEMAH P
13 3601044904030002 RINDIYANI P
14 3601040108670001 GUING L
15 3601042207940001 YAYAN.H L
16 3601040107660053 SONYA. S L
17 3601040107990052 IRWANTO. L L
18 3601041706760001 RAKUM L
19 3601040207580003 H. MUHDI L
20 3601044102040001 YANTI P
21 3601045106040007 ITA. P P
22 3601045812030002 RIKA. A P
23 3601044108100037 SUKARAH P
24 3601045404740001 REWI P
25 3602216609990001 SRI ALFIAH P
26 3601044202030002 PUPUT P
27 3601041305740001 H. ADE. S L
28 3601041101040001 KETY P
29 3601045309870001 ENO RURIAN P
30 3601040703650001 SUI L
31 3601044106950004 YENI. M P
32 3601046801700003 AISAH P
33 3601044107910062 IIN. S P
34 3601040107870040 SADIK L
35 3601045606000002 TUTI. S P
36 180724105020004 TIARA P
37 36010145405740001 RASEM. M P
38 3601044907990004 LENI. N P
39 3601045002740002 NUNUNG P
40 3601040108720002 UDIN. H L
41 360104540900002 ASNI P
42 3601046007880002 TETI P
43 3601040404000001 RUDI L
44 3601044107870003 AMAH MULYAMAH P
45 360104520570001 SANTI P
46 3601044507920009 RANTI P
47 3601040911650001 TOHIR L
48 32020703950002 SRI ADE TRIONO L
49 3601046106900001 DIAN. T P
50 3601042704750001 DARJA L
51 3601044107830086 RENTI P
52 3601044102650003 DASIMAH P
53 3601044184270001 TIJAH P
54 3601041002600001 RASJI L
55 3601040707780002 SUPRIADI L
56 3601046511980003 EUIS P
57 360104017950063 ROHMANI L
58 3602211108800002 REDI L
59 360041802020002 KRISNA MUKTI L
60 3601042601950002 AGUS L
61 3601042909840002 AHMAD. R L
62 3601044105870006 SUNIAH P
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

12-08-1995
01-04-2002
03-04-1978
12-09-1978
02-03-2001
18-04-1995
15-06-1990
01-10-2001
10-06-1975
10-07-1979
10-07-1987
06-06-1879
09-04-2003
01-08-1967
22-07-1994
07-08-1963
11-12-1999
17-06-1976
02-07-1958
04-11-2004
11-06-2004
18-12-2003
06-08-1977
14-04-1974
26-09-1999
02-02-2003
13-05-1974
11-01-2004
13-10-1987
07-03-1965
 01-06-1995
28-01-1970
07-07-1991
01-07-1992
16-06-2000
01-05-2002
07-06-1972
09-07-1999
10-02-1974
02-02-1968
14-04-1990
08-10-1986
04-04-2000
21-08-1988
12-05-1976
05-07-1992
09-11-1965
27-03-1995
03-08-1991
27-04-1975
31-03-1982
01-02-1965
01-04-1957
10-02-1960
07-07-1978
15-08-1998
17-09-1995
11-08-1980
18-07-2002
08-08-2002
29-09-1984
01-05-1987
 Kepesertaan BPJS (tul
'Ya' pada kolom yang
Alamat NO HP BPJS
PBI

SUKAWARIS 083834320703
SUKAWARIS 085695412693
SUKAWARIS 081315543448
SUKAWARIS 085216585186
SUKAWARIS 085694105815
SUKAWARIS 085818228484
SUKAWARIS 085211548129
SUKAWARIS 085692741283
SUKAWARIS 083151495925
KP. CIKAREO DESA SUKAWARIS 083871094505
SUKAWARIS 081315728146
SUKAWARIS 0855813590631
SUKAWARIS 085773751886
SUKAWARIS 081220642778
SUKAWARIS 082118132620
SUKAWARIS 087887132038
SUKAWARIS 085880240569
SUKAWARIS 085215864026
SUKAWARIS 085866761684
SUMURBATU 085692720209
SUMURBATU 085880253941
SUMURBATU 085718763135
SUKAWARIS 085866761684
SUKAWARIS 087889574014
PARUNG PANJANG 085718515227
SUKAWARIS 085882796604
SUKAWARIS 085719021174
RANCASENENG 085217367949
SUKAWARIS 085694276599
SUKAWARIS 085866761684
SUKAWARIS 082310769521
SUKAWARIS 082310769521
SUKAWARIS 085217105542
SUKAWARIS 085866761684
SUKAWARIS 085710954263
SUKAWARIS 081284055746
SUKAWARIS 085895877860
SUKAWARIS 082124750359
SUKAWARIS 085894541336
SUKAWARIS 085894541336
SUKAWARIS 085216560446
SUKAWARIS 085866761684
SUKAWARIS 085212606541
SUKAWARIS
SUKAWARIS 085866761684
SUKAWARIS 081316929188
SUKAWARIS 085283233832
SUKAWARIS 081388456976
SUKAWARIS 083807230108
SUKAWARIS 085219695455
TEMANGGUNG 082258462514
SUKAWARIS 085866761684
SUKAWARIS 085866761684
SUKAWARIS 0858866761684
SUKAWARIS 085866761684
CIWET 085715406130
SUKAWARIS 08388945194
LEBAK 083875405648
CIWET 082123160089
CIWET 085814138025
SUKAWARIS 082317676215
SUKAWARIS 081333671336
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal Tanggal
BPJS Non Merek Vaksin***
Screening Pemberian No. Batch
Non PBI Anggota
Vaksinasi
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac 23-08-2021 23-08-2021 '24200121
CoronaVac
 Dosis 2
Tanggal
No seri Pemberian No. Batch
Vaksinasi
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388 27-09-2021 24200121
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780892388
16220780890828 27-09-2021 24200121
16220780890828
16220780890828 27-09-2021 24200121
16220780890828
16220780890828
1622078892388 27-09-2021 24200121
1622078892388
1622078892388
1622078892388
1622078892388
1622078892388
1622078892388
1622078892388
16220780675252 27-09-2021 24200121
16220780675252
16220780675252
16220780675252 27-09-2021 24200121
16220780675252
16220780675252
16220780675252
16220780675252
16220780881936
16220780881936
16220780881936
16220780881936
16220780881936
16220780881936
16220780881936
16220780881936
23-08-2021 '24200121
 KET
No Seri

16219343252570
16219343252570

16219343252570

16219343252570

16219343252570

16219343252570

16220780675252 D1 DI JAKARTA
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044503790001 TARSUMI P
2 3601041805970001 PUAD FAJRIL L
3 301046408030002 LINA WATI P
4 3601044107420013 ENIH P
5 3601044307850004 EHA P
6 3601045508700004 SURIAH P
7 3601044412840002 ANIS P
8 3601044901860002 MUTMAINAH P
9 360104410768001 NAYAH P
10 3601044206820004 SUKESIH P
11 3601046003730001 BADRIAH P
12 3601041003060005 ARIF SARIF L
13 3601046011040001 LENDIS ADIYAWAN L
14 3601044101710004 FATMAWATI P
15 3601045808920002 HERLINA AGUSTIN P
16 3601044502860006 MISNAH P
17 3601040107900040 MUHAMAD SAID L
18 3601045103010001 SUCI LESTARI P
19 3601044101820002 HJ. ANI P
20 3601045910800001 RUHANAH P
21 3601041111030003 AMAK NOVALINO R L
 Umur
Kelompok
Pekerjaan* (18-59 INSTANSI Alamat
Umur
tahun)

05/03/1979 SUMURBATU
18/05/1997 SUMURBATU
24/08/2003 SUMURBATU
01/07/1942 SUMURBATU
03/07/1283 SUMURBATU
15/08/1970 SUMURBATU
04/12/1984 SUMURBATU
09/01/1986 SUMURBATU
01/07/1968 SUMURBATU
02/08/1982 SUMURBATU
20/03/1973 SUMURBATU
10/03/2006 SUMURBATU
20/11/2004 SUMURBATU
01/07/1981 SUMURBATU
18//08/1992 SUMURBATU
05/02/1986 SUMURBATU
22/07/1989 SUMURBATU
11-03-2001 SUMURBATU
01/01/1982 SUMURBATU
19/10/1980 SUMURBATU
03/11/2003 SUMURBATU
 Kepesertaan BPJS (tulis 'Ya'
Dosis I
pada kolom yang sesuai)
Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

085881197221 CORONAVAC 26/08/21 26/08/21

085846087149 CORONAVAC 26/08/21 26/08/21
081915043421 CORONAVAC 26/08/21 26/08/21
081546891283 CORONAVAC 26/08/21 26/08/21
08154891283 CORONAVAC 26/08/21 26/08/21
081546891283 CORONAVAC 26/08/21 26/08/21
085773210130 CORONAVAC 26/08/21 26/08/21
085695148217 CORONAVAC 26/08/21 26/08/21
085773210130 CORONAVAC 26/08/21 26/08/21
085861089682 CORONAVAC 26/08/21 26/08/21
085715794360 CORONAVAC 26/08/21 26/08/21
081221875271 CORONAVAC 26/08/21 26/08/21
085624586356 CORONAVAC 26/08/21 26/08/21
085894175166 CORONAVAC 26/08/21 26/08/21
08158278246 CORONAVAC 26/08/21 26/08/21
085810896862 CORONAVAC 26/08/21 26/08/21
08158278246 CORONAVAC 26/08/21 26/08/21
087752084509 CORONAVAC 26/08/21 26/08/21
087788703424 CORONAVAC 26/08/21 29/07/21
085710753777 CORONAVAC 26/08/21 26/08/21
085782266800 CORONAVAC 26/08/21 26/08/21
Dosis I Dosis 2

Tanggal
No.
No seri Pemberian No. Batch No Seri
Batch
Vaksinasi

24005121 16261620856141
24005121 16261620856141
24005121 16261620856141
24005121 16261620856141
24005121 16261620856141
24005121 16261620856141
24005121 16261620856141
24005121 16261620856141
24005121 16261620854581
24005121 16261620854581
24005121 16261620854581
24005121 16261620854581
24005121 16261620854581
24005121 16261620853021
24005121 16261620853021
24005121 16261620853021
24005121 16261620856141
24005121 16261620856141
2400514 26/08/21 24005121 16261620856141
24005121 26/08/21 24005121 16261620856141
24003121 26/08/21 24005121 16261620854581
KET
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601042511000001 DADAN. L L
2 3601042409940003 SAEPUDIN L
3 3601040909960003 CACA. C L
4 3601040107580133 SUPARTO L
5 3604056504740003 SARINAH P
6 3601040604740001 JUHEDI L
7 3601040507030004 WRTONO L
8 3601044107870138 IKA P
9 3601046808060001 ANI. W P
10 3601040211020005 ROSUL L
11 3601043112030002 YOGI L
12 3601040107960116 MEMED L
13 3601040207790001 BAED L
14 3601040300005 EMAN. S L
15 3601045507040002 HAMIDA P
16 3601044405680001 SARNITI P
17 3601042407000001 MAHENDRA L
18 3601044107030126 ANGGA. F L
19 3601044103020005 MAYA P
20 3601045505040003 WATI AYU P
21 3601040107820123 SARMAN L
22 3601041507030010 WAHYUDI L
23 3601044106030004 FITRIAH P
24 360104670290002 SITI PARIHATUN P
25 360104681202020005 TRI MULIA. W P
26 3601046812020005 TRI MULIA. A P
27 3601045602030001 ANNESA PUTRI P
28 3602210508760002 AGUS. M L
29 3601041205840005 CECE. T L
30 36010144107030163 RINA LESTARI P
31 36010140107870190 SA'I L
32 3601041401950004 HENDRI L
33 3601040701810004 SUARDI L
34 3601040107790141 TISNA L
35 3601040105840001 WARSO L
36 3601045407960001 DARMINIH P
37 3601046701030002 NENG IIN. B P
38 3601044107030180 ALDA ARISTAMA P
39 3601041204880003 TAUFIK L
40 3601040508800003 SUPRIADI L
41 3601044101030004 SITI. N P
42 3601046104030004 NIA. A P
43 3301050409030002 SARIFUL ANAM L
44 1802121603030002 SAIFUR. R L
45 1802122210020001 ARIF. S. A L
46 1801070310930004 SURDI L
47 360104107990074 ITA. P P
48 3602210904030004 MUHAJIRIN L
49 3601041001930001 WARNO L
50 3601045411960001 DIYAH P
51 360104070950002 ACHMAD. R L
52 3601041907030002 SOFYAN. M L
53 3175062209550003 ZAINAL. A L
54 3601042509020002 M. HAFIZ. K L
55 3601040107810218 KAMAD L
56 3601044706020001 SITI NURAENI P
57 3601047105010001 SITI SUSANAH P
58 3674055307970001 YUSTISIA P
59 3674054804720004 EFA MARIAH P
60 3601044709030003 ANISAH. S P
61 3601044511030008 DIANAH. M P
62 3601044808930002 SITI NURLAELASARI P
63 3601042707870002 JAMANI L
64 P-PELG52J7 120726231090002 M. RUSDI SIREGAR L
65 S-A23746F4 3601040107760008 MASRI L
66 3601040506780001 HARNA BIANTO L
67 S-9479733D 3601044507870004 NANI HARYANI P
68 P-FBGDDKFH 3601044208600001 ASMI P
69 P-E0YMO7JW 3601044805900007 SITI NURJANAH P
70 P-E0N7QXNJ 3601046208880001 INA ERLINA P
71 P-DT1W2N5I 3601044501890001 RAEFI L
72 3172020311660003 DIDIN L
73 P-GSCIMNZG 1802122001010002 ARIA JUMANTORO L
74 P-H6JQHR2C 1802124708780007 ERNA NINGSIH P
75 P-HLKS0TRK 1002125010730010 MURTA FINGSIH L
76 P-HNHZLNNO 3620062910020001 MIFTACHUL HUDA L
77 P-HNXMLHJB 33200619100320002 DIMAS F L
78 3601041509070001 M. DAFFA. R L
79 S-E492B29F 3601044404780001 WASTIJAH P
80 P-AZODGPGQ 3601040710060002 M RAYA KUSUMA L
81 P-LVO5G93Q 3601045104070002 SITI KHANSA A P
82 P-MA3BQ87K 3601044504880001 RASTINI P
83 P-MFB95WAJ 1806120406030006 ANDRE NUR AZIZ L
84 P-MGGFUHCJ 1806182303030004 DIAN EFENDI P
85 P-MMTXMTWH 3320140806020002 M FENDY L
86 3601040612480005 WAHYU HERLAMBANG L
87 3578011010930001 OKY MAULANA AJI L
88 3601044712940002 HENI. H P
 Umur Kelompok
Pekerjaan* INSTANSI
(18-59 tahun) Umur

25-07-2000
24-09-1994
09-04-1996
01-07-1958
25-04-1974
06-04-1974
18-05-2003
10-12-1989
11-06-2006
16-12-2002
31-12-2003
24-04-1999
02-07-1979
03-03-2001
28-03-2003
04-05-1968
24-07-2000
23-09-2003
01-03-2002
28-09-2007
01-07-1982
21-02-2004
12-11-2003
27-02-1996
28-12-2002
28-12-2002
06-02-2003
06-08-1975
12-05-1984
19-07-2000
01-07-1987
14-01-1995
07-01-1981
01-07-1975
 01-05-1984
04-06-1996
08-01-2003
01-07-2003
18-06-1988
06-08-1980
01-01-2003
21-04-2003
04-09-2003
16-03-2003
22-10-2002
03-10-1993
23-10-2000
09-04-2003
23-05-1992
04-11-1996
07-10-1995
19-07-2003
22-09-1955
25-09-2002
01-06-1979
07-06-2002
31-05-2001
13-07-1997
04-04-1972
07-09-2003
06-07-2003
08-08-1993
27-07-1987
23-10-1994

publik 06/02/1975 publik

publik 18/02/1987 publik
GURU 05-07-1987 SDN 1 SUMUR BAT
21-03-1972
08-05-1990
11-03-1986
05-01-1989
03-11-1966
 20-01-2001
23-11-1977
10-10-1973
21-07-2002
19-10-2003
04-09-2007
3/4/1978
10/7/2006
4/11/2007
4/5/1998
6/4/2003
3/23/2003
6/8/2003
30-12-2000
10-10-1993
17-11-1994
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota

UMBULAN 08776493261
SUKASENENG 085773265425
CIKEUSIK 081296415299
CIKEUSIK 081219681493
CIKEUSIK 085776873480
CIKEUSIK 081906158163
SUKASENENG 085219423936
SUKASENENG 081316927400
CIKEUSIK 085693480595
SUKASENENG 081382598060
SUKASENENG 085882754427
PARKOS 081510558304
PARKOS 081510558304
PARKOS 085694058122
CIKEUSIK 085798840106
SUKASENENG 085890649941
SUKASENENG 085693477233
SUKASENENG 085693477080
SUKASENENG 085894188214
SUKASENENG 085773891606
SUKAMULYA 082184485677
CIKEUSIK 085694473901
RANCASENENG 085715264076
UMBULAN 085710509804
SUKAMULYA 083874361686
SUKAMULYA 083874360980
CIKEUSIK 085776128267
UMBULAN 085212434122
LEUWIBALANG 085591641095
UMBULAN 085695323029
UMBULAN 082179034133
UMBULAN 085886147418
UMBULAN 081388148234
UMBULAN 085781399943
UMBULAN 085216070232
SUKASENENG 081213953763
CIWET 085811462206
CIWET 083879481071
CIKEUSIK 082311540318
RANCASENENG 081584376694
SUKAMULYA 085692969155
SUKAMULYA 085247992050
LAMPUNG TENGAH 087748108897
LAMPUNG TENGAH 087882385062
LAMPUNG TENGAH 085773213784
LAMPUNG SELATAN 081377865137
SUKASENENG 085694382993
WANASALAM 085710525609
TANJUNGAN 081383548890
TANJUNGAN 081383548890
NANGGALA 085775140227
NANGGALA 085771919354
BEKASI 081385820167
CIKEUSIK 083841379304
SUKASENENG 085283153624
CIWET 085693152657
SUKASENENG 085777750718
CEMPAKA PUTIH 081288608178
CIWET 08318757175
CIWET 083898508130
CIWET 083834363808
UMBULAN 081224388125
SUKASENENG 085776873581
CIKEUSIK 082312399266

CIKEUSIK 081317538180
SUMURBATU 081293320081
SUMUR BATU 085217129526
SUMUR BATU 085775258722
SUMUR BATU 081219691745
SUMUR BATU 085215497630
KP GUNUNG BATU 085814868613
DEPOK 082213258146
LAMPUNG TENGAH 085753012196
LAMPUNG TENGAH ;081286144272
LAMPUNG TENGAH 082375739892
JEPARA 085700146931
JEPARA 085900256471
CIKEUSIK 085694138651
KP SINAR GINTUNG 001/003 DS CURUGCIU 085697607114
KP CIKEUSIK 082310246932
UMBULAN 085773239659
CIKEUSIK 085717275661
TANGGAMUS 087769078247
TANGGAMUS 082335418256
JEPARA 085647262418
UMBULAN 081316674663
SURABAYA 085775141470
SUKAWARIS 085697583598
 Dosis I
Tanggal Tanggal
Merek Vaksin***
Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040512266
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040514762
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040513670
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040307126
CoronaVac 26-08-2021 26-08-2021 24004521 16247040520534
CoronaVac 26-08-2021 26-08-2021 24004521 16247040520534
CoronaVac 26-08-2021 26-08-2021 24004521 16247040520534
CoronaVac 26-08-2021 26-08-2021 24004521 16247040520534
CoronaVac 26-08-2021 26-08-2021 24004521 16247040520534
SINOVAC 29-06-2021 29-06-2021 24003121 16183002374021
coronaVac 6/29/2021 6/29/2021 24003121 16183002580565
coronaVac 6/29/2021 6/29/2021 24003121 16183002580565
SINOVAC 01-07-2021 01-07-2021 24003921 16213341169290
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
coronaVac 05-07-2021 05-07-2021 24003921 16213342037274
SINOVAC 7/22/2021 7/22/2021
SINOVAC 7/22/2021 7/22/2021
 SINOVAC 26/07/2021 24002221 16183002370745
SINOVAC 26/07/2021 24002221 16182990737841
SINOVAC 26/07/2021 24003121 16183002581969
SINOVAC 26/07/2021 24003121 16183002581969
SINOVAC 26/07/2021 24003121 16183002581969
CoronaVac 26-07-2021 26-07-2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
SINOVAC 7/28/2021 7/28/2021 24003121
CoronaVac 13-07-2021 13-07-2021 2400394
CoronaVac 21-07-2021 21-07-2021 24201421
CoronaVac 26-08-2021 26-08-2021 24004221
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

30-09-2021 16219309685597
26-08-2021 24004521 16247040307126
26/08/21 24005121 16261620854581 dosis 1
26/08/21 24005121 16261620856141 dosis 1
26/08/21 24005121 16261620854581
26/08/21 24005121 16261620854581
28/08/21 24005121 16261620854581
26/08/21 24005121 16261620853021
26-08-2021 24004521 16247040307126
26-08-2021 24004521 16247040514762
 26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040307126
26-08-2021 24004521 16247040307126
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040307126
26-08-2021 24004521 16247040307126
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040514762
26-08-2021 24004521 16247040307126 D1 D POLRES PANDEGLANG
26-08-2021 24004521 16247040514762 D1 DI RSAD BRAWIJAYA SURABAYA
27-09-2021 24200121 16219343252570 D1 DI PKM SUMUR
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045507830006 ERNI P
2 3601040500860004 RASMA L
3 36010414028020006 ADI SETIAWAN L
4 36010441511920003 FIKO. H L
5 3602140105840008 CECE IRAWAN L
6 3601044207950008 SARDI L
7 3601042808870002 ANDI L
8 3601042202030001 HIKMAT. F L
9 3601040706040002 RIANA PUTRA L
10 3601041207080007 SAPRUDIN L
11 360101040207060017 ZETA HADI L
12 3601046611990002 SINDI P
13 360104411010001 INTAN. R P
14 3602180203780001 MARHANI L
15 3602082002730001 SURDI L
16 3602011408870004 ROHMAN L
17 3601040203050001 DODI. S L
18 3601041906010003 IRWAN. E L
19 3601040701030011 CASWINTO L
20 3601046003020001 TAMEN L
21 3601044107880025 HELMI L
22 3601045202780001 RATINAH L
23 3601046302000003 SUPRIATNA L
24 3601044808000002 PUPUT. A P
25 3601040108010005 SAPRUDIN L
26 3601040806840002 MISRA L
27 3601044107910132 NILAWATI P
28 3601044507030006 RAHMADINA. H P
29 3601041407940002 SARIP L
30 3601041409660001 JUNEDI L
31 3602210701850004 DARMIN L
32 3601032212020001 SUDION L
33 3601041903060003 ARIF FATONI L
34 3601042610060002 ADA RIZKY L
35 3601046707020001 EHA P
36 3601040107850071 YAHYA L
37 3601042709960004 DODI. P L
38 3601044303060003 KARMILA P
39 3601042301030001 M. AKBAR. G L
40 360104200990004 M. HENDI L
41 3601045205050005 TATU AIDAH P
42 3601041402790001 YERI. T L
43 3601045203910001 NURHAYANI P
44 3602210705040001 ACIH. S P
45 3602217003070004 MARLINA P
46 3601044312030005 SINDI. S P
47 3601044305040001 SILVI. F P
48 360104481200004 INDRI. D P
49 3601040303980005 AKIRUL. M L
50 3601041202860001 ADMA L
51 3602210409990003 ASEP. H L
52 3601043009960001 M. IKBAL. M L
53 360104470890003 SUSI. S P
54 3601044912980001 RINDIYANI P
55 S-512E0E90 3601044107730353 ROHMAN YATI P
56 P-1OIDBB45 3601044107790166 PIAH P
57 P-GLQT2RRT 3601041005790001 SUPARTA L
58 Q-000B9TJ5 3601044103700001 ISAH P
59 Q-000B9TIG 361041901620001 ISMAIL L
60 S-4950747B 3601040702790001 JUANTA WIHARJA L
61 P-TNGJ0EVY 1803122205940001 ISMAN ISKANDAR L
62 Q-000JES6H 3601045006740001 PARIDAH P
63 Z-0007YVDH 3173010412620006 DAVID L
64 P-6LU7PVV0 3671021809780005 CARDIKI L
65 P-6VEB5EQ4 36010441007838372 IDAH P
66 P-70LX3RQS 36010407100001 MAKAR L
67 Q-000KM5N8 3320086908010021 M. ADIFA L
68 Q-000KMRN2 3601046603050001 ANDINI D P
69 Q-000KN3CE 1804171507020002 RYAN A L
70 P-9KB7CNM3 360104026840002 USNAN L
71 P-9NYEZC4D 360104010790037 JONI L
72 Q-000KND6C M DICKY L
73 Q-000KNHUV 3602021406970002 ERI W L
74 Q-000KNHS1 M. NAUFAL MUHAJI L
75 Q-000KNIHD AHMAD SUKAMIN L
76 P-AI00EOPV 360104107770035 WARSAD L
77 Q-000K40XQ 3317070608010002 M. ABDUL L
78 P-74898DEB 3601046505970001 ROSMAWATI P
79 Q-000K3STG 3601046512710001 INA DAINA P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

12-11-1986 CIKEUSIK
05-08-1986 CIKEUSIK
13-11-2002 CIKEUSIK
15-11-1992 CIKEUSIK
01-05-1984 CIWET
01-03-1993 CIKEUSIK
28-08-1987 CIKEUSIK
22-02-2004 CIKEUSIK
07-06-2004 CIKEUSIK
12-07-2008 SUKAWARIS
02-07-2006 CIKEUSIK
26-11-1999 CIKEUSIK
01-11-2001 CIKEUSIK
02-03-1978 LEBAK
20-02-1973 GUNUNG KENCANA
14-08-1987 GUNUNG KENCANA
02-03-2005 CURCI
19-06-2001 SUKASENENG
07-01-2003 CIKEUSIK
20-03-1982 RANCASENENG
14-08-1985 SUMURBATU
12-02-1978 RANCASENENG
23-02-2000 RANCASENENG
08-08-2002 CURCI
01-08-2001 RANCASENENG
08-06-1984 CIKEUSIK
28-10-1990 NANGGALA
05-07-2003 CURCI
14-07-1994 SUKAMULYA
14-09-1986 SUKAMULYA
07-01-1985 WANASALAM
22-12-2002 CIHANJUANG
19-03-2006 CIWET
26-10-2006 CIWET
27-07-2002 TANJUNGAN
24-04-1983 RANCASENENG
27-09-1996 SUKAWARIS
 03-03-2006 SUKAWARIS
23-01-2003 UMBULAN
20-09-1999 RANCASENENG
12-05-2005 CIWET
09-04-1977 CIKEUSIK
16-10-1992 CIKEUSIK
21-01-2006 KATAPANG
30-03-2007 KARANGPAMINDANG
03-12-2003 CIKADONGDONG
03-05-2004 PARKOS
09-12-2000 PARKOS
03-03-1988 RANCASENENG
12-021-1986 CIKEUSIK
25-04-1998 KATAPANG
30-08-1996 CIKEUSIK
07-08-1993 CIKEUSIK
09-12-1998 CIKEUSIK
GURU 02-03-1972 SDN 1 UMBULAN

KADER 26-08-1982 KADER DKP BARENGKOK DESA UMBULAN

10-05-1979 SUMUR BATU
01-03-1970 CIWET
19-01-1962 CIWET
07-02-1979 UMBULAN
22-05-1994 NANGGALA
10-06-1974 LKP PEMATANG SEMPUR
04-12-1962 JAKARTA BARAT
18-09-1987 BABAKAN BANDUNG
01-07-1983 SUKASENENG
12-09-1963 UMBULAN
29-08-2001 JEPARA
26-03-2005 CIKEUSIK
15-06-2002 SUKAHARJO
02-06-1984 PARKOS
01-12-1979 RANCASENENG
15-05-2003 TAMBAK
20-10-1997 WARUNG HUNI
25-02-2003 TAMBAK
18-05-1976 TANJUNGAN
01-07-1977 RANCASENENG
05-07-2003
25-05-1997 SUKAMULYA
25-12-1971 RANCASENENG
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Merek Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening
PBI Non PBI Anggota

081574274049 CoronaVac 30-08-2021

085210436418 CoronaVac 30-08-2021
081373115175 CoronaVac 30-08-2021
085810133808 CoronaVac 30-08-2021
087888201017 CoronaVac 30-08-2021
085210700046 CoronaVac 30-08-2021
081284923644 CoronaVac 30-08-2021
085773891877 CoronaVac 30-08-2021
082312399511 CoronaVac 30-08-2021
082315836761 CoronaVac 30-08-2021
085810134584 CoronaVac 30-08-2021
085215203195 CoronaVac 30-08-2021
082111031450 CoronaVac 30-08-2021
082311165931 CoronaVac 30-08-2021
085211788034 CoronaVac 30-08-2021
085716629514 CoronaVac 30-08-2021
085714213961 CoronaVac 30-08-2021
082275314693 CoronaVac 30-08-2021
085771396770 CoronaVac 30-08-2021
085781086702 CoronaVac 30-08-2021
085810361423 CoronaVac 30-08-2021
085773223943 CoronaVac 30-08-2021
085773224570 CoronaVac 30-08-2021
085710525635 CoronaVac 30-08-2021
081286012533 CoronaVac 30-08-2021
085719767785 CoronaVac 30-08-2021
085716243160 CoronaVac 30-08-2021
082260101998 CoronaVac 30-08-2021
081213479403 CoronaVac 30-08-2021
085894266893 CoronaVac 30-08-2021
085281724170 CoronaVac 30-08-2021
085692702033 CoronaVac 30-08-2021
085703150779 CoronaVac 30-08-2021
085776825971 CoronaVac 30-08-2021
081291961428 CoronaVac 30-08-2021
081617252229 CoronaVac 30-08-2021
081381318855 CoronaVac 30-08-2021
085773810987 CoronaVac 30-08-2021
085773757717 CoronaVac 30-08-2021
087886676488 CoronaVac 30-08-2021
081511838984 CoronaVac 30-08-2021
085892747354 CoronaVac 30-08-2021
085770507741 CoronaVac 30-08-2021
085659674773 CoronaVac 30-08-2021
081584772528 CoronaVac 30-08-2021
085282387727 CoronaVac 30-08-2021
085283056711 CoronaVac 30-08-2021
081380491599 CoronaVac 30-08-2021
087878843466 CoronaVac 30-08-2021
CoronaVac 30-08-2021
081542331314 CoronaVac 30-08-2021
087781027570 CoronaVac 30-08-2021
085797143459 CoronaVac 30-08-2021
085282339468 CoronaVac 30-08-2021
085693346668 CoronaVac 21-06-2021
081932715950 SINOVAC 01-07-2021
085213833699 coronaVac 05-07-2021
082130201476 coronaVac 05-07-2021
0852111701125 coronaVac 05-07-2021
081574901779 coronaVac 05-07-2021
082125348558 coronaVac 12-07-2021
085218230691 SINOVAC
085218726888 SINOVAC
081314198484 CoronaVac 29-06-2021
085774965042 CoronaVac 02-08-2021
08531396751 02-08-2021
085875421908 02-08-2021
085691153801 02-08-2021
085780389980 02-08-2021
085887242596 02-08-2021
085882165248 02-08-2021
085878146558 02-08-2021
083815484913 02-08-2021
08975151000 02-08-2021
085710363805 02-08-2021
082177165325 02-08-2021
CoronaVac 20-07-2021
085888161419 CoronaVac 10-02-2021
081219736959 CoronaVac 29-07-2021
 Dosis I Dosis 2
Tanggal Tanggal
Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
30-08-2021 24005121 16261621062685 27-09-2021 24200121
30-08-2021 24005121 16261621062685
30-08-2021 24005121 16261621062685
30-08-2021 24005121 16261621062685 27-09-2021 24200121
30-08-2021 24005121 16261621062685 27-09-2021 24200121
30-08-2021 24005121 16261621062685
30-08-2021 24005121 16261621062685
30-08-2021 24005121 16261621062685
30-08-2021 24005121 16261621062685 27-09-2021 24200121
30-08-2021 24005121 16261621062685
30-08-2021 24005121 162616620859901 27-09-2021 24200121
30-08-2021 24005121 162616620859901
30-08-2021 24005121 162616620859901
30-08-2021 24005121 162616620859901 27-09-2021 24005121
30-08-2021 24005121 162616620859901 27-09-2021 24200121
30-08-2021 24005121 162616620859901
30-08-2021 24005121 162616620859901 27-09-2021 24200121
30-08-2021 24005121 16261620859433
30-08-2021 24005121 16261620859433
30-08-2021 24005121 16261620859433
30-08-2021 24005121 16261620859433
30-08-2021 24005121 16261620859433
30-08-2021 24005121 16261620859433
30-08-2021 24005121 16261620855049
30-08-2021 24005121 16261620855049
30-08-2021 24005121 16261620855049
30-08-2021 24005121 16261620855049
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
30-08-2021 24005121 16261620850057 27-09-2021 24200121
21-06-2021 24002221 16164644021450 30/08/21 24003121

01-07-2021 24003921 16213341167886 30/08/21 24003121

05-07-2021 24003921 16213342037274 30-08-2021 24005121
05-07-2021 24003921 16213342037274 30-08-2021 24005121
05-07-2021 24003921 16213342037274 30-08-2021 24005121
05-07-2021 24003921 16213342037274 30/08/21 24003121
12-07-2021 24003921 16207156783663 30-08-2021 24005121
26/07/2021 24003121 16183002581969 30-08-2021 24005121
26/07/2021 24003121 16183002581969 30-08-2021 24005121
29-06-2021 24003121 30-08-2021 24004521
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30/08/21 24003121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
02-08-2021 24003121 16183046076642 30-08-2021 24005121
20-07-2021 24003121 30-08-2021 24005121
10-02-2021 202011042 30-08-2021 24005121
29-07-2021 24003121 30-08-2021 24005121
 KET
No Seri

16219343252570

16219343251322
16219343251322

16219343252570

16219343252570

16219343252570
16219343252570

16219343251322

16219343252570
16219343252570
16219343252570
16219343252570
16219343252570

16219343252570
16219343252570

16219343252570

16219343252570
16219343252570
16219343252570
16219343252570
16183045641558

16183045429258
162616620859901
16261620850057
16261620850057
16183045422690
16261620859433
16261620850057
16261620850057
16183046076642
162616620859901
16183045422690
16261620855049
16261620850057
16261620855049
16261620859433
162616620859901
16261620855049
16261620855049
16261620855049
16261620850057
16261620859433
16261620855049
16261620850057 D1 PKM CIKUPA
16261620850057
 Nama Penerima
NO No. Ticke NIK JK Pekerjaan*
Vaksin

1 3601040107800272 OLIB L
2 3601040107670071 BAKRA L
3 3601040107790165 PULUNG L
4 3601040107820028 SURYADIN L
5 3601040910720005 A.ASMAR L
6 3601042103810001 WIRJAYA L
7 3601045109980006 RIRIN KIRANA P
8 3601041205950005 AGUS RAHMAT L
9 3601045809870003 SUTINI P
10 3601044107910295 MAEMUNAH P
11 3601030702900001 HERMAN L
12 3601044607900001 MASITOH P
13 3601040803830001 ENCEP SAEPUDIN L
14 3601040612740001 ARIP L
15 3601044108850019 KULSUM P
16 3601056205930001 DIAH LISMAAN P
17 3601040106770005 AJAT L
18 3601044811960002 SUSI SUSANTI P
19 3601044712990005 SITI MAESAROH P
20 3601041901800001 ENUNG P
21 3601046509030004 SARNATI SEPTIANI P
22 3601044811880001 MARYATI MELIA PUTRI P
23 3601044107770121 SATINAH P
24 3601044107780382 SARWI P
25 3601044107800265 ASNI P
26 3601040707730001 IMAM L
27 3601044807990003 ANGGI HERMAWAN L
28 3601046411840003 ELA BUDIYANTI P
29 3601045009020004 SELVIA AMELIA P
30 3601045101030003 FERA AGUSTINA P
31 3601042406870001 ROSADI RUSTAN L
32 3601045108880002 SITI ROSINAH P
33 3601044107790166 PIAH P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang

Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

01/07/1980 UMBULAN 085779950817

17/07/1963 UMBULAN 081517020520
10/10/1980 UMBULAN 0857822666361
01/07/1982 UMBULAN 081511857475
09/10/1972 UMBULAN 085694496881
21/03/1980 UMBULAN 085718646723
11/09/1988 UMBULAN 085860396109
11/08/1994 UMBULAN 087773662788
18/09/1987 UMBULAN 085884831769
07/08/1983 UMBULAN 085214062823
02/07/1990 UMBULAN 085214886838
10/09/1992 UMBULAN 083875371569
08/03/1983 UMBULAN 083899139064
11/04/1973 UMBULAN 085284385225
24/07/1990 UMBULAN 081511407751
22/05/1993 UMBULAN 085885712053
06/6/1977 UMBULAN 081411027631
08/11/1996 UMBULAN 085773210112
07/12/1999 UMBULAN 085882165313
19/01/1958 UMBULAN 081280219143
25/09/2003 UMBULAN 085710509754
08/11/1988 UMBULAN 085891151932
01/07/1977 UMBULAN 085894828863
01/07/1978 UMBULAN 085697591951
01/7/1980 UMBULAN 081993655020
07/07/1973 UMBULAN 085219331306
27/07/2003 UMBULAN 085691857861
24/11/1984 UMBULAN 08578298964
29/09/2002 UMBULAN 085778076104
02/08/2003 UMBULAN 081219680079
24/06/1987 UMBULAN 085714781984
11/08/1988 UMBULAN 081585118843
26/08/1982 UMBULAN 081932715950
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal
Tanggal Pemberi
BPJS Non Merek Vaksin***
Screening an No. Batch No seri
Non PBI Anggota
Vaksina
si
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045422690
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045641558
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24003121 16183045429258
CORONAVAC 30/08/21 30/08/21 24200121 16220780675876
CORONAVAC 30/08/21 30/08/21 24200121 16220780675876
CORONAVAC 30/08/21 30/08/21 24200121 16220780675876
CORONAVAC 30/08/21 30/08/21 24200121 16220780675876
CORONAVAC 30/08/21 30/08/21 24200121 16220780675876
CORONAVAC 30/08/21 30/08/21 24200121 16220780675876
CORONAVAC 29/06/21 29/06/21
CORONAVAC 29/06/21 29/06/21 24003121
CORONAVAC 01/07/21 01/07/21 24003921
 Dosis 2
Tanggal
Pemberi KET
No.
an No Seri
Batch
Vaksina
si

30/09/202124200121 16219309680901
30/09/202124200121 16219309680901

27-09-202 24200121 16219343252570

30/09/202124200121 16219309680901

27-09-202 24200121 16219343252570

27-09-202 24200121 16219343252570

27-09-202 24200121 16219343252570

30/08/21 24003121 16183045429258

30/08/21 24003121 16183045429258
30/08/21 24003121 16183045429258
NO No. Ticket NIK Nama Penerima Vaksin

1 3601044510790001 RAMINAH
2 36010142607950001 NANO. S
3 3601041003750004 SUDIN
4 3601044602760005 ETI. S
5 3601040311900003 ABDUL GONI
6 3601044202020004 KARTIKA. T
7 3601042008910003 HENDRI. S
8 3601044107890064 LISYANA
9 3601040107880089 WARSO
10 3601044808040002 LIA AGUSTIN
11 3601045504740001 ROMLAH
12 3601046504700001 CASINAH
13 36010457040002 SITI NURHASANAH
14 3601046503780004 CASINIH
15 3601045312930001 HERLINA
16 3601044707950009 RAHMAYANTI
17 3601043011241003 ROSITA
18 3601040107920102 WARJAYA KUSUMA
19 3601044608940002 WATIAH
20 3523011910000001 ALFIAN LUKMAN. H
21 3601045707760002 RASJEM
22 3601041107930003 ASEP SAEFENDI
23 3601045504040002 SITI MARHAMAH
24 3601041508010003 TARYANTO
25 3302022601770001 KARSITO
26 3601045112070003 DEWI YULIYANTI
27 3601042003020002 YUSU SUNINGRAT
28 3601060107830107 WAWAN
29 60104410750415 ROHAYAH
30 3604052808750001 AGUS WAHYUDI
31 3601045311800004 SUNERSIH
32 3212100503800008 NURKHOLIL
33 3601040107890074 SUTARA
34 3601041208730002 KASAN
35 3601040107740039 SURANA. S
36 '3601045108770001 NARSITI
37 3601040107940071 AGUS. W
38 3601045009670001 SURYATI
39 3601044812950002 KARTINI
40 3601040110700001 CASMADI
41 3601040511740007 CANITA
42 3601045407800007 TASKEM
43 3601041402000005 HAZA. M
44 3601042710750002 RASDAM
45 3601044312930003 SURINAH
46 3601044107530035 TINUL
47 3601041503830004 IDI. H
48 3601040201880005 ATANG, S
49 3601044107650044 WARSITI
50 3601045006950006 ROHENAH
51 3602215711970004 LULU NABILA
52 3601041405820001 DARTO
53 360104600600004 KARIDAH
54 3601045507850026 SUMINIH
55 360104410730105 MASKINAH
56 3601040107800087 KAMSIR
57 36010144311800006 RASTEM
58 3601040107700035 SALEH TAMKASWARA
59 3213306404850007 NURAFIYAH
 Umur Kelomp
JK Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

P 07-12-1979
L 26-07-1995
L 05-03-1973
P 06-02-1976
L 28-03-1992
P 02-02-2002
L 21-08-1996
P 17-07-1989
L 24-01-1986
P 08-08-2004
P 15-04-1974
P 10-11-1968
P 17-04-2004
P 25-03-1978
P 13-12-1993
P 07-07-1997
P 30-11-2004
L 15-09-1992
P 06-08-1994
L 19-10-2000
P 17-07-1976
L 11-07-1993
P 15-04-2004
L 15-08-2001
L 26-01-1977
P 11-12-2007
L 20-03-2002
L 12-11-1981
P 01-07-1985
L 28-08-1975
P 13-11-1980
L 05-03-1980
L 08-08-1988
L 12-03-1973
L 20-11-1977
P 11-08-1977
L 01-07-1994
P 10-09-1967
P 08-12-1995
L 01-10-1971
L 05-11-1974
P 14-07-1980
L 14-02-2000
L 27-10-1975
P 03-12-1993
P 01-07-1953
L 15-03-1993
L 02-01-1988
P 01-07-1965
P 10-06-1995
P 29-01-2004
L 14-05-1985
P 20-06-1970
P 04-10-1988
P 05-04-1975
L 01-07-1980
P 03-11-1980
L 08-08-1975
P 24-04-1985
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota

RANCASENENG 085280160916
RANCASENENG 081585265303
RANCASENENG 085212814437
UMBULAN 081574738138
SUKAWARIS 085894272056
RANCASENENG 085774807839
TAMANSARI 083815996957
RANCASENENG 085282338975
RANCASENENG 085282338975
RANCASENENG 081318596059
RANCASENENG 083856819300
RANCASENENG 085695147508
CIKEUSIK 0859102608977
RANCASENENG 085891154110
RANCASENENG 085891154110
RANCASENENG 085692729436
SUKAMULYA 085779570608
RANCASENENG 08558167372
SUKASENENG 082112053277
TUBAN 085895516262
RANCASENENG 085217346948
RANCASENENG 085694946151
RANCASENENG 085773237514
RANCASENENG 081295097718
BANYUMAS 082243042559
RANCASENENG 085321519983
RANCASENENG 085819370380
RANCASENENG 085779570670
RANCASENENG 081585121979
RANCASENENG 083879024288
RANCASENENG 083103020381
RANCASENENG 083103020381
RANCASENENG 085216246335
RANCASENENG 087773613090
RANCASENENG 085213478388
RANCASENENG 082125843035
RANCASENENG 085782467953
RANCASENENG 083873759721
RANCASENENG 087880831813
RANCASENENG 082312162907
RANCASENENG 085715264212
RANCASENENG 085715264212
RANCASENENG 085215343734
RANCASENENG 085772728759
RANCASENENG 081511690460
RANCASENENG 085523514655
RANCASENENG 087718994457
RANCASENENG 085695267576
RANCASENENG 085313357255
RANCASENENG 085773239679
CILANGKAP 085716570408
RANCASENENG 085774802590
RANCASENENG 085694136140
RANCASENENG 08558167372
RANCASENENG 082312162907
RANCASENENG 082110190115
RANCASENENG 085216954840
RANCASENENG 081248283337
SUBANG 085282640837
 Dosis I
Merek Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri
Vaksinasi
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 15-06-2021 15-06-2021 24003921
CoronaVac 16-06-2021 16-06-2021 24001421
CoronaVac 29-07-2021 29-07-2021 24003121
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002583685
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002379029
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
CoronaVac 02-09-2021 02-09-2021 24003121 16183002364037
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

30-09-2021 24003121 16182997316829

30-09-2021 24200121 16219309477649
30-09-2021 24200121 16219309477649
02-09-2021 24003121 16183002364037
02-09-2021 24003121 16183002364037 D1 DI POLSEK
02-09-2021 24003121 16183002364037
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24200121 16220778705908
30-09-2021 24003121 16182997316829
30-09-2021 24200121 16220778705908
30-09-2021 24200121 16219309477649
30-09-2021 24200121 16220778705908
30-09-2021 24200121 16220778705908
30-09-2021 24200121 16220778705908
30-09-2021 24003121 16182997316829
30-09-2021 24200121 16220778705908
30-09-2021 24200121 16220778705908
30-09-2021 24200121 16219309477649
30-09-2021 24200121 16220778705908
30-09-2021 24200121 16219309477649
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24200121 16219309477649
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24200121 16219309477649
30-09-2021 24200121 16219309477649
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
30-09-2021 24003121 16182997316829
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601040502070001 DERIL RAYA P L

2 3601045406070001 DINDA YULISTA P
3 3601046106080003 DECA P
4 360104612000003 YANAH HILMAWAT P
5 3601046505890002 EROS ROSMAWATI P
6 3601044308030002 PERDIANA NARYA S L
7 3601046801020002 SRI MULATI P
8 36010410066020001 SOLEHUDIN L
9 3601041507070001 SYEHABUDIN L
10 3601042607060001 DAVID CHRISNUJIWA L
11 3601044410080004 SITI NURAINI P
12 3601040505030001 JAKA L
13 3601044304010010 ETIH S P
14 3601086209930001 SANTI P
15 3601043110020001 PAJAR KRISTIAN L
16 360104281920002 SARDI BIN RAPEI L
17 3601040401910003 JAKARIA L
18 3602215203830006 UCU NURHAYANI P
19 3601045708940006 RIA ANITA P
20 3601046502970001 DEWI SUHERNI P
21 3601040307950003 SURYANA L
22 3601040107950114 JUJUN JUNAEDI L
23 3601044511030008 AMAN L
24 3601046805970002 RINA FAUJIAH P
25 3601040311770001 RAMIN L
26 3601041003930001 KUSMAWAN L
27 3601040101010007 HENDI WAHUDI L
28 M ALI NURDIN L
29 3601044802930001 NURYATI P
30 3602212601030002 MICHAEL HADINATA L
31 3601046404830002 NUNUNG P
32 3601046803030002 DELIS AULIA P
33 3601045804820001 DEDE KHAERIAH P
34 3601045512920002 YUHENTI P
35 3211170109720008 DEDI JUNAEDI L
36 3601046608020003 IRA IRWANSAH P
37 3601040107770004 JUL JUNAEDI L
38 3601046302890001 DEDE YUNINGSIH P
39 3601042701830001 BAMBANG SARIPUDIN L
40 3207281204890003 IJANG L
41 3601042509900001 LATIF L
42 3601042302030003 AHMAD RIYADI L
43 SAMSUL NURHIDAYAT L
44 3601040107580096 SUKARTA L
45 3207034406870002 ELIS P
46 3601046604030001 SITI NURHALIMAH P
47 3601044107930293 SITI SUHAELIAH P
48 3601040107780144 ACIP L
49 SAMSUL NURHUDAYAT L
50 3601044404030001 CIND APRILIA N P
51 3601041808800002 ABDUL KARIM L
52 3601040303930004 ASEP MULYADI L
53 3601045310980001 TATI P
54 3601041403000004 SUHENDI L
55 360104410785025 SRI MULYAWATI P
56 3601044107850046 ASTI P
57 3601041001050007 LUCK LISTIO L
58 360104660290002 RUMINI P
59 3601045005050010 WARNI P
60 3601041411030001 SALAMET L
61 3601040810010002 BASORI L
62 360104070895003 INDRA MAULANA L
63 6472061806870001 SURYA FADLANI L
64 6472064811880001 DINIH P
65 3602164506880003 PANCA YUNIA P
66 P-Q9EARGAA 3601045207870006 YUSILAWATI P

67 P-2HNTHSDB 3601044107730104 SRI WASTINAH P

68 P-2ARQ7XF9 3601045806860001 NURAISAH P

69 P-5OQBN5RP 3601044107910070 SUMINIH P
70 360106220300002 ADI RAHMAT H L
71 P-MLW1ATJW 3601041903970003 M AMIN L
72 3601045212800002 SITI P
73 P-ILIN7NGD AMANDA PUTRI A P
74 P-8TRH1D3F 3601046302080001 NIKITA A P
75 P-9FMK8606 2102035203830007 ELISAH L
76 P-A5Q5JEV4 3601073002960001 MUKRIONO L
77 NIRMALA P
78 EKA P
79 '360104010760115 IRSAD L
80 P-1UJV3X9K 3601040209950001 ROHMAN L
81 3601049501860003 MASRIAH P
82 3601045205770002 ENDAH H P
83 S-B5527CCA 360104520289000 NENIH MARTINAH P
 Umur
Pekerjaan* Kelompok Umur INSTANSI Alamat
(18-59 tahun)

5/2/2007 CIKEUSIK
07/07/2007 CIKEUSIK
21/06/2008 CIKEUSIK
24/12/2000 NANGGALA
21/05/1989 NANGGALA
15/05/2003 SUKASENENG
28/01/2002 TAMBELAK
07/0/2002 SUKASENENG
14/07/2007 CIKEUSIK
26/07/2008 CIKEUSIK
07/10/2007 SUKASENENG
05/05/2003 PEUNDEY
26/12/2002 UMBULAN
20/07/1991 MUNJUL
31/10/2002 UMBULAN
8/10/1992 BARENGKOK
04/01/1991 UMBULAN
12/03/1983 WANASALAM
17/08/1994 SUKAWARIS
05/02/1997 TALANCA
03/07/1995 CIKADONGDONG
10/06/1994 PARKOS
07/04/1974 CIKEUSIK
28/05/1997 CIKEUSIK
03/11/1977 CIKEUSIK
10/03/1993 CIKEUSIK
01/01/2001 CIWET
03/09/2001 SUMURBATU
05/10/1992 CURUGCIUNG
26/01/2003 WANASALAM
24/04/1983 CIWET
28/03/2003 CIWET
18/04/1982 CIKUJANG
15/12/1992 CIKEUSIK
01/09/1972 SUMEDANG
26/08/2002 TANJUNGAN
03/03/1973 SUMURBATU
23/02/1989 SUKASENENG
 27/01/1983 CIKEUSIK
12/04/1985 CIPENDEUY
20/09/1990 CANGKORE
23/03/2003 CIKADONGDONG
14/12/2004 SUKASENENG
01/07/1958 NANGGALA
04/0/1987 CIPENDEUY
2/04/2002 SUMURBATU
07/07/1989 SUMURBATU
07/03/1978 PARKOS
19/12/2004 CIRIRGI
04/04/2003 CIKEUSIK
12/06/1978 CIWET/HUNIBERA
03/03/1993 SUMURBATU
18/08/1999 UMBULAN
14/03/2000 SUMURBATU
13/11/1983 SUKASENENG
20/0/1985 SUMURBATU
10/01/2005 KADIRI
26/02/1999 NANGGALA
10/5/2005 UMBULAN
14/11/2003 CIKEUSIK
08/10/1997 RANCASENENG
07/08/1995 SUKASENENG
18/06/1987 SAMARINDA
08/11/1968 SAMARINDA
05/06/1988 CIWET

GURU 12-07-1987 SMPN 2 CIKEUSCIWET

20-03-1962 RANCSENENG

PEL. PUBLIK 20-01-1987 KP. PENDEY DESA

KADER 04-11-1993 KADER RAN RANCASENENG

22/03/2000 PANIMBANG
3/10/1998 LEUWI BALANGF
10/07/1985 GUNUNG BATU
17-04-2003 RANCASENENG
23-02-2008 RANCASENENG
12-03-1989 RIAU
30-03-1996 CILACAP
'05-12-2005 CIKEUSIK
'14-10-2005 SUKASENENG
'01-05-1976 CIKEUSIK
02-09-1995 CIDAIMAH
 03/01/1990 GUNUNG BATU
01/05/1977 CIWET

GURU 25-03-1988 SDN 3 CIWET CIWET

 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal
Merek Tanggal Pemberi
NO HP BPJS BPJS Non Vaksin*** Screening an
PBI Non PBI Anggota
Vaksina
si
082312399510 CORONAVAC 02/09/21 02/09/21
085871616755 CORONAVAC 02/09/21 02/09/21
085773227501 CORONAVAC 02/09/21 02/09/21
085892747366 CORONAVAC 02/09/21 02/09/21
081517819280 CORONAVAC 02/09/21 02/09/21
081286111790 CORONAVAC 02/09/21 02/09/21
083191867220 CORONAVAC 02/09/21 02/09/21
085694617787 CORONAVAC 02/09/21 02/09/21
085697592261 CORONAVAC 02/09/21 02/09/21
085782134900 CORONAVAC 02/09/21 02/09/21
085773226587 CORONAVAC 02/09/21 02/09/21
081511407859 CORONAVAC 02/09/21 02/09/21
082397564335 CORONAVAC 02/09/21 02/09/21
081285297178 CORONAVAC 02/09/21 02/09/21
085213872712 CORONAVAC 02/09/21 02/09/21
085882411280 CORONAVAC 02/09/21 02/09/21
083548481909 CORONAVAC 02/09/21 02/09/21
085219695472 CORONAVAC 02/09/21 02/09/21
081347303320 CORONAVAC 02/09/21 02/09/21
08568831102 CORONAVAC 02/09/21 02/09/21
081584773231 CORONAVAC 02/09/21 02/09/21
085695278028 CORONAVAC 02/09/21 02/09/21
085212817706 CORONAVAC 02/09/21 02/09/21
08561006934 CORONAVAC 02/09/21 02/09/21
085348880374 CORONAVAC 02/09/21 02/09/21
081282750808 CORONAVAC 02/09/21 02/09/21
085711310317 CORONAVAC 02/09/21 02/09/21
085695806317 CORONAVAC 02/09/21 02/09/21
081574721235 CORONAVAC 02/09/21 02/09/21
085282259106 CORONAVAC 02/09/21 02/09/21
081510468775 CORONAVAC 02/09/21 02/09/21
085782716443 CORONAVAC 02/09/21 02/09/21
085694277280 CORONAVAC 02/09/21 02/09/21
083875401842 CORONAVAC 02/09/21 02/09/21
081315521270 CORONAVAC 02/09/21 02/09/21
085717350284 CORONAVAC 02/09/21 02/09/21
085281449201 CORONAVAC 02/09/21 02/09/21
085770973041 CORONAVAC 02/09/21 02/09/21
08170974113 CORONAVAC 02/09/21 02/09/21
085755093079 CORONAVAC 02/09/21 02/09/21
081385563878 CORONAVAC 02/09/21 02/09/21
085718707811 CORONAVAC 02/09/21 02/09/21
082125842304 CORONAVAC 02/09/21 02/09/21
082312750063 CORONAVAC 02/09/21 02/09/21
081574897083 CORONAVAC 02/09/21 02/09/21
081315630631 CORONAVAC 02/09/21 02/09/21
085210526169 CORONAVAC 02/09/21 02/09/21
085777789488 CORONAVAC 02/09/21 02/09/21
082125842304 CORONAVAC 02/09/21 02/09/21
085773882842 CORONAVAC 02/09/21 02/09/21
085886172684 CORONAVAC 02/09/21 02/09/21
081298938220 CORONAVAC 02/09/21 02/09/21
083874996708 CORONAVAC 02/09/21 02/09/21
085210952729 CORONAVAC 02/09/21 02/09/21
085215596671 CORONAVAC 02/09/21 02/09/21
0887433233094 CORONAVAC 02/09/21 02/09/21
085694567509 CORONAVAC 02/09/21 02/09/21
085836234580 CORONAVAC 02/09/21 02/09/21
085892746918 CORONAVAC 02/09/21 02/09/21
085695153429 CORONAVAC 02/09/21 02/09/21
081293980275 CORONAVAC 02/09/21 02/09/21
085210946695 CORONAVAC 02/09/21 02/09/21
082158425469 CORONAVAC 02/09/21 02/09/21
082158425469 CORONAVAC 02/09/21 02/09/21
081214790560 CORONAVAC 02/09/21 21/06/21
085210705235 SINOVAC 29-06-2021 29-06-2021
085779570639 SINOVAC 29-06-2021 29-06-2021

08561501581 SINOVAC 01-07-2021 01-07-2021

0852121655305 SINOVAC 01-07-2021 01-07-2021
087776129065 CORONAVAC 02/09/21 15/07/21
085781944207 SINOVAC 7/28/2021 ###
085772730281 CORONAVAC 02/09/21 30/07/21
085780302140 02-08-2021 02-08-2021
085773763824 02-08-2021 02-08-2021
085363404157 02-08-2021 02-08-2021
081310274239 02-08-2021 02-08-2021
'085692081943 CoronaVac 05-08-2021 05-08-2021
''081398428633 CoronaVac 05-08-2021 05-08-2021
'087788528179 CoronaVac 05-08-2021 05-08-2021
085711804582 CoronaVac 12-08-2021 12-08-2021
085772730281 CORONAVAC 02/09/21 30/07/21
081388063467 CORONAVAC 02/09/21 19/06/21
085782635792 SINOVAC 29-06-2021 29-06-2021
Dosis I Dosis 2
Tanggal
Pemberi KET
No.
No. Batch No seri an No Seri
Batch
Vaksina
si
24003121 16182990715205
24003121 16182990715205
24003121 16182990715205
24003121 16182990715205 30/09/202124200121 16219309685597
24003121 16182990715205 30/09/202124200121 16219309685597
24003121 16182990715205
24003121 16182990715205
24003121 16182990715205
24003121 16182990715205
24003121 16182990504449
24003121 16182990504449
24003121 16182990504449
24003121 16182990504449 30/09/202124200121 '16219309687313
24003121 16182990504449
24003121 16182990504449
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225
24003121 16182993803225 30/09/202124200121 16219309476245
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182990506493
24003121 16182990506493
24003121 16182990506493
24003121 16182990506493 30/09/202124200121 '16219309687001
24003121 16182990506493 30/09/202124200121 '16219309687313
24003121 16182990506493 30/09/202124200121 16219309681993
24003121 16182990506493
24003121 16182990506493
24003121 16182990506493
24003121 16182990716297
24003121 16182990716297 30/09/202124200121 16219309681993
24003121 16182993804629
24003121 16182993804629
24003121 16182993804629 30/09/202124200121 '16219309687313
24003121 16182993804629 30/09/202124200121 16219309681993
24003121 16182993804629
24003121 16182993804629
24003121 16182993804629
24003121 16182993804629
24003121 16182993804629 30/09/202124200121 16219309476245
24003121 16182993804629
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665 30/09/202124200121 16219309685597
24003121 16182993801665 30/09/202124200121 '16219309687001
24003121 16182993801665 30/09/202124200121 16219309681993
24003121 16182993801665
24003121 16182993801665 30/09/202124200121 16219309681993
24003121 16182993801665
24003121 16182993801665
24003121 16182993801665 30/09/202124200121 '16219309687001
24003121 02/09/21 24003121 16182990716297

24003121 16183002366377 02-09-202 24003121 16183002364037

24003921 16213341156810 02-09-202 24003121 16183002364037

24003921 16213341371762 02/09/21 24003121 16182990504449

24003921 16213341167886 02-09-202 24003121 16183002379029
24003121 0209/21 24003121 16182990716297

24003121 02/09/21 24003121 16182990516182997537413

24003121 02/09/21 24003121 16182990506493
24003121 16183046076642 02/09/21 24003121 16182990504449
24003121 16183046076642 02/09/21 24003121 16182990504449
24003121 16183046076642 02/09/21 24003121 16182990716297
24003121 16183046076642 02/09/21 24003121 16182990716297
24003121 16242626002901 02/09/21 24003121 16182993801665
24003121 16242626002901 02/09/21 24003121 16182993801665
24003121 16242626002901 02/09/21 24003121 16182990715205 24003121
24200121 16219944745764 02/09/21 24003121 16182993803225
24003121 16182990716297 02/09/21 24003121
24003121 02/09/21 24003121 16182990716297

24003121 16183002584777 02/09/21 24003121 16182990716297

NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601070308720002 JAKIM L
2 3601045509850001 SITI AISYAH P
3 360104010760099 AJUK KUSWANDI L
4 3601045406030003 TITI SUHARTINI P
5 3601042112820003 SUNADI L
6 3601040207830012 AZIS MS L
7 3601045606050001 SITI ROHMAH P
8 3601040107910033 UDI HERMAWAN L
9 360104010710243 NURJAYA L
10 180084602900005 IMAS MASINAH P
11 3601045304010005 RIA APRILIA. R P
12 3601046111770001 SITI ROHIMI P
13 3601044810810009 AMINAH P
14 3212150501920003 KURNADI L
15 3601040509890002 JENI L
16 360104421090004 SANTI P
17 360104010480007 UDIN SETIAWAN L
18 360104250392002 EMAN SUHERMAN L
19 3601044601910001 INTAN. P P
20 3601046501810003 RANITA L
21 3601045410870007 KOKOM. K P
22 3601041106780001 SADI L
23 3601045710820001 ACIH P
24 3601045112760001 ANITA P
25 36010405077900003 CARMA L
26 3601046909990001 ERNA SARI P
27 6201026202890005 WAWAS P
28 360104151050002 ACEP. S L
29 3601044510860001 ROHMAH P
30 3601045910060003 RATIH P
31 3601045409770001 RATNITI P
32 3601040504830004 ENDIN L
33 360104100777001 ANAN L
34 3601040107850275 EDI ERIYANTO L
35 3601041412890001 ENTIS. S L
36 6104121704870002 WARLAN L
37 3601040506900006 IWAN L
38 3601040309940001 SURATNO L
39 36010402021020005 ROHMAN L
40 3601042111980001 DANI L
41 3601042202920001 ERWAN L
42 3601044410020006 ALIPAH. T P
43 3601044211900002 WIDYAWATI P
44 3601046805050001 CINDY AULIA. M P
45 3601044107830066 MARIAM P
46 3601041912990007 RENALDI L
47 3329080305940005 KHORI. W L
48 3601046401000001 ERVIRA. D P
49 3601040107990060 RAMADAN L
50 6408021703820001 ENTIS L
51 3601045608030003 ANISAH P
52 3601044107000270 ASTRIANI P
53 3601041607720003 BOIMAN L
54 3601040911900002 DADANG L
55 3601040107780093 BAKAR L
56 3601043105780001 ANDI SYAEFUL L
57 190402270871001 ANDRIAN L
58 3601045806850001 IYAN FITRIYANI P
59 3601045106020004 ATIN P
60 3601046111040005 NUR ASIH. F P
61 3601040107800088 TARMA L
62 3601042801970002 KOSIM L
63 3601045012010005 NIAH FERA. P P
64 3601042411980002 HENDRI L
65 S-068B483E 3601046088500002 DALIM L

66 P-QAW0GEV2 3601041103930000 ADE SURETNO L

67 3601040107710149 AMONG ASPAR L
68 Q-000IP1PC 3601040207690003 PARDIMAN L
69 P-2T1KMZDL 3316071904990001 MUHAMAD ALIM C L
70 3524061507850003 MOCHAMAD SUCIPTO L
71 Q-000K2E10 3602260411020002 NURAMDAN L
72 Q-000KLULH 3601042910790003 SURITA L
73 Q-000KLX0M 360104107950129 SOIP L
74 Z-0008MF9D 3601046603950002 RISKA P
75 Q-000L5UND 360104080240001 SUMINTA L
76 Q-000L5D2D 3601044207020005 SONA P
77 Q-000L5UNL RASMADI L
78 Q-000L4Y5L 3601045703990004 DEWI RATNASARI P
79 Q-000L4YTI 3601045209000003 LOLA P
80 Q-000L580I '360104580980005 SUHETI P
81 Q-000L5W0C '3601041103010001 NABIL HAMID L
82 Q-000L3U6U 3601040107020125 WAHYU MAULANA L
83 Q-000L55CR '3601046309900001 SITI HAFIFAH P
84 Q-000L3U20 '3601040107020126 LESMANA L
85 P-3IY9VCY6 360104590840002 TAMINAH P
86 Q-000L55FU '3601040207750005 BUHRI L
87 Q-000L50CZ 3601045003850007 MELAWATI P
88 K-0000ECHC 3601040201980002 HELLDY L
89 '3601041904780002 DARMA L
90 Q-000BDX6 3215140303850006 ENDANG HOERUDIN L
91 3601041204780004 ASEP SAEPULLOH L
4 3601040310850002 DIAR KARANG SARI P
100 36010420110100002 ROMI AGUNG L
120 3601040101850001 KUSMAN L
121 3602211401020001 EMRON L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

03-08-1972 NANGGALA
15-08-1995 CIKEUSIK
07-05-1976 NANGGALA
14-06-2003 CIKEUSIK
23-12-1982 SUKASENENG
31-07-1983 CIKEUSIK
16-06-2005 PARKOS
06-03-1995 SUKAMULYA
20-08-1992 SUKASENENG
06-02-1990 CIKEUSIK
13-04-2001 CIKEUSIK
02-11-1997 CIKEUSIK
05-01-1972 SUKASENENG
05-01-1992 CURUGCIUNG
05-09-1989 SUMURBATU
02-10-1990 SUMURBATU
01-04-1983 CURUGCIUNG
25-03-1992 TANJUNGAN
20-08-1990 TANJUNGAN
12-09-1977 SUKASENENG
26-02-1986 SUKAMULYA
11-06-1978 TANJUNGAN
17-10-1982 TANJUNGAN
11-12-1976 SUKAMULYA
05-07-1979 SUKASENENG
29-09-1989 SUKASENENG
22-02-1989 KALIMANTAN TENGAH
15-10-1985 SUMURBATU
05-10-1986 SUMURBATU
19-10-2006 SUMURBATU
02-04-1973 SUKASENENG
05-04-1983 UMBULAN
10-07-1977 SUMURBATU
27-05-1985 CIKEUSIK
14-12-1989 CIKEUSIK
17-04-1987 RANCASENENG
05-06-1990 CIKEUSIK
01-11-1994 CIKEUSIK
20-09-1999 CIKEUSIK
 04-06-1998 TANJUNGAN
22-02-1992 NAKES PKM CKS UMBULAN
04-10-2002 CIKEUSIK
08-11-1991 CIPUTRI
28-05-2005 UMBULAN
11-06-1981 UMBULAN
19-12-1999 CIKADONGDONG
03-05-1994 RANCASENENG
24-01-2000 CIKEUSIK
13-12-1999 RANCASENENG
17-03-1982 KALIMANTAN TIMUR
16-08-2003 CIWET
17-04-2002 CIWET
16-07-1972 CIKEUSIK
09-11-1990 RANCASENENG
01-07-1976 SUKAWARIS
31-05-1978 TANJUNGAN
27-08-1971 UMBULAN
19-06-1985 TANJUNGAN
11-06-2002 RANCASENENG
21-11-2004 UMBULAN
12-07-1975 RANCASENENG
28-01-1997 TANJUNGAN
15-11-2002 CIWET
24-11-1998 UMBULAN
GURU 06-08-1985 SDN 2 CIWET CIWET

GURU 11-03-1993 SUKAWARIS

08/03/1974 POLSEK KADIRI
03-05-1968 CIKUJANG II 001/001 DS.TA
19-04-1999 DK.SINGGET, DS.BLEBOH
15/07/1985 POLSEK KEDUNGPIRING
04-11-2002 SUKASENENG
29-10-1979 PEMATANG SEMPUR, CIKEUSIK
05-06-1994 NANGGALA
GURU 26-03-1995 NANGGALA
08-04-1978 UMBULAN
'21-03-2001 TANJUNGAN
'09-04-1976 CIKEUSIK
'17-03-1999 RANCASENENG
'12-09-2000 CIKEUSIK
'18-08-1988 SUKAWARIS
'11-03-2001 RANCASENENG
 '27-11-2002 CIKEUSIK
'07-07-1993 SUKASENENG
'24-07-2001 CIKEUSIK
'19-07-1990 SUKASENENG
'05-08-1985 CIKEUSIK
'10-03-1985 SUKAWARIS
02-10-1998 SUKAWARIS
19-04-1978 SUKASENENG
03-03-1985 KARAWANG
12-04-1978 SUKAMULYA
15/10/1984 POLSEK CIKIRUHWETAN
03-03-2000 POLSEK CIWET
13/06/1986 POLSEK SUKAWARIS
05/04/1996 POLSEK WANASALAM
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi
081632392227 CoronaVac 06-09-2021 06-09-2021
081299125566 CoronaVac 06-09-2021 06-09-2021
081632392227 CoronaVac 06-09-2021 06-09-2021
081584688255 CoronaVac 06-09-2021 06-09-2021
085820431947 CoronaVac 06-09-2021 06-09-2021
082310400255 CoronaVac 06-09-2021 06-09-2021
085694590496 CoronaVac 06-09-2021 06-09-2021
081413490544 CoronaVac 06-09-2021 06-09-2021
085779161585 CoronaVac 06-09-2021 06-09-2021
082113960841 CoronaVac 06-09-2021 06-09-2021
085695380751 CoronaVac 06-09-2021 06-09-2021
082310248429 CoronaVac 06-09-2021 06-09-2021
081210666028 CoronaVac 06-09-2021 06-09-2021
081214323797 CoronaVac 06-09-2021 06-09-2021
085213638711 CoronaVac 06-09-2021 06-09-2021
085213638711 CoronaVac 06-09-2021 06-09-2021
085217834496 CoronaVac 06-09-2021 06-09-2021
081517284249 CoronaVac 06-09-2021 06-09-2021
0816742725 CoronaVac 06-09-2021 06-09-2021
087741687044 CoronaVac 06-09-2021 06-09-2021
085691244008 CoronaVac 06-09-2021 06-09-2021
085719347841 CoronaVac 06-09-2021 06-09-2021
085719347841 CoronaVac 06-09-2021 06-09-2021
085710722713 CoronaVac 06-09-2021 06-09-2021
085781656206 CoronaVac 06-09-2021 06-09-2021
082310578163 CoronaVac 06-09-2021 06-09-2021
085821441579 CoronaVac 06-09-2021 06-09-2021
081215244676 CoronaVac 06-09-2021 06-09-2021
082125756726 CoronaVac 06-09-2021 06-09-2021
082125756726 CoronaVac 06-09-2021 06-09-2021
085284395445 CoronaVac 06-09-2021 06-09-2021
083821023952 CoronaVac 06-09-2021 06-09-2021
082125756726 CoronaVac 06-09-2021 06-09-2021
082135817900 CoronaVac 06-09-2021 06-09-2021
085705855848 CoronaVac 06-09-2021 06-09-2021
081345398895 CoronaVac 06-09-2021 06-09-2021
085695264299 CoronaVac 06-09-2021 06-09-2021
085776808825 CoronaVac 06-09-2021 06-09-2021
088296149772 CoronaVac 06-09-2021 06-09-2021
08237220720903 CoronaVac 06-09-2021 06-09-2021
085717767046 CoronaVac 06-09-2021 06-09-2021
083893644191 CoronaVac 06-09-2021 06-09-2021
083812881145 CoronaVac 06-09-2021 06-09-2021
085269945722 CoronaVac 06-09-2021 06-09-2021
081617126573 CoronaVac 06-09-2021 06-09-2021
085886828886 CoronaVac 06-09-2021 06-09-2021
085219673242 CoronaVac 06-09-2021 06-09-2021
081214511693 CoronaVac 06-09-2021 06-09-2021
083815151911 CoronaVac 06-09-2021 06-09-2021
085810157262 CoronaVac 06-09-2021 06-09-2021
085776871900 CoronaVac 06-09-2021 06-09-2021
085695388425 CoronaVac 06-09-2021 06-09-2021
085714784024 CoronaVac 06-09-2021 06-09-2021
082150455466 CoronaVac 06-09-2021 06-09-2021
082324110692 CoronaVac 06-09-2021 06-09-2021
085718763787 CoronaVac 06-09-2021 06-09-2021
082282325640 CoronaVac 06-09-2021 06-09-2021
085889411086 CoronaVac 06-09-2021 06-09-2021
081284923531 CoronaVac 06-09-2021 06-09-2021
085694383384 CoronaVac 06-09-2021 06-09-2021
085779561212 CoronaVac 06-09-2021 06-09-2021
08386632167 CoronaVac 06-09-2021 06-09-2021
081213189689 CoronaVac 06-09-2021 06-09-2021
082298135610 CoronaVac 06-09-2021 06-09-2021
081953516010 SINOVAC 29-06-2021 29-06-2021
085219322377 SINOVAC 29-06-2021 29-06-2021
085894828283 CORONAVAC 06/09/21 08/07/21
0855-1786-628 SINOVAC 7/22/2021 7/22/2021
082131228546 SINOVAC 7/22/2021 7/22/2021
085251641433 CORONAVAC 06/09/21 22/07/21
085894196324 CoronaVac 28-07-2021 28-07-2021
081319912971 CoronaVac 02-08-2021 02-08-2021
085947050922 CoronaVac 02-08-2021 02-08-2021
085774222751 CoronaVac 05-08-2021 05-08-2021
081283773295 CoronaVac 05-08-2021 05-08-2021
'081517297440 CoronaVac 05-08-2021 05-08-2021
'082113852038 CoronaVac 05-08-2021 05-08-2021
'085695148530 CoronaVac 05-08-2021 05-08-2021
'085770973163 CoronaVac 05-08-2021 05-08-2021
'0817777974961 CoronaVac 05-08-2021 05-08-2021
'085893307006 CoronaVac 05-08-2021 05-08-2021
'085697188568 CoronaVac 05-08-2021 05-08-2021
'085693031870 CoronaVac 05-08-2021 05-08-2021
''081313198665 CoronaVac 05-08-2021 05-08-2021
'085281449160 CoronaVac 05-08-2021 05-08-2021
'085695380751 CoronaVac 05-08-2021 05-08-2021
''082157046909 CoronaVac 05-08-2021 05-08-2021
085211850091 CoronaVac 05-08-2021 05-08-2021
082155500460 CoronaVac 02-08-2021 02-08-2021
081219904079 CoronaVac 07-05-2021 07-05-2021
081317466675 CoronaVac 08-08-2021 08-08-2021
081994117005 CORONAVAC 06/09/21
081219681409 CORONAVAC 06-09-2021
081282341415 CORONAVAC 06-09-2021
085782648615 CORONAVAC 06-09-2021
Dosis I Dosis 2
Tanggal
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi
24004521 16246911618061
24004521 16246911618061 04-10-2021 24003121 16182997536149
24004521 16246911618061
24004521 16246911618061 04-10-2021 24003121 16182994686981
24004521 16246911618061
24004521 16246911618061
24004521 16246911618061
24004521 16246911618061
24004521 16246911618061
24004521 16246911618061 04-10-2021 24003121 16182997536149
24004521 16246911619621 04-10-2021 24003121 16182997536149
24004521 16246911619621 04-10-2021 24003121 16182997536149
24004521 16246911619621 04-10-2021 24004521 16246017648164
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621 04-10-2021 24003121 16182994686981
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621
24004521 16246911619621
24004521 16246911618217
24004521 16246911618217 04-10-2021 24003121 16182994686981
24004521 16246911618217 04-10-2021 24003121 16182994686981
24004521 16246911618217 04-10-2021 24003121 16182997536149
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217
24004521 16246911618217 04-10-2021 24003121 16182997536149
24004521 16246911618217
24004521 16246911618217
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16182993804317
24003121 16183002584777 06/09/21 202108151I 16291706842998

24003121 16183002366377 06/09/21 202108151I 16291706842998

24003121 06/09/21 202108151I 16291706842998
06-09-2021 24003121 16182993804317
06/09/21 202108151I 16291706842998
24003121 06/09/21 202108151I 16291706842998
24003121 06-09-2021 24004521 16246911618061
24003121 16183046076642 06-09-2021 24004521 16246911618061
24003121 16183046076642 06-09-2021 24004521 16246911618061
24003121 16242626002901 06-09-2021 24004521 16246911618061
24003121 16242626002901 06-09-2021 24004521 16246911618061
24003121 16242626002901 06-09-2021 24003121 16182993804317
24003121 16242626002901 06-09-2021 24004521 16246911618217
24003121 16242626002901 06-09-2021 24004521 16246911618061
24003121 16242626002901 06-09-2021 24004521 16182993804317
24003121 16242626002901 06-09-2021 24004521 16246911619621
24003121 16242626002901 06-09-2021 24003121 16182993804317
 24003121 16242626002901 06-09-2021 24004521 16246911618061
24003121 16242626002901 06-09-2021 24003121 16182993804317
24003121 16242626002901 06-09-2021 24003121 16182993804317
24003121 16242626002901 06-09-2021 24003121 16182993804317
24003121 16242626002901 06-09-2021 24004521 16246911618061
24003121 16242626002901 06-09-2021 24004521 16246911619621
24003121 06-09-2021 24004521 16246911618061
24003121 06-09-2021 24003121 16182993804317
24003921 06-09-2021 24004521 16246911618217
24201821 06-09-2021 24004521 16182993804317
06/09/21 202108151I 16291706842998
06-09-2021 202108151I 16291706862214
06-09-2021 202108151I 16291706862214
06-09-2021 202108151I 16291706862214
KET
DOSIS 2

DOSIS 2
D1 DI JAKARTA
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601040107860001 ZAINAL ARIFIN L

2 3601044207890001 CASMIN L
3 3602210207930007 ROBI L
5 3601130396770011 YUNIARTO L
7 3601040901030003 BUDI SANTOSO L
9 3601041002820006 M.SYAHRUL HIDAYAT L
10 3602210909930001 RENDI WIJAYA L
11 3601040701760001 ANDA L
12 3601040405010002 MUHAMAD AJIDAH L
13 3602210405000004 AGIP MOCH ALGOFI L
14 3601044202850004 SAROH P
17 3601040510860005 IBROHIM L
18 3601040903880002 DENI L
19 3601042309970002 DEDE MUKLIS L
20 3601044806970001 NIDA PUTRI P
21 3601124107880082 MUTIA SARI P
22 3601041204990010 YUDI L
24 3601046401830001 WIWIN P
25 3601042207040001 NARMA MUDITA L
26 3601040906040004 KELEN L
27 3601044107890157 TITA PUSPITASARI P
28 3601040409020005 YANTO L
29 3601043012620005 DINTA L
30 3601040209000005 ARI WIBOWO L
31 3601045104980005 SITI HANIFAH P
32 3601040704830004 JAYANI L
33 3202012207010005 DODI L
34 3601040508050004 HENDAR L
35 3601046310820003 SARYATI P
36 3602211511900001 ROHMAN L
37 3671101006980005 RAHMA H L
38 3601041211020003 RIAN ARDIANSYAH L
39 3601021302950001 BODIN L
40 3602210102050003 SUPIRMAN L
41 3601040103950011 ILHAM L
42 3601042612950003 YAYAN SOPYAN L
43 3213030301990001 DEDE SUHAEFI L
44 3602212002030001 SATRIA L
45 3601041002680005 MA'MUN' L
46 3601046003900001 AENI ANGRAENI P
47 3601041611710001 LOMRI SASMITA L
49 3173010806720014 TARMIZI L
50 3601021601030003 ASEP L
51 3601031207000007 ELI L
52 3601040205000001 HASANUDIN L
53 3601041004800006 DADI L
54 3601045712780001 SOPIAH L
55 3209304608740010 UNARI P
56 3601045401830002 MARNI P
57 3601046703810001 TATI P
58 3601045110020004 NOPELA AMELIA P
59 3602210505820004 YUSUP HUDAERI L
60 3602092506970001 USMAN L
61 3601043007810002 UDIN L
62 3602210207830004 RIJAL ZAMANI L
63 3601120107930079 DEDE MUNANDAR L
64 3601046802960002 ERLA NAZMIATUL P
65 3601044609980005 ERLA NURAZIZAH P
66 3601044107900044 NUNUNG NURHAYATI P
67 3601040107780361 M YUSUP L
68 3601041707820001 ROHANTA L
69 3601040102710003 CARDI L
70 3601041605770001 HERMAN L
71 3672041310990002 AHMAD FAUKI L
72 3601042005770003 UDI L
73 3602012202000004 SAPRUDIN L
74 3601046007840002 MAEMANAH P
75 3601045201840002 SURINIH P
76 3602213012380001 SAPIK L
77 3601045209000001 AI NUR AJIZAH P
78 3601040308830002 M ALI AKBAR L
79 3601040902800005 ADI SUPANDI L
80 3601040707060006 RIZKI SAPUTRA L
81 3601040208050002 PAROJI L
82 3601041904020001 CECEP SUPRIYADI L
83 3602210305030002 SADIN L
84 3601030505990002 MISRAN L
85 3601030701900001 AHMAD L
86 3601040107810175 SOEKMA DILAGA L
87 3601042610710002 CASPIN L
88 3601041707720004 BUDI SUTRISNO L
89 3601045608830003 IIN APRIANTI P
90 3213254107820005 TATI P
91 3601044705800006 BACIH P
92 3601040109900001 HERU L
93 3601042703030003 SUHERMAN MAULANAL
94 3602090503010001 AGY L
95 3601034107690074 ROHAYATI P
96 3601045204840004 SUHAYATI P
97 3601040104960002 EKO ANDRIAWAN L
98 3601044512830002 SOPIAH P
99 3601040107650030 KASNADI L
101 3602210104950004 HELMI FAUZAN L
102 3602082702750001 UKANDI L
103 3601045506800001 ENENG HENI P
104 3601040101000024 AHMAD JUNAEDI L
105 3601045508760002 SRI AGUSTINA P
106 3601046508840001 DEWI P
107 3601045511750001 JOELAEHA F. A. P
108 3601041705890003 KASMURI L
109 3601041809670002 R. BUDIYUDIN L
110 3601045008940004 TIAH P
111 3601041307580001 SARJA L
112 3602211708880006 AMINUDIN L
113 3601042103880002 TARSIH P
114 360 1045408590001 DASKEM P
115 3601045609910001 TITA P
116 3602215105840004 NENE SURYANI P
117 3601041001480001 KUMEDI L
118 3601040204910003 CEPI ANDRIANI L
119 3601040404790004 SYUKUR KURNIAWAN L
122 3602212504000001 HENDRI L
123 3601045511970004 INA SUSANTI P
124 3601044210770001 ESIH LISTIAWATI P
125 3601041311030001 IMAM SANTOSA L
126 3601044607700003 KAMSAH P
127 3601041006730003 SANTIBI L
 Umur Kelompok
Pekerjaan* INSTANSI Alamat
(18-59 tahun) Umur

01/07/1986 POLSEK CIKIRUHWETAN

02/07/1989 POLSEK CIKIRUHWETAN
02/07/1993 POLSEK CIKIRUHWETAN
03/06/1977 POLSEK LAMPUNG
09/01/2003 POLSEK CIKIRUHWETAN
10/02/1982 POLSEK CIKIRUHWETAN
05/08/1998 POLSEK WANASALAM
07/01/1978 POLSEK CIKIRUHWETAN
03/07/2002 POLSEK SUKASENENG
19/11/2000 POLSEK WANASALAM
02/02/1985 POLSEK SUMURBATU
05/10/1986 POLSEK SUKAWARIS
09/031988 POLSEK CIKIRUHWETAN
23/09/1997 POLSEK CIKIRUHWETAN
08/06/1997 POLSEK CIKIRUHWETAN
07/10/1999 POLSEK CIKIRUHWETAN
10/04/1999 POLSEK MALANGSARI
24/01/1983 POLSEK CIKIRUHWETAN
15/07/2000 POLSEK CITARUM
POLSEK CIKIRUHWETAN
05/02/1982 POLSEK CIKIRUHWETAN
09/04/2002 POLSEK CIKIRUHWETAN
16/08/1970 POLSEK CIKIRUHWETAN
09/09/2000 POLSEK SUMURBATU
11/04/1998 POLSEK CIKIRUHWETAN
07/04/1983 POLSEK CIKIRUHWETAN
22/07/2001 POLSEK SUKABUMI
05/08/200 POLSEK HUNIBERA
23/10/1982 POLSEK CIKIRUHWETAN
02/11/1990 POLSEK WANASALAM
10/06/1998 POLSEK TANGERANG
12/11/2002 POLSEK SUKAWARIS
13/02/1996 POLSEK CIMANGGU
01/08/2005 POLSEK WANASALAM
01/03/1995 POLSEK CIKAREO
26/12/1995 POLSEK SUKAWARIS
03/01/19999 POLSEK CIHEULEUT
05/08/1998 POLSEK WANASALAM
08/06/1971 POLSEK CIKIRUHWETAN
02/05/1992 POLSEK MALINGPING
05/06/1975 POLSEK CIKIRUHWETAN
08/06/1972 POLSEK CIKIRUHWETAN
16/01/2003 POLSEK CIMANGGU
03/12/2000 POLSEK CIJAKU
14/09/2002 POLSEK CIKIRUHWETAN
17/10/1997 POLSEK CIKIRUHWETAN
17/12/1978 POLSEK CIKIRUHWETAN
06/08/1974 POLSEK CIREBON
07/05/1981 POLSEK CIKIRUHWETAN
27/03/1981 POLSEK CIKIRUHWETAN
11/10/2001 POLSEK SUKAWARIS
05/05/1982 POLSEK CIKIRUHWETAN
25/06/1997 POLSEK BANJARSARI
30/07/1981 POLSEK CIKIRUHWETAN
02/07/1983 POLSEK WANASALAM
20/11/1993 POLSEK LABUAN
28/02/1996 POLSEK CIKIRUHWETAN
06/09/1998 POLSEK WANASALAM
17/08/1990 POLSEK SUKAWARIS
08/07/1980 POLSEK CIKIRUHWETAN
17/07/1982 POLSEK CIGEBANG
01/02/1971 POLSEK MUARA DUA
16/05/1977 POLSEK CIKUJANG
13/10/1999 POLSEK CILEGON
20/05/1977 POLSEK UMBULAN
17/07/1999 POLSEK MALINGPING
20/07/1984 POLSEK CIKIRUHWETAN
01/04/1984 POLSEK CIKIRUHETAN
30/12/1938 POLSEK WANASALAM
08/07/2000 POLSEK CIKIRUHWETAN
03/08/1983 POLSEK CIKIRUHWETAN
16/02/1983 POLSEK CIKIRUHWETAN
07/07/2006 POLSEK CIKIRUHWETAN
02/08/2005 POLSEK CIKIRUHWETAN
09/04/2003 POLSEK CIKIRUHWETAN
02-06-1996 POLSEK WANASALAM
05-05-1999 POLSEK CIBALIUNG
07-01-1990 POLSEK CIBALIUNG
03-05-1980 POLSEK MUARA DUA
26-10-1971 POLSEK MUARA DUA
17-07-1972 POLSEK TUBAN
16-08-1983 POLSEK MALANGSARI
01-07-1982 POLSEK SUKAWARIS
07-05-1980 POLSEK SUKAWARIS
27-07-1992 POLSEK SUKAWARIS
27-03-2003 POLSEK TANJUNGAN
17-02-2001 POLSEK BANJARSARI
01-07-1969 POLSEK CIWET
15-05-1986 POLSEK CIWET
18-03-1997 POLSEK SUKAWARIS
03-09-1986 POLSEK CIWET
01-07-1965 POLSEK SUKAWARIS
01-04-1995 POLSEK MUARA BINUANGE
27-02-1975 POLSEK GUNUNG KENCANA
15-06-1980 POLSEK TANJUNGAN
01-01-2000 POLSEK TANJUNGAN
15-08-1976 POLSEK SINARJATI
25-08-1984 POLSEK MUARA DUA
04-07-1975 POLSEK MUARA DUA
03-07-1979 POLSEK MUARA DUA
10-02-1975 POLSEK SUKAWARIS
10-08-1994 POLSEK MUARA DUA
09-10-1954 POLSEK MUARA DUA
17-08-1988 POLSEK BINUANGEN
04-07-1987 POLSEK MUARA DUA
14/08/1959 POLSEK CIKIRUHWETAN
16/09/1991 POLSEK BABAKAN BDG
11/05/1984 POLSEK BINUANGEUN
10/01/1948 POLSEK CIKIRUHWETAN
30/12/1993 POLSEK CIKIRUHWETAN
04/04/1979 POLSEK MUARA DUA
19/04/1999 POLSEK WANASALAM
15/11/1997 POLSEK CIKIRUHWETAN
02/10/1977 POLSEK CIKIRUHWETAN
13/11/2003 POLSEK CIKIRUHWETAN
06/07/1970 POLSEK CIKIRUHWETAN
10/06/1973 POLSEK CIKIRUHWETAN
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal Tanggal
Merek
NO HP BPJS BPJS Non Screeni Pemberi
Vaksin*** an
PBI Non PBI Anggota ng
Vaksina
si
085212403333 CORONAVAC 06/09/21 06/09/21
085694587277 CORONAVAC 06/09/21 06/09/21
081282770786 CORONAVAC 06/09/21 06/09/21
085267308439 CORONAVAC 06/09/21 06/09/21
083841442585 CORONAVAC 06/09/21 06/09/21
081291815634 CORONAVAC 06/09/21 06/09/21
085694701727 CORONAVAC 06/09/21 06/09/21
085694587277 CORONAVAC 06/09/21 06/09/21
081286111794 CORONAVAC 06/09/21 06/09/21
082120248288 CORONAVAC 06/09/21 06/09/21
082122714446 CORONAVAC 06/09/21 06/09/21
081289891955 CORONAVAC 06/09/21 06/09/21
083802190207 CORONAVAC 06/09/21 06/09/21
081219678341 CORONAVAC 06/09/21 06/09/21
081319387197 CORONAVAC 06/09/21 06/09/21
085311110748 CORONAVAC 06/09/21 06/09/21
0851995315241 CORONAVAC 06/09/21 06/09/21
085695147813 CORONAVAC 06/09/21 06/09/21
085283862060 CORONAVAC 06/09/21 06/09/21
081294917968 CORONAVAC 06/09/21 06/09/21
085773898256 CORONAVAC 06/09/21 06/09/21
0858861602048 CORONAVAC 06/09/21 06/09/21
085219335688 CORONAVAC 06/09/21 06/09/21
081222964088 CORONAVAC 06/09/21 06/09/21
081211378006 CORONAVAC 06/09/21 06/09/21
081413316477 CORONAVAC 06/09/21 06/09/21
085215820241 CORONAVAC 06/09/21 06/09/21
081287357287 CORONAVAC 06/09/21 06/09/21
085882834823 CORONAVAC 06/09/21 06/09/21
085881529275 CORONAVAC 06/09/21 06/09/21
08775351735 CORONAVAC 06/09/21 06/09/21
085217104687 CORONAVAC 06/09/21 06/09/21
085774029574 CORONAVAC 06/09/21 06/09/21
087873587732 CORONAVAC 06/09/21 06/09/21
08988681090 CORONAVAC 06/09/21 06/09/21
085283046015 CORONAVAC 06/09/21 06/09/21
085781330423 CORONAVAC 06/09/21 06/09/21
08787358732 CORONAVAC 06/09/21 06/09/21
085894185420 CORONAVAC 06/09/21 06/09/21
085773506196 CORONAVAC 06/09/21 06/09/21
085312959896 CORONAVAC 06/09/21 06/09/21
085694541553 CORONAVAC 06/09/21 06/09/21
085811286119 CORONAVAC 06/09/21 06/09/21
085773757592 CORONAVAC 06/09/21 06/09/21
087886589322 CORONAVAC 06/09/21 06/09/21
081214809728 CORONAVAC 06/09/21 06/09/21
087890052199 CORONAVAC 06/09/21 06/09/21
085212810647 CORONAVAC 06/09/21 06/09/21
082332912918 CORONAVAC 06/09/21 06/09/21
085781468187 CORONAVAC 06/09/21 06/09/21
085780319880 CORONAVAC 06/09/21 06/09/21
08583973981 CORONAVAC 06/09/21 06/09/21
083819332601 CORONAVAC 06/09/21 06/09/21
085210535699 CORONAVAC 06/09/21 06/09/21
081211551192 CORONAVAC 06/09/21 06/09/21
083176710708 CORONAVAC 06/09/21 06/09/21
083802976996 CORONAVAC 06/09/21 06/09/21
083890673944 CORONAVAC 06/09/21 06/09/21
085775396947 CORONAVAC 06/09/21 06/09/21
082117648657 CORONAVAC 06/09/21 06/09/21
083875335266 CORONAVAC 06/09/21 06/09/21
087773233241 CORONAVAC 06/09/21 06/09/21
08158273860 CORONAVAC 06/09/21 06/09/21
087774824837 CORONAVAC 06/09/21 06/09/21
081511407825 CORONAVAC 06/09/21 06/09/21
085782104375 CORONAVAC 06/09/21 06/09/21
083871079340 CORONAVAC 06/09/21 06/09/21
083871079340 CORONAVAC 06/09/21 06/09/21
085960105447 CORONAVAC 06/09/21 06/09/21
085692182679 CORONAVAC 06/09/21 06/09/21
085693582554 CORONAVAC 06/09/21 06/09/21
081381142540 CORONAVAC 06/09/21 06/09/21
082269891831 CORONAVAC 06/09/21 06/09/21
081317328684 CORONAVAC 06/09/21 06/09/21
082127859173 CORONAVAC 06/09/21 06/09/21
083873587732 CORONAVAC 06-09-2021 06-09-2021
085591769110 CORONAVAC 06-09-2021 06-09-2021
085524646160 CORONAVAC 06-09-2021 06-09-2021
085693636975 CORONAVAC 06-09-2021 06-09-2021
085280193047 CORONAVAC 06-09-2021 06-09-2021
085770879832 CORONAVAC 06-09-2021 06-09-2021
085781020936 CORONAVAC 06-09-2021 06-09-2021
085866761684 CORONAVAC 06-09-2021 06-09-2021
085780319880 CORONAVAC 06-09-2021 06-09-2021
;087772736294 CORONAVAC 06-09-2021 06-09-2021
081511863895 CORONAVAC 06-09-2021 06-09-2021
081574920384 CORONAVAC 06-09-2021 06-09-2021
085814339733 CORONAVAC 06-09-2021 06-09-2021
081802170240 CORONAVAC 06-09-2021 06-09-2021
085776119354 CORONAVAC 06-09-2021 06-09-2021
082124298734 CORONAVAC 06-09-2021 06-09-2021
085775396947 CORONAVAC 06-09-2021 06-09-2021
083834936200 CORONAVAC 06-09-2021 06-09-2021
081584374903 CORONAVAC 06-09-2021 06-09-2021
08158273860 CORONAVAC 06-09-2021 06-09-2021
085719425935 CORONAVAC 06-09-2021 06-09-2021
081411032837 CORONAVAC 06-09-2021 06-09-2021
082311527565 CORONAVAC 06-09-2021 06-09-2021
085715503363 CORONAVAC 06-09-2021 06-09-2021
082311527565 CORONAVAC 06-09-2021 06-09-2021
085811459765 CORONAVAC 06-09-2021 06-09-2021
08212278560 CORONAVAC 06-09-2021 06-09-2021
08212278560 CORONAVAC 06-09-2021 06-09-2021
083841378175 CORONAVAC 06-09-2021 06-09-2021
085210535699 CORONAVAC 06-09-2021 06-09-2021
085282259149 CORONAVAC 06-09-2021 06-09-2021
085770131007 CORONAVAC 06-09-2021 06-09-2021
085888157261 CORONAVAC 06-09-2021 06-09-2021
087802090576 CORONAVAC 06-09-2021 06-09-2021
085283710880 CORONAVAC 06-09-2021 06-09-2021
085311588155 CORONAVAC 06-09-2021 06-09-2021
085810288783 CORONAVAC 06-09-2021 06-09-2021
085754572570 CORONAVAC 06-09-2021 06-09-2021
083878803285 CORONAVAC 06-09-2021 06-09-2021
085694541559 CORONAVAC 06-09-2021 06-09-2021
085777462074 CORONAVAC 06-09-2021 06-09-2021
085777462074 CORONAVAC 06-09-2021 06-09-2021
Dosis I Dosis 2
Tanggal
Pemberi KET
No. Batch No seri an No. Batch No Seri
Vaksina
si
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706842998 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
202108151I 16291706862214 DOSIS 1
 Nama Penerima Umur
NO No. Ticke NIK JK Pekerjaan*
Vaksin (18-59 tahun)

1 3601041101850002 ARHADI L 5/10/1986

2 3601040107700172 JUMRI AARYADI P 7/9/1970
3 3601046503800001 MAMAY MAETI P 3/25/1980
4 3601042712620001 BAHRUDIN L 3/4/1967
5 3602211605700001 DANA IRIANA L 5/6/1972
6 3601040104860001 KARJA L 4/1/1986
7 3601045204720002 MASNAH P 4/11/1972
8 3601044406080005 CELSA P 8/4/2008
9 3601040102740002 TARINDA L 2/1/1972
10 3601040902620001 H. MUHAMAD L 2/9/1962
11 3601041307680002 KP TAMBELAK L 7/13/1968
12 3601040209740002 SARTIM L 9/2/1974
13 3601044705700002 SUMYATI P 5/7/1974
14 3601044206700002 WARYAH P 6/2/1970
15 3601040601720003 DAKIM L 1/6/1972
16 3601040504820010 TARSAM L 4/5/1982
17 3601041003770001 OTONG L 7/5/1979
18 3601040405670002 SUKARI L 7/1/1971
19 3601020312940001 YULIAN L 1/12/1993
20 3601042312620001 SARLI L 12/23/1962
21 3601046403080001 CACA AYU P 8/24/2008
22 3601040803660002 NARSA L 3/8/1966
23 3601040107940212 SULAEMAN L 11/3/1993
24 3601045411090002 SITI KARSINAH P 11/14/2009
25 3601186110810001 ANISA KHUSNUL K P 10/21/1981
26 3601042107700001 SUKANI L 7/21/1970
27 3601045502650003 ETI P 2/15/1965
28 2174084702061002 SISKA KAHAYU N P 2/7/2006
29 3601045608020002 SELVIA DIANA P P 2/16/2002
30 3601041302090001 JANAIM L 2/13/2009
31 3601045805780002 NUNUNG P 5/18/1978
32 3601041209830003 ARIP HIDAYAT L 9/12/1983
33 3601252801080001 GUNTUR SUPRIYADIL 1/29/2008
34 3601040807740001 AJAT L 7/8/1974
35 3601045410060003 UMYATI P 10/14/2006
36 3601040111090001 WISNU L 3/27/2008
37 3601040605070001 RIZAL SETIAWAN L 5/6/2007
38 3601043003070001 AHYUDIN L 10/1/2007
39 3601042411070001 MUHKTADIR L 11/24/2007
40 3601042001930002 JUANDI L 8/17/1990
41 3601040712940003 M APANDI L 7/7/1994
42 3602210207070005 DIMAS SAEFULLOH L 10/21/2006
43 3601045901060001 MAE P 10/12/1982
44 3601040801830001 ANDI L 6/6/1994
45 3602214505080003 SITI KATONAH P 5/5/2008
46 3601045208040002 SUSI SUSANTI P 8/12/2004
47 3601045604040002 INTAN PRADINA P 3/18/2005
48 3601040902980002 UU SYAHRUL L 2/9/1998
49 3602261110050002 SAPARUDIN L 5/5/2005
50 3601041304060002 M IRWANSYAH L 4/4/2006
51 3601040707750001 MAHPUDIN L 3/25/1976
52 3601045107080001 EEN P 7/11/2009
53 3602215412080002 INES P 12/14/2008
54 3601044911040001 SITI NURJANAH P 11/9/2004
55 3601040303890001 OJI SUGIANTORO L 3/3/1989
56 3601045412050004 SARTIM P 12/14/2005
57 3602214512060003 LILIS MEILANI P 5/13/2006
58 3601045510970004 SUSI SUSANTI P 10/15/1997
59 3212022303940002 M SAEPUDIN L 3/23/1994
60 3602214105030009 SURYADI L 5/2/2003
61 3601042005060002 SAHRUL GUNAWANL 5/20/2006
62 3601045810750001 ITI P 10/18/1975
63 3601040802020001 KHAIRUL ANAM L 3/12/2003
64 3604080803030003 FIRMANSYAH L 3/28/2003
65 3602214708000002 RATIH P 9/16/1999
66 3602015512020008 DEWI P 12/15/2002
67 3601045405030002 RUBIAH P 5/14/2003
68 3604082306080001 AHMAD MAHDI L 6/23/2007
69 3601045403990002 YENI YULIANTI P 9/3/2001
70 3601041507080005 MISNAN L 7/15/2008
71 3601044107020157 KRISNA L 10/12/2008
72 3601040809080001 M ARIFIN L 9/8/2008
73 3602217103060002 MILA AULIA P 31/04/2006
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Kelomp
INSTANSI Alamat NO HP BPJS BPJS
ok Umur
PBI Non PBI

KP SUKAMANDI 085891154410
KP SINAPEUL 085319359630
KP LEUWIMUJA 085219690385
KP LEUWIMUJA 08528290394
KP RENGHAS CONDONG 087779398434
KP TAMBELAK 085693645968
KP LEUWIMUJA 082151190233
PESANTREN 082297972843
KP TAMBELAK 085211270585
KP SUKASENENG 082311404137
KP TAMBELAK 08385681022
KP SINAPEUL 085319539630
KP SINAPEUL 085319359630
KP TAMBELAK 083856810226
KP PEMATANG SEMPUR 081219942110
KP TAMBELAK 0838568108226
KP LEUWIMUJA 085212098216
KP SUKAMANDI 085313782229
KP TAMBELAK 0815119868573
KP TAMBELAK 085215993088
PESANTREN 082297972843
KP JAHA 085283959461
KP KIARA JANGKUNG 085217106061
PESANTREN 082297972843
KP KALAHANG MASJID 082117696473
KP SINAPEUL 085319359630
KP SUKASENENG 082122414919
PESANTREN 082297972843
KP TAMBELAK 082128427237
PESANTREN 082297972843
KP LEUWIMUJA 085210550403
KP LEUWIMUJA 08571752696
PESANTREN 082297972843
KP TAMBELAK 085210708063
PESANTREN 082297972843
PESANTREN 082297972843
PESANTREN 082297972843
PESANTREN 082297972843
PESANTREN 082297972843
KP UMBULAN 085694011996
KP TAMBELAK 082128477237
PESANTREN 082297972843
KP JAHA 085214152535
KP CIRIRIGI 082152132615
PESANTREN 082297972843
KP CURUGCIUNG 085283753491
PESANTREN 082297972843
KP SUKASENENG 085210708706
PESANTREN 082297972843
PESANTREN 082297972843
KP LEUWIMUJA 085319359540
PESANTREN 082297972843
PESANTREN 082297972843
PESANTREN 082297972843
KP CIRIRIGI 085752599095
PESANTREN 082297972843
PESANTREN 082297972843
KP LEUWIMUJA 082297972843
KP LEUWIMUJA 082297972843
KP RENGHAS CONDONG 081311282606
PESANTREN 082297972843
KP TAMBELAK 081292833438
KP TAMBELAK 081292833438
PESANTREN 082297972843
KP BEJOD 081217482898
KP PASIR AWI 082111031447
PESANTREN 082297972843
PESANTREN 082297972843
KP LEUWIMUJA 082111031447
PESANTREN 082297972843
PESANTREN 082297972843
PESANTREN 082297972843
PESANTREN 082297972843
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai)
Tanggal Tanggal
Non Merek Vaksin***
Screening Pemberian No. Batch
Anggota
Vaksinasi

CORONAVAC 9/7/2021 9/7/2021 2021081511

CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021 9/7/2021 2021081511
CORONAVAC 9/7/2021
 Dosis 2

Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi

16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
16291706836124 DOSIS 1
9/7/2021 2021081511 162917068DOSIS 2
NO No. Ticket NIK

1 360104510730005
2 3601040611750001
3 3601040107760217
4 3601047004690001
5 3601045001820001
6 3601045008780002
7 3601044301000006
8 3601045107790005
9 3601045307830002
10 3601045105790002
11 3601046011930001
12 3601045102830005
13 3601045609860001
14 3601041209800005
15 3601044107890177
16 1609142502720001
17 3601045103860003
18 3601045504760003
19 3601044101900008
20 3601045110900003
21 3601045006870004
22 3601044602760003
23 3601045001820003
24 360104410790284
25 3601044107740106
26 3601040109810001
27 360104018770002
28 3601042004500003
29 360104440880001
30 3601044106920001
31 3601044610850001
32 3601041007780005
33 3601045405790001
34 360104650680001
35 3601045610860001
36 3601041407710001
37 3601045001800003
38 3601040106850002
39 3601041901820001
40 3601044205780002
41 360104528800001
42 3601041412780001
43 3601045905760001
44 360104560800001
45 360104500870002
46 3601045510870004
47 3601041112790001
48 3601040206950002
49 3602095403820002
50 3601044109940006
51 3602226506770001
52 3601044108760002
53 3601042104810001
54 3601040104580009
55 3601045107780003
56 3601047003660001
57 3601045504700001
58 3601045502860002
59 3601046506850001
60 3601041312700002
61 3601041011730002
62 3601045806710001
63 3601040107710129
64 3601044709850003
65 3601044701820008
66 360104302800003
67 3601044804830001
68 3601044108620003
69 3601046511790001
70 3601045103940003
71 3601044107800305
72 3601044506840001
73 3601045504750002
74 3601040107800212
75 3601046402850003
76 3202085005790011
77 3601044405760003
78 3601044101700002
79 360104550675000
80 3601040902790001
81 3601045003900003
82 3601044708030001
83 3601046501770001
84 3601354107750136
85 3601045504860003
86 3601045905800001
87 3601040303750001
88 3601045107810004
89 3601046008620002
90 3601045901750001
91 3601040504550001
92 3601041005700001
93 3601044910860005
94 3601045204800005
95 3601045208030002
96 3601044108790002
97 36010141402720001
98 3601042507630003
99 3601041306780003
100 3601041401960002
101 3601045001820004
102 360104511800005
103 3601021204930003
104 3601044104800005
105 3601040104000011
106 3601041003930004
107 3601041510900001
108 3601041102990005
109 3601040107830286
110 3601044107860216
111 3601040609830002
112 3601040104810002
113 3601041011000006
114 3601044310760002
115 3601041207830002
116 3601042812910001
117 3601044702850005
118 3601041011680004
119 3601041007570004
120 3601045604790001
121 360104017930110
122 360104250810001
123 3601040207800002
124 3601041102760001
125 3601045104810001
126 3601044107930258
127 3601045005800001
128 3601040806730001
129 3601040801750003
130 3601040903720002
131 3601040107910117
132 3601045611800002
133 3601040107870171
134 3601040605820003
135 3601046911860001
136 3601041507700032
137 3601041105810002
138 3601044108810003
139 36010447880003
140 3601044505000003
141 3601040912820003
142 3601040108790001
143 3601044608750001
144 3601041012920002
145 3601044107050014
146 3601044103800003
147 3601045311850003
148 3601045609950001
149 3601040707000002
150 3601040602930005
151 3601042210890001
152 3601040107810160
 Umur Kelomp
Nama Penerima Vaksin JK Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

LILIS P 11-07-1979
SARKIMAN L 06-01-1975
MASJA L 01-07-1976
ERMAH P 30-04-1969
RAMAH P 10-01-1982
MARNI P 10-08-1978
YANTI. M P 03-01-2000
SITI BAEDAH P 11-07-1979
SURTINAH P 13-07-1983
RASMI P 11-05-1979
SUJAN L 20-11-1993
JUMSI P 11-02-1983
LILIS P 15-09-1986
ISRA L 12-09-1980
DEDE P 01-07-1989
ABUN L 10-11-1954
ISAH P 11-03-1985
SARNI P 15-04-1976
ALINAH P 01-01-1990
SUMIYATI P 11-10-1990
UUN P 10-06-1987
ICAH P 06-02-1976
ETI P 10-01-1982
NOPI P 08-12-1992
RUKMINI P 01-07-1974
SANDRA L 01-09-1981
LIBA L 01-08-1977
ARSID L 20-04-1950
ENOR P 04-08-1980
SITI SUNAMAH P 28-08-1994
KETI P 06-10-1985
SARJA L 10-07-1978
SANTI/SUCI P 14-05-1979
SANITI P 25-06-1983
NAWATI P 16-10-1988
KURSIAH P 05-04-1975
ANISAH P 10-01-1980
SUKMA L 01-06-1985
KODIR L 19-01-1982
RAMEN P 10-03-1981
KARTINIH P 12-08-1960
RASID L 04-02-1980
EMAH P 19-05-1975
TINAH P 16-08-1980
NUNUNG P 10-08-1970
UNING L 15-10-1987
KARDI L 11-12-1979
MARSID L 02-06-1995
KOKOM P 14-03-1982
SITI MUSI P 01-09-1994
EHA P 25-06-1977
MUHANAH P 01-08-1976
SUKAT L 21-04-1981
ARJAK L 01-04-1958
MARYAM P 11-07-1978
SARNMAH P 30-03-1966
HASANAH P 05-01-1971
ACIH P 15-02-1986
CARTINAH P 12-09-1990
KARSANI L 13-12-1970
SARHANI L 10-11-1970
EEM P 18-06-1971
SARWIAN L 01-04-1970
HASANAH P 07-09-1985
UMAYAH P 07-01-1982
TARIH P 13-02-1980
ROSITA P 08-04-1986
AMAH P 01-08-1962
TARINAH P 25-11-1976
SITI ROHMAH P 18-08-1994
SUTINAH P 01-07-1980
SUMENAH P 05-06-1984
NURYANI P 15-04-1975
ENJAT L 02-06-1982
AMNAH P 24-02-1985
ITOH MASITOH P 17-03-1979
NURHASANAH P 17-04-1976
ESIH P 01-01-1970
SAWEN P 15-06-1975
SANUDIN L 09-02-1979
MASKAH P 10-03-1990
AYU PUTRI P 28-06-2003
NURMAH P 25-01-1977
SURINI P 01-07-1975
ROHENAH P 15-04-1986
NUNING P 19-05-1980
TOTO L 03-03-1975
MASINAH P 11-07-1981
ERUM P 20-08-1962
ENENG P 19-06-1991
DARJO L 05-04-1955
OLEH L 10-05-1970
ERUK P 09-10-1986
ARNAH P 12-06-1984
SARTI P 14-07-2001
SUNAYAH P 01-08-1979
RASKIM L 14-02-1972
TAHYAT L 29-04-1974
MASTA L 13-06-1978
MELAWATI P 02-08-1995
SULASTRI P 10-01-1982
TUTI P 11-11-1980
ENUR L 11-07-1967
WASNI P 01-04-1980
ADE HERMAWAN L 23-09-2002
UJANG ADIWINATA L 10-05-1993
KARTOYO L 15-10-1990
TOMI L 11-02-1999
NAI L 01-07-1983
RASTIRAH P 01-05-1992
ASMA ASIKIN L 16-05-1987
WARNO L 01-04-1985
MAHPUDIN L 15-07-2001
ROHENAH P 03-10-1976
TEDI L 12-07-1983
JAMILUDIN L 28-12-1991
ROSITI P 07-02-1985
KARMAN L 15-01-1970
ARDI L 10-07-1957
JULEKA P 16-04-1979
IIF AFANDI P 07-07-1992
KARNO L 17-11-2000
ENTUS L 03-08-1979
SARMANI L 26-06-1976
SARTIAH P 11-04-1981
TITI P 01-07-1993
EMUS P 10-05-1980
MISRA L 08-06-1976
SAMAD L 08-01-1965
SAEPUR L 09-03-1972
DUDU L 10-02-1991
NASIH P 16-11-1980
KARSUDIN L 01-07-1987
RASIDI L 06-05-1982
UUN KURNAESIH P 03-04-1988
TALING L 15-07-1970
SARMANI L 11-05-1981
ASMAH P 01-08-1982
SARNI P 07-07-1988
KARTI P 05-05-2000
ANDI ROSADI L 09-12-1982
TB. RAHMAT HIDAYAT L 12-03-1979
TINAH P 06-08-1975
ENGKUS L 10-12-1992
NELI MEYLANI P 23-05-2005
HENI P 09-11-1985
MULYATI P 01-03-1989
ERMAWATI P 23-11-1995
SAKIR L 07-07-2000
TATA L 08-02-1993
SUKURNA L 22-10-1984
ANDA L 17-09-1983 ODGJ
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Merek
Alamat NO HP BPJS BPJS Non Vaksin***
PBI Non PBI Anggota

SUKAMULYA 081517223431 CoronaVac

SUKAMULYA 085782221605 CoronaVac
SUKAMULYA 085883000666 CoronaVac
SUKAMULYA 085883000566 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085715270429 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 082371488315 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085883000566 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
GUNUNG SAHARI 085694344193 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085777477264 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085773484819 CoronaVac
SUKAMULYA 085774963416 CoronaVac
SUKAMULYA 085694275843 CoronaVac
SUKAMULYA 085781086550 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085692729271 CoronaVac
SUKAMULYA 085714781984 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085778986944 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 0858877711070 CoronaVac
SUKAMULYA 085883000566 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085691137653 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085718647097 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085771197209 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 083878312472 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085718647097 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 082113372034 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771775 CoronaVac
UMBULAN 085252369862 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 081574228083 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085781086550 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085691137653 CoronaVac
SUKAMULYA 08567809855 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085711304700 CoronaVac
SUKAMULYA 085781086550 CoronaVac
SUKAMULYA 085781086550 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085718763865 CoronaVac
SUKAMULYA 085212578868 CoronaVac
SUKAMULYA 081511868770 CoronaVac
SUKAMULYA 085286434724 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 081213436207 CoronaVac
SUKAMULYA 085764750779 CoronaVac
SUKAMULYA 085891581108 CoronaVac
SUKAMULYA 087780467475 CoronaVac
SUKAMULYA 085714955233 CoronaVac
UMBULAN 085695268346 CoronaVac
SUKAMULYA 081574349137 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 085887771070 CoronaVac
PARKOS 081646085417 CoronaVac
SUKAMULYA 085887771775 CoronaVac
PARKOS 085891580722 CoronaVac
PARKOS 085882372470 CoronaVac
SUKAMULYA 085887771775 CoronaVac
SUKAMULYA 081346172675 CoronaVac
SUKAMULYA 085775567451 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 085311379360 CoronaVac
SUKAMULYA 085887771070 CoronaVac
PARKOS 085710123696 CoronaVac
SUKAMULYA 085781086550 CoronaVac
SUKAMULYA 085819327939 CoronaVac
SUKAMULYA 081351070015 CoronaVac
SUKAMULYA 08577348819 CoronaVac
SUKAMULYA 085779062100 CoronaVac
CIKEUSIK 08167125303 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 081617125303 CoronaVac
SUKAMULYA 085883000566 CoronaVac
SUKAMULYA 085883000566 CoronaVac
SUKAMULYA 081511401751 CoronaVac
SUKAMULYA 085887771070 CoronaVac
KAPUK 087889180093 CoronaVac
SUKAMULYA 082312399197 CoronaVac
SUKAMULYA 081511959161 CoronaVac
SUKAMULYA 081213436207 CoronaVac
SUKAMULYA 083841505933 CoronaVac
SUKAMULYA 085781085366 CoronaVac
SUKAMULYA 085894816088 CoronaVac
SUKAMULYA 085887771070 CoronaVac
SUKAMULYA 08225815207 CoronaVac
 Dosis I Dosis 2

Tanggal Tanggal
Tanggal
Screening Pemberia
Pemberian No. Batch No seri No. Batch
n
Vaksinasi
Vaksinasi

08-09-2021 08-09-2021 2021081511

08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
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08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
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08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
28-06-2021 28-06-2021 24002021 08-09-2021 2021081511
29-06-2021 29-06-2021 08-09-2021 2021081511
15-07-2021 15-07-2021 24003921 08-09-2021 2021081511
15-07-2021 15-07-2021 24003921 08-09-2021 2021081511
15-07-2021 15-07-2021 24003121 08-09-2021 2021081511
09-08-2021 09-08-2021 24003121 08-09-2021 2021081511
09-08-2021 09-08-2021 24003121 08-09-2021 2021081511
29-06-2021 29-06-2021 '24003121 08-09-2021 2021081511
15-07-2021 15-07-2021 24003921 08-09-2021 2021081511
29-06-2021 29-06-2021 24003021 08-09-2021 2021081511
08-09-2021 08-09-2021 2021081511
28-06-2021 28-06-2021 08-09-2021 2021081511
28-06-2021 28-06-2021 24002221 08-09-2021 2021081511
28-06-2021 28-06-2021 24002221 08-09-2021 2021081511
09-07-2021 09-07-2021 24003321 08-09-2021 2021081511
29-06-2021 29-06-2021 24003121 08-09-2021 2021081511
22-10-1984 22-10-1984 24003121 08-09-2021 2021081511
21-06-2021 21-06-2021 24002221 08-09-2021 2021081511
 KET
No Seri
021081511
021081511
021081511
021081511
021081511
021081511
021081511
021081511
021081511 D1 DI POLSEK
021081511 D1 DI KEL. PLUIT

021081511
021081511
021081511
021081511 D1 DI KLINIK POLRES TANJUNG PINANG
021081511
021081511
021081511
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045403020002 SITI ATIKAH P

2 3601040107950033 ARIFIN L
3 3601042502930001 RIDWANULLAH L
4 3601044101860003 UPIT SARIMANAH P
5 3601040102810005 MAMAN L
6 3601044506760003 ANI P
7 360101045206040003 DIVA DIANA P
8 3601034707910003 SITI IFAT. F P
9 3601044106940004 IMAS YANI P
10 36012210211890003 ADE HIDAYAT L
11 3601041007600008 H. MA'MUN L
12 360104580990005 YATI SEPTIANSYAH P
13 3601045712970003 YOSI YULIANTI P
14 3601040107600056 SARAN L
15 3601042109080002 GALANG SAPUTRO L
16 3601045705860001 MASNI P
17 3601044107820080 KENAH P
18 3601047105070002 TIARA DEWI P
19 3601047105070001 INTAN LESTARI P
20 3601045410810001 DARSIH P
21 3601045004860007 LILIS P
22 3601044304870001 MURSANATI P
23 360104290790003 DANU IRAWAN L
24 3672045605930001 SURNI P
25 36010409038600004 MUDI L
26 3601030903900002 M. SYARIFUDIN L
27 3601041102080004 YUSEP NURWAHID L
28 360104407070001 NIA P
29 3601034806900001 ENENG P
30 3601040107900121 RASMIN L
31 3601040560001 SACA L
32 3601044807050002 AI P
33 360104209010002 ADI MAULANA L
34 3601042202000003 ANGGA FEBRIANTO L
35 3601041011000005 RIKI GUNAWAN L
36 3601045606980007 MILA CARMELIA P
37 3601041907000003 YAYAN MUJIONO L
38 3601045911030001 CUCU CAHYATI P
39 3601044309000003 ANI SETIANI P
40 3601031210020001 TONI L
41 3601045303890004 ADE RATNENGSIH P
42 3601034208060002 SITI RAHMAWATI P
43 3601041209050003 RAHEL MAHENDRA L
44 3601034105040004 ELTA BAQISTA P
45 3601044211030005 SITI FATIMAH P
46 3601045005050047 CUCUM SUMIATI P
47 3601044803050004 SINDY ANGGRAENI P
48 3601042706960002 ROHMAN L
49 3601045302060001 INES RAHMA P
50 3601045707040003 RISYANA WAHYU L
51 3601041908000002 RUDI L
52 3601041502020001 RIKI YANTO L
53 3601044505890008 MIMIN. T P
54 3601041207970004 YADI L
55 3601046706010001 SUNARTI P
56 3601040110000001 AAS KUSNADI L
57 3601041511890001 IRMAN L
58 3601065808910001 SUNENI P
59 3601045708030004 AYU LESTARI P
60 3601045704060004 DEVI APRILIANTI P
61 3601044311720001 WATMI P
62 3601040506990001 JAMSU L
63 3601040407800004 HERU PURWANTO L
64 3601044107000309 LALA YULIANTI P
65 3601041007850001 TOHA L
66 3601034110980005 CINAH P
67 3601040405960002 DEDE SUARJA L
68 3601042408010002 ENJUN L
69 3601041408890001 IWAN ELFIRWAN L
70 3601040107650071 SARMU L
71 3601046511040001 RINI P
72 3601044812730001 NINDA P
73 3602024812050003 SUMARNI P
74 3601042208040002 IRWAN AFANDI L
75 3602212703030007 LUCKY PRATAMA. M L
76 360104310720001 JULIUS DAHSYAH L
77 3601045409040001 ANANTA RAHAYU P
78 3601045212020002 DEPI APIATI P
79 3601044107000209 TASSA ASTRI P
80 3601042705040001 RIZKY PURNAMA L
81 3601041111890004 AHMAD BADRU L
82 3601040908860002 EDI SUPRIYADI L
83 360104290690003 DEVI SANJAYA L
84 36010146006040002 FITRIYANI P
85 3601044206900005 KARTINI P
86 3601046412030001 ANI SUSIAWATI P
87 3601045011040001 EPA NOPIANA P
88 3602285907040010 DELA NURALIA P
89 3601045311860001 IIS P
90 3601040107010146 NURYADI L
91 3601072007970001 WAHYU L
92 3601040602030002 NAHDIAH FIZRIATUL P
93 3601046607040002 PUTRI WAHYUNI P
94 3601045309040001 WIDIA PUTRI P
95 3601044301020005 SITI YULIASTI P
96 3601044302040003 ANISA P
97 3601046005040001 IMELDA P
98 3601040107930062 IBIN L
99 3601040307760003 UJANG SUTISNA L
100 3601045311020001 ANGGI SEPTIA P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

14-02-2002 SUMURBATU 085215864045

16-12-1995 SUMURBATU 082215301578
25-05-1995 NANGGALA 085778282566
19-04-1990 NANGGALA 085212923383
12-10-1983 NANGGALA 085280416713
05-06-1976 NANGGALA 085714953431
12-06-2004 CURUG CIUNG 085717367670
07-07-1990 NANGGALA 085215562229
01-06-1994 NANGGALA 085216146747
10-02-1992 NANGGALA 085216099216
10-07-1960 NANGGALA 082297768800
18-09-1995 NANGGALA 085719841063
17-12-1997 NANGGALA 085210600529
01-07-1960 NANGGALA 081807412698
21-09-2008 NANGGALA 085695268314
17-05-1986 NANGGALA 085212186396
01-07-1962 NANGGALA 085776184636
31-05-2007 NANGGALA 085282388701
31-05-2007 NANGGALA 081280313639
14-10-1987 NANGGALA 085694146773
10-04-1986 NANGGALA 085771308710
03-04-1987 NANGGALA 08568003044
06-04-1995 NANGGALA 081384166086
16-05-1993 NANGGALA 085773624471
24-10-1986 NANGGALA 085310128042
14-12-1992 NANGGALA 085718590926
11-02-2008 SUKAMULYA 085710506233
04-07-2007 NANGGALA 085773624138
02-02-1992 CIBALIUNG 085210618780
29-12-1990 NANGGALA 081517729985
05-09-1976 NANGGALA 085880004628
08-07-2005 NANGGALA 085773624151
24-09-2001 NANGGALA 08582813650
22-02-2002 NANGGALA 085591763240
02-08-2001 NANGGALA 085882780266
18-01-2000 NANGGALA 085714772568
19-07-2000 NANGGALA 085694913974
19-11-2003 NANGGALA 085697417101
03-09-2000 NANGGALA 085892747374
11-08-2002 CIBALIUNG 085283848518
28-10-1985 PARKOS 085710140911
02-08-2006 CIBALIUNG 081317580579
12-09-2005 NANGGALA 085892746836
01-05-2004 CIBALIUNG 083861173723
02-11-2003 NANGGALA 085718782478
10-05-2005 CIKEUSIK 085691309458
08-03-2005 SUKASENENG 085714979231
23-05-1996 NANGGALA 0816174561314
13-01-2006 CIBALIUNG 083897409439
17-07-2004 CIKADONGDONG 085817995679
25-03-2000 SUKASENENG 081289199929
04-04-2002 NANGGALA 085691137675
15-05-1989 NANGGALA 085697597670
12-07-1997 NANGGALA 085886414194
04-06-2002 NANGGALA 081511868408
17-05-2001 SUMURBATU 085283233118
05-04-1989 CIKEUSIK 085211680914
18-07-1992 PANIMBANG 081385343582
17-08-2003 NANGGALA 081646061722
17-04-2006 RANCASENENG 081295074837
09-04-1978 NANGGALA 082111614253
28-03-1999 NANGGALA 081517844550
04-07-1980 NANGGALA 085219605634
01-07-2000 NANGGALA 082111614253
10-07-1992 SUKAMULYA 0856951549154983
01-10-1996 CIBALIUNG 085695154983
04-05-1995 NANGGALA 085310128042
24-08-2001 NANGGALA 081584956660
14-08-1988 CIKEUSIK 085694856186
20-06-1969 NANGGALA 085779170380

25-11-2003 CIKEUSIK 085892378584

29-12-2005 CIKEUSIK 085218572625
08-12-2005 PANGGARANGAN 085893317787
22-08-2004 CURUG CIUNG 085717828416
27-03-2003 WANASALAM 083892646794
31-07-2001 NANGGALA 083898746404
14-09-2004 CIKEUSIK 081511412428
30-12-2002 CIKEUSIK 088294608612
09-02-2003 CURUG CIUNG 081219604974
27-05-2004 SUKASENENG 085773491693
11-11-1989 NANGGALA 085773765903
09-08-1986 NANGGALA 085717893630
29-07-1996 CURUG CIUNG 085313196752
20-06-2004 CIKEUSIK 085719069834
02-06-1990 NANGGALA 085210829889
24-12-2003 RANCASENENG 085694941731
10-11-2004 CIKEUSIK 082113240195
19-07-2004 CIKONCANG 081586524431
13-11-1986 NANGGALA 08569137268
02-02-1981 CIKEUSIK 085216176781

20-07-1997 ANGSANA 085872408275

06-02-2003 CIKEUSIK 085798840117
26-07-2004 CURUG CIUNG 085715407494
13-09-2004 CIKEUSIK 085779568762
03-01-2002 UMBULAN 085782555450
03-02-2004 CIKEUSIK 085693542126
28-05-2004 CIKEUSIK 085783557958
25-07-1992 SUKAWARIS 081211640903
03-07-1976 JEBUG 085214062820
13-11-2002 CIKEUSIK 085281459518
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

CoronaVac 09-09-2021 09-09-2021 2021081511

09-09-2021 09-09-2021 2021081511

09-09-2021 09-09-2021 2021081511

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Tanggal
No seri Pemberian No. Batch No Seri
Vaksinasi
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KET
D1 DI TANGCITY MALL
D1 DI PKM SIMPANG TERITIP
 Nama Penerima
NO No. Ticke NIK JK Pekerjaan*
Vaksin

1 3601041201010003 WIKAN L
2 3601041304040002 M YAN SYAFARUDIN L
3 3601045402830002 SANTI P
4 3601041007960003 ALI L
5 3601044105750001 SAENAH P
6 3601042506680002 MAJA L
7 ANA YOLA SARI P
8 3601045905070004 BUNGA ANGGRAENI P
9 3601042412000003 EKO DARMAWAN L
10 ADE FATMA P
11 3602216505060001 JULIANTI P
12 3501045001050004 RISMA ARYANI P
13 360221640700003 SHINTIA MAHARANI P
14 3601046409060006 RAHMA RAMA DANI P
15 3601011404070001 RAHDIAN MULYANI P
16 3601045604050004 SOPI ANANTA P
17 3603305605060005 SANTIAH P
18 3601045606060006 SHELVI AYU ANDRIANI P
19 3601045006040000 UMBULAN P
20 3602215301950002 ROHENAH P
21 3601045103650001 IKAH P
22 3601042706820001 ROSID L
23 3601045604030003 SITI NURHAENI P
24 3602014703070001 ASMI RANDA P
25 3601044304050003 AWALIA P
26 3602216703070003 NINA FATMAWATI P
27 3601041307100001 YADI PRIANSA L
28 3601044207050015 SITI NURHASANAH P
29 3601040101060006 JAJANG NURJAMAN L
30 3601040207050009 RAFLI MUHAMAD L
31 3602211903060004 RIZAL L
32 3602210503970001 LIA SAFITRI P
33 3601046910050009 IRMA FADILAH P
34 3601046503060002 ISEU P
35 3601044407050001 FATRIA SUCI P
36 3601043101060003 ADITIA FIRMANSYAH L
37 3601044207070009 ITA WAHYUNINGSIH P
38 3601043009970001 MUHAMAD DICKY R L
39 3601045005060001 DARSITI P
40 3601044402000001 TURINIH P
41 3601042710040002 RUDI MULYADI L
42 3602216408060002 JARSINAH P
43 3601041003770002 M AZLAN L
44 3601041002050004 AGUNG L
45 3602211605060001 ARPAN HERDIANA L
46 3601034308060001 SITI ELISAH P
47 3601041504070005 ERIK L
48 3601040403020004 RIZKI MAULANA L
49 3601042001060001 DEDE ABEL L
50 3602215204060004 SILPI P
51 3601034406050001 REVA PAULINA DJODJI P
52 3601046205050003 KARINA JUMAETI P
53 3601042211060001 RIFKI FAUZI L
54 3601045112730002 YATI P
55 3601040703090001 M ARDIANSYAH L
56 3601040107000308 GILANG RAMADHAN L
57 3601040809060004 MUHAMAD RIZWAN L
58 3601045108050001 ENI NURAENI P
59 1807245901060001 FITRI AYU P
60 3601045011050002 FITRI NURSIFAH P
61 3601046007060002 INDI NURHAYATI P
62 3601041701060001 AGUNG SETIAWAN L
63 3601042403060001 DIAS ANDREAS L
64 3601046705050001 SITI MARHAMAH P
65 3601046705070003 TIARA PUTRI P
66 1809054210060003 NIA RAMADHANI P
67 3602216703010001 ROHMI L
68 3602211008050003 NASARI L
69 3601040207060011 NENG LINDA P
70 360104700900002 NURAINI HASTATI P
71 3601045404050001 SITI MARYAM P
72 3601040807060002 M. RIFKI FRATAMA L
73 3601041208820004 BAI L
74 3601041012050006 M KIKI HAPIYUDIN L
75 3601355809050003 YANI ARTATI P
76 3602214209020008 YELIS AMELIA P
77 3601044510040001 JULAEHA P
78 3601045609050001 ANGGI LESTARI P
79 3601099412050005 ANI DESTIANI P
80 3602214405040009 LILIS FAUZIAH P
81 3601041705050001 DIMAS MULAWAN L
82 3601044502060003 CINDY ANASTSYA P
83 3601030902040000 JUNARTA L
84 3602216003060002 ENI ANGGRAENI P
85 3602210508790003 JUJUN JUNAEDI L
86 3601084505050000 LIA AMELIA PUTRI P
87 3601044405050000 DISNA P
88 3601046508050004 NIA AGUSTINA P
89 3602215306020002 JASTI P
90 3601040203060006 YUSUF L
91 3601042911040001 ADI SUSANTO L
92 3601042106050002 M RIHAN FAUJZI L
93 3601044501050003 ILAH ROHILAH P
94 3601041107050004 MOH IRFAN L
95 3601042808040000 DENI L
96 3601042711050002 NUR SUPYANI L
97 3601044103870007 PURMINAH P
98 3601041410050002 TARI KHOMSAH P
99 3601041903040000 MUHAMAD ARIP L
100 3602214412030001 INAH INAYA P
101 3602210608020004 DEDE KHOERUDIN L
102 3601044601040001 KARLINA P
103 3602210606000002 SUHDI L
104 3601045805040001 EDAH P
105 3601042612020002 JEJE L
106 3601041308050001 ANISAH P
107 3602212904050001 ANDRI WIGUNA L
108 3601040612030001 DENDI L
109 3601041100801001 LILI L
110 3601045004020002 SITI SUNINGRAT P
111 3601040810050002 JAYUNI L
112 3601041508050001 AGUS GUNAWAN L
113 3601045502060001 IRNAWATI P
114 3601040802060001 IAN MUHAMAD AMINUDINL
115 3601042808030003 MOCH FAUZAN ALGF L
116 9201075003060003 ADILIA AGUSTINA IMBIR P
117 3601041204020005 SARMIN L
118 3601040107780409 ATIM L
119 3601047101030002 MARNI P
120 3601034306050008 SELPI RAHMAWATI P
121 3601046204050001 JUITA AYU PP P
122 3601040711050003 SURENO L
123 3601041309050003 NURYADI L
124 3601046205050005 REVALINA P
125 3601040106060009 PAHRI PAUJI L
126 3601041203050003 IKBAL L
127 3601044408050001 NASIH KURNIAWATI P
128 3601044406040003 NURHALIMAH P
129 3601044206060008 SARNI P
130 3601041307060002 MASRIO L
131 3602210102020002 SUKARDI L
132 3601345408060002 YEYEN P
133 3601042502060002 ALDI MAULANA L
134 3601046010040003 WINDA SARI P
135 3601042810060002 ZAINAL HIDAYATUL H L
136 3601040705050003 ARYA MAESAPUTRA L
137 3604152611050001 ZIYANUL KUMMAL L
138 3601046411040001 SELVI P
139 3601044112050001 SITI NURHERAWATI P
140 3602211708060002 M ARSUDIN L
141 3601041508050002 M RIZKI L
142 3601041406060002 ARIEL SUNAM L
143 3601032707030002 ADE GUNAWAN L
144 3601042301050001 GIWAN GINANJAR L
145 3601047007050004 WITRI MITA ROSALI P
146 3601042905040001 FAHRUROZI L
147 3601040502060005 DAMAN HURI L
148 3601046912040002 AYU ASTUTI P
149 3601040207050018 MUSTOFA L
150 3212242508040001 AKHMAD JASON AFFANDL
151 3601046609040002 MIRNA AMELIA P
152 3601045501040002 SRI AYU NINGSIH P
153 3602210107030011 RUMANI L
154 3601045205050004 SITI PATIMAH P
155 3601045402050002 DEDE SURYATI L
156 3601044808040001 SITI KHALIFAH P
157 3602211101050004 SUMARDI L
158 3601030107060030 AAN DARMAWAN L
159 3602211304050002 ROYADI L
160 3601040808020003 TOHIR L
161 3601045003030006 JUEDAH P
162 3601042510050001 ADITIAN L
163 3601042312040004 M ILHAM ARIPIN L
164 3601040311060002 KIKI MAULANA L
165 3601044106050002 RISNA RISTIANI P
166 3601042509050001 FIRMANSYAH L
167 3602210808040005 SOFIYAN L
168 3601044412050003 YUNINDA ANISA P
169 3601042708040004 DONI PERMANA L
170 3601040707040002 BANGBANG SURYONO L
171 6301071605050001 SARDI L
172 3601046206050001 SANTI SUSILAWATI P
173 3602212708040004 RIJAL PAHMI L
174 3601044802050001 DINA R LANDA P
175 3602210101050009 ARMAN MAULANA L
176 3601040503050002 ARI SAPUTRA L
177 3602215006040004 SITI MARHAMAH P
178 3601040607020005 WARSO L
179 3601045007060001 SITI RAHMAWATI P
180 3601046907050002 SERLIS P
181 3601044102050012 FITRI FEBRIANI P
182 3602210103030001 MUHAMAD UTOMI L
183 3601046710050000 SRI AYU P
184 3601041701040010 RANI ANGGRAENI P
185 3601040904050002 AMSAR AFIANI P
186 3601042911140001 DERRY IRAWAN L
187 3601045101060002 RIANA TANTRI P
188 3601081911040001 RUDI ARYANTO L
189 3601044502050008 ESIH P
190 3601040210050000 FARID FIRMANSYAH L
191 3601041007040000 AGUNG SAPRONI L
192 3601040712040001 TEGUH FARISKY L
193 3601046906050005 HERMAWATI P
194 3602212401050000 SUPRIYADI L
195 3601044705050005 WEY WULAN P
196 36010450100500004 RINDIANI P

197 3601044207040013 NURUL FATIMAH P

198 3601046206060001 YANTI NURHAYATI P

199 3602210707040001 SUKANDI L

200 3601045307040003 SHALSA SHINTA AULIA P

201 3601046708060001 MARYATI P

202 3601040807060005 HARIS L
203 3601046302050001 IROH P
204 360104107780409 ATIM L

205 360104410770083 CARYUM P

206 MEGA DWI SELVIANA P

207 NURHASANAH P

208 3601045006040001 PADLAH P

209 SITI AISYAH P

210 3601045811050001 ANGELINA P

211 3602215802060002 YENI P

212 3601046404060001 WINAH P

213 3601044307070003 VIKA TRIYANI P

214 36010469050003 SELA ANDRIANI P

215 3601040108840003 SUNARDI L

216 3601045008970005 SARNI P

217 3601045111050005 TIA P

218 360221640706003 SHINTIA MAHARANI P

219 3601046404060011 WINAH APRILIANI P

220 3501045001050004 RISMA ARYANI P

221 3601046605030002 MENUR MAULANI P

222 3601041102070003 REHAN ADI SAPUTRA L

223 360131707070003 SURYANA L

224 3601045101060003 ANITA P

225 3601041204620001 KEMAN L

226 3601041803060002 MUHAMAD RIDWAN M L

227 3601044107890051 HALIAH P

228 3601040701085140 ANGGINI P

229 3601046210060004 LIA SAFITRI P

230 360104450907001 CICI AYATI P

231 360104561105001 ELAWATI P

232 3601047011060001 IKA SUSILAWATI P

233 3601041212980009 RIAN L

234 3601040408060002 DIKI PERMANA L

235 3602214401060002 SITI AISYAH P

236 3601042407060001 ARYA YUDISTIRA L

237 3601042207060005 AMIN NURJAYA L

238 3601040201060005 HERMAWAN L

239 3601042007068002 ALDI FEBRIANSAH L

240 3601046209060001 NINDI AULIA P

241 3601044205060003 LINDA P

242 360104607070001 M. NIKI L

243 3602215607050001 RANI PAJI P

244 3601040610060002 M. IIN NUR RAMADANI L

245 3601040401060001 FARIHUNUFUS L

246 3601042907060003 M. ZIDAN L

247 3604220107060005 M. ADITYA FASHA L

248 3601044601060002 NENENG JUNITA P

249 3601044107080021 CARTI P

250 3601045611690001 SANI P
251 3601045312010001 SITI AMINAH P
252 3601040301070001 IMAN SAHIB L
253 3209276702060001 KUSWATI P
254 3602210201070007 BENI L
255 3601047003070001 LINDA P
256 3601041112060001 MUHAMAD DAVID DANIEL L
257 3601040107930016 SURNATA L
258 3601042212050002 AANG L
259 3601041202060002 AHMAD FAUJI L
260 3601045003070002 NURHENI P
261 3601046006060007 YULI YANTI P
262 3601040504780001 HANI SURYA PERMANA P
263 3601084107080009 SITI JULAEHA P
264 3601040309040005 HUMAEDI L
265 3601044102040008 INTAN AMELIA P
266 3601046511050003 FITRI AYU ASTUTI P
267 3601045407100003 IIS LISTA P
268 3602212306050003 SALIM RAZBANI L
269 3601045406060001 NURJANA L
270 3601042309050002 SANDI HERMAWAN L
271 3601040403080021 WAHYUDIN L
272 3602217004000003 NENG NUR ASIAH P
273 3601040107940037 LENI P
274 3601044302040004 DILA P
275 3601045606760001 ARNI P
276 360104406060001 INTAN LESTARI P
277 3601041702060001 M. DODI SUDRAJAT L
278 3601042104050001 M. SANDI L
279 3601045812050006 AMELIA NURIZKI P
280 3602215506040006 LISTINA P
281 3601045401060006 SITI NURASIYAH P
282 3601040107050030 ANDRIAWAN L
283 3601044207050027 ANGGI NURSATI P
284 3601041503050002 M. NENDI L
285 3601040211860001 PERI ISKANDAR L
286 3601044803030006 JESSICA P
287 3601041409050003 ADI MAULANA SUSILO L
288 3601040203070001 ADRIAN FIRMANSYAH L
289 3601041209040000 AL ISRO L
290 3601042908070001 SUPYAN H L
291 3601044207000004 TARSIAH P
292 3602210405040002 APRIJAL L
293 3601040911040001 IBNU HAKIM L
294 3601044709050001 SELI YAWATI P
295 3601046010040001 SASKIA P
296 3601046611040001 SITI SUSANTI P
297 360104610105005 SITI MAESAROH P
298 3601041402060003 ULUNG L
299 3601041105050005 IMAN CAHYADI L
300 3601041301060001 JEPRI MAULANA L
301 3601036810060002 PITRI AULIA P
302 3601044310050001 RISMA RAMADHANI P
303 3602214110040003 SATI'AH P
304 360104140207040010 DUDI SAEPUL ANWAR L
305 3601044904050004 YANI SAFITRI P
306 3601044803850002 UCU P
307 36022162060001 SITI JULAEHA P
308 3602210607040004 AJI SAPUTRA L
309 3602212912040602 ADITYA SAPUTRA L
310 3601046311050001 VINA LAELY KUSUMA P
311 3601045805050001 RIKA PUSPITASARI P
312 3602212308050004 M. FAHMI L
313 3601045504050004 RIKA AMELIA P
314 360104480804003 RIKA RIZKIYAH P
315 3602211208091720 DIDIN L
316 3601044101050008 SITI AISAH P
317 3601040512050001 EKA FIRMANSYAH L
318 3601042203060003 ANTON PERMANA L
319 3601041907060001 TOHIR L
320 3601045709060002 REGITA ROSALIA P
321 3602212007040001 ROHMAN MALIK KUDUS L
322 3601040111040005 WANDI L
323 3601042208060005 M CEPI L
324 3601046507060002 RISA ANGGRAENI P
325 3601040210040002 RIYAN FIRMANSYAH L
326 3602040807830002 KHOIRUL S L
327 3671037009060002 MUNA ESA AKIRI L
328 3601045506050002 RATIH ASTUTI P
329 3601042512050001 YOGI ISKANDAR L
330 3601042108040001 SUNARTO L
331 3601040705080001 SIDIK L
332 3601044210050001 SITI HALIMAH P
333 3601040111050002 KARIMIN L
334 3601044910040001 SITI HOLIPAH P
335 3601046111040001 IYUM LINDIANA P
336 3602212901050002 SARJA SAHREJA L
337 3601043004060001 BAYU SAPUTRA L
338 3601041301050002 MUHAMAD NURJANA L
339 3601041012040001 MUHAMAD ADING L
340 3601041405050004 NANDI DANUARTA L
341 6408086410040002 DEFI L
342 3601043008040003 SAIPUL BAHRI L
343 3601040309040003 JAJAT HERMAWAN L
344 3601041103050002 DEDE UNDANA L
345 3601041310040003 ARIYO ARDI L
346 36010422706050001 BAYUREVALDO L
347 3601041011040002 YUDA KOSASIH L
348 3602215512060002 SITI JAHROH P
349 3601036102060001 RIANTI P
350 217111007049005 DANU SAPUTRA L
351 3601034107000277 RUMSAH P
352 3602214512050001 RIHA OKTAVIA P
353 3601044206050003 TIA LESTARI P
354 3602216507050001 DINA AMELIA P
355 3601040105050001 SUPARDI WIJAYA L
356 3601040502040001 ADIT PRATAMA L
357 3601041305060003 MUHAMD RIDWAN L
358 3601040902040003 HENDI HERDIANA L
359 3601044404020001 SITI ROHANIAH P
360 3601040311050001 AMIR MAULANA L
361 3601041701050002 RUSTANDI L
362 36022110407050000 MUHAMAD IWAN L
363 3601041508040004 M. LINGGA BUANA L
364 3601041203040006 SELAMET L
365 3601045308050003 MELAWATI P
366 1808094702050001 SITI OKTAPIANI P
367 3601045005050003 SINDI ANITA P
368 3601042707040003 DENI AKBAR L
369 3601040712050001 IWAN L
370 3601042009050003 RIPAIDI L
371 3601040212070001 JUBAEDI L
372 3601042103050003 HENDAR SUNANDAR L
373 3602214210060004 SITA P
374 3601040110750002 SARMANI L
375 3601046111890004 IMAS P
376 3601041802590002 SAUDIN L
377 3601040803900001 DARNA L
378 3601042712010002 RIYAN HIDAYAT L
379 3601040107870206 KARIM L
380 3602032405720001 SURYANTO L
381 3601042404010004 SURANDI L
382 3601045710730001 CICIH P

383 3601046010830001 ANIH P

384 9271014306050002 FIA.G.H.RUMBEWAS P

385 36001041903180003 KASWA L

386 3603181006800024 JUNAEDI L
387 3601186509860001 HIJRAH MURHAYATI P
388 3601045010060004 NEYSA NUZULUL SIAM P
389 3601042811700001 MUHIDIN L
390 3601042811700001 MUHIDIN L
391 3601046511020002 SUCI RAHAYU P
392 3601046809830001 CARINIH P
393 3601045604800008 NENGSIH P
394 3601046009990003 WANDI L
395 3601046603890002 WALINAH AISAH P
396 3601041908040002 LEO SIPI L
397 3374054701710005 OMSYAH D P
 Umur
Kelomp
(18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

12/01/2000 MASYARAKAT RANCASENENG 085211135810

14/03/2005 SMKN CKS CIKEUSIK 085217869951
14/02/1982 MASYARAKAT KARANG SAMBUNG 085217869951
10/07/1996 MASYARAKAT CIKEUSIK 081328431894
01/05/1977 MASYARAKAT PEMATANG SEMPUR 085213478363
25/06/1968 MASYARAKAT SUKAMULYA 085782651211
15/11/2006 SMKN CKS KARANG JONGKENG 085269966735
14/05/2007 SMKN CKS TANJUNG JAYA 083891222078
24/12/2000 MASYARAKAT PEMATANG SEMPUR 085282338965
17/10/2005 SMKN CKS BUNUT GIRANG 085694956656
25/05/2006 SMKN CKS PARUNGSARI 085691901804
10/05/2005 SMKN CKS CIKEUSIK 085695850308
24/07/2006 SMKN CKS PARUNG SARI 085695385928
24/09/2006 SMKN CKS SUKASENENG 081511865926
14/04/2007 SMKN CKS TAMBELAK 081210625622
16/04/2005 SMKN CKS LEWI GEDE 085210821610
16/05/2006 SMKN CKS RENGHAS CONDONG 083891937547
16/06/2006 SMKN CKS UMBULAN 085781086765
10/04/2006 SMKN CKS UMBULAN 085774961427
15/06/1998 MASYARAKAT MALANGSARI 083898254644
10/08/1972 MASYARAKAT TANJUNGAN 085217827775
27/06/1982 MASYARAKAT TANJUNGAN 081514441314
16/04/2003 SMKN CKS CIKEUSIK 085798830573
07/03/2007 SMKN CKS PARUNGSARI 085782637212
23/06/2006 SMKN CKS BUNGURGEDE 085693151831
27/03/2007 SMKN CKS CILANGKAP 085693505494
10/08/2005 SMKN CKS RANCASENENG 085214550702
13/08/2006 SMKN CKS CITARIK 082125753240
01/01/2006 SMKN CKS CANGKORE 085695267549
12/05/2005 SMKN CKS KARANG SAMBUNG 081316931604
19/03/2006 SMKN CKS B. CIKONCANG 085715282226
10/08/2006 SMKN CKS PASIR NANGKA 085607334089
29/10/2005 SMKN CKS MARGASARI 085880005371
25/03/2006 SMKN CKS CIKEUSIK 085813586384
04/07/2005 SMKN CKS RANCASENENG 085697826958
01/03/2006 SMKN CKS PENDEUY 08577896927
28/04/2007 SMKN CKS CIBULUH 085773236692
30/09/1997 MASYARAKAT TANJUNGAN 085714538716
29/05/2006 SMKN CKS P.SEMPUR 085693293617
04/07/1999 MASYARAKAT CIKEUSIK 085814309522
27/10/2004 SMKN CKS SUMURBATU 085715504228
23/07/2006 SMKN CKS RENGHAS CONDONG 083812315929
10/03/1977 SMKN CKS CIRIRIGI 085312826846
10/02/2005 SMKN CKS RANCASENENG 085811947061
18/05/2006 SMKN CKS RENGHAS CONDONG 083894417891
03/08/2006 SMKN CKS KIBODAS 081382869674
15/04/2007 SMKN CKS CIKADONGDONG 085715497592
04/03/2002 SMKN CKS CIKEUSIK 085779-54285
25/12/2006 SMKN CKS BATUBANTAR 085770973049
12/04/2006 SMKN CKS PARUNG PANJANG 085894539403
09/03/2006 SMKN CKS KIBODAS 082310597553
22/05/2005 SMKN CKS CILANCAR 1 085719069089
02/11/2006 SMKN CKS CIBULUH 081317119746
03/07/1986 MASYARAKAT RANCASENENG 087773373277
15/03/2005 SMKN CKS SUMBER JAYA 082123756855
27/10/2005 SMKN CKS PEMATANG SEMPUR 085781549451
08/09/2006 SMKN CKS KOLECER 082125756740
11/08/2005 SMKN CKS NANGGALA 085691095219
19/01/2006 SMKN CKS KIARA JANGKUNG 081292833156
16/11/2005 SMKN CKS CIRIRGI 085282390073
20/07/2006 SMKN CKS SUKASENENG 085697592166
17/01/2006 SMKN CKS CIKEUSIK 08570308385
24/03/2005 SMKN CKS SITUPOTONG 085773225597
27/05/2005 SMKN CKS SIKAMULYA 081511405336
27/05/2007 SMKN CKS RANCASENENG 085710515902
01/10/2006 SMKN CKS CIKUJANG 085810910299
07/08/2006 SMKN CKS BUNUT GIRANG 085178330391
30/08/2005 SMKN CKS BOJONG KONENG 085894545284
15/12/2005 SMKN CKS CITARIK 085692386046
03/09/2006 SMKN CKS NANGGALA 08588567318
14/04/2005 SMKN CKS KIARA JANGKUNG 085773757855
08/07/2006 SMKN CKS BENGER 085722186468
12/08/1982 MASYARAKAT CIWET 085773647850
10/12/2005 SMKN CKS CIKEUSIK 081310368918
18/09/2005 SMKN CKS CIKEUSIK 085772730649
02/09/2002 MASYARAKAT WANASALAM 08582802732
09/06/2006 SMKN CKS CIBANGKONOL 085811459883
16/09/2005 SMKN CKS CIKEUSIK 085780952576
05/12/2005 SMKN CKS PERMATANG 081213437322
04/05/2004 SMKN CKS BABAKAN PSANTREN 083192353172
17/05/2005 SMKN CKS CIRIRGI 085773226550
05/08/06 SMKN CKS SUKAWARIS 085692486499
09/07/2004 SMKN CKS LIMPAS 085215995176
20/06/2004 SMKN CKS BUNUT GORANG 085691920231
03/06/2005 SMKN CKS BEJOD 085695176364
05/05/2005 SMKN CKS PILAR 081528212693
04/05/2005 SMKN CKS KENDAL 085710525617
25/08/2005 SMKN CKS KONDANG 081646061711
15/06/2004 SMKN CKS BUNUT GIRANG 081511046651
02/03/2006 SMKN CKS CIKEUSIK 085721569290
29/11/2004 SMKN CKS CIKUJANG 085695114136
21/06/2005 SMKN CKS SINAR GINTUNG 085715391874
05/01/2005 SMKN CKS CILIKUT 085770641639
11/07/2004 SMKN CKS UMBULAN 085695267460
28/08/2004 SMKN CKS KIARA JANGKUNG 082113208019
27/11/2005 SMKN CKS PEMATANG SEMPUR 085693473820
17/10/1987 SMKN CKS SUKASENENG 083813032597
14/10/2005 SMKN CKS CURUGCIUNG 083848120952
07/07/2004 SMKN CKS LEWIBALANG 08568534246
04/12/2003 SMKN CKS SAWAH BARU 085860730753
19/05/2006 SMKN CKS CIEMAS 085695293036
06/02/2004 SMKN CKS LEWIBULED 085776128334
23/05/2005 SMKN CKS CIEMAS 085776136293
18/05/2004 SMKN CKS KUBANG MAKAR 081280797838
25/12/2003 SMKN CKS NANGGALA 085918945496
13/08/2005 SMKN CKS CIKUJANG TIMUR 082378501180
07/05/2003 SMKN CKS PASIR BUNTU 085778388941
16/12/2003 SMKN CKS CIKEUSIK 085770972296
10/08/2001 SMKN CKS SUKAWARIS 081218024086
08/08/2001 SMKN CKS TANJUNGAN 081218024086
08/10/2005 SMKN CKS CIKEUSIK 085848619396
16/08/2005 SMKN CKS CIKEUSIK 085773219225
12/02/2006 SMKN CKS SUKASENENG 085894698819
08/02/2006 SMKN CKS PEMATANG SEMPUR 085810876539
28/08/2003 SMKN CKS CIKEUSIK 081311665975
10/07/2006 SMKN CKS SORONG 082198806084
12/04/2002 SMKN CKS PEMATANG SEMPUR 081382362741
01/07/1987 SMKN CKS CURUGCIUNG 08569300296
11/08/2006 SMKN CKS SUKASENENG 081511406388
20/06/2005 SMKN CKS LIMPAS 085779061532
12/04/2005 SMKN CKS CIKUJANG 085691863464
07/11/2005 SMKN CKS KIARA JANGKUNG 081511592462
13/09/2005 SMKN CKS SUKASENENG 085770972362
22/052005 SMKN CKS SUKARENDAH 087876014898
01/06/2006 SMKN CKS SUMURBATU 085770972753
14/02/2005 SMKN CKS CIRIRIGI 085861171467
04/08/2005 SMKN CKS CILUKUT 081315195599
04/06/2004 SMKN CKS TANJUNGAN 081282773360
14/11/2005 SMKN CKS PARKOS 085880004579
22/02/2007 SMKN CKS CILEUNGSIR 085691437623
20/10/2003 SMKN CKS CIKARANG 0852212733084
14/08/2006 SMKN CKS SUKAWARIS 081214654739
25/02/2006 SMKN CKS RANCASENENG 085892746966
16/02/2005 SMKN CKS BBK CIBALIUNG 085778986928
28/11/2006 SMKN CKS BOJONG DATAR 085714061243
07/05/2005 SMKN CKS RANCASENENG 085694239438
29/10/2005 SMKN CKS SERANG 081216392701
24/11/2004 SMKN CKS SUKARENDAH 082315367848
01/12/2005 SMKN CKS SUMURBATU 085646787166
17/08/2006 SMKN CKS PARUNGSARI 085811084179
15/08/2005 SMKN CKS RANCASENENG 085770620469
14/06/2006 SMKN CKS RANCASENENGG 085810903423
27/07/2003 SMKN CKS CIHANJUANG 085694527095
23/01/2006 SMKN CKS LEUWIBALANG 085311558297
30/07/2005 SMKN CKS RANCASENENG 081295091435
29/05/2004 SMKN CKS PEMATANG SEMPUR 085718763289
05/02/2006 SMKN CKS CURUGCIUNG 085890550031
29/12/2004 SMKN CKS CIKEUSIK 085714772558
18/09/2005 SMKN CKS CIKEUSIK 085773236652
25/08/2004 SMKN CKS CANGKORE 083145182678
26/09/2004 SMKN CKS CIRIRIGI 085776901372
15/01/2005 SMKN CKS CURUGCIUNG 085776899413
10/05/2016 SMKN CKS WANASALAM 085218566504
12/05/2005 SMKN CKS BUNGUR GEDE 085880004176
14/02/2005 SMKN CKS CIKEUSIK 083192300951
08/08/2004 SMKN CKS UMBULAN 085718265180
11/01/2005 SMKN CKS CIKARANG 081584357055
28/01/2006 SMKN CKS CIPINANG 0857101110912
02/04/2005 SMKN CKS PARUNGSARI 085710509034
08/08/2002 SMKN CKS NANGGALA 085891791962
10/03/2003 SMKN CKS NANGGALA 085893317985
25/10/2005 SMKN CKS PEMATANG SEMPUR 085781350435
23/12/2004 SMKN CKS SUKAJAYA 085773226479
03/11/2005 SMKN CKS UMBULAN 085695061488
01/06/2005 SMKN CKS CIKEUSIK 085692955383
25/09/2005 SMKN CKS SUMURBATU 081511407749
08/08/2004 SMKN CKS WANASALAM 085894185363
04/12/2005 SMKN CKS UMBULAN 085694162825
27/08/2004 SMKN CKS CIKEUSIK 085880250388
19/02/2004 SMKN CKS SUKASENENG 081280312800
16/05/2005 SMKN CKS SUKAMULYA 085782070064
14/05/2005 SMKN CKS CIKEUSIK 085691159051
27/08/2004 SMKN CKS WANASALAM 085718723588
08/02/2005 SMKN CKS TANJUNGAN 081298786730
04/07/2006 SMKN CKS WANASALAM 085694725038
05/03/2005 SMKN CKS SUKAMULYA 081282809073
19/12/2005 SMKN CKS WANASALAM 085811549176
28/06/2003 SMKN CKS SUKAMULYA 081584375223
10/07/2006 SMKN CKS RANCASENENG 085770972026
29/07/2005 SMKN CKS UMBULAN 085691137599
01/02/2005 SMKN CKS SUKASENENG 081213437344
01/03/2003 SMKN CKS WANASALAM 085695397112
27/10/2005 SMKN CKS UMBULAN 085773500549
07/09/2004 SMKN CKS CIKEUSIK 081584376612
09/07/2005 SMKN CKS SUKASENENG 085715264177
02/04/2005 SMKN CKS CIKEUSIK 081382339998
01/11/2005 SMKN CKS KIARA JANGKUNG 085779061028
18/11/2004 SMKN CKS GUNUNG BATU 085894815053
05/02/2005 SMKN CKS CIKEUSIK 085718724647
05/10/2005 SMKN CKS CIKEUSIK 082312074864
10/07/2003 SMKN CKS CIKEUSIK 0831192353794
07-12-2004 SUKASENENG 085694083229
29-06-2005 SUMURBATU 085770640912
24-01-2005 KP. SAWAH BARU 082113240196
07-05-2005 CIKEUSIK 085773216610
10-10-2005 SUKASENENG 081413316392
09-08-2005 CITARIK 085889411140
22-06-2006 CIKEUSIK 08383619814
07-07-2004 KARANG PAMIDANGAN 085811288740
13-07-2004 KIARAJANGKUNG 083874731819

27/08/2006 SMKN CIKEUSIK 085710515969

08/02/2006 SMKN CIKEUSIK 085693594172
23/02/2005 SMKN CIKUESIK 085770972354
01/07/1978 KP. SINAR GANTUNG 085693300296
01/07/1977 KARANG SAMBUNG 081287276072
03/04/2007 SMKN CIKEUSIK 085782269368
08/03/2005 SMKN CIKEUSIK 085781455237
10/04/2006 SMKN CIKEUSIK 085774961427
19/2/2006 SMKN CIKEUSIK 085779562623
18/11/2006 SMKN CIKEUSIK 081316679664
18/02/2006 SMKN CIKEUSIK 085283234981
24/04/2006 SMKN CIKEUSIK 081210508291
03/06/2007 SMKN CIKEUSIK 085781626544

29/05/2006 SMKN CIKEUSIK 085718265078

01/08/1984 SUKAMULYA 085658301601
31/10/1999 SUMURBATU 085781501511
11/11/2005 SMKN CIKEUSIK 085719423164
24/07/2006 SMKN CIKEUSIK 085695385928
24/04/2006 SMKN CIKEUSIK 0812105082291
10/05/2005 SMKN CIKEUSIK 085695850308
26/05/2003 SMKN CIKEUSIK 081297935349
11/02/2007 SMKN CIKEUSIK 082123112471
17/07/2007 SMKN CIKEUSIK 083895095589
11/01/2006 SMKN CIKEUSIK 085773208670
06/11/1971 TANJUNGAN 085217827775
01/11/2006 SMKN CIKEUSIK 085778182854
13/11/1978 RANCASENENG 085718515198
01/04/2006 SMKN CIKEUSIK 085715851364
22/10/2006 SMKN CIKEUSIK 085714772526
05/09/2006 SMKN CIKEUSIK 085714231059
16/11/2005 SMKN CIKEUSIK 085774965042
25/12/2006 SMKN CIKEUSIK 085718256112
12/12/1998 SUMURBATU 082349720973
04/08/2006 SMKN CIKEUSIK 081584375332
04/01/2006 SMKN CIKEUSIK 085695397115
24/07/2006 SMKN CIKEUSIK 085782264309
22/07/2006 SMKN CIKEUSIK 085695150043
02/01/2006 SMKN CIKEUSIK 085891590756
20/07/2006 SMKN CIKEUSIK PERMATANG SEMPUR 081578934719
22/09/2006 SMKN CIKEUSIK LEUWI GEDE 085715817679
02/05/2006 SMKN CIKEUSIK SUKASENENG 085773883409
04/10/2006 SMKN CIKEUSIK UMBULAN 085770972885
13/04/2006 SMKN CIKEUSIK BABAKAN PESANTREN 085719445613
06/10/2006 SMKN CIKEUSIK SUKASENENG 08782134870
07/11/2006 SMKN CIKEUSIK CIKEUSIK 085813109164
29/07/2006 SMKN CIKEUSIK MARGASARI 081385565539
01/07/2006 SMKN CIKEUSIK KIARA JANGKUNG 081360633040
06/01/2006 SMKN CIKEUSIK CIRIRIGI 085782980835
06/02/2007 SMKN CIKEUSIK KIARA JANGKUNG 085283236065
12/01/1969 MASYARAKAT CIKEUSIK 085691096532
13/12/2001 MASYARAKAT UMBULAN 085892625418
03/01/2007 MASYARAKAT CILENGSIR 085773892872
27/02/2006 SMKN CIKEUSIK UMBULAN 085871279024
02/01/2007 MASYARAKAT CENGKOK 085881649618
30/03/2007 MASYARAKAT KENDAL 081280270218
11/12/2006 SMKN CIKEUSIK KOLECER 085216617218
01/07/1993 MASYARAKAT SUKAWARIS 082349720973
22/02/2005 SMKN CIKEUSIK BENGER 085810132458
12/02/2006 SMKN CIKEUSIK CIKARET 085311379326
10/03/2007 MASYARAKAT NANGGALA 081289662847
20/06/2006 SMKN CIKEUSIK BARENGKOK 085770620571
05/04/1978 MASYARAKAT SUMURBATU 081286952367
05/05/2006 SMKN CIKEUSIK CIGALIH 083891226561
03/09/2004 SMKN CIKEUSIK CURUGCIUNG 0856949590549
05/11/2005 SMKN CIKEUSIK SUMURBATU 085693620149
25/11/2005 SMKN CIKEUSIK RANCASENENG 085892626447
02/12/2005 SMKN CIKEUSIK BARENGKOK 081292833037
23/01/2005 SMKN CIKEUSIK BABAKAN PESANTREN 081382862920
24/06/2006 SMKN CIKEUSIK CIKEUSIK 085691908978
23/09/2005 SMKN CIKEUSIK CIKEUSIK 085691158985
15/06/2006 SMKN CIKEUSIK CIKEUSIK 085892622391
30/04/2006 SMKN CIKEUSIK KATAPANG 081291972245
01/07/1994 MASYARAKAT SUMURBATU 083818225674
03/02/2004 SMKN CIKEUSIK SUKARENDAH 083823663844
16/06/1976 MASYARAKAT SUMURBATU
16/08/2006 SMKN CIKEUSIK SUMBERJAYA 085719761210
17/02/2006 SMKN CIKEUSIK RANCASENENG 08569470536
21/04/2005 SMKN CIKEUSIK LEUWIMUJA 082184434120
18/12/2005 SMKN CIKEUSIK KARANG SAMBUNG 085715269588
15/06/2004 SMKN CIKEUSIK BUNTUT GIRANG 085710502854
14/01/2006 SMKN CIKEUSIK SITUPOTONG 085780503724
02/04/2006 SMKN CIKEUSIK PERMATANG SEMPUR 085775201047
02/07/2005 SMKN CIKEUSIK SUKAWARIS 085892954713
15/03/2005 SMKN CIKEUSIK UMBULAN 085771003217
02/11/1986 MASYARAKAT TANJUNGAN 085717044871
08/03/2003 MASYARAKAT PARKOS 085771917490
14/09/2005 SMKN CIKEUSIK PASIR KALIKI 085774300477
08/11/2005 SMKN CIKEUSIK PERMATANG SEMPUR 081280312704
12/09/2004 SMKN CIKEUSIK PARKOS 085710314416
29/08/2007 SMKN CIKEUSIK CILENGSIR 085882165309
09/06/2005 SMKN CIKEUSIK CITARIK 081316753034
04/05/2004 SMKN CIKEUSIK CENGKOK 085795136755
09/11/2004 SMKN CIKEUSIK CIKEUSIK 082171351213
01/01/2005 SMKN CIKEUSIK UMBULAN 085695154309
07/08/2005 SMKN CIKEUSIK SUKASENENG 085891152728
26/11/2004 SMKN CIKEUSIK CIRIRIGI 085693636469
21/01/2005 SMKN CIKEUSIK SUKARATU 081295091425
09/10/2005 SMKN CIKEUSIK LEUWIMUJA 085770620338
11/05/2005 SMKN CIKEUSIK CANGKORE 085782264358
13/01/2006 SMKN CIKEUSIK LEUWI GEDE 085283712379
28/10/2006 SMKN CIKEUSIK LIMPAS 085880004772
03/10/2005 SMKN CIKEUSIK RANCASENENG 085770620515
01/01/2004 SMKN CIKEUSIK R. CONDONG 083878955848
10/05/2004 SMKN CIKEUSIK CIKEUSIK 085719069774
09/04/2005 SMKN CIKEUSIK TANJUNGAN 081296009062
08/03/1985 MASYARAKAT SUMURBATU 085695147800
25/07/2005 SMKN CIKEUSIK R. CONDONG 087782644113
25/01/2005 SMKN CIKEUSIK PARUNG PANJANG 081280313424
29/12/2004 SMKN CIKEUSIK BEJOD KALER 085776131226
23/11/2005 SMKN CIKEUSIK UMBULAN 085695203520
18/05/2005 SMKN CIKEUSIK NANGGALA 081584956401
23/08/2005 SMKN CIKEUSIK PAJAGAN 085770144312
15/04/2005 SMKN CIKEUSIK CURUGCIUNG 085770147730
08/07/2004 SMKN CIKEUSIK SUKATANI 085894531637
10/05/2004 SMKN CIKEUSIK CIKARANG 081280562779
01/01/2005 SMKN CIKEUSIK NANGGALA 085774965096
05/12/2005 SMKN CIKEUSIK RANCASENENG 085697591978
22/03/2006 SMKN CIKEUSIK CIRIRIGI 085776879363
12/07/2005 SMKN CIKEUSIK SUKARENDAH 085817515622
17/09/2006 SMKN CIKEUSIK CIKEUSIK 085773757318
20/07/2004 SMKN CIKEUSIK PARUNG PANJANG 085776136702
01/11/2004 SMKN CIKEUSIK SUKARATU 081310662956
22/08/2006 SMKN CIKEUSIK CIBALIUNG 085810876312
25/07/2005 SMKN CIKEUSIK RANCASENENG 085782269380
02/10/2004 SMKN CIKEUSIK CIKEUSIK 085692573042
23/06/2005 SMKN CIKEUSIK PERMATANG 085718256177
31/01/2006 SMKN CIKEUSIK BATUSARI 085772330277
15/05/2005 SMKN CIKEUSIK CIKARET 085892626466
25/12/2005 SMKN CIKEUSIK CIKARET 085719021120
21/08/2004 SMKN CIKEUSIK CIRIRIGI 085813109170
18/07/2006 SMKN CIKEUSIK SITUPOTONG 081511690541
02/10/2005 SMKN CIKEUSIK UMBULAN 085773491624
07/05/2006 SMKN CIKEUSIK SINAPEL 081295089224
09/10/2005 SMKN CIKEUSIK BUNGUR GEDE 085871279034
21/11/2004 SMKN CIKEUSIK CILANCAR 085717029609
29/01/2005 SMKN CIKEUSIK SAWAH BARU 081281279688
30/04/2006 SMKN CIKEUSIK KARANG JONGKENG 085710142033
13/01/2005 SMKN CIKEUSIK TAMBELAK 085892626530
10/12/2004 SMKN CIKEUSIK PEMATANG SEMPUR 081210502871
14/05/2005 SMKN CIKEUSIK SUKASENENG 081296605083
24/10/2004 SMKN CIKEUSIK SUMURBATU 081363193238
30/08/2004 SMKN CIKEUSIK LEUWIKOPO 082123167119
03/09/2004 SMKN CIKEUSIK SUMURBATU 08385168840
11/05/2005 SMKN CIKEUSIK CIRIRIGI 085692365818
13/10/2004 SMKN CIKEUSIK RANCASENENG 085871616766
27/06/2005 SMKN CIKEUSIK RANCASENENG 085882165296
10/11/2004 SMKN CIKEUSIK CIKEUSIK 082113222482
15/03/2006 SMKN CIKEUSIK BUNUT HILIR 085894185346
06/02/2006 SMKN CIKEUSIK PERMATANG SEMPUR 081213176153
10/07/2004 SMKN CIKEUSIK UMBULAN 085212102288
20/09/2006 SMKN CIKEUSIK LIMPAS 081511865936
07/10/2005 SMKN CIKEUSIK KATAPANG 0858811459177
02/06/2005 SMKN CIKEUSIK BABAKAN CIBALIUNG 085892626628
25/07/2004 SMKN CIKEUSIK BINUANGEN 081213347828
09/05/2005 SMKN CIKEUSIK SUMURBATU 081398498203
27/07/2004 SMKN CIKEUSIK PARKOS 085710525539
13/05/2006 SMKN CIKEUSIK SUMBERJAYA 085283234127
09/02/2004 SMKN CIKEUSIK LEWIKOPO 085882816204
08/04/2002 SMKN CIKEUSIK CIKEUSIK 085778182923
03/11/2005 SMKN CIKEUSIK SUMURBATU 085782773236
17/01/2005 SMKN CIKEUSIK SINAPEL 082125842307
04/07/2005 SMKN CIKEUSIK BEJOD 085772329698
15/08/2004 SMKN CIKEUSIK PARKOS 08570723103
12/03/2004 SMKN CIKEUSIK CIKARET 085714379717
13/08/2005 SMKN CIKEUSIK CIKEUSIK 085695202744
10/10/2006 SMKN CIKEUSIK CIKEUSIK 085718733617
10/05/2005 SMKN CIKEUSIK BABAKAN CIBALIUNG 085694941700
27/07/2004 SMKN CIKEUSIK BALAGUNG 081299368079
01/06/2005 SMKN CIKEUSIK CIBANGKONOL 085718246808
24/09/2005 SMKN CIKEUSIK SUKAWARIS 085773233091
02/12/2007 SMKN CIKEUSIK SUKAJAYA 085715282135
21/09/2005 SMKN CIKEUSIK CILUKUT 085695851906
02/10/2006 SMKN CIKEUSIK KATAPANG 081511757267
01/10/1975 MASYARAKAT CIKEUSIK 08558711479
21/11/1989 MASYARAKAT UMBULAN 085721272040
18/02/1959 MASYARAKAT CIKEUSIK 085279126839
07/05/1989 MASYARAKAT TANJUNGAN 085774013169
27/12/2001 MASYARAKAT KARANG SAMBUNG 085693477211
01/07/1987 MASYARAKAT BARENGKOK 0853313704887
24/05/1972 MASYARAKAT PASIR GOMBANG 081282875345
24/04/2001 SMKN CIKEUSIK SUKASENENG 085352825717
09/01/1970 TANJUNGAN 085772833556
01/04/1982 SUMURBATU 085732997956
03/06/2005 SMKN CIKEUSIK 081240727748
19/03/1978 SUKASENENG 085711046079
10/06/1980 MASYARAKAT CIKUPA 0859331863780
25/09/1986 MASYARAKAT KADUPINANG 081219468996
10/10/2006 SMKN CKS RANCASENENG 085735581955
28/11/1970 MASYARAKAT TANJUNGAN 081348297165
07/10/1990 MASYARAKAT SUMURBATU 085781501511
25/11/2002 MASYARAKAT RANCA SENENG 085778986738
28/09/1983 MASYARAKAT SUKA SENENG 085711046079
16/04/1980 MASYARAKAT SUKAWARIS 081315728146
20/09/1999 MASYARAKAT PEMATANG SEMPUR 085781080007
02/07/1990 MASYARAKAT SUKASENENG 081287276072
19/08/2004 MASYARAKAT SUKASENENG 083872737009
07/01/1971 MASYARAKAT UMBULAN 081319411818
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal
Merek Tanggal
BPJS BPJS Non Screeni No.
Vaksin*** Pemberian No seri
PBI Non PBI Anggota ng Batch
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SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
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SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
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SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24200121
SINOVAC 09/09/21 09/09/21 24003121
SINOVAC 09/09/21 09/09/21
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SINOVAC 09/09/21 09/09/21
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SINOVAC 09/09/21 09/09/21
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SINOVAC 09/09/21 09/09/21
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SINOVAC 09/09/21 09/09/21
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SINOVAC 09/09/202109/09/2021
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SINOVAC 09/09/21 12/08/21 24200121
SINOVAC 09/09/21 12/08/21 24200121
SINOVAC 09/09/21 12/08/21 24200121
SINOVAC 09/09/2021
SINOVAC 09/09/202112/08/2021
SINOVAC 09/09/2021
SINOVAC 09/09/202129/07/2021
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SINOVAC 09/09/2021
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SINOVAC 09/09/21 05/08/21 24003121
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SINOVAC 09/09/21 09/08/21 24003121
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SINOVAC 09/09/21 09/08/21 24003121
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi
DOSIS 1
09/09/21 24200121 DOSIS 2
09/09/21 24200121 DOSIS 2
09/09/21 24200121 DOSIS 2
09/09/2021 24200121 DOSIS 2
09/09/2021 24200121 DOSIS 2
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9/9/2021 24200121 DOSIS 2
09/09/2021 24200121 DOSIS 2
09/09/2021 24200121 DOSIS 2
09/09/2021 24200121 DOSIS 2
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09/09/21 24200121 DOSIS 2
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09/09/21 24200121 DOSIS 2
09/09/21 24200121
09/09/21 24200121 DOSIS 2
09/09/21 24200121 DOSIS 2
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09/09/21 24200121 DOSIS 2
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601041102910004 MEDI L
2 3601042010890000 ANANG SURYANA L
3 3601044211860001 ADAH BT JUMAN P
4 3601045101780001 WARTI P
5 3601045103650004 SUPIAH P
6 3601044703830002 ENAH P
7 3601044101760002 RODIAYAH P
8 3601041203920001 RO'I L
9 3601044104930001 SARNAWATI P
10 3601045207890004 SANTI P
11 3601044303800001 SARNAH P
12 3601044507870007 SITI JUHARIAH P
13 3601044111800001 KASNITI P
14 3601044702920004 UMAYAH P
15 3601045009720003 JARMAH P
16 3601040102820000 MADRAS L
17 3601040503810001 KANTA L
18 3601044609940005 SITI SUNIMAH P
19 1811021111860004 EMAN DIDI SUPRIADI L
20 3601044910890001 SATIKAH P
21 3601040411900003 DEDI L
22 3601045609020003 MILAWATI P
23 3601045703730001 SADAH P
24 3601044701640001 NARWATI P
25 3601040603900001 RAHMAT L
26 3601044701820007 EMI P
27 3601044407740001 SURNI P
28 3601044111690002 MISNAH P
29 3601045503690002 ANIS P
30 3601040104770003 HASAN BASRI L
31 3601044112790001 ARMAENI BT JASWAD P
32 3601045903890001 ERUM RUMSYIAH P
33 3601040101910002 RUSLAN L
34 3601045901880000 ARCENAH P
35 3601046801900002 BAYI P
36 3601044608890003 RUMSAH P
37 3601044107720088 ESIH P
38 3601044403780000 HODIJAH P
39 3601040701920003 HUMAEDI L
40 3601044109040006 NENI P
41 3601044403770002 ETI P
42 3601045103750001 DARSIH BT DALIM P
43 3601042607870002 ANDI KUSWANDI L
44 3601045109870002 SARNAWATI P
45 3601045110850001 CUCUN SUNAETI P
46 3601046507800004 NURHAYATI BT NASIRP
47 3601044108850016 WATI P
48 3601044511910001 IPIN L
49 3601046511850000 NURJANAH P
50 3601045204940003 RENNY APRILIANTI P
51 3601044904880002 JUMINAH P
52 3601044507800003 SARWIT P
53 3601045101860001 SAETI P
54 3601044910700001 NURMI P
55 3601044206850002 SARNI P
56 3601044102930019 TATI NURHAYATI P
57 3601044209900003 NURAENI P
58 3601044404650001 PARMINAH P
59 3601045708990005 HENI NURAENI P
60 3601044511660001 SAPIAH P
61 3601045909820004 NENG SALAMAH P
62 3601044304920005 SITI SUSANTI P
63 3601041104880005 AJUY L
64 3601045101890000 INAH P
65 3601044206910000 DESI P
66 3601045110520000 SARKIMAH P
67 3601040301850005 JAENUDIN L
68 3601040108850000 JUMHADI L
69 3601041601780000 ADI NURAHDI L
70 3601040411730001 OON SAHRONI L
71 3601041201900001 SARBINI L
72 3601040505910001 MUHAMAD JALIL L
73 3601040708860004 ABDUROHMAN L
74 3601040401700001 SANTIBI
75 3601041111780001 KURTUBI L
 Umur Kelompok
Pekerjaan* INSTANSI
(18-59 tahun) Umur

11/02/1991 MASYARAKAT
20/10/1989 MASYARAKAT
02/11/1986 MASYARAKAT
11/01/1978 MASYARAKAT
11/03/1965 MASYARAKAT
07/03/1983 MASYARAKAT
01/01/1976 MASYARAKAT
20/02/1990 MASYARAKAT
01/04/1993 MASYARAKAT
12/07/1989 MASYARAKAT
03/03/1987 MASYARAKAT
05/07/1987 MASYARAKAT
01/11/1980 MASYARAKAT
20/03/1994 MASYARAKAT
10/09/1972 MASYARAKAT
07/03/1985 MASYARAKAT
02/03/1982 MASYARAKAT
06/09/1994 MASYARAKAT
11/11/1986 MASYARAKAT
09/10/1989 MASYARAKAT
04/11/1990 MASYARAKAT
16/09/2002 MASYARAKAT
19/08/1978 MASYARAKAT
07/01/1964 MASYARAKAT
06/03/1990 MASYARAKAT
07/01/1982 MASYARAKAT
04/07/1974 MASYARAKAT
01/02/1975 MASYARAKAT
15/03/1969 MASYARAKAT
06/06/1997 MASYARAKAT
18/08/1983 MASYARAKAT
09/02/1980 MASYARAKAT
08/03/1990 MASYARAKAT
08/03/1985 MASYARAKAT
28/10/1985 MASYARAKAT
07/03/1981 MASYARAKAT
05/07/1982 MASYARAKAT
04/03/1878 MASYARAKAT
07/01/1992 MASYARAKAT
01/09/2004 MASYARAKAT
20/02/1971 MASYARAKAT
11/03/1975 MASYARAKAT
26/07/1987 MASYARAKAT
09/06/1990 MASYARAKAT
11/10/1986 MASYARAKAT
04/07/1989 MASYARAKAT
01/08/1985 MASYARAKAT
05/11/1991 MASYARAKAT
25/11/1985 MASYARAKAT
12/04/1992 MASYARAKAT
04/01/1988 MASYARAKAT
05/07/1980 MASYARAKAT
11/01/1976 MASYARAKAT
12/04/1975 MASYARAKAT
02/06/1985 MASYARAKAT
01/02/1993 MASYARAKAT
02/09/1990 MASYARAKAT
04/04/1964 MASYARAKAT
17/08/1999 MASYARAKAT
05/11/1966 MASYARAKAT
05/05/1986 MASYARAKAT
06/01/1992 MASYARAKAT
11/04/1988 MASYARAKAT
11/01/1989 MASYARAKAT
02/06/1991 MASYARAKAT
11/10/1952 MASYARAKAT
01/03/1995 MASYARAKAT
06/05/1988 MASYARAKAT
09/11/1980 MASYARAKAT
05/05/1974 MASYARAKAT
20/03/1988 MASYARAKAT
20/02/1991 MASYARAKAT
07/08/1986 MASYARAKAT
21/071979 MASYARAKAT
21/06/1978
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)

Alamat NO HP BPJS BPJS Non

PBI Non PBI Anggota

LEUWIBALANG 085697188427
SUKAWARIS 083873691125
LEUWIBALANG 085694528122
LEUWIBALANG 081584597841
LEUWIBALANG 085861051687
LEUWIBALANG 085697186427
LEUWIBALANG 085697180427
LEUWIBALANG 085770954200
LEUWIBALANG 085691437278
LEUWIBALANG 085691312842
LEUWIBALANG 081584597841
LEUWIBALANG 085773237513
LEUWIBALANG 085885443115
LEUWIBALANG 085871616802
LEUWIBALANG 085821782319
LEUWIBALANG 085782490951
LEUWIBALANG 085811946793
LEUWIBALANG 085691096361
LEUWIBALANG 085716925216
LEUWIBALANG 081517028191
LEUWIBALANG 085695309765
LEUWIBALANG 085882378175
LEUWIBALANG 085776830008
LEUWIBALANG 085770954200
LEUWIBALANG 085782311580
LEUWIBALANG 081517355201
LEUWIBALANG 081517355201
LEUWIBALANG 085885443113
LEUWIBALANG 081577355201
LEUWIBALANG 085886901442
LEUWIBALANG 085821782319
LEUWIBALANG 081517355201
LEUWIBALANG 85691312724
LEUWIBALANG 085697180427
LEUWIBALANG 085882797489
LEUWIBALANG 081517355201
LEUWIBALANG 085811157163
LEUWIBALANG 081517355201
LEUWIBALANG 085782490969
LEUWIBALANG 085695409586
LEUWIBALANG 081517355201
LEUWIBALANG 085718725096
LEUWIBALANG 085715920310
LEUWIBALANG 085776830008
LEUWIBALANG 085775554474
LEUWIBALANG 085886901442
LEUWIBALANG 085813588705
LEUWIBALANG 085770136388
LEUWIBALANG 08581358705
LEUWIBALANG 085775554474
LEUWIBALANG 085715440793
LEUWIBALANG 081517181538
LEUWIBALANG 085697180427
LEUWIBALANG 085811157163
LEUWIBALANG 08581358705
LEUWIBALANG 085893390973
LEUWIBALANG 085715440793
LEUWIBALANG 085811157163
LEUWIBALANG 08581358705
LEUWIBALANG 08581358705
LEUWIBALANG 08571892411
LEUWIBALANG 081517181538
LEUWIBALANG 085691096361
LEUWIBALANG 085695267645
LEUWIBALANG 081617140503
LEUWIBALANG 08581358705
LEUWIBALANG 085892178765
LEUWIBALANG 085772304197
LEUWIBALANG 085811652590
LEUWIBALANG 08571892411
LEUWIBALANG 085771731859
LEUWIBALANG 081617370499
LEUWIBALANG 085772730616
LEUWIBALANG 085776105140
085776105140
 Dosis I

Tanggal Tanggal
Merek Vaksin***
Screening Pemberian No. Batch No seri
Vaksinasi

CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339

CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291706860339
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
CORONAVAC 10/09/2021 10/09/2021 202108151I 16291713431872
 Dosis 2
Tanggal
Pemberi KET
an No. Batch No Seri
Vaksina
si
NO No. Ticket NIK Nama Penerima Vaksin

1 360327510170001 ADELIA
2 36010410907060001 SITI JAOZAH
3 36010414070001 MOH. PAISAL ABDALI
4 360104410706000123 EUIS IRIYANTI
5 3601040207070009 SUTISNA
6 JANIN
7 3601046904070001 OLIVIA
8 1312060607060002 RISKI MATONDANG
9 M.MASRI
10 3601041310870001 CALI
11 601041811070001 AWALUDIN
12 RIA ASTARI
13 SAEPUL
14 3601044501080005 WINDA LAURA
15 3601042003070002 MUHAMAD MARJUK
16 36010402070013 ABDUL SUKIRNO
17 NURYANDA
18 3601044510080003 RANTIAH
19 3601041200060002 HARIS MAULANA
20 3601030806930001 ASEP
21 3601045908010001 AULIA
22 3601040211060001 ELMAN YOGA
23 36010456060005 ANA AISYAH
24 3601045410070006 NIA DWI. S
25 OMAN SUKMAWAN
26 3601041203060003 RIDWAN
27 3601047004070003 ALESYA SUKEMAN
28 180905211200002 DAVID HERMAWAN
29 3601044802060002 FATMAWATI
30 3601044106880001 ELIS NURHAYATI
31 AYU TRIYANTI
32 3601045412060001 ANISA WAHYUNI
33 ARYA SUKIN
34 3601041805060002 M. ABDULAH
35 3601041302050003 HENDRI. M
36 3601044204080003 TIARA
37 SISKA
38 36041104070002 M. RIO FEBRIAN
39 360104506070004 RISKI
40 IRNAWATI
41 HANAPI
42 3603181504060012 M. ICHSAN NAWAWI
43 OJI PRIATNA
44 3601041309070001 SUPRANI
45 3601045502070002 DIANA FEBRIANTI
46 3602214207060001 INTANIA
47 DORI
48 3601046808870002 ADE ROHAYATI
49 3601040701030003 SUPYANA
50 SITI FATIMAH
51 3601041606050001 SERA YUDHISTIRA
52 3601040207050017 M. ERLANGGA
53 3601042502050001 SOFYAN
54 3601046210060003 SITI RADA
55 SHELLY SAFITRI
56 3601042209030002 ARI LANDONA
57 ALDA LAILA
58 3601042301040002 DEDE DARUSALAM
59 360104812070001 SITI AYU SRI MULASIH
60 3601041708080008 ARDA ARDIANSYAH
61 3601045363080001 ERLINA. DR
62 3601046203090001 AULIA DIFAH
63 3602216912080006 IIN AULIYA
64 NURUL
65 3601045509090003 ELSA
66 3601042908080002 AGIH RAMADAN
67 3601044810680001 DELA NURLATIFAH
68 3601046302090003 RENI
69 IRSYANDI WIRANATA
70 3601041612820002 TARSONDI
71 SINTIA
72 3601041700200006 ABDUL ROHMAN
73 3601045104090001 UNAY
74 3601042911090001 MAMAN ABDUROHMAH
75 360104590780002 SOFIYAH
76 3601044312080001 CANISAH
77 3601040908090002 KRISH YANDI
78 3601040701082110 MARLINA
79 '3601042202090001 M. ARIP
80 3601044205090004 NENG PUPUT
81 3601042002090001 NANANG
82 3601044503090003 TASIH MAELANI
83 VIANA APRILIA
84 3601047108090003 NASILA RIANA
85 3601040810080001 HABIBI MUSTOPA
86 3602215004090002 SITI FADILAH
87 DIANA KHOMSAH
88 SAWI
89 SRI MEGA
90 3601045805080001 HERLINDA
91 DEDE RANI
92 NASIROH
93 3601042303900002 ROIP
94 MUCHLISH
95 M. RIDIANSYAH
96 EVA YULIANTI
97 FITRI AULIA
98 3601042308060005 AHMAD JUNAEDI
99 360104021080001 WARHAMNA
100 ECA TRESHANA
101 3172024710070006 OKTALIA
102 OTIH NABILA
103 3601044212080001 DESTI ANDINI
104 3601040609070001 JAMANI
105 3601045707070001 ANITA
106 3601042912080009 REVI ALIF
107 MULYANA
108 360104451080001 ICA NURKHOLISAH
109 3202085107070004 AIRA
110 3602214712060002 SITI NURJANAH
111 3601044404080006 NILASARI
112 3601041109060005 AHMAD
113 M. FARIZ
114 3601046102070005 ULFAH UZIAH
115 TISNA
116 3601040910280004 IDAM
117 3601045209070001 SITI DIANA
118 DIDO
119 1506115807080001 SOPIA RAHMAWATI
120 3601046401080001 EUIS CAHYANI
121 3601042105830004 MAMI SUTAMI
122 3601046310920001 KESIH
123 3601041906070002 ANDRI YANA
124 SITI RIA KHOSIAH
125 DINI AULIA
126 AHYANI
127 3601044202090001 SAROH
128 3601042202080001 RAFA PRATAM
129 3601044301080002 ANITA
130 ASEP SAEPUDIN
131 3601043005820001 DERI
132 3601044708060005 SITI NURAISAH
133 360105206070001 SUSI JUNIYATI
134 3601045004070001 LASTRI
135 3601046107080002 AMELIA
136 3601041612060002 EGI T
137 3601040207060009 FIRMAN
138 3601041403910001 M. BUDIN
139 3602210406070004 M. ALPIANDI
140 360104400806004 SITI NURINA
141 3601045704070001 MIRNAWATI
142 36010441070700027 HAYATI
143 360104090208004 M. ARIF ISMAIL
144 3601042906750002 TODI
145 NANANG M RIZKI
146 360104490980002 NOVI PEBRIANTI
147 3601042412960001 SARNA
148 3601042802780001 SARTONO
149 3601045312070001 HERNI CAHYA
150 RIANY
151 3601044107760221 KARTI
152 3601046712060002 MITA MIRANDA
153 3601045210070001 RIA ASTARI
154 3601044910060002 RAHMAWATI
155 3602210711070001 ROYADIANSYAH
156 3601040803070001 MARFIN MAUZAT
157 3601044908030003 DEFIT
158 3601042402060002 ARNAH
159 3602214911990002 RAHMA ALYA
160 3601041007800004 APING
161 3601044305080005 SOFI
162 3601040107930233 SAMAN
163 3601044107830361 UNENTI
164 3601044207060005 UTAMI
165 360104606080003 POPI PUSPITASARI
166 3601041209060003 M. SELAMET
167 3601046602070002 FAUZIAH
168 3601042610800001 RASJA
169 SANI ATIKA SARI
170 3601044807080004 SELA
171 3601042610030001 WAHYU
172 3601045001750003 CARINIH
173 3601041005890008 EMUH
174 3601046702080001 TATIANA
175 36010442070070008 MILA FAUZIAH
176 3601041102040001 SANA
177 3601046110910003 NURHASANAH
178 3601042503070001 MUHAMAD ALIP
179 3601044112070001 ANGGUN MUHIRA
180 3601042506080001 TAMRIN
181 3601040110840003 SARPIN
182 3601042904070001 FAZRIANSYAH
183 36010402007060012 WAHYUDIN
184 3601045001070000 SITI FADILAH
185 HAYATI NUPUS
186 3601043107070001 REGA ANGGARA
187 3601044107000232 WIWIN DAMAYANTI
188 3601044107970183 NARPEN
189 3601046207070002 RAHMAWATI
190 3601046910070002 ANIS KHOIRUNNISA
191 3601040609080002 CANDY PURNAMA
192 360104230303060003 YOGI SAPUTRA
193 WULAN AYU
194 3601044106810003 KARWI KURNIASIH
195 3601040103070001 RINO ANTONI
196 3601044702690001 WASTIAH
197 3601045204070005 MIA HANDAYAN
198 3601041002070003 RENO
199 3601044708060006 SITI KHODIJAH
200 3600421650204002 SUHETI
201 3602214507990006 SUSI SULISTIANI
202 3601044107850268 ATIFAH
203 3602214602030002 ITA PURNAMASARI
204 3601042802060003 APDAL
205 3601040508910001 MOH. FAIZA
206 3601040207050013 JASRIP
207 3601041505070002 RANGGA
208 SINDI YANTINI
209 3602211708060005 REPAN
210 HERDIANSYAH
211 3601044505080002 IKA AULIA
212 3601045702080005 SITI ROHENAH
213 360104540060003 YANTI
214 3601040705070006 YOGA
215 3601041012030001 HANAPI
216 3601042802070003 FRENGKY
217 3601047008070004 ZAHWA NAJILAH
218 3601045307060001 SHINTA
219 3601040004060002 FAIZAL PUJI KANDUNG
220 3601047011930001 NOVA NOVITASARI
221 3601042703060001 ADI SEPTIYADI
222 3601044501080007 SITI MARYAM
223 3601041511050001 DIMAS AJI
224 3601042306050001 FAISAL FAUZI
225 360221270906005 BAYU RAMDAM
226 3601042512080008 MIRANTO HAMDAN
227 3601040407740003 SUKRANI
228 3601042312080001 MUHAMAD FIKRI
229 3601046204090001 ENUR HASANAH
230 3601043005090004 CHOIRUL ANWAR
231 3601041011080003 ROJALI
232 3601041206090003 FERI HASANUDIN
233 3601040702080001 INDRA
234 3602094407090001 RAHMA HANIFA
235 3601041101120003 M. KHALID
236 3601042001090004 MOH SAEFUL
237 3601042501080001 IRMAN
238 3601044309090001 INDAH
239 3601040604090001 RIPA
240 3601044611000001 HANI FADILAH
241 3601040402720002 PANDI
242 360104071008001 MISTRA
243 3601045401090001 INTAN JELIKA
244 3601040101090006 DIMAS SETIAWAN
245 3601045203090004 INTAN NURAENI
246 3601041505090001 PERDI
247 3601044812080002 ADHANA MUSARIPAH
248 2172046605090001 SOVIANO DEWI
249 3602214402040002 SYIFA RISKA
250 3602214210080001 LIA RAHMAWATI
251 3602210709090004 SURYANA
252 3602214606080001 M. ILHAM
253 3601041105080001 FERLI
254 3602212912080001 M. FAHRUL ROJI
255 3601040704020000 KESYA R
256 3601044206080006 RANI YULIANI
257 3601044407070003 YULIANTI
258 3602214210070004 ELSA RAMADANI
259 3601044603080001 NURHESTI
260 3601040207070011 NURHIDAYAT
261 3601045808070003 SILVIANI
262 3601040107070015 DODI KURNIA
263 3601040501090002 JAJA
264 AKBAR MAULANA
265 SURYANAH
266 3601042603080003 ALAN M YUSUF
267 3601040707080002 AHMAD FAUZAN
268 3601042503070003 JUJUN JUNAEDI
269 SURYADI
270 3601044009096002 SITI NURHASANAH
271 3601046812040001 MUTIA AYU
272 3601043006070002 RAHMAT
273 3601047101000001 ERVINA
274 3601045606090001 ERLINA
275 3601042212060001 RASYA DERAHMAN
276 180905680404004 YANAH
277 3601044107080020 JUWITA KOMALA
278 3601041309990001 ANDARA SERLI
279 360104500080002 JUWITA AYU LESTARI
280 3602214101080010 SUHERNI
281 3601044603080001 FARHAN FAUZAN
282 3601042410070002 KARNO
283 3601044109070003 SITI KHOSIAH
284 3601040901080005 YANDI
285 3601041501090003 SURITNO
286 3601041802080001 FIKRI FEBRIANSYAH
287 3601040107040060 WAHIDIN
288 3601042003080001 MULYA WIGUNA
289 3601041505080005 A. WIRA SATYA
290 3601040505060001 DENI IRAWAN
291 3212061508080002 SATRIA HERDINU
292 3601040508080001 IRPAN
293 3601040302080001 AHYANI
294 3601047004090006 SEKAR
295 3601041204090005 HERYANTO
296 360104110308004 M. ARIPIN
297 P-9HMORNI1 3601044702960005 NOPIANA DEWI
298 P-0HXK4VJA 3212051808900002 SUNARTO
299 P-5SAVUKVG 1806180508010002 AGUS PURWANTO
300 P-69AHNSLI 1806181506010002 DEDE SAPUTRA
301 P-6NK0YX2A 3601043103980001 SUPRIYADI
302 360320107920068 DIATUL M
303 3601042107820001 SUANI
304 P-3LCALBSX 3601045105080001 RIRI
305 P-2ND6B1CPO 3601041507800016 ENDI SUTARJO
306 180618060620001 INDRI JAILANI
307 3601044407020003 CINDY AUKIA. R
308 ENENG SITI ROFIKOH
309 RODIN MAULAN
 Umur Kelompok
JK Pekerjaan* INSTANSI
(18-59 tahun) Umur

P 11-01-2007 MTSN 6 CKS

P 29-07-2006 MTSN 6 CKS
L 14-04-2007 MTSN 6 CKS
P 04-04-2007 MTSN 6 CKS
L 28-02-2006 MTSN 6 CKS
L 14-02-1982 MASYARAKAT
P 29-04-2007 MTSN 6 CKS
L 06-07-2008 MTSN 6 CKS
L
L 06-07-1985 MASYARAKAT
L 18-11-2007 MTSN 6 CKS
P 15-10-2007 MTSN 6 CKS
L 15-03-2007 MTSN 6 CKS
P 05-01-2008 MTSN 6 CKS
L 20-03-2007 MTSN 6 CKS
L 25-03-2007 MTSN 6 CKS
L 06-04-1985 MASYARAKAT
P 05-10-2008 MTSN 6 CKS
L 12-10-2006
L 08-06-1993 MTSN 6 CKS
P 14-08-2001 MTSN 6 CKS
L 02-11-2008 MTSN 6 CKS
P 16-06-2006 MTSN 6 CKS
P 14-10-2007 MTSN 6 CKS
L 04-08-1986 MASYARAKAT
L 12-03-2006 MTSN 6 CKS
P 30-04-2007 MTSN 6 CKS
L 21-12-2000
P 08-02-2006 MTSN 6 CKS
P 29-07-1991
P 22-05-2007 MTSN 6 CKS
P 14-12-2006 MTSN 6 CKS
L 03-10-2007 MTSN 6 CKS
L 18-05-2006 MTSN 6 CKS
L 13-02-2005
P 02-04-2008 MTSN 6 CKS
P 21-07-2008 MTSN 6 CKS
L 11-04-2007 MTSN 6 CKS
L 05-06-2007 MTSN 6 CKS
P 15-03-2004
L 28-12-1991
L 15-04-2006 MTSN 6 CKS
L 17-02-2007 MTSN 6 CKS
L 13-09-2007 MTSN 6 CKS
P 15-02-2007 MTSN 6 CKS
P 02-07-2006 MTSN 6 CKS
L 04-08-2003
P 28-08-1987
L 12-04-2002
P 06-10-1996
L 16-06-2005
L 20-05-2004
L 25-07-2005
P 22-10-2006
P 18-11-2007 MTSN 6 CKS
L 22-09-2003
P 01-11-2008
L 23-01-2004
P 28-12-2007 MTSN 6 CKS
L 17-08-2008 MTSN 6 CKS
P 13-09-2009
P 22-12-2009
P 29-12-2008 MTSN 6 CKS
P 15-08-2008 MTSN 6 CKS
P 15-09-2009 MTSN 6 CKS
L 29-08-2008 MTSN 6 CKS
P 08-10-2008 MTSN 6 CKS
P 23-02-2009 MTSN 6 CKS
L 11-10-2008 MTSN 6 CKS
L
P 03-06-2009 MTSN 6 CKS
L
P 11-04-2009
L 29-11-2009
P 19-07-2008 MTSN 6 CKS
P 03-12-2008 MTSN 6 CKS
L 09-08-2009 MTSN 6 CKS
P 09-04-2009 MTSN 6 CKS
L 22-02-2009 MTSN 6 CKS
P 02-05-2009 MTSN 6 CKS
L 20-02-2009 MTSN 6 CKS
P 05-03-2009 MTSN 6 CKS
P 20-04-2008 MTSN 6 CKS
P 31-08-2009 MTSN 6 CKS
L 08-10-2008 MTSN 6 CKS
P 10-04-2009 MTSN 6 CKS
P 13-02-1997 MTSN 6 CKS
P 01-09-1967 MTSN 6 CKS
P 14-08-2008 MTSN 6 CKS
P 18-05-2008 MTSN 6 CKS
P 22-01-2007 MTSN 6 CKS
P 05-09-2009 MTSN 6 CKS
L 23-03-1990
L 31-03-2007 MTSN 6 CKS
L 22-11-2007 MTSN 6 CKS
P 02-01-2008 MTSN 6 CKS
P 01-10-2008 MTSN 6 CKS
L 23-08-2006 MTSN 6 CKS
L 02-11-2008 MTSN 6 CKS
P 08-08-2008 MTSN 6 CKS
P 07-10-2007 MTSN 6 CKS
P 16-01-2009 MTSN 6 CKS
P 02-12-2008 MTSN 6 CKS
L 06-09-2007 MTSN 6 CKS
P 08-07-2007 MTSN 6 CKS
L 29-12-2008 MTSN 6 CKS
L 15-01-2008 MTSN 6 CKS
P 05-11-2008 MTSN 6 CKS
P 11-07-2007 MTSN 6 CKS
P 01-07-2008 MTSN 6 CKS
P 04-04-2008 MTSN 6 CKS
L 11-09-2006 MTSN 6 CKS
L 06-01-2006 MTSN 6 CKS
P 20-12-2007 MTSN 6 CKS
P 28-09-2008 MTSN 6 CKS
L 09-10-2008 MTSN 6 CKS
P 12-09-2007 MTSN 6 CKS
L 12-03-2008 MTSN 6 CKS
P 18-07-2008 MTSN 6 CKS
P 24-01-2008
L 21-05-2983
P 23-10-1992
L 19-08-2007 MTSN 6 CKS
P 26-04-2007 MTSN 6 CKS
P 30-03-2008 MTSN 6 CKS
L 02-02-2008 MTSN 6 CKS
P 04-02-2009 MTSN 6 CKS
L 22-02-2008 MTSN 6 CKS
P 03-06-2008 MTSN 6 CKS
L 08-08-2000 MTSN 6 CKS
L 17/0/1981 MASYARAKAT
P 07/08/2006 MTS 6 CIKEUSIK
P 12/06/2007 MTS 6 CIKEUSIK
P 10/04/2007 MTS 6 CIKEUSIK
P 21/07/2008 MTS 6 CIKEUSIK
L MTS 6 CIKEUSIK
L 29/11/2006 MTS 6 CIKEUSIK
L 21/11/1990 MASYARAKAT
L 04/06/2007 MTS 6 CIKEUSIK
P 09/08/2006 MTS 6 CIKEUSIK
P 17/04/2007 MTS 6 CIKEUSIK
P 10/07/2007 MTS 6 CIKEUSIK
L 09/02/2008 MTS 6 CIKEUSIK
L 29/06/1975 MASYARAKAT
L MTS 6 CIKEUSIK
P 09/09/2008 MTS 6 CIKEUSIK
L 24/12/1998 MASYARAKAT
L 10/04/1975 MASYARAKAT
P 13/12/2007 MTS 6 CIKEUSIK
P 20/10/2006 MTS 6 CIKEUSIK
P 18/01/1974 MASYARAKAT
P 27/12/2006 MTS 6 CIKEUSIK
P 15/10/2007 MASYARAKAT
P 09/10/2006 MTS 6 CIKEUSIK
L 20/01/2007 MTS 6 CIKEUSIK
L 08/03/2007 MTS 6 CIKEUSIK
L 09/08/2003 MTS 6 CIKEUSIK
P 24/02/2000 MTS 6 CIKEUSIK
 P 28/02/2008 MTS 6 CIKEUSIK
L 20/08/1970 MASYARAKAT
P 03/05/2008 MASYARAKAT
L 01/07/1993 MASYARAKAT
P 06/12/1980 MASYARAKAT
P 02/02/2006 MTS 6 CIKEUSIK
P 23/05/2007 MTS 6 CIKEUSIK
L 12/09/2001 MTS 6 CIKEUSIK
P 26/02/2007 MTS 6 CIKEUSIK
L 26/10/1980 MASYARAKAT
P 12/08/2006 MTS 6 CIKEUSIK
P 28/01/2008 MTS 6 CIKEUSIK
L 12/04/2004 MTS 6 CIKEUSIK
L 10/01/1975 MASYARAKAT
L 10/05/1989 MASYARAKAT
P 27/02/2008 MTS 6 CIKEUSIK
P 12/06/2007 MTS 6 CIKEUSIK
L 11/02/2004 MTS 6 CIKEUSIK
P 21/10/1991 MASYARAKAT
L 25/03/2007 MTS 6 CIKEUSIK
P 01/12/2007 MTS 6 CIKEUSIK
L 25/06/2008 MTS 6 CIKEUSIK
L 01/10/1964 MASYARAKAT
L 29/04/2007 MTS 6 CIKEUSIK
L 17/02/2007 MTS 6 CIKEUSIK
P 10/01/2007 MTS 6 CIKEUSIK
P 26/05/2008 MTS 6 CIKEUSIK
L 31/07/2007 MTS 6 CIKEUSIK
P 05/01/1999 MASYARAKAT
P 15/05/1996 MASYARAKAT
P 22/07/2007 MTS 6 CIKEUSIK
P 29/10/2007 MTS 6 CIKEUSIK
L 06/09/2008 MTS 6 CIKEUSIK
L 23/03/2006 MTS 6 CIKEUSIK
P 14/07/2007 MTS 6 CIKEUSIK
L 01/06/1981 MASYARAKAT
L 12/03/2004 MTS 6 CIKEUSIK
P 15/07/1976 MASYARAKAT
P 04/12/2007 MTS 6 CIKEUSIK
L 10/02/2007 MTS 6 CIKEUSIK
P 07/08/2006 MTS 6 CIKEUSIK
P 25/02/2004 MTS 6 CIKEUSIK
P 11/03/2004 MTS 6 CIKEUSIK
P 05/01/1984 MASYARAKAT
P 24/01/2004 MTS 6 CIKEUSIK
L 28/02/2006 MTS 6 CIKEUSIK
L 05/08/1991 MASYARAKAT
L 23/06/2006 MTS 6 CIKEUSIK
L 02/05/2007 MTS 6 CIKEUSIK
P 16/02/2004 MTS 6 CIKEUSIK
L 17/08/2006 MTS 6 CIKEUSIK
L 29/10/2001 MTS 6 CIKEUSIK
P 05/05/2008 MTS 6 CIKEUSIK
P 17/02/2008 MTS 6 CIKEUSIK
P 12/1/2006 MTS 6 CIKEUSIK
L 07/05/2007 MTS 6 CIKEUSIK
L 10/12/2003 MTS 6 CIKEUSIK
L 28/02/2007 MTS 6 CIKEUSIK
P 30/08/2007 MTS 6 CIKEUSIK
P 13/07/2006 MTS 6 CIKEUSIK
L 09/04/2006 MTS 6 CIKEUSIK
P 30/11/1993 MASYARAKAT
L 27/03/2006 MTS 6 CIKEUSIK
P 05/01/2008 MTS 6 CIKEUSIK
L 15/11/2005 MTS 6 CIKEUSIK
L 23/06/2006 MTS 6 CIKEUSIK
L 27/09/2006 MTS 6 CIKEUSIK
L 25/12/2008 MTS 6 CIKEUSIK
L 04/07/1974 MASYARAKAT
L 23/12/2008 MTS 6 CIKEUSIK
L 22/04/2009 MTS 6 CIKEUSIK
L 30/05/2009 MTS 6 CIKEUSIK
L 10/11/2008 MTS 6 CIKEUSIK
L 12/06/2009 MTS 6 CIKEUSIK
L 07/02/2008 MTS 6 CIKEUSIK
P 04/07/2009 MTS 6 CIKEUSIK
L 29/04/2009 MTS 6 CIKEUSIK
L 20/01/2009 MTS 6 CIKEUSIK
L 25/01/2008 MTS 6 CIKEUSIK
P 03/09/2009 MTS 6 CIKEUSIK
P 06/04/2009 MTS 6 CIKEUSIK
P 06/11/2000 MTS 6 CIKEUSIK
L 15/07/1963 MTS 6 CIKEUSIK
L 07/10/2008 MTS 6 CIKEUSIK
P 14/01/2009 MTS 6 CIKEUSIK
L 01/01/2009 MTS 6 CIKEUSIK
P MTS 6 CIKEUSIK
L 08/11/1961 MTS 6 CIKEUSIK
P 08/12/2008 MTS 6 CIKEUSIK
P 26/05/2009 MTS 6 CIKEUSIK
P 08/09/2008 MTS 6 CIKEUSIK
P 04/06/2008 MTS 6 CIKEUSIK
L 07/09/2009 MTS 6 CIKEUSIK
L 17/08/2008 MTS 6 CIKEUSIK
L 12/02/2009 MTS 6 CIKEUSIK
L 29/12/2008 MTS 6 CIKEUSIK
L 10/02/2009 MTS 6 CIKEUSIK
P 02/06/2008 MTS 6 CIKEUSIK
P 04/07/2007 MTS 6 CIKEUSIK
P 02/10/2007 MTS 6 CIKEUSIK
P 06/03/2008 MTS 6 CIKEUSIK
L 27/08/2007 MTS 6 CIKEUSIK
P 18/08/2007 MTS 6 CIKEUSIK
L 36/06/2008 MTS 6 CIKEUSIK
L 06/01/2009 MTS 6 CIKEUSIK
L 26/03/2008 MTS 6 CIKEUSIK
L 18/09/1995 MASYARAKAT
L 26/03/2008 MTS 6 CIKEUSIK
L 07/07/2008 MTS 6 CIKEUSIK
L 25/03/2007 MTS 6 CIKEUSIK
L 07/12/2008 MTS 6 CIKEUSIK
P 09/09/2009 MTS 6 CIKEUSIK
P 28/12/2004 MTS 6 CIKEUSIK
L 30/06/2007 MTS 6 CIKEUSIK
P 31/01/2009 MTS 6 CIKEUSIK
P 16/06/2008 MTS 6 CIKEUSIK
L 22/12/2006 MTS 6 CIKEUSIK
P 28/04/2004 MTS 6 CIKEUSIK
P 20/06/2008 MTS 6 CIKEUSIK
P 25/09/2007 MTS 6 CIKEUSIK
P 10/05/2008 MTS 6 CIKEUSIK
P 01/01/2008 MTS 6 CIKEUSIK
L 26/03/2008 MTS 6 CIKEUSIK
L 24/10/2007 MTS 6 CIKEUSIK
P 01/09/2007 MTS 6 CIKEUSIK
L 19/01/2008 MTS 6 CIKEUSIK
L 15/01/2009 MTS 6 CIKEUSIK
L 18/02/2008 MTS 6 CIKEUSIK
L 11/03/2003 MTS 6 CIKEUSIK
L 20/03/2008 MTS 6 CIKEUSIK
L 15/05/2008 MTS 6 CIKEUSIK
L 05/05/2006 MTS 6 CIKEUSIK
L 15/08/2008 MTS 6 CIKEUSIK
L 05/08/2008 MTS 6 CIKEUSIK
L 03/02/2008 MTS 6 CIKEUSIK
P 30/04/2009 MTS 6 CIKEUSIK
L 12/12/2009 MTS 6 CIKEUSIK
L 11/03/2008 MTS 6 CIKEUSIK
P 07-02-1996
L 08-06-1993
L 05-08-2001
L 15-06-2001
L 31-03-1998
L 20-04-1991
L 21-07-1982 MASYARAKAT
P 11-05-2008
L 11-11-1982
P 06-06-2002
P 04-07-2002
P 18-05-1994
L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)

Alamat NO HP BPJS BPJS Non

PBI Non PBI Anggota

SUKAMULYA 085695382155
NANGGALA 085694238061
LEUWIBALANG 085773714960
SUKASENENG 085217381803
CIKEUSIK 085774961519
LEUWIBALANG 085214127600
SUKASENENG 085775165459
CURUGCIUNG 085861173881
CIKEUSIK 081282770126
UMBULAN 085283233122
CIKEUSIK 085752236447
PEMATANG SEMPUR 085691312870
CIKEUSIK 085775202842
UMBULAN 085714776316
LEUWIBALANG 08565143996
PEMATANG SEMPUR 08521578973
085212693476
PEMATANG SEMPUR 083874365262
NANGGALA 085810134101
NANGGALA 085893684887
RANCASENENG 085773504165
CIKEUSIK 085624601932
CIKEUSIK 085776131139
SUKASENENG 081514562644
CIKEUSIK 085886414155
CIKEUSIK 085211641455
CIKEUSIK 085772730720
TELUK PANDAN 088286290538
CIKEUSIK 085813586108
SUKAMULYA 08568906043
CANGKORE 085213478204
PEMATANG SEMPUR 085773491631
CIKEUSIK 085624978452
085216585298
CIKEUSIK 083808269990
CIKEUSIK 085216176782
SUKASENENG 085715854492
PEMATANG SEMPUR 085891029466
CIKADONGDONG 085889199277
PARUNG PANJANG 08571851521
TANJUNGAN 085697640403
KUTRUK 082114995216
CIKEUSIK 081318829664
NANGGALA 085860730697
RANCASENENG 085216662802
KATAPANG 085893317204
MALIMPING 083871587260
CIKEUSIK 085718256133
CIKEUSIK 085782134866
CIMANGGU 085211270630
CIKEUSIK 085770973155
CIKEUSIK 08571017635433
CIKEUSIK 085759794062
NANGGALA 085715496808
085767449414
CIKEUSIK 085781444323
CIKEUSIK 085711045301
CIKEUSIK 085773238346
SUKALAKSANA 085218230242
SUMURBATU 085213833699
PEMATANG SEMPUR 085891483138
CIKEUSIK 081545977489
KATAPANG 085753945475
KATAPANG 085779561142
SUKAMULYA 085810903489
NANGGALA 085782260610
CIKEUSIK 085694570407
CIKEUSIK 085782260610
PEMATANG SEMPUR 081511406433
RANCASENENG 085891470081
RANCASENENG 081511952971
SUKAWARIS 083841512786
CIKEUSIK 085871279066
CIKEUSIK 085864161446
NANGGALA 081511899205
CIKEUSIK 089684838471
CIKEUSIK 085814340350
CIKEUSIK 085880004783
SUKASENENG 082113240125
CIKADONGDONG 085891007652
CIKEUSIK 081906158163
KENDAL 081210952211
CIKEUSIK 085313196963
SUKASENENG 081584565967
CIKEUSIK 081210952211
WANSALAM 085694445470
SUKAWARIS 083113036015
SUKAWARIS 087808780608
KP. SAWAH 082125677082
CIKEUSIK 085773892887
CIKEUSIK 085719069873
PEMATANG SEMPUR 083856819567
CIBALIUNG 085697882920
NANGGALA 085884397302
CIKEUSIK 087772800300
KATAPANG 087885556172
CIKEUSIK 085773226470
RANCASENENG 083813032597
SUKASENENG 081285858261
PEMATANG SEMPUR 081282809039
CIKADONGDONG 085892000128
CIKEUSIK 085774305393
CIKEUSIK 085694542761
SUKASENENG 085779061089
NANGGALA 085215981048
CIKEUSIK 081318377474
CIRIRIGI 085219291261
SUKASENENG 085715410031
SUKAMULYA 085886414155
KATAPANG 081240800603
CIKEUSIK 085311639972
LEUWIBALANG 085882501930
UMBULAN 85217302570
SUKAMULYA 082310248930
CIKEUSIK 085892746833
CIKEUSIK 085695409625
NANGGALA 085719064013
SUKASENENG 085718733630
CIKEUSIK 082185554647
LEUWIBALANG
SUKAWARIS 085787692586
SUKAWARIS 085787692586
SUKASENENG 085776862950
CIKEUSIK 085210070986
NANGGALA 08569137614
CIKEUSIK 085212930771
CIKEUSIK 085654439209
08159815880
KENDAL 085283710811
CIBALIUNG 082249374702
CIKEUSIK 087773636329
NANGGALA 085695268367
NANGGALA 081511406435
NANGGALA 085800005416
CIKEUSIK 085774963330
CIKEUSIK 085695153212
CIKEUSIK 083812911727
CIWET 085694230756
WANASALAM 085776136301
SUKASENENG 085810907338
SUKASENENG 081297374665
CIKEUSIK 085215944414
SUKALAKSANA 08567833678
RANCSENENG 087772603792
SUKASENENG 085217302020
CIKEUSIK 081514568055
UMBULAN 085777635346
PEMATANG SEMPUR 085173219335
CIKEUSIK 085319358131
CIKEUSIK 082151186912
CIKEUSIK 085773219335
NANGGALA 085880004669
PEMATANG SEMPUR 085691312870
RANCSENENG 085773647851
KATAPANG 081514579023
CIKEUSIK 087871413658
NANGGALA 085212931827
LEUWIBALANG 085772728881
KATAPANG 081282437649
SUKAMULYA 082310248930
SUKASENENG 081382566697
SUKASENENG 085811562938
SUKASENENG 085773219335
CIKEUSIK 085779061536
UMBULAN 085719219693
SINAPEL 085810910252
CURUGCIUNG 085217834496
RANCASENENG 082311161441
PEMATANG SEMPUR 085773892866
PEMATANG SEMPUR 085213478218
NANGGALA 081295006158
SUKAMULYA 081646085519
TANJUNGAN 085216452169
NANGGALA 085778279515
CIKEUSIK 081319536394
SUKAWARIS 085781360352
CIKEUSIK 085215986145
CIKEUSIK 081511407914
CIKEUSIK 085770248113
CIKEUSIK 085875797190
TANJUNGAN 085245565989
SUKASENENG 087813003914
PEMATANG SEMPUR 08531045376
CIKEUSIK 085770675462
SUKAJAYA 085694724272
CURUGCIUNG 085715407680
PEMATANG SEMPUR 081510566885
SUKASENENG 081311481848
PEMATANG SEMPUR 085217413230
NANGGALA 085210852418
PEMATANG SEMPUR 081317119754
SUKASENENG 085774607046
CIKEUSIK 083812700806
SUKASENENG 085814205887
CIKEUSIK 085890126802
SUKASENENG 087888159282
SUMURBATU 085888866490
CIKEUSIK 082114960797
CIKEUSIK 085873277662
PARUNGSARI 085693542798
PARUNG PANJANG 085269384486
SUKASENENG 081511868562
PARUNG PANJANG 081617339745
CIKEUSIK 085282387723
SUKASENENG 082312056691
CIKEUSIK 085624970439
CIKEUSIK 085714215218
TANJUNGAN 085710517079
KATAPANG 085691096392
MALINGPING 083878954947
CIKEUSIK 085773758501
RANCASENENG 085776131059
CIKEUSIK 085310658171
CIKEUSIK 085703083396
SUKASENENG 085283234171
SUKASENENG 085710509805
SUMURBATU 085224853453
CIKEUSIK 085718256092
SUKASENENG 085871279104
SUKAWARIS 085773753493
PARKOS 082130513730
CIKEUSIK 085782266128
SUKASENENG 081316931602
CIKEUSIK 082310400255
CISARAP 083891728360
CIKEUSIK 082125045188
CIKEUSIK 082261132013
KATAPANG 085283233908
CIKEUSIK 085695722444
SUMURBATU 08159815764
CIKEUSIK 082252107223
CIKEUSIK 085212401212
KIARAJANGKUNG 085781660659
CIDAHU 085217286307
SINAPEL 081297935349
CIKEUSIK 085775138342
CIKEUSIK 085779569040
CIKEUSIK 085212404559
SUKAMULYA 085773225663
SUMURBATU 081517842166
SUKASENENG 085778987274
CIKEUSIK 08577349105
SUKASENENG 085216587084
085813586058
CIKEUSIK 085773889716
CIKEUSIK 085779161372
SUKASENENG 085212346809
TANJUNG PINANG 085280418689
CENGKOK 08159191802
KATAPANG 085711038522
PARUNG PANJANG 085810910045
SUKASENENG 085213108877
CIKEUSIK 082312750064
KATAPANG 085894532003
CIKEUSIK 085782490359
CIKEUSIK 081315915572
SUKAMULYA 081517322198
KATAPANG 085773236689
CIKEUSIK 087870826352
CIKEUSIK 085782491041
KIARAJANGKUNG 085813586155
CIKEUSIK 087709929341
CIKEUSIK 08819968008
CIKEUSIK 08581329491
CIBINGBIN 085697593267
PEMATANG SEMPUR 08571513331
RANCASENENG 083813032597
LEUWIBALANG 085774961361
SUKASENENG 085781549568
CIKEUSIK 085718256107
TANJUNGAN 085819601468
CIKEUSIK 085216585275
SUKASENENG 081513672119
CIKEUSIK 085213223433
CIKEUSIK 085715854289
CIKUJANG 085717238759
SUKASENENG 083848555490
NANGGALA 085715282154
CIKEUSIK 085882502059
KATAPANG 085770147710
CIKEUSIK 085782266710
PEMATANG SEMPUR 085718270190
CIKEUSIK 081213437381
NANGGALA 085695268475
CIKEUSIK 085864154850
CIKEUSIK 085281130532
CIKEUSIK 085810877130
CIKEUSIK 081280312643
CIKEUSIK 081905642922
CIKEUSIK 083813032597
PEMATANG SEMPUR 08249733686
NANGGALA 085810132437
SUKASENENG 085280255811
SUKASENENG 085779562224
KARANG SAMBUNG 081285858261
CIKEUSIK 085884597907
SUKAWARIS 081315543448
UMBULAN 085650840776
DUSUN RAWA JADI 087818872694
KOTA AGUNG BARAT 087899616482
RANCASENENG 085691437617
085604907124
TANJUNGAN 085691863468
CIWET 083856594005
CIKEUSIK 081380500700
TANGGAMUS 081278408539
SUMURBATU 085219880358
CIKEUSIK
JAMBI
 Dosis I Dosis 2

Merek Tanggal Tanggal

Tanggal
Vaksin*** Screening Pemberia
No. Batch No seri Pemberian
n
Vaksinasi
Vaksinasi

SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316

SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778919316
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778923060
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778698732
SINOVAC 13-09-2021 13-09-2021 24200121 16220778922592
SINOVAC 13-09-2021 13-09-2021 24200121 16220778922592
SINOVAC 13-09-2021 13-09-2021 24200121 16220778922592
SINOVAC 13-09-2021 13-09-2021 24200121 16220778922592
SINOVAC 13-09-2021 13-09-2021 24200121 16220778922592
SINOVAC 13-09-2021 13-09-2021 24200121 16220778910252
SINOVAC 13-09-2021 13-09-2021 24200121 16220778910252
SINOVAC 13-09-2021 13-09-2021 24200121 16220778910252
SINOVAC 13-09-2021 13-09-2021 24200121 16220778910252
SINOVAC 13-09-2021 13-09-2021 24200121 16220778910252
SINOVAC 13-09-2021 13-09-2021 24200121 16220778910252
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780245628
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
SINOVAC 13-09-2021 13-09-2021 24200121 16220780299544
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778919316
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
CoronaVac 13/09/2021 13/09/2021 24200121 16220778923060
02-08-2021 02-08-2021 24003121 16183046076642 13-09-2021
CoronaVac 12-08-2021 12-08-2021 24200121 16219944745764 13-09-2021
CoronaVac 12-08-2021 12-08-2021 24200121 16219944745764 13-09-2021
CoronaVac 12-08-2021 12-08-2021 24200121 16219944745764 13-09-2021
CoronaVac 12-08-2021 12-08-2021 24200121 16219944745764 13-09-2021
CoronaVac 12-08-2021 12-08-2021 24200121 16219944745764 13-09-2021
SINOVAC 12-08-2021 12-08-2021 24200121 13-09-2021
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732 13-09-2021
CoronaVac 16-08-2021 16-08-2021 24200121 16220780453732 13-09-2021
SINOVAC 29-07-2021 29-07-2021 24003121 13-09-2021
SINOVAC 13-09-2021
SINOVAC 13-09-2021
SINOVAC 13-09-2021
Dosis 2

KET
No. Batch No Seri
24200121 16220780299544
24200121 16220778922592
24200121 16220778910252
24200121 16220778922592
24200121 16220778910252
24200121 16220778923060
24200121 16220780299544
24200121 16220780299544
24200121 16220778922592
24200121 16220778910252
24200121 16220780299544
24200121 16220780299544 D1 DI RSU BANTEN
24200121 16220780299544 D1 DI TEMPAT LAIN
 Umur
Nama Penerima
NO No. Ticke NIK JK Pekerjaan* (18-59
Vaksin
tahun)

1 3601044508840002 NURBAETI P 05/08/1984

2 3601041007890002 ASEP SOESWANTO L 10/07/1989
3 3601040503800001 ASAN L 05/03/1980
4 3601040207810003 ROHMAN L 02/07/1981
5 3601041210700004 MAHMUD L 12/10/1970
6 3601042008710002 NURKASAN L 05/06/1975
7 3601040107920201 SARMIN L 06/07/1989
8 3601040703760003 DENI RAHAYU L 06/05/1977
9 3601042506670004 SURYA L 25/06/1967
10 3601040610820001 DARMIN L 06/10/1982
11 3601040102800006 RUDIANTO L 06/06/1981
12 3601040708030004 MATIN L 07/08/2003
13 3601040105710002 SANTA L 01/05/1971
14 3601045305790001 ENONG P 13/05/1979
15 3601041706860001 SARIPUL L 16/07/1987
16 3601040505910001 MUHAMAD JALIL L 20/02/1991
17 3601040401700001 SANTIBI L 21/07/1979
18 3601044107710128 CARTINI P 01/07/1971
19 3601045506920002 IMAS P 15/06/1992
20 3601040308970006 JOJON L 03/08/1997
21 3601040107910291 JOJON L 17/06/1994
22 3601040107780250 JUANDA INDRIANA L 04/07/1978
23 3601041901720003 RANIMAN L 19/01/1972
24 3601044301780001 EMAH INDRIANI P 03/01/1978
25 3601044401890004 NURIAH P 05/04/1985
26 3601042812790002 SARIP L 28/12/1979
27 3601040107960191 RAHUDI L 10/08/1996
28 3601040501020002 DEDE KURNIAWAN L 17/07/2002
29 3602215102850004 SALIAH P 11/02/1985
30 3601040107680250 MISKARI L 24/12/1973
31 3601040107640040 LATO L 01/07/1973
32 3601040701010008 SUKRIA L 19/09/2002
33 3601040107840107 ANI L 01/07/1984
34 3601045501750001 SARNAH P 15/01/1975
35 3601044603760001 LOMRAH P 06/03/1976
36 3601044607800005 ENENG SAENAH P 06/07/1980
37 3601044107660150 SANAMAH P 01/07/1966
38 3601044808880003 YUYUN P 08/08/1988
39 3601040107750175 SUBANDI L 12/03/1962
40 3601044107850370 UMI P 01/07/1985
41 3601044501990004 ITA JULIAWATI P 01/01/2000
42 3601044104820002 JUMI P 01/04/1982
43 3601045507890004 SAETI P 15/07/1989
44 3602012001000004 RONI SOPIAN L 04/05/1997
45 3601044107620061 IONG P 01/07/1962
46 3601041002020001 REGI UBAEDILAH L 10/02/2002
47 3601045003750003 SUMIATI P 10/03/1975
48 3601044603800005 SUHATI P 06/03/1980
49 3601040107660115 HENDAR L 01/07/1966
50 3601044603780001 EDAH P 13/04/1987
51 3601045205900000 INAH P 12/05/1990
52 3601044704940002 MARSANI L 07/04/1994
53 3601040107780240 SUHENDRA L 01/07/1978
54 3602212508740001 ADE HAETAMI L 25/08/1974
55 3601044103860004 MARNI P 01/03/1986
56 3601041111750002 SARDI KURNIAWAN L 27/03/1985
57 3601044105980006 MIA MELIANI P 01/05/1998
58 3601044504750001 ERNA P 05/04/1975
59 3601040902960007 AANG L 11/08/1996
60 3601041005780003 AHDA L 10/05/1978
61 3601044103840003 SARTIAH P 01/03/1984
62 3601041102850003 ROHMAT L 15/05/1982
63 3601040107840109 TIRAH P 20/04/1984
64 3601044107650128 ENGKUS P 01/07/1965
65 3601040602818002 ROSAD L 06/02/1981
66 3601040902630002 MIRDAN L 09/02/1963
67 3601046601660001 UMINAH P 26/01/1966
68 3601040804850002 MUMIN L 05/07/1980
69 3601044604830001 NENG UUN P 06/04/1983
70 3601046506070001 IRNA P 25/06/2016
71 3602215911850001 UMINAH P 19/11/1985
72 3601044204820005 SURNI P 02/04/1982
73 3601040408600002 ELI L 04/08/1960
74 3601041008860003 SUHADI L 10/08/1966
75 3601046107890001 SITI P 21/07/1989
76 3601044904830001 ACIH P 09/04/1983
77 3601040212740001 JUNED L 02/12/1974
78 3601045906900003 MISNI P 19/06/1990
79 360104407020003 CINDY AULIA P 04/07/2002
80 3601075101830001 AGNES PRILLY P 25/04/1978
81 3601044106880001 ELIS NURHAYATI P 29/07/1995
82 3375040412910000 M ZAINUDIN L 04/12/1991
83 3601041002870004 AGUS KHAELANI L 10/02/1987
84 3601040904890002 ERWIN HERIYANTO L 20/08/1989
85 3601040503010001 MUHAMAD RIFAI L 13/11/1999
86 3601045402660002 SANIMAH P 14/02/1966
87 3601041812970001 MOH IMRON TAUFIK L 18/12/1997
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Kelomp
INSTANSI Alamat NO HP BPJS BPJS Non
ok Umur
PBI Non PBI Anggota

05/08/1984 CURUGCIUNG 085691108516

10/07/1989 SUKSASENENG 085210829917
05/03/1980 CIKADONGDONG 082175921790
02/07/1981 CIKADONGDONG 085213007819
12/10/1970 CURUGCIUNG 085292341897
05/06/1975 SUKASENENG 081382339989
06/07/1989 CURUGCIUNG 085693789076
06/05/1977 CURUGCIUNG 085886900964
25/06/1967 CURUGCIUNG 085779072161
06/10/1982 CURUGCIUNG 085886665350
06/06/1981 CURUGCIUNG 085779054270
07/08/2003 CURUGCIUNG 085779072161
01/05/1971 CURUGCIUNG 085213408609
13/05/1979 CURUGCIUNG 085779072161
16/07/1987 CURUGCIUNG 085882501960
20/02/1991 LEUWIBALANG 081617370499
21/07/1979 LEUWIBALANG 085776105140
01/07/1971 CIKADONGDONG 08558165467
15/06/1992 UMBULAN 085711038659
03/08/1997 UMBULAN 085711038659
17/06/1994 CURUGCIUNG 085691123788
04/07/1978 CURUGCIUNG 085780536460
19/01/1972 CURUGCIUNG 085779054270
03/01/1978 CIKADONGDONG 082125723726
05/04/1985 CIKADONGDONG 082399314991
28/12/1979 CURUGCIUNG 085871273898
10/08/1996 CURUGCIUNG 085771253682
17/07/2002 CIKADONGDONG 082311264830
11/02/1985 CIKADONGDONG 081292647098
24/12/1973 CURUGCIUNG 085782490386
01/07/1973 CIKADONGDONG 085717656563
19/09/2002 CIKADONGDONG 081298792996
01/07/1984 CIKADONGDONG 085714790040
15/01/1975 CIKADONGDONG 085778277597
06/03/1976 CIKADONGDONG 085718256061
06/07/1980 CIKADONGDONG 081511865846
01/07/1966 CURUGCIUNG 085311672384
08/08/1988 CURUGCIUNG 085860739713
12/03/1962 CURUGCIUNG 085311672384
01/07/1985 CURUGCIUNG 085779054270
01/01/2000 CIKADONGDONG 085681847983
01/04/1982 CIKADONGDONG 081511406395
15/07/1989 CURUGCIUNG 085692188720
04/05/1997 CIKADONGDONG 085776131076
01/07/1962 CIKADONGDONG 085669320049
10/02/2002 CIKADONGDONG 085779561230
10/03/1975 CIKADONGDONG 085710135807
06/03/1980 CIKADONGDONG 085718707811
01/07/1966 CIKADONGDONG 084511406395
13/04/1987 CIKADONGDONG 085782767753
12/05/1990 CIKADONGDONG 085782767753
07/04/1994 CIKADONGDONG 085810134592
01/07/1978 CIKADONGDONG 085776891448
25/08/1974 CIKADONGDONG 085776891448
01/03/1986 CIKADONGDONG 085624586138
27/03/1985 CURUGCIUNG 085313634728
01/05/1998 CURUGCIUNG 085211488676
05/04/1975 CIKADONGDONG 085695274131
11/08/1996 CIKADONGDONG 085776097612
10/05/1978 CURUGCIUNG 085771905716
01/03/1984 CIKADONGDONG 085218782122
15/05/1982 CIKADONGDONG 085779455059
20/04/1984 CIKADONGDONG 085817951846
01/07/1965 CIKADONGDONG 085817951846
06/02/1981 CIKADONGDONG 081511757223
09/02/1963 CIKADONGDONG 085777218549
26/01/1966 CIKADONGDONG 081511757223
05/07/1980 CIKADONGDONG 082399314991
06/04/1983 CIKADONGDONG 082311264830
25/06/2016 CURUGCIUNG 085782266758
19/11/1985 CIKADONGDONG 085776891448
02/04/1982 CIKADONGDONG 081511757223
04/08/1960 CIKADONGDONG 082312056552
10/08/1966 CIKADONGDONG 085281760590
21/07/1989 CIKADONGDONG 085281760590
09/04/1983 CIKADONGDONG 0855865467
02/12/1974 CIKIRUHWETAN 081510427402
19/06/1990 CIKADONGDONG 085711943562
04/07/2002 SUMURBATU 085219680358
25/04/1978 ANGSANA 081280844022
29/07/1995 SITUPOTONG 08568906043
04/12/1991 PEKALONGAN 081238354886
10/02/1987 CIKADONGDONG 085692741293
20/08/1989 CIKADONGDONG 085882762225
13/11/1999 CIKADONGDONG 085883898310
14/02/1966 CURUGCIUNG 085280137496
18/12/1997 CURUGCIUNG 085888394672
 Dosis I Dosis 2
Tanggal
Merek Tanggal Tanggal Pemberi
Vaksin*** Screening Pemberian No. Batch No seri an
Vaksinasi Vaksina
si
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291713431872
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021 13/09/2021 2021081511 16291725318644
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
SINOVAC 13/09/2021
13/09/2021
Dosis 2

No. Batch No Seri KET

DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
 DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
2021081511 16291725318644 DOSIS 2
 Nama Umur
Kelomp
NO No. Ticke NIK Penerim JK Pekerjaan* (18-59 INSTANSI
ok Umur
a Vaksin tahun)

1 360104420MARYAM P 02-01-1969 POLSEK

2 360104460RASNI P 06-09-1992 POLSEK
3 360104120BOIM L 12-03-1967 POLSEK
4 360104050KADINI L 05-03-1967 POLSEK
5 360104580CARSITI P 12-02-1990 POLSEK
6 360104410CASIAH P 01-07-1985 POLSEK
7 360104660TASINAH P 26-061962 POLSEK
8 360104560DARSIH P 16-05-1979 POLSEK
9 360104410SUTAMI P 01-07-1960 POLSEK
10 360104440RITA PUR P 04-08-1980 POLSEK
11 360104410ASIAH P 22-10-1978 POLSEK
12 360104410MUNASIH P 01-08-1968 POLSEK
13 360104611SANAH P 21-10-1981 POLSEK
14 360104410RUSMINI P 12-07-1973 POLSEK
15 360104410CASTEM P 01-07-1964 POLSEK
16 360104410NURMI P 01-07-1974 POLSEK
17 360104480DASNI P 18-03-1968 POLSEK
18 360104530CASTINI P 13-01-1980 POLSEK
19 360104470KASTI P 07-03-1974 POLSEK
20 360104200SABRONI L 20-04-1971 POLSEK
21 360104460SITI P 06-07-1986 POLSEK
22 360104410DAMINAH P 01-07-1989 POLSEK
23 360104500ISEM P 10-03-1987 POLSEK
24 360104421KASNITI P 02-11-1978 POLSEK
25 360104550TANI P 05-06-1979 POLSEK
26 360104581NURHANAH P 18-11-1994 POLSEK
27 3601043012RACHMAT L 01-07-1985 PKM CKS
28 3601040212KARNA L 02-12-1979 PKM CKS
29 3601045006NURETI P 10-06-1987 PKM CKS
30 360104160MUHAMADL 16-06-1985 POLSEK
31 360104480RUMI P 08-02-1984 POLSEK
32 360104570CARINIH P 17-08-1984 POLSEK
33 360104410RASTINI P 01-07-1977 POLSEK
34 360104550TUNI'AH P 15-07-1980 POLSEK
35 360104660UUN KURNP 26-07-1972 POLSEK
36 360104540SAETI P 14-07-1970 POLSEK
37 360104410CASYATI P 11-08-1977 POLSEK
38 360104410RASITI P 12-04-1974 POLSEK
39 360104410CAINI P 01-07-1969 POLSEK
40 360104510MELA SARP 11-05-2000 POLSEK
41 360104180YANTO L 18-07-1983 POLSEK
42 360104410TARSIH P 01-07-1972 POLSEK
43 360104661SONIAH P 26-11-1976 POLSEK
44 360104410ROKISAH P 01-07-1973 POLSEK
45 360104270SARWAN L 27-07-1955 POLSEK
46 360104470KARENI P 08-07-1991 POLSEK
47 360104550JUNIAH P 04-05-1987 POLSEK
48 360104410ANISA P 01-07-1988 POLSEK
49 360104420MURNASI P 02-01-1970 POLSEK
50 360104040SUANDA L 04-06-1965 POLSEK
51 360104651ASTI P 25-10-1975 POLSEK
52 360104050EDI L 05-02-1970 POLSEK
53 360104681APIPAH P 28-11-1981 POLSEK
54 360104410IDAH P 01-07-1965 POLSEK
55 360104410AAH P 01-07-1961 POLSEK
56 360104430RUNTASIHP 03-08-1974 POLSEK
57 360104521MAR'AH P 12-11-2002 POLSEK
58 360104530SITI AISA P 13-03-1989 POLSEK
59 360104550SUHERNAP 15-06-1988 POLSEK
60 360221130ASEP SUPL 13-07-1984 POLSEK
61 360104130ANDRI L 13-01-1983 POLSEK
62 360104200ENDI L 20-01-1972 POLSEK
63 360104450INA P 05-07-1985 POLSEK
64 360104070SUPIYAN L 07-03-1992 POLSEK
65 360104450ARLINA P 05-05-1980 POLSEK
66 360104420SUNARIYAP 20-01-1983 POLSEK
67 3601045103SITI AISAH P 01-05-1990 PKM CKS
68 3601044708WARTINI P 07-08-1962 PKM CKS
69 3601044811RUMINIH P 20-11-1981 PKM CKS
70 3601041405PULUNG SUL 14-05-1985 PKM CKS
71 3601044107NUR AISAH P 01-07-1982 PKM CKS
72 3601044107ASMARIAH P 01-07-1973 PKM CKS
73 3601044911SITI HERIKAP 09-11-1999 PKM CKS
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
Alamat NO HP Pemberi
BPJS BPJS Non Vaksin** Screeni No.
* ng an
PBI Non PBI Anggota Batch
Vaksina
si
DESA CIK 081284998977 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085714379677 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 087866778688 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 081388148231 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA SU 083875414682 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 08558160728 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 08211986514 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 083877318686 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085819255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 081382362710 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 081382362710 CoronaVac14-09-21 14-09-21 20218151I
DESA RANC085210963433 CoronaVac 14-09-21 14-09-21 20218151I
DESA CIKEU085892746930 CoronaVac 14-09-21 14-09-21 20218151I
DESA CIKEU085892746930 CoronaVac 14-09-21 14-09-21 20218151I
DESA CIK 085892746930 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085693594309 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085892746930 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085280254271 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 087772006224 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 087772006224 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 087888010688 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 20218151I
DESA CIK 085282258664 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085319128764 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085219602231 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 083185587791 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085283329304 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085283329304 CoronaVac14-09-21 14-09-21 24003121
DESA SUK085283329CoronaVac 14-09-21 14-09-21 24003121
DESA SUK085283329304 CoronaVac14-09-21 14-09-21 24003121
DESA SUK081283568120 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 082312237097 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085697652093 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 08558664474 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085781086537 CoronaVac14-09-21 14-09-21 24003121
DESA SUK085283329304 CoronaVac14-09-21 14-09-21 24003121
DESA SUK085773225554 CoronaVac14-09-21 14-09-21 24003121
DESA SUK085283329304 CoronaVac14-09-21 14-09-21 24003121
DESA CIK 085891255722 CoronaVac14-09-21 14-09-21 24004221
DESA CI 085796700697 CoronaVac 14-09-21 14-09-21 24004221
DESA CIK 085719436917 CoronaVac 14-09-21 14-09-21 24004221
DESA CIK 085891255722 CoronaVac 14-09-21 14-09-21 24004221
DESA NANG081511407970 CoronaVac 14-09-21 14-09-21 24004221
DESA CIKEU083175738859 CoronaVac 14-09-21
DESA CIKEU085216176782 CoronaVac 14-09-21
DESA CIKEU085779097961 CoronaVac 14-09-21
DESA CIKEU0877885281C CoronaVac 14-09-21
DESA CIKEU0816460617C CoronaVac 14-09-21
DESA CIKEU085693591915 CoronaVac 14-09-21
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16291725318644 Dosis 1
16183002371837 Dosis 1
16183002371837 Dosis 1
16183002371837 Dosis 1
16183002371837 Dosis 1
16183002371837 Dosis 1
16183002371837 Dosis 1
16183002371837 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002376689 Dosis 1
16183002374801 Dosis 1
16183002374801 Dosis 1
16183002374801 Dosis 1
16183002374801 Dosis 1
16183002374801 Dosis 1
16183002374801 Dosis 1
16183002374801 Dosis 1
16242625997597 Dosis 1
16242625997597 Dosis 1
16242625997597 Dosis 1
16242625997597 Dosis 1
16242625997597 Dosis 1
14-09-2021202181511 1629172531Dosis 2
14-09-21 24003121 1618300237Dosis 2
14-09-197924003121 1618300237Dosis 2
14-09-397924003121 1618300237Dosis 2
14-09-597924003121 1618300237Dosis 2
14-09-797924004221 1624262599Dosis 2
 Nama Umur
Kelomp
NO No. Ticket NIK Penerim JK Pekerjaan* (18-59 INSTANSI
ok Umur
a Vaksin tahun)

1 360104702SUKRI L 07-02-1976
2 360104040MISTA L 04-01-1988
3 360104670ANIS MARP 27-06-1999
4 360104410ENOK P 04-05-1966
5 360104630MIMIN MI P 23-09-1998
6 360104060DEDI KARL 06-06-1977
7 360104410SATI P 01-08-2002
8 360104450SUNARSIHP 05-09-1969
9 360311170MUHAMMAL 17-08-1992
10 360303180SUPRIADIL 18-08-1976
11 360104190ANSORI FL 19-03-1980
12 360104550ROHENAHP 15-08-1982
13 360105070TUKI L 17-02-1977
14 332192503IFAN TAUFL 25-03-2000
15 360104120SARHANI L 12-06-1978
16 360104460DEDE ROHP 06-07-1999
17 360104020SARJAYA L 02-08-1963
18 360104550ESIH P 15-06-1965
19 360104010BERI IRA L 11-12-1993
20 360104250YERI IRA L 25-04-2004
21 360104240IRFAN KU L 24-05-2001
22 360104800WARNI P 20-08-2003
23 360104508HAERUDINL 05-08-1997
24 180525280SUWARI L 28-03-1981
25 180115180SARIYO L 18-07-1997
26 360202480ENENG FITP 02-12-1999
27 127111090HARTONOL 09-05-1990
28 360104010UKAT L 01-01-1981
29 180115430PIPIT WU P 03-09-2003
30 360104230YOGI MUSL 23-09-1997
31 360104230HENGKI L 23-06-1955
32 360104080NURMAN L 08-01-1999
33 360104126JAJANG KL 12-08-2003
34 360104210REZA SUKL 21-03-1984
35 360104100SARKADI L 10-08-1975
36 360104021HUSMANAL 02-12-1997
37 360104191MUSA L 19-11-1984
38 360104130ANAS L 08-08-1980
39 360104471HJ. TUNA P 12-10-1971
40 360104150SAWIN L 15-01-1986
41 360104540ATI P 14-03-1981
42 360104010ARYANI L 01-06-1975
43 360104070ABENG L 07-08-1982
44 230204170BAMBANGL 17-08-1998
45 360104190RIDO SUHL 19-09-2006
46 360104200KARJA B SL 20-01-1951
47 360104520ARNI P 12-02-1982
48 360104510LAMRAH P 11-03-1972
49 360104048AGUS DANL 04-08-2002
50 360104530RESTI P 13-04-2004
51 330802201BAGAS L 20-10-2002
52 360104121ADE APIH L 12-12-1970
53 360104100RIKI SUBAL 10-02-2001
54 360104110IBROHIM L 11-02-1976
55 360104070AHMAD SUL 07-09-1967
56 360104010FAUJI ADIL 01-08-2003
57 360104430SAENI P 03-07-1982
58 360104220REVI PAISL 22-07-2006
59 360104530RATIAH P 13-03-1983
60 '36010449 NONONG P 09-10-1945
61 360104190RIJAL L 19-02-2004
62 360104070ROHMAN L 07-08-1998
63 360104010ABASUDINL 01-06-1977
64 360104020HERU L 02-07-1998
65 360104510MAYA L 11-06-1984
66 360104140DARSUN L 14-08-1985
67 360104151DONI L 15-11-1989
68 180115230FIRDAUS L 23-07-1999
69 360104140ABIDIN L 17-03-1978
70 330802310WIDIYANTL 31-03-2003
71 360104520TAMI P 12-09-1980
72 360104470ENI NURAP 07-05=1999
73 360104240RIYAN SA L 2-05-2005
74 360104010CARSIM L 01-01-1958
75 180117170RUDI SANL 17-02-1995
76 360104120EMAN L 12-01-1983
77 360104130SAHADA L 13-08-2006
78 360104270M. LUKMAL 27-08-2005
79 360104240DASO L 24-01-2007
80 360104641JUMSIH P 9/11/2003
81 360106441YAYAH P 01-01-2005
82 360104470SANTI SU P 07-01-2006
83 360104530RATIH P 13-06-2005
84 360104540NITI P 14-05-1980
85 ACIH KURP
86 360104100KARSAN L 10-09-1987
87 360104450LILIS P 05-06-2004
88 360104560SANTI P 16-08-2005
89 360104110SAPTA L 11-07-1995
90 360104280EJI L 28-04-2008
91 180719150PAID L
92 360104410ANAH P 01-08-1971
93 317404160M. PAUD L 16-09-2005
94 360104520MUMUN P 12-06-1985
95 147111180M. AULIA L 18-07-2004
96 360104491DEDEH P 07-09-1977
97 180712130FATUR R L 13-06-2003
98 317405110BENZIRA L 11-02-2002
99 317306171SADDAM M L
100 217111080M. FAUZA L 08-07-2004
101 360428060RIVALDI L 06-06-2005
102 317101221RIDHO AHL 22-11-2004
103 327502030ZIDAN L 03-05-2005
104 332909160ANDRIYANL 16-06-2004
105 317107200DZAIN FATL 20-09-2005
106 332607310M. FIRDA L 31-08-2003
107 327505140ANGGA I L 14-07-2003
108 321621300ILHAM L 30-01-2003
109 360104541FITRIYANIP 14-10-1992
110 150301030MAHROJAL 03-08-2005
111 360104451SITI KARMP 05-11-2006
112 327502080M. DZIKRI L 08-02-2004
113 360104490PUTRI. A P 09-03-2006
114 180115200SAFEI L 20-06-1997
115 217111111M. ASHRAL 11-12-2008
116 332301101MIFTAHULL 10-12-2003
117 330806060WAHYUDIL 19-07-2002
118 330815280M. ANDI L 28-07-2004
119 330815160HARSONOL 16-02-2002
120 330809210DANI L 21-01-2004
121 357304510WIDYAT L
122 330821140IZA L 14-02-2001
123 360104200ZENI TAUFL 20-08-1990 ODGJ
124 330820280PANDU L 28-05-2004
125 187113171CAHYO B L 17-10-1980
126 350310650IKA KARTIP 26-06-1996
127 330820481ANA MAHAP 08-10-1995
128 330814190AHMAD AJL 19-07-2002
129 321509450RIRIN NR L 05-09-1997
130 330814150WAHYUDIL 15-02-1993
131 360122260SUKMA L 28-05-1990
132 181002650INDAH MEP 25-04-2002
133 360104520SINTA BE P 18-06-1997
134 360104011DIKI SUNAL 01-10-1996
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
Alamat NO HP Pemberi
BPJS BPJS Non Vaksin** Screeni No.
* ng an
PBI Non PBI Anggota Batch
Vaksina
si
TANJUNG085281808748 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG085692971302 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG085892749252 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG085213811232 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG085694693580 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG085691872751 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG081574897219 SINOVAC 15-09-202 15-09-202 2400121
TANJUNG085691872751 SINOVAC 15-09-202 15-09-202 2400121
JAMBU KA082298857294 SINOVAC 15-09-202 15-09-202 2400121
TIGARAKS081311867339 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG08574095551 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085694693580 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085719131345 SINOVAC 15-09-202 15-09-202 24003121
TAWANGS085697596359 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG083892659129 SINOVAC 15-09-202 15-09-202 24003121
CIWET 081584946181 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG08577375718 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG081511196526 SINOVAC 15-09-202 15-09-202 24003121
TANJUNGAN SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085892748103 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG081574897108 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085776845987 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085694230703 SINOVAC 15-09-202 15-09-202 24003121
KARYA BHAKTI SINOVAC 15-09-202 15-09-202 24003121
SUMBER S08541702152 SINOVAC 15-09-202 15-09-202 24003121
HEGARMANGAH SINOVAC 15-09-202 15-09-202 24003121
CIPETE 08119909975 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085771425747 SINOVAC 15-09-202 15-09-202 24003121
BANDAR 085832215027 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG08558246634 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG089616171061 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085697771550 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085695149969 SINOVAC 15-09-202 15-09-202 24003121
TANJUNGAN SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085892749252 SINOVAC 15-09-202 15-09-202 24003121
TANJUNGAN SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085719291041 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085775271453 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085695271364 SINOVAC 15-09-202 15-09-202 24003121
TANJUNGAN SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085721569256 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG081584369859 SINOVAC 15-09-202 15-09-202 24003121
TANJUNG085774690238 SINOVAC 15-09-202 15-09-202 24003121
DWI TIRO 082293916662 SINOVAC 15-09-202 15-09-202 24003121
CIWET SINOVAC 15-09-202 15-09-202 24003121
SUKAWAR085719435396 SINOVAC 15-09-202 15-09-202 24004521
TANJUNG085776832768 SINOVAC 15-09-202 15-09-202 24004521
SUKAWAR081316929188 SINOVAC 15-09-202 15-09-202 24004521
TANJUNGAN SINOVAC 15-09-202 15-09-202 24004521
TANJUNG085776881546 SINOVAC 15-09-202 15-09-202 24004521
WANUREJO SINOVAC 15-09-202 15-09-202 24004521
TANJUNG085718271530 SINOVAC 15-09-202 15-09-202 24004521
TANJUNG085882449069 SINOVAC 15-09-202 15-09-202 24004521
TANJUNG085813590623 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085692811757 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085694473730 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085333319902 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR081574093751 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR085714303654 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR081646081797 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG082312398884 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081282866992 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081282866992 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085798118699 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085892749252 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR082312601867 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085245565989 SINOVAC 15-09-202 15-09-202 24004221
BANDAR 083894305485 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085691508900 SINOVAC 15-09-202 15-09-202 24004221
BOROBUDUR SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085691508900 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR085719435396 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG08571528258564 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR081646081797 SINOVAC 15-09-202 15-09-202 24004221
TRIMOMU082177351930 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081286654069 SINOVAC 15-09-202 15-09-202 24004221
TANJUNGAN SINOVAC 15-09-202 15-09-202 24004221
TANJUNG089616171069 SINOVAC 15-09-202 15-09-202 24004221
TANJUNGAN SINOVAC 15-09-202 15-09-202 24004221
TANJUNGAN SINOVAC 15-09-202 15-09-202 24004221
TANJUNGAN SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085719721575 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085695329495 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081584369483 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG0895335039988 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081584369483 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081280313483 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG081584369326 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085216680056 SINOVAC 15-09-202 15-09-202 24004221
CIWET 081513707949 SINOVAC 15-09-202 15-09-202 24004221
SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR085822749252 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
SUKAWAR085892749252 SINOVAC 15-09-202 15-09-202 24004221
PEKAN BA085215128400 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085891152196 SINOVAC 15-09-202 15-09-202 24004221
LAMPUNG085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
TANJUNG085692971302 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC 15-09-202 15-09-202 24004221
CIWET 081574888923 SINOVAC 15-09-202 15-09-202 24004221
BANDAR 085609207410 SINOVAC 15-09-202 15-09-202 24004221
AN-NAHL 085215128400 SINOVAC
GANDURE085865989612 SINOVAC
NGARGOMUYO SINOVAC
CANDIMU 085781221728 SINOVAC 06-08-202 06-08-2021
CANDIMU 082138299399 SINOVAC 06-08-202 06-08-2021
CANDIMU 083877250290 SINOVAC 06-08-202 06-08-2021
085891152240 SINOVAC
BANDAR S082133674187 SINOVAC
TANJUNGAN SINOVAC
KRINCING085727637455 SINOVAC
KEMILING082371758859 SINOVAC
MELIS 083830817161 SINOVAC 16-08-202 16-08-2021
SUKODADI085741277759 SINOVAC 14-07-202 14-07-202 24002621
BEJOSARI082297191616 SINOVAC
TAMBANGSARI SINOVAC 16-08-202 16-08-2021
TANJUNG081225634145 SINOVAC 14-07-202 14-07-202 24002621
TANJUNGAN SINOVAC 16-08-202 16-08-2021
TANJUNG0895704451605 SINOVAC 16-08-202 16-08-2021
TANJUNG085882495185 SINOVAC 01-07-202 01-07-2021
TANJUNG085773757718 SINOVAC 24-06-202 24-06-2021
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
16220780464496
16220780464496
16220780464496
16220780464496
16220780464496
16220780464496
16220780464496
16220780464496
16220780464496
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16182997534277
16245411836773
16245411836773
16245411836773
16245411836773
16245411836773
16245411836773
16245411836773
16245411836773
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
16242650896133
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
1624650687405
15-09-202 24004221 162465068D1 D TEMPAT LAIN
15-09-202 24004221 162465068D1 D MAGELANG
15-09-202 24004221 162465068D1 D MAGELANG
15-09-202 24004221 162426508D1 DI MAGELANG
15-09-202 24004221 162426508D1 DI MAGELANG
15-09-202 24004221 162426508D1 DI MAGELANG
15-09-202 24004221 162426508DOSIS 1 DI TEMPAT LAIN
15-09-202 24004221 162426508DOSIS 1 DI TEMPAT LAIN
15-09-2022021040436
15-09-202 24004521 162454118D1 DI JAWA
15-09-202 24003121 161829975D1 DI POLSEK WANASALAM
15-09-202 24003121 16182997532873
15-09-202 24003121 161829975D1 DI MALIMPING c
15-09-202 24003121 161829975D1 DI MALIMPING c
15-09-202 24003121 16182997532873
15-09-202 24003121 161829975D1 DI MALIMPING c
15-09-202 24003121 16182997534277
15-09-202 24003121 16182997534277
15-09-202 24003121 16182997534277
15-09-202 2400121 16220780464496
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 36013529060700031 M. SYAHRI L
2 180115211290001 ASTAWI L
3 1671074411060006 ZAHRA P
4 3601041908780003 DEDE L
5 1671078008080008 DHIYA P
6 3601042781850001 SUNARYA L
7 3601044107650032 KASPIAH P
8 3601041503770004 SUNLI L
9 3601041306860001 DENI AHYANI L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI

29-06-2007 TANJUNGAN
21-12-1982 BANDAR AGUNG 082131253834
04-11-2006 PALEMBANG 081218605524
19-08-1978 TANJUNGAN 089531093896
20-06-2008 PALEMBANG 081218605524
27-04-1985 TANJUNGAN 085892811142
17-10-1985 SUKAWARIS 085891279182
15-03-1977 TANJUNGAN
21-03-1984 TANJUNGAN
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri
Anggota
Vaksinasi

CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405

CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 15-09-2021 15-09-2021 24004221 1624650687405
CoronaVac 16-08-2021 16-08-2021 24200121
 Dosis 2
Tanggal
Pemberi KET
No.
an No Seri
Batch
Vaksina
si

15-09-202 24004221 1624650687405

 Nama Umur
Kelomp
NO No. Ticke NIK Penerim JK Pekerjaan* (18-59 INSTANSI Alamat
ok Umur
a Vaksin tahun)

1 360104420FITRI P 02/03/1999 NANGGAL

2 360104231AGUNG L L 23/12/2006 NANGGAL
3 360104410EEN NURAP 30/04/2002 NANGGAL
4 360411540SITI SUSAP 14/03/2005 KRAGILAN
5 360104600RIKA P 20/05/2006 SUKAWAR
6 360104200PERI L 20/06/2003 UMBULAN
7 360411650IMA RAHMP 25/05/2006 CIKEUSIK
8 360104200ALDI L 20/08/2003 CIKEUSIK
9 360104010RANDI L 01/05/2005 RANCASE
10 360104050RENDI CAL 07/06/2006 SUKAMUL
11 360104640NOPIAN P 24/05/2005 CIKEUSIK
12 360104010JUIN L 01/07/1960 SUMURBA
13 360104430AINUN DWP 03/07/2006 NANGGAL
14 360104410TARSEM P 01/07/1968 CIKEUSIK
15 360104090RIANTO L 24/07/2007 CIKEUSIK
16 360104410WARTINI P 10/05/1991 SUKASEN
17 360104151DARTO L 15/10/2005 CIKEUSIK
18 360221440AI NUROHP 04/07/2004 KATAPAN
19 360104490ANI SUWAP 09/05/2001 CIKEUSIK
20 360104440SILVI DAYP 04/09/2004 CIKADON
21 360104410DWI JULIAP 01/07/2004 NANGGAL
22 360104010KIKI PER L 01/01/1999 CIKIRUHW
23 360104531RIMA OKTP 13/10/2021 CIKEUSIK
24 360104080NURSYUFL 08/06/2004 UMBULAN
25 360104410TARMI P 01/07/1970 CIKEUSIK
26 360104551NAJWA AYP 15/10/2005 CIKIRUHW
27 360104280RIYANTI FL 24/04/2001 SUKASEN
28 360104410WASTI P 01/07/1972 CIKEUSIK
29 360104700DALILAH P 30/05/1985 SUKASEN
30 360104450RIYANI P 05/05/2005 RANCASE
31 360104670ANGGI P 27/05/2006 SUMURBA
32 360104601SUKENI P 20/12/1981 SUKAWAR
33 360104450INTAN AMP 05/08/2006 UMBULAN
34 360104540SELA SELP 14/05/2005 CIKEUSIK
35 360104501METI P 10/10/1992 CIKEUSIK
36 360104540INA YULIAP 14/02/2007 SUKAWAR
37 360104010NURITO L 01/09/1997 SUKAWAR
38 360104660SITI HELEP 26/07/2006 SUMURBA
39 360104571PINA P 17/10/2005 SUKAMUL
40 360104451WARTEM P 05/12/1977 CIKEUSIK
41 360104471IKLIMAH P 07/11/2005 SUKAMUL
42 360104450DEDE ANJP 05/07/2002 UMBULAN
43 360104410PUTRI WAP 01/08/2006 NANGAGL
44 360104411SARMILA P 01/12/2005 SUKAWAR
45 360104410ESIH P 01/07/1978 SUMURBA
46 360104410JUENI P 25/04/1974 SUKASEN
47 360104510IMAS MELP 11/05/1997 LEWIBALA
48 360104040AHMAD L 04/01/1980 CURUGCI
49 360104460ERNAWATP 06/04/1990 SUMURBA
50 360104661RITA P 26/12/1991 SUMURBA
51 360104460MELIAWATP 06/10/2005 UMBULAN
52 360104580SITI NURAP 18/05/2006 UMBULAN
53 360103410RITA PUSPP 01/08/2004 CIHANJUA
54 360104010DARKINAHP 01/07/1978 CIKEUSIK
55 360104410SANI P 01/07/1965 SUKASEN
56 360104410EMAH P 15/11/1992 CURUGCI
57 360104460MARDIAH P 07/08/2006 UMBULAN
58 360104150WAHYUDIL 15/07/1975 CIKEUSIK
59 360104651TITIN P 10/03/2002 UMBULAN
60 360104450DIAN RIANP 21/07/1988 CIKEUSIK
61 360104160SAEPUL BL 16/02/2005 SUKASEN
62 360104430IIS MARYAP 03/03/1994 NANGGAL
63 360104570LIA SAPIT P 31/01/2003 CURUGCI
64 360104641SUKASENP 24/11/1983 SUKASEN
65 317510301DIRWANT L 30/10/1966 CIPAYUNG
66 360221040ASEP SUJL 04/02/1991 LEWIBALA
67 360104070JANUR L 28/02/2000 SUMURBA
68 360104700SITI MELI P 30/08/2008 LEWIBALA
69 360104420RASMINA P 12/05/1960 CIKEUSIK
70 360104010ASEP DAML 11/01/1991 SUKASEN
71 360104480SUKARSIHP 06/06/1973 CIKEUSIK
72 360104290TASKA P 29/09/1974 CIKEUSIK
73 360104150AKYAS NUL 15/05/2002 CIKEUSIK
74 360104520EVA FAUZP 12/06/2006 UMBULAN
75 360104410NENI SUL P 07/11/2005 CIKEUSIK
76 360104120HERIAANSL 12/08/2006 SUKAWAR
77 360104060TONI HID L 24/04/2000 UMBULAN
78 911005251IRFAN BAIL 25/11/2006 PAPUA
79 360104650ICIH P 25/073/1964 CIKEUSIK
80 360104050SUTARJO L 10/01/1989 SUKASEN
81 360104410JUNARIAHP 01/07/1962 NANGGAL
82 360104071GUGUN HL 23/10/2001 UMBULAN
83 360221520NINA P 01/08/2004 WANASAL
84 360104030TARENDI L 03/04/2002 CIKEUSIK
85 360104610SUMAAH P 21/05/1970 CIKEUSIK
86 360104600LARAS SAP 20/09/2003 SUKASEN
87 360104490RESTI P 09/05/2006 PARKOS
88 360103010AGUS L 14/09/1992 CIHANJUA
89 360104110DIDING L 11/9/1986 NANGGAL
 90 360104010WARYUDIL 13/06/1994 UMBULAN
91 360104250ALIF GUSTL 25/08/2007 CIKEUSIK
92 360221030WAHYUDIL 03/07/1988 WANASAL
93 360104550WASTINA P 15/05/1984 CIKEUSIK
94 360104280ROHIDIN L 28/01/1999 SUKASEN
95 360104051WARIIH L 05/10/1983 UMBULAN
96 360104580ANDINI DW P 18/01/2008 CIKEUSIK
97 360104520DEVI RAMP 12/09/1969 LEWIBALA
98 360104550KARSAH P 15/07/2007 LEWIBULE
99 360104040MAMAN S L 08/09/1992 SUKAWAR
100 057702150ANGGA DW L 15/08/1994 MANGGU
101 360104420SUKESIH P 02/08/1984 RANCASE
102 360104150AEPUDIN L 04/06/2003 SUKASEN
103 360104420UMRIAH P 05/02/1986 CIKEUSIK
104 360104440SITI MARI P 04/05/2007 PARKOS
105 360104620NENG LIS P 22/05/2006 PARKOS
106 360104410KARTINI P 01/07/1974 CIKEUSIK
107 360104180SARIPUDIL 16/06/1986 LEWIBALA
108 360108450EVA MULYP 05/09/2005 MUNJUL
109 360104070WULAN P 07/03/2006 CURUGCI
110 360104171SAMSUDI L 05/07/1998 UMBULAN
111 360104250DEVITA SAP 12/02/2003 UMBULAN
112 360104290WARSANAL 03/05/2003 CIKEUSIK
113 360104440NURHAYAL 05/01/1990 RANCASE
114 360104240WARLAN L 04/06/1971 CIKEUSIK
115 360104441EDAH P 04/10/1988 NANGGAL
116 360104501RITA ANGP 27/03/2000 SUKAMUL
117 360104410IIN NOPIY P 16/12/1986 UMBULAN
118 360104260RAMUNI L 02/07/1975 CIKEUSIK
119 360104631WATIAH P 23/10/1982 CIKEUSIK
120 360104501ERNI P 10/10/1996 RANCASE
121 360104510ETI P 01/07/1990 UMBULAN
122 360104070JAENI L 04/06/2003 UMBULAN
123 360104541HANI AMEP 18/02/2007 CURUGCI
124 360104090TUBAGUSL 09/03/2002 SUKAMUL
125 360104451RESI PRI P 05/10/1997 CIKEUSIK
126 360104681SITINURA P 28/10/2007 CIKEUSIK
127 360104410MELFA NUL 16/10/2006 CIKEUSIK
128 360104441PUTRI NUP 04/10/2005 CIKEUSIK
129 360104150RIAN FIR L 12/03/2002 CIKEUSIK
130 360221661MIRA P 26/12/1999 BARENGK
131 360104040RAFEI L 04/02/1987 BATUJAYA
132 360104270KARIM L 27/07/1989 UMBULAN
133 360104020SAKARI L 02/01/1986 SUKAMUL
134 360108010SAMSUDI L 18/03/1987 CIKEUSIK
135 360104260YUSUP SUL 26/07/1995 CIKIRUHW
136 360104406IROH P 06/06/2006 SUMURBA
137 360104410SITI SEPTP 03/09/2000 UMBULAN
138 360104581MITA AMEP 18/11/1997 UMBULAN
139 360104560MEGA RIRP 16/07/1997 CIKEUSIK
140 360216081SARNA L 08/11/1997 CIJAKU
141 360104571TITI KARTP 17/11/1996 RANCASE
142 360104480KURNAESIP 08/06/1982 UMBULAN
143 180513091DHANI KUL 09/11/2002 SUDOMOL
144 180802050MAHFUDI L 17/05/2002 TALANG
145 180702110DIMAS DWL 11/03/2003 MARGASA
146 180802081MAKHDUML 08/11/1997 TALANG
147 360104650VIVI ANGEP 25/02/2005 CIKIRUHW
148 360104050DARNO L 05/02/1993 SUKASEN
149 360104580RISKA AULP 18/04/1997 SUMURBA
150 360104440ESIH P 04/05/1958 CIKEUSIK
151 360104410MURSAH H P 08/06/1993 LEWIBALA
152 360104010MAIN L 01/07/1963 CURUGCI
153 360104510SULASTRIP 11/06/1977 CIKEUSIK
154 360104010DEDE S L 05/05/1966 SUKASEN
155 360104560LELIAH P 16/03/2004 CANGKOR
156 360104420ANDINI P 15/05/2006 CIKEUSIK
157 360221420SAYU P 02/01/2006 GENGGON
158 360104670WASNI P 27/08/2005 CIKEUSIK
159 360104010TEDI SAP L 01/07/2005 CIKIRUHW
160 360104440TUTI P 04/01/1991 SUKASEN
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
NO HP Pemberi
BPJS BPJS Non Vaksin** Screeni No.
* ng an No seri
PBI Non PBI Anggota Batch
Vaksina
si
085811464551 CORONAV16/09/202116/09/202124005121 16261492091244
085782135131 CORONAV16/09/202116/09/202124005121 16261492091244
085210829897 CORONAV16/09/202116/09/202124005121 16261492091244
081513672093 CORONAV16/09/202116/09/202124005121 16261492091244
085797418280 CORONAV16/09/202116/09/202124005121 16261492091244
085694566813 CORONAV16/09/202116/09/202124005121 16261492091244
085892876402 CORONAV16/09/202116/09/202124005121 16261492091244
085779097961 CORONAV16/09/202116/09/202124005121 16262302488968
081511407890 CORONAV16/09/202116/09/202124005121 16262302488968
085782266046 CORONAV16/09/202116/09/202124005121 16262302488968
085886425249 CORONAV16/09/202116/09/202124005121 16262302488968
085213477334 CORONAV16/09/202116/09/202124005121 16262302488968
087733173987 CORONAV16/09/202116/09/202124005121 16262302488968
085715094330 CORONAV16/09/202116/09/202124200121 16262302488968
085695148610 CORONAV16/09/202116/09/202124005121 16262301486784
085777565890 CORONAV16/09/202116/09/202124005121 16262301486784
081315527514 CORONAV16/09/202116/09/202124005121 16262301486784
085884388654 CORONAV16/09/202116/09/202124005121 16262301486784
081574609520 CORONAV16/09/202116/09/202124005121 16262301486784
085693636524 CORONAV16/09/202116/09/202124005121 16262301486784
085692710197 CORONAV16/09/202116/09/202124005121 16262301486784
08120903521 CORONAV16/09/202116/09/202124005121 16262301486784
085283862084 CORONAV16/09/202116/09/202124005121 16262301486784
085891806464 CORONAV16/09/202116/09/202124005121 16220780880844
081574284041 CORONAV16/09/202116/09/202124005121 16220780880844
0812186604951 CORONAV16/09/202116/09/202124005121 16220780880844
081574284041 CORONAV16/09/202116/09/202124005121 16220780880844
085773494580 CORONAV16/09/202116/09/202124005121 16220780880844
085288993818 CORONAV16/09/202116/09/202124005121 16220780880844
085692729335 CORONAV16/09/202116/09/202124005121 16220780880844
083807187150 CORONAV16/09/202116/09/202124005121 16220780880844
085773166705 CORONAV16/09/202116/09/202124005121 16220780880844
085283767617 CORONAV16/09/202116/09/202124005121 16220780880844
085814304785 CORONAV16/09/202116/09/202124005121 1626391491448
085210829917 CORONAV16/09/202116/09/202124005121 1626391491448
085719027915 CORONAV16/09/202116/09/202124005121 1626391491448
085695336912 CORONAV16/09/202116/09/202124005121 1626391491448
085891278900 CORONAV16/09/202116/09/202124005121 1626391491448
085216040572 CORONAV16/09/202116/09/202124005121 1626391491448
085719064085 CORONAV16/09/202116/09/202124005121 1626391491448
081385562893 CORONAV16/09/202116/09/202124005121 1626391491448
085624601907 CORONAV16/09/202116/09/202124005121 1626391491448
085753876144 CORONAV16/09/202116/09/202124005121 16261492091712
085813107240 CORONAV16/09/202116/09/202124005121 16261492091712
082324117985 CORONAV16/09/202116/09/202124005121 16261492091712
085312827766 CORONAV16/09/202116/09/202124005121 16261492091712
085771184094 CORONAV16/09/202116/09/202124005121 16261492091712
085813065289 CORONAV16/09/202116/09/202124005121 16261492091712
081804900439 CORONAV16/09/202116/09/202124005121 16261492091712
085772135471 CORONAV16/09/202116/09/202124005121 16261492091712
081316931617 CORONAV16/09/202116/09/202124005121 16261492091712
085779570690 CORONAV16/09/202116/09/202124005121 16261492091712
085694146765 CORONAV16/09/202116/09/202124005121 16220780669636
085773883429 CORONAV16/09/202116/09/202124005121 16220780669636
085781080007 CORONAV16/09/202116/09/202124005121 16220780669636
085813065289 CORONAV16/09/202116/09/202124005121 16220780669636
085770149315 CORONAV16/09/202116/09/202124005121 16220780669636
085798840104 CORONAV16/09/202116/09/202124005121 16220780669636
085778187688 CORONAV16/09/202116/09/202124005121 16220780669636
085695722444 CORONAV16/09/202116/09/202124005121 16220780669636
082117474890 CORONAV16/09/202116/09/202124005121 16220780669636
08563603551 CORONAV16/09/202116/09/202124005121 16261491870036
081617679157 CORONAV16/09/202116/09/202124005121 16261491870036
082114988926 CORONAV16/09/202116/09/202124000121 16261491870036
085716284429 CORONAV16/09/202116/09/202124005121 16261491870036
081511865850 CORONAV16/09/202116/09/202124005121 16261491870036
085882443097 CORONAV16/09/202116/09/202124005121 16261491870036
085718724928 CORONAV16/09/202116/09/202124005121 16261491870036
081293290810 CORONAV16/09/202116/09/202124005121 16261491870036
085779062040 CORONAV16/09/202116/09/202124005121 16261491870660
085773883429 CORONAV16/09/202116/09/202124005121 16261491870660
085773883429 CORONAV16/09/202116/09/202124005121 16261491870660
081284561178 CORONAV16/09/202116/09/202124005121 16261491870660
083874952318 CORONAV16/09/202116/09/202124005121 16261491870660
085215115499 CORONAV16/09/202116/09/202124005122 16261491870660
082310245407 CORONAV16/09/202116/09/202124005121 16261491870660
0857802978882 CORONAV16/09/202116/09/202124005121 16220780674316
081347890824 CORONAV16/09/202116/09/202124005121 16220780674316
085719435767 CORONAV16/09/202116/09/202124005121 16220780674316
085692729319 CORONAV16/09/202116/09/202124005121 16220780674316
085216099226 CORONAV16/09/202116/09/202124005121 16220780674316
085774687459 CORONAV16/09/202116/09/202124005121 16220780674316
085776872205 CORONAV16/09/202116/09/202124005121 16220780674316
082124792408 CORONAV16/09/202116/09/202124005121 16220780674316
081280312643 CORONAV16/09/202116/09/202124005121 16220780674316
085212849680 CORONAV16/09/202116/09/202124005121 16220780674316
085695271691 CORONAV16/09/202116/09/202124005121 16261491871284
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081318023775 CORONAV16/09/202116/09/202124005121 16261492086096
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081270740790 CORONAV16/09/202116/09/202924005121 16261491864420
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085887771220 CORONAV16/09/202116/08/203124005121 16261491864420
085280174933 CORONAV16/09/202116/09/203124005121 16261491864420
085782266714 CORONAV16/09/202116/08/203224005121 16261491864420
085775261092 CORONAV16/09/202116/09/203224005121 16261491864420
085773239759 CORONAV16/09/202116/08/203324005121 16261491864420
081584376665 CORONAV16/09/202116/09/203324005121 16261491864420
081584376665 CORONAV16/09/202116/08/203424005121 16261491873156
085797143453 CORONAV16/09/202116/09/203424005121 16261491873156
081319411282 CORONAV16/09/202116/08/203524005121 16261491873156
085882844696 CORONAV16/09/202116/09/203524005121 16261491873156
085694608849 CORONAV16/09/202116/09/203624005121 16261491873156
085771547392 CORONAV16/09/202116/08/203724005121 16261491873156
085695153406 CORONAV16/09/202116/09/203724005121 16261491873156
085775140185 CORONAV16/09/202116/08/203824005121 16261491873156
081318704098 CORONAV16/09/202116/09/203824005121 16261491873156
085694528143 CORONAV16/09/202116/08/203924005121 16261491873156
085694230629 CORONAV16/09/2021 24005121 16261492086252
087770249765 CORONAV16/09/2021 24005121 16261492086252
085219607992 CORONAV16/09/2021 24005121 16261492086252
085219607992 CORONAV16/09/2021 24005121 16261492086252
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085212298391 CORONAV16/09/2021 24005121 16261492086252
082139736066
08581051686 CORONAV16/09/202112/08/2021
08571906748 CORONAV16/09/202116/08/202124200121
087774153461 CORONAV16/09/202112/08/202124200121
081282349757 CORONAV16/09/202112/08/202124200121
085714550586 CORONAV16/09/202116/08/202124200121
085710313192 CORONAV16/09/202116/08/202124200121
082310918668 CORONAV16/09/202116/08/202124200121
082289624504 CORONAV16/09/202105/08/202124003121
082366950060 CORONAV16/09/202116/08/202124200121
081373153913 CORONAV16/09/202105/08/202124003121
085224890728 CORONAV16/09/202116/08/202124200121
085773488248 CORONAV16/09/202119/08/202124005121
083893644281 CORONAV16/09/202129/07/202124003121 19/06/2021
085782816158 CORONAV16/09/202116/08/202124200121 19/06/2021
081293290810 CORONAV16/09/202116/08/202124200121 19/06/2021
085718924111 CORONAV16/09/202108/07/202124002221 19/06/2021
085694608871 CORONAV16/09/202112/08/202124200121 19/06/2021
08531370615 CORONAV16/09/202116/08/202124200121 16220780669636
085212827766 CORONAV16/09/202112/08/202116/09/2021
085695267520 CORONAV16/09/202116/08/202124200121
081511791421 CORONAV16/09/202116/08/202124200121
085773898808 CORONAV16/09/202116/08/2021
085311381142 CORONAV16/09/202116/09/2021
085691857780 CORONAV16/09/202116/09/2021
085894828757 CORONAV16/09/202105/08/2021
 Dosis 2
Tanggal
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No.
an No Seri
Batch
Vaksina
si
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16261491871284 DOSIS 1
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16261492086252 DOSIS 1
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DOSIS 1
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 19/06/2021 162614920DOSIS 2
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16220780669636 DOSIS 2
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NO No. Ticket NIK Nama Penerima Vaksin

1 MISNAH
2 PURDI
3 3601044207790003 YAYAH NIHAYAH
4 3309161603930010 IMAM WAHYUDI
5 360104410380003 ERLINA
6 3601046001840001 MIMIN
7 360103251100001 JEJE
8 3601044808990003 NURDIANA
9 3601044510760004 PATONAH
10 3601040107790084 WASIM
11 3601010207850002 ROSIDIN
12 3601030705800003 KUDIL
13 3601030612720001 TARMANI
14 3601030203750001 ARSAN
15 3601044107770112 SUMSARI
16 3601040303070001 ANDRI HIDAYAT
17 3601046402810004 CARTEM
18 3601040809070001 DONI HERMAWAN
19 3601044611070001 ESTI WULNDARI
20 3601041507070006 HERU/IJOY
21 3601040102070007 KARNITA
22 3601044207060010 RANI RAHAYU
23 3601040706070001 SATRIO
24 3601045603070002 SITI AISYAH
25 3601044107060027 SAMINAH
26 3601046010070001 WANDI
27 3601041308760001 SANUSI
28 3601045102770005 ROHAYATI
29 3601046010770001 RASEM
30 360104671070004 SAPITRI
31 3601046708070004 GITA AGUSTINA
32 3601045001080003 NAYISILA
33 3601044212010003 ROLANI
34 3601041010070001 EGI. M.S
35 3601040107540018 SAKTI
36 3601044205050004 RASNIYAH
37 3601045206990003 PIKA SASABILA
38 3601042704900001 ANDI WIJAYA
39 3601044710640001 ANAH BT ADHURI
40 3601046071870001 KARMI
41 36013181012060009 NURYANA
42 3601041010060003 USNADI
43 3601045806010002 GISNA NURHAYATI
44 3601041310040001 YADI F
45 3601045707890002 EMAH
46 3601012411070002 IKHSAN MAULANA
47 3601041504960004 SUMARDIANTO
48 3601040311070001 DERI SYAHRUDIN
49 3601042909060002 M. FIKRI RAMADAN
50 360104510707009 ENO MELODIANA
51 3173012001051002 AJI JANWAR
52 3601046006080002 FITRI NURMAEN
53 3601045706970006 MERI YANTI
54 3601045408720001 ANI
55 3601044210750005 NARSIH
56 3601046412050002 NAZWA
57 3601045202070005 NIRMALA
58 '3601040706080001 M. YANTO
59 M. ARDIANA
60 3601013005070001 RIDWAN. A
61 3602210102000007 REVI
62 3601044207070001 SITI NURAISAH
63 3601044107830368 MASKUNI
64 3601044307080007 ELIN
65 3601041701020003 SUMARNA
66 3601042707070001 RIZA ARIFQI
67 3601046709960004 TITI IRIANTI
68 3601044107750143 TASINAH
69 3601044604650001 KODIJAH
70 3601046201080001 JUBAEDAH
71 3601045106700003 TATING
72 3601045105080003 MAYA LESTIANA
73 3601045211960001 DEWI
74 3601031010060002 DAPIN RAMDANI
75 3601041702080001 REPI AZHARI
76 3601045008070006 RISKA ADETIA
77 3601042209090001 NABIL RAMDAN
78 3601040603900003 ENO SUTISNA
79 3601042910050001 HARLAN
80 36010406070008 ARIL SAPUTRA
81 3604054711070002 NOVI ANDINI
82 3601044806090001 MIRA
83 ANNISA JULIKA
84 3601047003080003 EKA WAHYUDI
85 3601041006000001 SAPRUDIN
86 3601042710970002 YOGA ADITIA
87 3601046610080001 SIPA ANDINI
88 3601041010750004 ADNA
89 36010456068080003 AYUNI AGUSTIN
90 36010465011970007 MIMIN
91 3601044201020003 INDY SABILA
92 3601041311020001 INDRA
93 3601044906080002 RATINAH
94 360104620290001 SANI
95 3601044205130002 WULANDARI
96 TRI AYU CAHYA
97 3601045002080002 WIWI MULYATI
98 MAULANA MUHAMAD
99 3601040601880002 WARLA
100 3601040110090001 SATRIA INDRA
101 3601041510080001 SYUHANDA
102 3601044510070002 LELA KURNIA
103 3601040905090003 WANDI
104 3601044807090001 SITI WULAN. P
105 3601045705090002 RAPIKA
106 3601046302090002 NURAIDA
107 3601046806090001 MELISA ANGGRAENI
108 3601040401080004 ANANG HERMANSYAH
109 3601040303090002 ERMAWAN
110 3601040901090002 DIKA FAUJI
111 3601046309090002 IRANA
112 3601041210090002 GINANJAR
113 3601046412020001 ELA . N
114 3601040107910132 SUPIANTO
115 3601046009040002 INTAN PUSPITA SARI
116 3601044207050022 NAILAH
117 3601042912060001 RELA ARDIANSYAH
118 3601045301010001 MILA NUR AZIZAH
119 3601044606030002 FATIMAH SRI
120 3601046112030001 SOVI ANGGRAENI
121 3601081002740001 RUYANI
122 3601024301880007 SITI AISAH
123 3601045604020003 KARSIH
124 3601044309770002 HAETI
125 3601046906860001 RENI
126 3601046505650002 HADIJAH
127 3601040107690092 PENDI SETIAWAN
128 SOFWAH NAYLA
129 3601044107760049 WARTINEM
130 3601041001070007 SUPRIADI
131 3601040102060012 II SUMIRAT
132 SANDI
133 DWI WICAKSONO
134 MAEMAH
135 ROHMAT HIDAYAT
136 UNASIH. S
137 3601040107630177 DARKUM
138 RACHMAN HAKIM
139 3601044708540001 KARNI
140 AMIN WIJAYA PUTRA
141 3601044107900144 CASTINAH
142 3601041502020003 SUKARI
143 3601024809910001 HERLINA M
144 3173012806840005 WANDI
145 3601040201080007 ADHAN NURJAMAN
146 JUMALI
147 3601042509070001 AHDI MAULANA
148 3601030205840004 SUNAKAH
149 3671015011790010 DANING SRI
150 3602044920800006 ODAH
151 3601045012040006 MEGA ASTRA
152 3601040302060001 ROBI
153 3601042502080001 MAULANA RIZKI P
154 3601044107060027 SAMINAH
155 3601045108000003 AGISTA
156 3601044703070001 SITI YULLYA
157 3601045001107003 ALDA NURAIDA
158 3601041504070001 MUHAMAD SUHADA
159 3601045310080001 NARULITA
160 3601042120060001 WAWAN SETIAWAN
161 3601046603880001 SITI PATIMAH
162 3601044111070001 RASTINIH
163 3601046808890001 YULIAWATI
164 3601045506790001 DARWINAH
165 3601040912060001 RESTU AZMI
166 3601044208070003 WINDI
167 3601042107010005 RAHMAT
168 36010412040000 AGI FAUZI
169 3601041712070003 ANDRE HERDIANSYAH
170 3601044107580109 ROKAYAH
171 3601044107730414 TITIN
172 3601044707800004 UMU KULSUM
173 3601046304140001 AMANDA
174 3601044110070001 FITRIYANI
175 3601044609000005 NENG ELIASIH
176 3601045707830002 WIWIN WIARSIH
177 3601043012050001 HENDRI
178 3601042802050002 INDRA
179 3601040107080025 IRWAN
180 3601040107930132 SARMANI
181 3671106010060002 RAHMA FITRIYANI
182 3601044207070020 NURRAFILAH
183 3601045410070005 ONI L.L
184 3601046008090001 FITRI ANDRIAYANI
185 3601046311070001 UFITRIANI
186 3601046808070001 ROHAYATI
187 3601044107510209 ROKANI
188 3601040107080026 KIKI KUSNANTO
189 3601041405080002 HALIKA ILHAM
190 3601044107080019 MILA SUFITRI
191 3601045003850001 IIN TARSINIH
192 3601045702080007 NYMAS MEYLANI
193 3601045504080002 TIARA
194 3601042212080002 DANI
195 3601042309610001 RUHMAN
196 3601044109740000 CARMINI
197 3601045201090002 RANI
198 3601041811070001 RIANTO
199 3601041402080002 VIOLA
200 3601045004070003 RINDA
201 3601044111080002 WITRI
202 3601042505090001 SUNANTO SAPUTRA
203 3601040203080001 M. TORIK
204 3601046510020001 NUR HIDAYATUN NISA
205 3601042007080001 FAJAR ALWAN
206 3601040107090015 JUMIAT SAPALAS S
207 3601046408080004 KARSINAH
208 3601044911070001 NOLA AULIA
209 3601046201080002 SARNIMI
210 3601041809080005 NAUVAL ADI NUGROHO
211 3601041712940003 RASITA
212 3601044107780232 IYAM
213 3601045710000001 LIA H
214 3601040711080003 JAMALUDIN
215 3601040812081209001 M ALIMUDIN
216 3601042512170001 IRMA
217 3602210705900003 ADE KOSASIH
218 3601041409090001 RAFIQ ADRI WINATA
219 3601046601890001 NARISKA
220 3601046908090001 RASYA RAMADANI
221 3601040407930004 RIYAN
222 3671010611080007 TEDI ALFANKI
223 360104010750035 REHAN
224 3601043011870003 RISKI HIDAYAT
225 3601044201990064 HERNASARI
226 3601041611020001 YOGA R
227 3601040107960264 PEPEN
228 3601045307620003 RATIMAH
229 3601045903020001 LISDIAWATI
230 3601044806030006 AAN
231 3601046508030003 YULIA ANANTA
232 36010401067060016 NURKARIM
233 3601041505610002 TATA
234 3601044210050004 PIHA KHOLIPAH
235 3601040701060002 M GIZI
236 3601044205780000 WARTINIH
237 3601045111940003 IROH
238 3601040401980001 RIZAL BAHTIAR
239 3601040305700004 KAPIDIN
240 3601043005030001 NURDIN FIRMANSYAH
241 3601044107550030 TARINIH
242 3601046808830001 ERNA MULYA SAROH
243 3601042610060001 RAMDAN MAULANA
244 3601086809030002 HANI PRIANTA
245 3602211506020002 HERI HARTOPO
246 3601042910900001 JAENUDIN ADI
247 3601042708770001 WARKI
248 3601040107700153 RASTIRAH
249 3601045209820001 UMYATI
250 3601030710940001 MOCH KOSWANDI
251 3601045207810003 ROKMAH
252 3601041512000005 MULYADI
253 3601041006720001 SUTIKNO
254 3601040502870003 SARIM
255 MARIANIH
256 3601041402030001 JULFIKAR
257 3601041409850001 MARJA
258 3601042804030002 TARNA
259 3329032003970001 MIOH RIKI SUBAGJA
260 3316102105000001 ERVA H
261 3601044104110000 DILA EFRILIA
262 3601041005800003 AGUS KOMALA
263 3210094109910022 SANTI ANDRIANTI
264 3601041112860002 DIDI SARMEDI
265 3601041302070001 IDRUS
266 3601042007990002 SUNANDAR
267 3601040702130003 FREDY H
268 3601045208020001 AYUNI D
269 CAKAM
270 3601041201730001 R. ENDAY
271 3601046710950003 SUPRIATI
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273 3322186309990001 HANIFA SALMA
274 360104500600003 RITA. M
275 3601046011970006 FELLA AHAQI
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277 3601045908010002 GIETA DEVANY
278 3601040404000001 RUDI
279 3602210703690001 AHMAD ISKANDAR
280 3601046303040002 IRMA AINI
281 3601045507720002 MUSAROPAH
282 3601042600020002 M. HADINATA
283 3601040601730001 WALIM
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

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Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

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CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CoronaVac 20-09-2021 20-09-2021 24003121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 20/09/2021 34200121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 24005121
CORONAVA20/09/2021 20/09/2021 2400121
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CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
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CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
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CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVA20/09/2021 20/09/2021 2400121
CORONAVAC
CORONAVAC

20/09/2021 23/08/2021 24003121

CoronaVac 19-08-2021 19-08-2021 24200121
20/09/2021 23/08/2021 24003121
CORONAVA20/09/2021 02/08/2021 24200121
20/09/2021 12/08/2021 2420021
CORONAVA20/09/2021 05/07/2021 24003121
CORONAVA20/09/2021 23/08/2021 24003121
CORONAVA20/09/2021 23/08/2021 24003121
CORONAVA20/09/2021 16/08/2021 24200121
CORONAVA20/09/2021 20/09/2021 24200121
CORONAVA20/09/2021 22/07/2021 24002221
CORONAVA20/09/2021 19/08/2021 24200121
CORONAVA20/09/2021 19/08/2021 24200121
CORONAVA20/09/2021 23/08/2021 24003121
CoronaVac 19-08-2021 19-08-2021 24200121
CoronaVac 16-08-2021 16-08-2021 24200121
 19-08-2021 19-08-2021 24200121
CoronaVac 01-08-2021 01-08-2021 24004421
CoronaVac 19-08-2021 19-08-2021 24200121
CoronaVac 29-06-2021 29-06-2021 24002121
CoronaVac 19-08-2021 19-08-2021 24200121
CoronaVac 29-08-2021 29-08-2021 24003121
CoronaVac 23-08-2021 23-08-2021 24200121
CoronaVac 19-08-2021 19-08-2021 24200121
CoronaVac 19-08-2021 19-08-2021 24200121
CoronaVac 16-08-2021 16-08-2021 24200121
CoronaVac 19-08-2021 19-08-2021 24200121
CoronaVac 16-08-2021 16-08-2021 210054389
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
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 20/09/202124200121 DOSIS 2
20-09-202 2400121 16220780673224
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16183002159693 20/09/20212400121 DOSIS 2
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20-09-202 24003121 16262301269476
20-09-202 24003121 162623012D1 D KLINIK POLRES
20-09-202 24003121 16262301269476
20-09-202 24003121 16262301269476
20-09-202 24003121 16262301269476
20-09-202 24003121 16262301269476
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20-09-202 2400121 16220780890048
20-09-202 2400121 16220780673224
20-09-202 2400121 162207806D1 DI KPH BANTEN
 Kepesertaan BPJS (tulis 'Ya'
Umur pada kolom yang sesuai)
Nama Penerima Kelompok
NO No. Ticket NIK JK Pekerjaan* (18-59 INSTANSI Alamat NO HP
Vaksin Umur BPJS Non
tahun) BPJS PBI
PBI

1 3601046706850010 WASTIAH P 27/06/2021 CIKEUSIK 081348444805

3601044107700111 ENCIH P 05/04/1977 CIKEUSIK 085825111980
2
3 3601040207040028 NANI SAPUTRA L 14/07/2004 CIKEUSIK 085860730651
3601044603010003 SANTI RISMAWATI P 06/03/2001 NANGGALA 081289662799
4
5 3601044204720002 DAIMAH P 02/04/1972 CIKEUSIK 085860730651
3601044606830002 DARMINIH P 06/06/1983 RANCASENENG 081511334099
6
7 3601045203740001 JUHAETI P 12/03/1974 CIKEUSIK 085871616850
3173014603850021 RODIAH P 06/03/1985 CENGKARENG 085899289792
8
9 3601030702020005 DARTO WIGUNA L 07/02/2002 CIHANJUANG 082180677244
3601044908090007 AIDA PITRIAH P 09/08/2009 CIKEUSIK 085691095221
10
11 3601044703910001 DILAH P 07/03/1991 SUKASENENG 085217857756
3601040205980002 ROHENDI L 02/05/1998 SUKASENENG 081513086748
12
13 3601041505860003 HASAN BISRI L 13/09/1986 SUMURBATU 082157610308
3601044606790002 EMAH SAEMAH P 06/06/1979 SUKAWARIS 085013590631
14
15 3203021804940003 SUPRIADI L 18/04/1994 MEKARWANGI 085782264344
3601045507970007 ANGGRAENI P 15/07/1997 RANCASENENG 085782264344
16
17 3601041002680003 SARKAMAN L 10/02/1968 CIKEUSK 08558654606
3601042103720001 LAMAN L 21/03/1972 NANGGALA 085697416764
18
19 3601045208600001 MARKINAH P 12/08/1960 LANSIA CIKEUSIK 085693222387
3601045009750001 WARTI P 10/09/1975 CIKEUSIK 085810526053
20
21 3601040803940002 J.FIRMANSYAH L 01/03/1994 NANGGALA 082128427364
3601045306740001 NURYATI P 13/06/1974 SUKASENENG 085767449414
22
23 3601040107630314 WASLIM L 01/07/1963 SUKASENENG 082310248435
3601044107880204 KOMARIAH P 01/07/1988 CIKEUSIK 085210474720
24
25 3601045103950003 KANITI P 11/03/1995 CIKEUSIK 081282870409
3601040306900002 ONIH SUMIARSIH P 03/06/1990 SUKASENENG 085773891623
26
27 3601044210020005 YANI OKTOPIANI P 02/10/2002 CIKEUSIK 081339478642
3601045207800003 RATINI P 17/07/1980 CIKEUSIK 085719806578
28
29 3601044107860052 DASRI P 1/7/1986 SUKAWARIS 085866761684
3601030107820091 NURHASAN L 01/07/1982 CIHANJUANG 85215987139
30
31 3601041612910001 KARMI P 10/01/1991 SUKASENENG 081511791538
3601044107630167 TARKEM P 01/07/1963 LANSIA CIKEUSIK 085777151511
32
33 3601045709770001 RATNA P 20/03/1978 SUKASENENG 081571791538
3601042007020001 ESA L 20/07/2003 CIKEUSIK 081584956590
34
35 3307052004820002 PUJI SUYITNO L 20/04/1982 BANYUMAS 082116262997
3601041204990009 AGI PUJI HERMAWAL 12/04/1999 SUMURBATU 085773115899
36
37 3602214802000007 CASMINI P 08/02/2000 WANASALAM 082315684376
3602215409970001 KHAIVA PRATIWI P 14/09/1997 WANASALAM 085216526533
38
39 3601044090800004 OMA L 09/08/2000 SUKASENENG 085883240545
3601044910650002 WARTISEM P 09/10/1965 SUKASENENG 085218581863
40
41 3601046210800001 INAH P 15/10/1980 CIKEUSIK 085218581863
3601041203880005 KARSIMIN L 12/03/1988 SUKAWARIS 082175875568
42
43 3601045605070001 SITI MAYA KARTIKA P 26/03/2007 KARANGSAMBUNG 085213080175
3602090405630003 SUKRISMAN L 04/05/1963 CIKEUSIK 085695409730
44
45 3601041901040001 GUNTUR PERIANSYL 14/02/2004 CIKEUSIK 081584362119
3601044806970003 SITI ROHMAH P 08/06/1997 CURUGCIUNG 087770294330
46
47 3601040512780002 NURHADI L 05/12/1980 SUMURBATU 085693152642
 3601044901030001 NINA INDRIANI P 09/01/2003 TANJUNGAN 085891152242
48
49 3601042203980003 NURHASAN L 22/03/1998 LEBAK WARU 081233758232
3601045210720003 SARTUMI P 12/10/1972 CIKEUSIK 081511334099
50
51 36010448106550001 AAS P 08/10/1965 SUKAWARIS 085866761684
3601044107990263 SURYANAH P 11/11/1999 CURUGCIUNG 085215836367
52
53 3601042705040002 MUHAMAD L 27/05/2002 NANGGALA 085282390344
3601040107780066 ANIM L 07/11/1985 SUMURBATU 085946040235
54
55 3601040708840003 JANAR L 07/08/1984 SUKAMULYA 081511870226
3601040508960006 DARSONO L 05/08/1996 SUMURBATU 087775879070
56
57 3601040112890001 EMPIN L 01/12/1989 SUKAWARIS 085866761684
3601044710850001 JUMANAH P 07/10/1985 SUKAMULYA 085893643134
58
59 3601044205910004 YATI TOPIAH P 02/05/1991 SUKASENENG 085732125145
60 3601040107960028 RISWANTO L 01/07/1996 SUMURBATU 085694896886
61 3601041605790002 OMAN L 16/05/1979 CURUGCIUNG 085773662371
62 3601046702000002 SITI NURLELA P 09/10/2000 CIKEUSIK 081295099713
63 3601042004960001 SONARI SOESONO L 20/04/1996 TANJUNGAN 085866024330
64 3601045601990006 EKA PITRIA SUSILA P 16/01/1999 RANCASENENG 081959624163
65 3601044607070006 ROBIAH P 06/07/2007 CIKEUSIK 083856819760
66 3601046703060001 RIKA ARDIAYANTI P 27/03/2006 CIKEUSIK 085773490979
67 3601044807060003 YULIA ARISTY P 08/07/2006 CIKEUSIK 085721665729
68 3601044502080003 LENARA P 05/02/2008 CIKEUSIK 085814297880
69 36010455070440002 ILAMIDA P 28/02/2003 CIKEUSIK 085798840106
70 3601044808990001 VEGA ISMAYA SARI P 08/08/1999 RANCASENENG 085715265981
71 3202096505890010 LIA YULIANI P 28/08/1969 SUKAWARIS 081213710822
72 3601044302060005 YESI JULIANTI P 03/07/2006 CIEKEUSIK 087870079010
73 3601044102000299 IMAS P 27/01/2006 CIKEUSIK 085715440575
74 3601045711040001 NANI P 17/11/2008 CIPAAS 081574848317
75 3601045205760001 SANTI P 12/05/1976 SUKAWARIS 085866761684
76 3601040107020178 SULEMAN L 27/11/2001 SUKASENENG 082120335150
77 3601045504880005 LILIS P 15/04/1988 SUKAWARIS 085866761684
78 3601041012860004 RUSTANA P 10/12/1986 SUKAWARIS 085866761684
79 3601044811760002 RANI P 08/11/1976 SUKAWARIS 085888681684
80 3601044107800064 OMI P 01/07/1973 SUKAWARIS 085866761684
81 3601041302700001 AMIRUDIN L 13/02/1970 SUKAWARIS 085866761684
82 3601044904860002 KOTIJAH P 09/04/1986 CIKEUSIK 085311639972
83 3601045807750002 EEM EMAWATI P 04/05/1974 SUKAWARIS 085866761684
84 3601044101920002 SITI MASRIAH P 01/01/1992 SUKAWARIS 085866761684
85 3601044101950016 YOYOH P 10/10/1991 SUKAWARIS 081280959896
86 3601046507000001 EZA ISLAHATI AINU P 25/07/2000 UMBULAN 085211432311
87 3601046403910002 IMAS MAESAROH P 07/07/1990 SUKAWARIS 0813860880601
88 3601044107820045 ENOK ROHAYATI P 14/03/1975 SUKAWARIS 085866761684
89 3601044605950005 SUMYATI P 06/05/1995 SUKAWARIS 085866761684
90 3601045002960002 TINI MARYANTI P 07/07/1996 SUKAWARIS 085282309009
91 3601045001680004 SACI P 10/01/1968 SUKAWARIS 085866761684
92 3601044107630072 KURNAESIH P 01/07/1963 SUKAWARIS 085866761684
93 3601040107570025 SUHARNA S.PD L 19/05/1961 LANSIA SUKAWARIS 087773038477
94 3601044106470001 IRAH P 01/06/1947 SUKAWARIS 085866761684
95 3601044105910007 NENG DINA P 01/05/1991 SUKAWARIS 085866761684
96 3601041504820006 DULHADI L 15/04/1982 CIKEUSIK 081315915572
97 3601045210660001 TINAH P 12/10/1966 SUKAWARIS 085866761684
98 3602042507620004 DASRIP L 06/05/1982 SUMURBATU 085773105889
99 3601044107740013 SALMAH P 01/03/1983 SUMURBATU 085773105889
100 3601044707900010 IIS DAHLIA P 07/07/1990 SUKAWARIS 085866761684
101 3601040107930049 JOHAN FIRDAUS L 27/08/1993 SUMURBATU 081286268667
102 3601044107760036 SARMANAH P 01/07/1983 SUMURBATU 085875894907
103 3202016805690007 NENI P 28/05/1989 SUKAWARIS 085866761684
104 3601040511710001 AMING L 01/01/1969 SUKAWARIS 085866761684
105 3601044710830003 SAENI P 07/10/1983 SUKAWARIS 085866761684
106 3601045703740002 UNAH P 17/03/1974 SUKAWARIS 085866761684
107 3601040107050003 AGUNG KHAERUDINL 24/11/2005 SUKAWARIS 082312395989
108 3601044506940001 MARIAH P 05/06/1994 SUKAWARIS 085866761684
109 3601045211960005 SUMARNI P 12/11/1996 SUKAWARIS 085772428891
110 3601045104750003 ADE ASTUTI P 11/04/1975 SUKAWARIS 085866761684
111 3601044208810001 HAYATI P 05/01/1983 SUKAWARIS 085866761684
112 3601045007000008 WIDIAH P 10/07/2000 SUKAWARIS 085866761684
113 3601046406890001 NANI P 24/04/1989 SUKAWARIS 085666761684
114 3601044101980009 NURASIAH P 01/01/1998 CURUGCIUNG 085651513404
115 3601044102900006 ROSTIANAH P 07/07/1990 CURUGCIUNG 085771002609
116 3601045603960003 NURHAYATI P 16/03/1996 SUKASENENG 085283048197
117 3601040107910081 GUSTIANA PUTRA L 04/06/1989 SUKAWARIS 087871037222
118 3601041401060003 RIAN HIDAYAT L 14/01/2006 SUKAWARIS 0852822665056
119 3601045002730004 SUMIRAH P 10/02/1973 SUKAWARIS 085866764684
120 3601044102950004 IDA ROSIDA P 12/12/1992 CURUGCIUNG 085830287251
121 3601044108040002 SITI NURHAYATI P 01/08/2004 RANCASENENG 08558657771
122 3601046009770001 RASTI P 20/09/1977 CIKEUSIK 085694608776
123 3601045512970001 RAHAYU SUNENGSIP 15/12/`997 LEUWISARI 087781454359
124 3601040706850003 ZAENAL ARIPIN L 07/06/1985 GUNUNG KENCANA 082176438108
125 3601041507730001 MARSID L 04/05/1977 CIKEUSIK 083879448205
126 3601043105920002 KUSDANI L 31/05/1992 SUKASENENG 081347137313
127 3601045010020002 RINI ANTIKA P 10/10/2000 NANGGALA 082312020654
128 3601045201990003 ARSIH P 12/01/1999 SUKAWARIS 085694504449
129 3601044107830095 OCAH P 08/05/1977 SUKAWARIS 085694504449
130 3601046711760002 ETI ROHAYATI P 27/11/1976 RANCASENENG 085215786488
131 3601040107760036 SAKRI L 25/04/1981 SUMURBATU 085888351579
132 3601040607950005 SUIDIT L 06/07/1995 SUKASENENG 085692654753
133 3601040406830005 MAMAN SUPRATMAN
L 04/06/1963 SUKAWARIS 081511953006
134 3602215603910004 DEDE SARTIKA P 16/03/1991 SUKAWARIS 085213485041
135 3601044711030002 IKE NONJELITA P 07/11/2003 SUKAWARIS 081292834183
136 3601040107850050 CECE AKBAR L 22/03/1983 SUMURBATU 081385545268
137 3601045507000001 RADIF LESMANA L 02/05/2000 CIKEUSIK 081247941150
138 3601042510750001 RUCITA L 25/10/1975 CIKEUSIK 087772552393
139 3601044107670120 AMAH BT ABRORI P 02/04/1976 SUKAWARIS 085283952374
140 3600104540980004 CICIH P 14/09/1980 SUKAWARIS 085666761684
141 3601044203930005 EMUN MAEMUNAH P 02/03/1993 SUMURBATU 081385545268
142 3601046101050006 DIANI SAFITRI P 21/01/2005 CIKEUSIK 085891604684
143 360104011030002 NANDA TRI SYAFAAP 01/11/2003 CIKEUSIK 085695409674
144 3601040403930002 WAWAN KUSWANTOL 04/03/1993 TANJUNG SARI 085883178172
145 3601044107720028 DAYI L 17/10/1969 SUKAWARIS 066505345328
146 3601044309020002 SAITA P 13/09/2002 TANJUNGAN 085694723425
147 3602214109000002 MARNI P 17/11/2003 PARUNGJANJANG 085695178554
148 360104180483000 SURTANI BT ADIS P 18/04/1983 SUKAWARIS 085866761684
149 3601040107920250 DERI SUPIAN L 06/06/2003 SUKAWARIS 085283952374
150 3601041607700004 UWENDA P 15/07/1963 CIKEUSIK 085311639972
151 3601044185720006 ERI L 07/05/1972 SUKAWARIS 085866761972
152 1905065710860001 SITI P 17/10/1986 SUKAWARAIS 085866761684
153 3601044204420001 LIKA HANIFAH P 11/03//1992 UMBULAN 085217286303
154 360104612030002 RITA EKA PUSPITA P cv MALANGSARI 085882811820
155 3175062209550003 ZAINAL ABIDIK L 22/09/1955 BEKASI 081385820167
3601042104840001 AMIR L 10/07/1987 SUKAWARIS 081315728146
156
157 3604051509630004 ABDUL HAMID L 15/09/1963 LANSIA CIKEUSIK 085781108831
3604056504740003 SARINAH P 25/04/1974 CIKEUSIK 085776873480
158
159 3601046808060001 ADI WIDIANTI PUTRIL 11/06/2006 CIKEUSIK 085693480595
3601040107580133 SUPARTO L 01/07/1958 CIKEUSIK 081219681493
160
161 3602210608760002 AGUS MULYANA L 06/08/1976 UMBULAN 085212434122
3601041909990001 ALWAN MUSTOVA L 06/09/1999 CIKEUSIK
162
163 3601041507030010 WAHYUDI L 21/02/2004 CIKEUSIK
3601040107900324 SARMAN L 01/07/1990 ODGJ SUKASENENG 082155500460
164
165 3601045411960001 DIYAH P 14/11/1986 TANJUNGAN 081383548890

166 3601040710950002 ACHMAD RIDHWAN L 07/10/1995 NANGGALA

167 3601044107830086 RENTI P 31/03/1982 TEGALSARI 082258462514
168 3601044102040001 YANTI ARDILASARI P 04/11/2004 SUMURBATU 085692720209
169 3601040107840163 SUNTAMA L 01/07/1984 SUNTAMA 081318704554
170 3601044107890003 AMAH MULYAMAH P 21/08/1988 SUKAWARIS 085866761684
171 3601041101040001 KETI HAYATRI P 11/01/2004 RANCASENENG 085217367949
172 1002121603030002 SAIFUL L 16/03/2003 LAMPUNG TENGAH 087882285062
173 18021222100020001 ARIF S.A L 22/10/2003 LAMPUNG TENGAH 085773213784
174 3601047007010002 TINI NURBAETI P 30/07/2001 CIKIRUHWETAN 085697596595
175 3601045812030002 RIKA AMELIA P 18/12/2003 SUMURBATU 085718763135
176 3601045106040007 ITA PURNAMA SARI P 11/06/2004 SUMURBATU 085880253941
177 3601045203780003 SUNARIAH P 12/03/1978 UMBULAN 082213486621
178 3601040211020005 ROSUL L 16/12/2002 SUKASENENG 081302598060
179 3601044102650003 DASIMAH P 01/02/1965 LANSIA SUKAWARIS 085866761684
180 3301050409030002 SARIFUL ANAM L 04/09/2003 SURABAYA 087748108897
181 3601041907030002 SOFYAN MUJIONO L 19/07/2003 CIKEUSIK 085771919354
182 3601044101030004 SITI NURANDI P 01/01/2003 SUKAMULYA 085692969155
183 3601044107020119 AMANDA SULISTIAWP 19/09/2003 CIKEUSIK 081511750959
184 3601046104030004 NIA APRILIYANI P 21/04/2003 SUKAMULYA 085247992050
185 3601041076760001 RAKUM L 17/06/1976 SUKAWARIS 085215864026
186 3601044202030002 PUPUT FEBRIANTY P 02/02/2003 SUKAWARIS 085882796604
187 3601043112030002 YOGI L 31/12/2003 SUKASENENG 085882754427
188 3601046512000001 SITI APAULIN ABIATP 25/12/2000 CIKEUSIK 085771913286
189 3601040607400001 JUHEDI L 06/04/1974 CIKEUSIK 081906158163
190 3601045602030001 ANNESA PUTRI P 06/02/2003 CIKEUSIK 085776128267
191 3601046812020005 TRI MULIA ASTUSIE P 28/12/2002 SUKAMULYA 083874360980
192 3601044106950004 YENI MARYANI P 01/06/1995 SUKAWARIS 082310769521
193 3601044107030163 RINA LESTARI P 19/07/2000 UMBULAN 085695323029
194 3601046812020004 TRI MULIA WATIE P 28/11/2002 SUKAMULYA 083874361686
195 3601046801700003 AISAH P 28/01/1970 SUKAWARIS 082310769521
196 3601044107990274 ITA PURWANTI P 23/10/2000 SUKASENENG 085694382993
197 3601046702960002 SITI PARIHATUN P 27/02/1996 UMBULAN 085710509804
 3601044106030004 FITRIAH P 19/11/2003 RANCASENENG 085715264076
198
199 3601040804780004 SUMINTA L 08/04/1978 UMBULAN 081283773295
3601044203640001 DEDEH ROHAENI P 02/03/1964 CIKEUSIK 082310392899
200
201 3602210904030004 MUHAJIRIN L 09/04/2003 WANASALAM 085710525609
3601044311870001 SUNARTI P 03/01/1987 CIKEUSIK 0857674490414
202
203 3601044706940002 ROWILIS P 07/06/1994 ODGJ CIKEUSIK 082311540334
3601045712020001 NURMALIA FIJRIANTP 17/12/2002 NANGGALA 085770621486
204
205 3601040703650001 SUI L 07/03/1965 SUKAWARIS 085866761684
3601042409940003 SAEPUDIN L 24/09/1994 SUKASENENG 085773265425
206
207 3601044606010004 PINA LEPIANA P 06/06/2001 SUKAWARIS 085283234518
3601040507030004 WARTONO L 18/03/2003 SUKASENENG 085219423936
208
209 3601044405680001 SARNITI P 04/05/1968 SUKASENENG 085890699941
 aan BPJS (tulis 'Ya'
Dosis I Dosis 2
olom yang sesuai)
Merek Tanggal Tanggal Tanggal KET
Non Vaksin*** Screening Pemberia Pemberia
No. Batch No seri No. Batch No Seri
Anggota n n
Vaksinasi Vaksinasi
23/09/2021 23/09/2021 2400121 16220780661820

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23/09/2021 23/09/2021 2400121
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23/09/2021 23/09/2021 2400121 16220700465120
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23/09/2021 23/09/2021 2400121 16220780661196
23/09/2021 23/09/2021 2400121 16220780661196
23/09/2021 23/09/2021 2400121 16220780661196
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23/09/2021 23/09/2021 2400121 16220780661196
23/09/2021 23/09/2021 2400121 16220780661196
23/09/2021 23/09/2021 2400121
16220780965432
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16220780965432
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16220780965432
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16220780672600
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16220780880532
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16220780676344
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16220780889284
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23/09/2021 23/09/2021 2400121
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23/09/2021 23/09/2021 2400121
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23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
23/09/2021 23/09/2021 2400121
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23/09/2021 23/09/2021 2400121 1622078066 DOSIS 2

23/09/2021 23/09/2021 2400121 1622078067 DOSIS 2

23/09/2021 23/09/2021 2400121 1612078067 DOSIS 2

23/09/2021 23/09/2021 2400121 1622078067 DOSIS 2

23/09/2021 23/09/2021 2400121 1622078067 DOSIS 2

23/09/2021 23/09/2021 2400121 1622078067DOSIS 2

23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
23/09/2021 23/09/2021 2400121
DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078088DOSIS 2
23/09/2021 23/09/2021 2400121
1622078067DOSIS 2
23/09/2021 23/09/2021 2400121
1622078067DOSIS 2
23/09/2021 23/09/2021 2400121
1622078067DOSIS 2
23/09/2021 23/09/2021 2400121
1622078096DOSIS 2
23/09/2021 23/09/2021 2400121
1622078096DOSIS 2
23/09/2021 23/09/2021 2400121
1622078096DOSIS 2
23/09/2021 23/09/2021 2400121
1622078096DOSIS 2
23/09/2021 23/09/2021 2400121
1622078096DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121
1622078096DOSIS 2
23/09/2021 23/09/2021 2400121 1622070046DOSIS 2
23/09/2021 23/09/2021 2400121 1622070046DOSIS 2
23/09/2021 23/09/2021 2400121 1622070046DOSIS 2
23/09/2021 23/09/2021 2400121 1622078089DOSIS 2
23/09/2021 23/09/2021 2400121 1622070046DOSIS 2
23/09/2021 23/09/2021 2400121 1622070046DOSIS 2
23/09/2021 23/09/2021 2400121 1622078089DOSIS 2
23/09/2021 23/09/2021 2400121 1622078089DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
23/09/2021 23/09/2021 2400121 1622078066DOSIS 2
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601040904770001 DIDIH L
2 3601041006040001 MULYANA L
3 3601046205840001 TUNI P
4 3601044107780483 RUSINAH P
5 ERNA P
6 3573016012910002 PURI PRASETYORINI P
7 DIDIN NASRUDIN L
8 WAWAS WASTINI L
9 360104010780271 DASKIM L
10 3601040203890002 HERU L
11 3601042001570001 SAUDI L
12 3601042703610001 SADIRAH L
13 ARIAH P
14 360104231280002 IWAN. S L
15 DEDE AGUS. S L
16 3671064202870009 RIDAYANTI P
17 NURHAYATI P
18 3601042702700002 WARIS L
19 LELA PADILAH P
20 3601046306900001 RUNIAH P
21 3601092408980001 YANDI JUNAEDI L
22 3601044701890003 ANAH P
23 KASIH P
24 3601044612880004 RUSTINAH P
25 TASLIM L
26 1801065004920001 ROHAPIANA P
27 360104580830002 LULU NURHAYATI P
28 3601044110710001 TURINAH P
29 3601044101990001 CUANAH P
30 3209362503590001 HARYONO L
31 3601044107850183 ROHEMI P
32 3601041404750003 GANDA L
33 NURWANTI P
34 RAYON L
35 FAJAR NURMALIK L
36 3601044104970003 NENG DEPI P
37 KARYATI P
38 360104903020001 SAEPUL L
39 DARYADI L
40 ROKAH P
41 3601044507790005 HJ. NANI. S P
42 FERDIAN FIRMANSYAHL
43 3601044102080011 LISDA RATU ADELIA P
44 360104010794003 SUHENDRA L
45 KOKOM RATNA. N P
46 3601044402790002 ADE ROHANAH P
47 3601044506030001 KASEM P
48 3601040909090001 SUHARDI L
49 ROSSY. N P
50 3601045803030002 DINA MAHARANI P
51 HAYATI P
52 3601042206000001 RUKMANA L
53 3173062505790014 FERDIYAN L
54 3601045011810001 ADE SUPRIATNA L
55 MARYAM P
56 3601044108950010 SITI FATIMAH P
57 3601047004040001 AISYAH PUTRI. V P
58 3601044107840026 MIRAH P
59 OCIH P
60 3601045907850003 NENNA KURNIAWATI P
61 3601044409950002 DAHLIA P
62 HANAFI, ST L
63 EKA SAPUTRA L
64 3601040909020005 KOMARUDIN L
65 SAEFUL ANWAR L
66 3601046708990002 SITI AISYAH P
67 NURHAENI P
68 3601041207700002 ABAD L
69 3601046008020004 SAMSIAH P
70 3602211112990001 INDRA. L L
71 3601040207950003 SABAR L
72 KAMINAH P
73 ELIS SUSILAWATI P
74 TARPAN L
75 3601046807960002 KURIAH L
76 SUTRISNO L
77 JUMANI L
78 ARMAN L
79 SAAD SAPUTRA L
80 MARDIANTI P
81 3601045309080003 ROSIAH P
82 3601045111050006 MELDA. N P
83 3601046907000004 AYU SUNAYAH P
84 3601044712940002 HENI. H P
85 3601040102020006 M. AFANDI L
86 3601044605850008 NUNUNG ALFI P
87 360104010320003 ADITYA MALIK IBRAHIML
88 IGUN MAULANA L
 Kepesertaan BPJS (tu
'Ya' pada kolom yan

Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

09-04-1977 SUKAWARIS 085216967721

10-06-2004 SUKASENENG 081584772544
22-05-1984 CILUKUT 085216967721
01-07-1978 KIAR JANGKUNG 081292548912
06-08-1983 SUKAMULYA 085764681950
20-12-2001 BATU 0859102612757
12-09-1997 MUNJUL 083188700961
25-06-1994 CIKEUSIK 083875337107
01-07-1971 PEMTANG SEMPUR 081584362099
02-03-1989 PARKOS 085764681950
20-01-1957 CIKEUSIK 085695203486
27-03-1961 CIKEUSIK 087773112121
11-06-1972 CIKEUSIK 085697596550
23-12-1998 SUKASENENG 085211135758
07-08-2003 CIKEUSIK 085656507480
02-02-1987 CIKEUSIK 085282598706
06-03-1982 SUKASENENG 085790409189
27-02-1970 SUKASENENG 085883507949
05-09-1998 CIKEUSIK 081295098534
23-06-1990 CIKEUSIK 083897453556
06-07-1999 SUKASENENG 085215115454
07-01-1989 SUKASENENG 085891153800
01-07-1988 SUKASENENG 085776862550
06-12-1988 CIKEUSIK 082310248431
01-07-1963 SUKAWARIS 083871494582
15-04-1992 SUKAWARIS 081310957006
18-08-2003 SUKAWARIS 085283704752
01-10-1971 SUKAWARIS 082321641963
07-09-2002 SUKAWARIS 082321641963
25-03-1959 CIREBON 081250253923
01-07-1985 RANCASENENG 085217367949
14-04-1975 BATU JAYA 085210926520
13-02-2006 CIKEUSIK 085880005334
16-08-1990 SUKAWARIS 085882795455
04-04-1999 CIWET 082214202108
04-11-1999 SUKAWARIS 082214202106
22-11-1986 CIKARET 081584368612
11-05-2002 CIRIRIGI 085773758520
14-04-1988 RANCASENENG 085782266359
14-04-1988 RANCASENENG 085782266359
05-07-1979 JAKUT 082122982088
12-01-1999 UMBULAN 081911080770
06-08-2001 SUKASENENG 085777721140
01-07-1994 SUMURBATU 081210742986
28-04-1977 CIWET 083333894715
06-07-1983 KADIRI 083841424781
15-03-2003 RANCASENENG 081510153680
09-09-1959 CIKEUSIK 085714976099
23-01-2003 CIPOCOK 085773592842
18-03-2003 CIWET 085693594926
12-07-1971 SUKAWARIS 083151495925
14-08-2000 KADIRI 085693521586
25-05-1979 CIWET 087773432162
06-07-1980 CIBANGKONOL 081511696063
06-07-1980 SUKAMULYA 081511696063
01-08-1996 UMBULAN 081295007656
30-04-2004 UMBULAN 085891152951
01-07-1985 CITEUREUP 085210534710
17-03-1989 SUMURBATU 082124750340
19-07-1985 SUKASENENG 085771003787
29-09-1995 CIKEUSIK 081318024031
10-06-1982 SUKASENENG 085771003599
05-10-2001 SUKASENENG 085770973165
09-09-2002 CIKEUSIK 082114993348
12-05-1998 RANCASENENG 083115548604
27-08-1999 SUMURBATU 085894691361
01-07-1985 UMBULAN 085210919745
12-07-1969 NANGGALA 081910956461
20-08-2002 CIKEUSIK 085714776092
15-12-1998 KATAPANG 085695026280
29-09-1995 CIKEUSIK 085319140438
02-06-1980 SUKAMULYA 085860730724
27-09-1998 CIWET 083813252564
12-10-1984 SUKASENENG 085776130290
28-07-1996 SUKASENENG 081310328804
04-04-1988 SUKASENENG 081310328804
06-07-1997 SUKAWARIS 081291279642
11-02-1982 SUKAWARIS 085894687026
09-10-1999 TANJUNGAN 085709229874
08-08-2002 SUKAWARIS 081385546278
13-09-2008 SUKASENENG 085719437017
11-11-2005 RANCASENENG 085892876335
29-07-2000 CIKEUSIK 087884832900
17-11-1994 SUKAWARIS 085697583598
13-06-2002 NANGGALA 085212931672
06-05-1985 CIKEUSIK 085215981077
01-03-2002 CIRIRIGI 085779569033
30-04-2001 NANGGALA 085782134882
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi

CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322

CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343251322
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 28-08-2021 28-08-2021 24005021
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 29-07-2021 29-07-2021 24003121
CoronaVac 26-08-2021 26-08-2021 24004221
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24200121 16219343252570
CoronaVac 27-09-2021 27-09-2021 24005121 16219343252570
 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

27-09-2021 24200121 16219343252570 DI PKM CIREBON

27-09-2021 24200121 16219343252570
27-09-2021 24200121 16219343252570 D1 DI PKM SUMUR
NO No. Ticket NIK Nama Penerima Vaksin

1 3601044605060002 SITI ALMINAH. S

2 3601046711060001 SRI AYU WINENGSIH
3 3601065812050004 ULISTIA RAHMA
4 3602274311060003 ESI OCTAVIANI
5 3601047009010002 ELIS SAPITRI
6 3601044108050006 RODIAH AYULINDA
7 3601044805050002 AURIL RIZKI PAUJIAH
8 360104580110001 FITRIANI
9 3601045011050005 RISMA NOVIYANI
10 3601041502050001 ANDRI KANIDI
11 360221210870001 M, JAZI PERMADIANSYAH
12 3601044100050001 SITI PATIMAH
13 3602210209050002 WILDAN RAMADAN
14 3601044102050011 SITI INDAH LESTARI
15 3601040509060001 CANDRA IRAWAN
16 3601042501060001 RENDI
17 3602211701990001 HARUN ALPARIJI
18 3601042001050002 DIKA UDITIA
19 3601041008040003 RIZKI FATAHILLAH
20 3601041711040005 DEDE. S
21 3601040508040001 RIFAI NOPIANSYAH
22 360104550350004 ITA ILYASA
23 3601045002040002 SITI BAROKAH
24 3601044111060002 DEDE YULIANTI
25 3601047005050002 LIPA NURPATIHA
26 3601042305870003 JAIS MADRAIS
27 3601041712060001 WARIO
28 3601045608040001 DINA
29 360104500360002 NENG OLIS
30 3601046406060004 NURUL FITRIYANI
31 3602214508050004 SUPI FITRIYANI
32 3601045003060002 RESTIKASARI
33 3602010000610444 DIKRI AROHMAN
34 3601045812050007 ANITA SOPIAN
35 3601044812050003 HANA SOFA
36 3601044201070010 DEA PUSPITA
37 3601046106050003 ASTI SOLEHA
38 3601045404010003 FEBI ROMADINA
39 3602212210110003 RAMADANI
40 3601044806030002 TATU KUSRENI
41 3601045909040001 SEPTI PUSPITA SARI
42 3271066703040004 NIAWATI
43 3601042202050002 RENDI PEBRIAN
44 3601290503030004 ROY YUDIANTARA
45 3601041407040003 R TEDI PURBAYA
46 3601044212060002 SISKA
47 3601044904050003 ELSA SAFITRI
48 3602212501050002 PAIZ PAUZI
49 3602214101040001 WINDARI
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat
ok Umur
tahun)

P 06-05-2006 SMK ARKID MADANI CIWET

P 27-11-2006 SMK ARKID MADANI SUKAWARIS
P 18-12-2005 SMK ARKID MADANI MUARA
P 03-11-2006 SMK ARKID MADANI KARANG NUNGGAL
P 27-04-2004 SMK ARKID MADANI CIWET
P 01-08-2005 SMK ARKID MADANI SUKAWARIS
P 08-05-2005 SMK ARKID MADANI MUARA 2
P 12-11-2004 SMK ARKID MADANI CIWET
P 10-11-2005 SMK ARKID MADANI CIWET
L 01-11-2004 SMK ARKID MADANI CIWET
L 21-08-2006 SMK ARKID MADANI MUARA
P 01-01-2004 SMK ARKID MADANI SUMURBATU
L 02-09-2005 SMK ARKID MADANI WANASALAM
P 01-02-2005 SMK ARKID MADANI KANANGA
L 05-09-2006 SMK ARKID MADANI CIWET
L 25-01-2006 SMK ARKID MADANI TANJUNGAN
L 18-09-2004 SMK ARKID MADANI MUARA
L 20-01-2005 SMK ARKID MADANI CIWET
L 10-08-2004 SMK ARKID MADANI HUNIBERA
L 17-11-2004 SMK ARKID MADANI BABAKAN BANDUNG
L 05-08-2004 SMK ARKID MADANI CIWET
P 15-03-2005 SMK ARKID MADANI KADIRI
P 01-07-2004 SMK ARKID MADANI KADIRI
P 01-11-2006 SMK ARKID MADANI CIWET
P 30-05-2005 SMK ARKID MADANI BABAKAN BANDUNG
L 18-12-1988 SMK ARKID MADANI MALANGSARI
L 17-12-2006 SMK ARKID MADANI TANJUNGAN
P 16-08-2004 SMK ARKID MADANI PARKOS
P 10-03-2006 SMK ARKID MADANI KADIRI
P 24-06-2006 SMK ARKID MADANI CIWET
P 05-08-2005 SMK ARKID MADANI KARANG MALANG
P 10-03-2006 SMK ARKID MADANI SUMURBATU
L 27-12-2005 SMK ARKID MADANI BABAKAN BANDUNG
P 18/12/2005 MALANGSARI
P 08/12/2005 B. BANDUNG
P 02/01/2007 CIKIRUHWETAN
P 21/06/2005 CIKIRUHWETAN
P 19/10/2005 HUNIBERA
L 15/10/2006 WANASALAM
P 08/06/2003 SUKAMULYA
P 19/09/2004 TANJUNGAN
P 27/03/2004 KEMANG KIARA
L 22/02/2005 SUKAWARIS
L 05/03/2003 PASIR KADU
L 14/07/2004 CIKIRUHWETAN
P 02/12/2006 TANJUNGAN
P 09/04/2005 SUMURBATU
L 25/01/2005 MUARA
P 19/09/2006 WANASALAM
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

081511791531 CoronaVac 29-09-2021 29-09-2021

085882451638 CoronaVac 29-09-2021 29-09-2021
083871333842 CoronaVac 29-09-2021 29-09-2021
085776886052 CoronaVac 29-09-2021 29-09-2021
085795308438 CoronaVac 29-09-2021 29-09-2021
081511943645 CoronaVac 29-09-2021 29-09-2021
085693636860 CoronaVac 29-09-2021 29-09-2021
085697596593 CoronaVac 29-09-2021 29-09-2021
085714783742 CoronaVac 29-09-2021 29-09-2021
081280562467 CoronaVac 29-09-2021 29-09-2021
083875405814 CoronaVac 29-09-2021 29-09-2021
081295093749 CoronaVac 29-09-2021 29-09-2021
083871564504 CoronaVac 29-09-2021 29-09-2021
081383742415 CoronaVac 29-09-2021 29-09-2021
081584340075 CoronaVac 29-09-2021 29-09-2021
081574990991 CoronaVac 29-09-2021 29-09-2021
081906156691 CoronaVac 29-09-2021 29-09-2021
085694566815 CoronaVac 29-09-2021 29-09-2021
085771606195 CoronaVac 29-09-2021 29-09-2021
085210827668 CoronaVac 29-09-2021 29-09-2021
085710517069 CoronaVac 29-09-2021 29-09-2021
085860730573 CoronaVac 29-09-2021 29-09-2021
085719063802 CoronaVac 29-09-2021 29-09-2021
085695147583 CoronaVac 29-09-2021 29-09-2021
085773900268 CoronaVac 29-09-2021 29-09-2021
081299734588 CoronaVac 29-09-2021 29-09-2021
085773758184 CoronaVac 29-09-2021 29-09-2021
085710499267 CoronaVac 29-09-2021 29-09-2021
085705669643 CoronaVac 29-09-2021 29-09-2021
085773210186 CoronaVac 29-09-2021 29-09-2021
083899139211 CoronaVac 29-09-2021 29-09-2021
085311036493 CoronaVac 29-09-2021 29-09-2021
085715543688 CoronaVac 29-09-2021 29-09-2021
0857772728856 CORONAVAC29/09/2021 29/09/2021
083890674343 CORONAVAC29/09/2021 29/09/2021
082312261294 CORONAVAC29/09/2021 29/09/2021
081316720334 CORONAVAC29/09/2021 29/09/2021
085861173891 CORONAVAC29/09/2021 29/09/2021
085216426533 CORONAVAC29/09/2021 29/09/2021
082120537147 CORONAVAC29/09/2021 29/09/2021
081574227637 CORONAVAC29/09/2021 29/09/2021
085780577694 CORONAVAC29/09/2021 29/09/2021
081906156691 CORONAVAC29/09/2021 29/09/2021
085311036496 CORONAVAC29/09/2021 29/09/2021
083195518125 CORONAVAC29/09/2021 29/09/2021
085775206815 CORONAVAC29/09/2021 29/09/2021
085217578180 CORONAVAC29/09/2021 29/09/2021
083139574656 CORONAVAC29/09/2021 29/09/2021
085711045245 CORONAVAC29/09/2021 29/09/2021
Dosis I Dosis 2

Tanggal
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
24200121
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
2021081541
KET
NO No. Ticket NIK Nama Penerima Vaksin

1 3601044307050004 ANISAH
2 3601045205050006 ARINI
3 3601044207050003 RENA
4 3601045112050001 RINI INDAH LESTARI
5 3601046508050005 NURSIAH
6 ANJELI SEPTIYANANDA
7 ROHENI
8 3601041806050003 SAHRUL ARIANSYAH
9 3601024501070004 SITI FADILAH
10 3601040804060002 TOPAN AZIZ
11 GILANG RAMADAN
12 3601046912050004 RICAH
13 3601041706060002 IPAN MAULANA
 Umur Kelomp
JK Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

P 11-03-2005 SMK ARKID MADANI CIWET

P 12-05-2005 SMK ARKID MADANI TANJUNGAN
P 17-08-2004 SMK ARKID MADANI TANJUNGAN
P 11-12-2005 SMK ARKID MADANI CIWET
P 25-08-2005 SMK ARKID MADANI CIWET
P 05-09-2006 SMK ARKID MADANI PESAWARAN
L 15-10-1993 SMK ARKID MADANI TANJUNGAN
L 18-06-2005 SMK ARKID MADANI CIWET
P 05-01-2007 SMK ARKID MADANI CIBALIUNG
L 08/04/2006 SMK ARKID MADANI SUKAWARIS
L 15/10/2005 SMK ARKID MADANI CIKIRUHWETAN
P 29/12/2005 SMK ARKID MADANI SAWAH
L 17/06/2006 SMK ARKID MADANI SUMURBATU
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

083179506228 CoronaVac 29-09-2021 29-09-2021

085714197623 CoronaVac 29-09-2021 29-09-2021
085776845960 CoronaVac 29-09-2021 29-09-2021
085882413138 CoronaVac 29-09-2021 29-09-2021
083896971061 CoronaVac 29-09-2021 29-09-2021
085893165274 CoronaVac 29-09-2021 29-09-2021
082219687483 CoronaVac 29-09-2021 29-09-2021
081210114817 CoronaVac 29-09-2021 29-09-2021
085776126458 CoronaVac 29-09-2021 29-09-2021
081211551129 CORONAVA 29/09/2021 29/09/2021
085776119354 CORONAVA 29/09/2021 29/09/2021
082310134607 CORONAVA 29/09/2021 29/09/2021
085773239695 CORONAVA 29/09/2021 29/09/2021
Dosis I Dosis 2

Tanggal
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

24200121
24200121
24200121
24200121
24200121
24200121
24200121
24200121
24200121
24200121
24200121
24200121
24200121
KET
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045011800010 SUNIAH P
2 3601044304970003 EVA APRIYANTI P
3 3601046003860001 MARIA ULFAH P
4 3601044510790001 RAMINAH P
5 3601040107800288 WASRA L
6 3601046412890001 NIKYTA WATI P
7 3601044107740118 CARTINAH P
8 3601044303910005 ROHANAH P
9 3601044707030012 LILIS P
10 3601044605800003 ROMLAH P
11 360044107880210 YANTI P
12 3601044107600040 RUSTINIH P
13 360104021900001 CARKIMAN P
14 3601040204520001 SAKIM L
15 3601045608010003 TUNIROH P
16 3601043004020001 PENDI SUTIAWAN L
17 360104407910109 SUSANTI P
18 3601046307690002 NINA ERLINA P
19 3601046909920002 MIRNAWATI P
20 3601044208770001 RUMINAH P
21 3601044107780128 KHODIJAH P
22 3601045803990005 IIS ANISA P
23 360104150800003 TARYANTO L
24 3601041803020003 RIZKY ANDIKA L
25 3601042501700002 KADMA L
26 3601045412940001 NURHAYATI P
27 3601046707820003 TATI P
28 3601046511820001 ROSMINIH P
29 3601044107010142 SRI WAHYUNI P
30 3601046705830002 CARITI P
31 360104670280003 KURSIH P
32 3601044107940072 DIAN RATNASARI P
33 3601044107830107 AYI SUDARYI P
34 3601044205000005 MIA WAHYUNI P
35 3601042810010002 M. BAHRI L
36 3601041205960002 AGUNG FIRMANSYAH L
37 3601040107950092 YUSRI L
38 3601042808010002 M. BAGUS. A L
39 3601044504880008 JURIYAH P
40 3601040908760003 CECEP L
41 3601045205880002 SRI ERNAWATI P
42 3601044107930084 TARSINIH FEBRIANI P
43 360104107660034 SANI P
44 1611075606960002 HERNAWATI P
45 3601046101040001 MELLY JULIANI P
46 360104106870003 IKA NURWATI P
47 3601041003750004 SUDIN L
48 3601040107730125 FATONI L
49 3601044704790002 RAMINAH P
50 36010427280002 ALI TONI L
51 3601040501900001 FAHRUROZI L
52 3601042711790003 INDRA CAHYADI L
53 3601042512990004 DEVI PERMATASARI P
54 3601045207770004 INAH P
55 3601040107700074 RASIDI L
56 3601040107700079 WARID L
57 3601044808970004 RIKI PASWATI P
58 3601045708770006 JAENI P
59 3601045405920003 ATUN SUSILAWATI P
60 3601045212010002 BETTY PRAMESTI P
61 3601044908870006 NANI SUMARNI P
62 3601044107810061 RUMINIH P
63 360144107700070 SUNIORAH P
64 3601044107940071 NIA MILAWATI P
65 3601044107250008 SITI HODIJAH P
66 3601045507820003 TRIANAWATI P
67 3601040407790002 CASMANI P
68 3601041501720001 NASIRIN L
69 3601042705950003 SUPANDI L
 Umur
Pekerjaan* Kelompok Umur INSTANSI
(18-59 tahun)

10-11-1980 UMUM
03-04-1997 UMUM
20-03-1986 UMUM
07-12-1979 UMUM
01-07-1980 UMUM
24-12-1989 UMUM
01-07-1958 LANSIA
03-03-1991 UMUM
07-07-2003 UMUM
06-05-1980 UMUM
01-07-1988 UMUM
08-04-1965 UMUM
21-11-1990 UMUM
02-04-1952 LANSIA
16-08-2000 UMUM
30-04-2002 UMUM
01-07-1991 UMUM
23-07-1996 UMUM
29-09-1992 UMUM
02-08-1970 UMUM
09-03-1978 UMUM
10-03-1989 UMUM
15-08-2001 UMUM
18-03-2002 UMUM
02-07-1973 UMUM
14-12-1994 UMUM
27-04-1982 UMUM
25-11-1982 UMUM
31-12-2000 UMUM
27-05-1983 UMUM
27-02-1998 UMUM
02-07-1993 UMUM
03-11-1971 UMUM
02-05-2000 UMUM
28-10-2001 UMUM
12-05-1996 UMUM
07-12-1995 UMUM
28-08-2001 UMUM
05-04-1988 UMUM
09-08-1976 UMUM
12-05-1988 UMUM
10-08-1993 UMUM
01-08-1966 UMUM
16-06-1996 UMUM
21-01-2004 REMAJA
26-08-1989 UMUM
05-03-1973 UMUM
05-12-1969 UMUM
07-04-1979 UMUM
12-08-1977 UMUM
05-01-1989 UMUM
27-11-1979 UMUM
27-12-2000 UMUM
12-07-1977 UMUM
12-08-1967 UMUM
01-07-1970 UMUM
08-08-1997 UMUM
17-08-1977 UMUM
14-05-1992 UMUM
21-09-2001 UMUM
09-08-1987 UMUM
01-07-1981 UMUM
17-04-1973 UMUM
07-03-1996 UMUM
UMUM
08-12-1987 UMUM
06-06-1986 UMUM
15-01-1972 UMUM
27-05-1995 UMUM
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Merek
Alamat NO HP BPJS BPJS Non Vaksin***
PBI Non PBI Anggota

RANCASENENG 085693645971 CoronaVac

RANCASENENG 085692654490 CoronaVac
RANCASENENG 081646042844 CoronaVac
RANCASENENG 085280160916 CoronaVac
RANCASENENG 085693636443 CoronaVac
RANCASENENG 081210678418 CoronaVac
RANCASENENG 081210678418 CoronaVac
RANCASENENG 085894980650 CoronaVac
RANCASENENG 085891512646 CoronaVac
RANCASENENG 081585457613 CoronaVac
RANCASENENG 085695154752 CoronaVac
RANCASENENG 085695154752 CoronaVac
RANCASENENG 08568525752 CoronaVac
RANCASENENG 085810876441 CoronaVac
RANCASENENG 085770972251 CoronaVac
RANCASENENG 085781086839 CoronaVac
RANCASENENG 085319535660 CoronaVac
RANCASENENG 085819370342 CoronaVac
RANCASENENG 085215222953 CoronaVac
RANCASENENG 085219423917 CoronaVac
RANCASENENG 085213478251 CoronaVac
RANCASENENG 087864231734 CoronaVac
RANCASENENG 081295097718 CoronaVac
RANCASENENG 085695267346 CoronaVac
RANCASENENG 085213557782 CoronaVac
RANCASENENG 081413316515 CoronaVac
RANCASENENG 085711867204 CoronaVac
RANCASENENG 085891154421 CoronaVac
RANCASENENG 085215801856 CoronaVac
RANCASENENG 085883202826 CoronaVac
RANCASENENG 085773763874 CoronaVac
RANCASENENG 085775234410 CoronaVac
RANCASENENG 081213028985 CoronaVac
RANCASENENG 083874952331 CoronaVac
RANCASENENG 085782266442 CoronaVac
RANCASENENG 087773338733 CoronaVac
RANCASENENG 085810901318 CoronaVac
RANCASENENG 082151186925 CoronaVac
RANCASENENG 085794449044 CoronaVac
RANCASENENG 085211444664 CoronaVac
RANCASENENG 081386326158 CoronaVac
RANCASENENG 081586283928 CoronaVac
RANCASENENG 085774802590 CoronaVac
RANCASENENG 085778987163 CoronaVac
RANCASENENG 085886413965 CoronaVac
RANCASENENG 087774705761 CoronaVac
RANCASENENG 085212814437 CoronaVac
RANCASENENG 085694376240 CoronaVac
RANCASENENG 085882795613 CoronaVac
RANCASENENG 085882795613 CoronaVac
RANCASENENG 085215759611 CoronaVac
RANCASENENG 081646042844 CoronaVac
RANCASENENG 085779570656 CoronaVac
RANCASENENG 085774802590 CoronaVac
RANCASENENG 085774802590 CoronaVac
RANCASENENG 085773763786 CoronaVac
RANCASENENG 081513465663 CoronaVac
RANCASENENG 081383708729 CoronaVac
RANCASENENG 081775226463 CoronaVac
RANCASENENG 081383708729 CoronaVac
RANCASENENG 085778216741 CoronaVac
RANCASENENG 081254042529 CoronaVac
RANCASENENG 085774802590 CoronaVac
RANCASENENG 085894197815 CoronaVac
RANCASENENG 085778216441 CoronaVac
RANCASENENG 083895409646 CoronaVac
RANCASENENG 083895409646 CoronaVac
RANCASENENG 085219673010 CoronaVac
RANCASENENG 085779985914 CoronaVac
 Dosis I Dosis 2
Tanggal Tanggal Tanggal
Screening Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
30-09-2021 30-09-2021 24200121 16220778705908
30-09-2021 30-09-2021 24200121 16220778705908
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16220778705908
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309477649
30-09-2021 30-09-2021 24200121 16219309687625
30-06-2021 30-06-2021 24002321 30-09-2021 24200121
30-09-2021 30-09-2021 24200121 16219309687625
30-09-2021 30-09-2021 24200121 16219309687625
30-09-2021 30-09-2021 24200121 16219309687625
30-09-2021 30-09-2021 24003121 16182997314161
30-09-2021 30-09-2021 24003121 16182997314161
30-09-2021 30-09-2021 24003121 16182997314161
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
30-09-2021 30-09-2021 24003121 16182997316829
 KET
No Seri

16219309687625 D1 D UNIVERSITAS PANCASILA

NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601043005980002 WARNOTO L
2 3601044501020002 IIS AMELIA P
3 3601040107030067 BAYU PRATAMA L
4 3601042805080002 ADITIA L
5 3601044410850005 HJ.SITI WASIAH P
6 3601044107680160 CARTI P
7 3601042011860001 TRISNO L
8 3601040103000002 TEDI SETIAWAN L
9 3601041105830001 SUHARNA L
10 3276026502040005 SITI AISYAH ALAIKA P
11 3601040206960004 SUPRIADI L
12 3601045009830001 ANI P
13 3601044107030126 ANGGA FERISQI L
14 3601041007880002 MUDIN L
15 3601044107760220 CARNI P
16 361041505010002 ASEP SUJONO L
17 3601041602920003 ENDI L
18 3601044405920003 HETI P
19 3601046007000004 DEVI ARDIANTI P
20 3601041408980003 AMAN TRIANA L
21 3601041906010003 IRWAN EFENDI L
22 36010455001790001 RUKMI P
23 3601044107730430 SUNENTI P
24 3601040605570001 H.KAMIDI L
25 3601040103020008 DEDEN SUPENDA L
26 3601044507830005 TINAH P
27 3601040701030011 CASWINTO L
28 3601044302790001 ERAH P
29 3601040701020005 NANANG L
30 3601046008070003 AYU LESTIANA P
31 3601045301070003 SITI NENGSIH P
32 3601044107870070 MARINAH P
33 3601046211930003 MARYANI P
34 360104100302006 LUFKI L
35 3601040810720001 TAWEN P
36 3602210808880001 ANDI SAPUTRA L
37 3601040309020003 ADI JAMADI L
38 3601040309010003 M. ALI NURDIN L
39 3601045311800002 AYU ASIH P
40 3601045707990002 LAILA RAHMATIN M P
41 3601040802010002 HERMAWAN L
42 3601040107010305 DIDIT ADITYA L
43 3601041208020003 EEM DIMYATI L
44 3601041508010001 OPAN L
45 3601041101000002 AYATULLAH HUMAENI L
46 3601041208330001 SUP SUPRIATNA L
47 3601046406040001 SAENAH P
48 3601040107030011 ARDA L
49 360104230203003 AHMAD RIYADI L
50 36010409040001 BILLY BIMA N L
51 3601044602760005 ETI SUHETI P
52 3601046711830002 RUSNIA P
53 3601044904850006 NENA SOLIHAH P
54 36010406807370001 IDA ROSIDA P
55 3601044808930002 SITI NURLAELASARI P
56 3601044811880001 MARYATI AMELIA P
57 3601044107760242 TASINI 1P
58 36010454410800003 RATINAH P
59 3606042401040003 M.UHAMAD RISKY L
60 3601041801710002 SOBIRIN L
61 3601044107930293 SITI SUHAELAH P
62 360104451870005 ROFIAH P
63 3601040708950003 INDRA MAULANA L
64 3601045609020002 NINING RATINIH P
65 3601044107970221 SAINAH P
66 3601046510030002 NOVA OKTAVIYANA P
67 36010460068700001 RASMINIH P
68 3601045010730003 DANESIH P
69 3601040503930002 TAUFIK HIDAYAT P
70 3601042806750001 RASTAWI L
71 3601041706030002 JULIA ADI PURNOMO L
72 3601041605020001 DIDI L
73 3601042603810001 DUDI L
74 3601044209000001 SITI RUKAYAH P
75 3601044107830358 CASWATI P
76 3601040212840001 RHANI L
77 3601046609800002 CASTINI P
78 3601040107940099 SAFEI L
79 ARTIAH P
80 3601045507750015 AENAH P
81 3601042207940001 YAYAN HERMAWAN L
82 3601045805030001 KARMI P
83 3601044904850006 NENA SOLIHAH P
84 36010406807370001 IDA ROSIDA P
85 3601044808930002 SITI NURLAELASARI P
 Umur Kelompo
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) k Umur

30-05-1998 CIKEUSIK 0812-1983-5775

05-07-2002 NANGGALA 0856-9360-3647
14-08-2002 NANGGALA 0856-9709-7496
28-05-2008 KIARA JANGKUNG 0812-3730-8129
04-10-1985 KP.MALANGSARI 0858-1102-5536
01-07-1968 CIKEUSIK 0813-1746-2540
28-11-1987 NANGGALA 0856-9526-8479
08-09-2002 CIKEUSIK 0852-1281-7263
11-05-1983 CIKEUSIK 0857'8108-6537
2/25/2004 SUKASENENG 0857-7485-8469
02-06-1986 CIKEUSIK 0815-8512-2403
9/10/1983 CIKEUSIK 0815-8122-2043
23-09-2003 SUKASENENG 0856-9347-7080
7/10/1988 CIKADONGDONG 0858-9299-5705
01-07-1976 SUKASENENG 0838-0719-0117
15-05-2001 SUKASENENG 0856-9354-2079
16-02-1992 CIKADONGDONG 0857-1902-0144
01-06-1985 SUMURBATU 0857-18763786
20-07-2001 UMBULAN 0858-9234-1175
8/14/1998 SUKASENENG 0823-1089-8933
19-06-2001 SUKASENENG 0822-7531-4693
15-01-1979 SUKAWARIS 0815-7464-5184
01-07-1973 SUKASENENG 081584375277
5/6/1957 CIKEUSIK 0813-8045-3075
3/1/2002 RANCASENENG 0857-7459-5662
7/6/1983 SUKASENENG 0852-8370-5605
1/7/2003 CIKEUSIK 0857-7139-6770
2/3/1985 SUKASENENG 085313199723
14-10-2002 RANCASENENG 0857-8165-6217
8/20/2007 CIKEUSIK 0857-7905-4173
1/13/2007 CIKEUSIK 0857-7905-4173
10/6/1989 CIKEUSIK 0852-1234-5220
11/22/1993 CIKEUSIK 0813-1684-9381
4/10/2002 PARUNGKOKOSAN 0857-8213-4972
01-07-1975 CIKEUSIK 0858-1090-3845
8/8/1988 CIKIRUHWETAN 0857-57635205
03-09-2002 SUKASENENG 0857-8166-0191
9/3/2001 SUMURBATU 0856-9580-6317
07-06-1985 SUKASENENG 0852-1988-4172
17-07-1999 SUKAWARIS 0812-9275-6537
11/25/2000 SUKASENENG 0858-1114-4937
01-07-2001 SUKASWARIS 0812-9541-3849
12-08-2002 SUKAMULYA 0831-4806-1772
12/29/2005 SUKASENENG 0857-7161-3860
9/11/1999 SUKASENENG 0816-1734-3763
1/11/1979 SUKASENENG 0852-1988-4172
6/1/2004 PARUNGKOKOSAN 0823-1024-7041
2/15/2003 CIKEUSIK 082150900851
2/23/2003 CIKADONGDONG 0857-1870-7811
4/9/2004 RANCASENENG 085711830115
2/6/1976 UMBULAN 0815-7473-8138
11/27/1983 CIKEUSIK 0853-1311-7508
09-041985 CIKIRUHWETAN 085280526783
28-03-1977 UMBUL;AN 08777316983
8/8/1993 UMBULAN 0812-2438-8125
11/8/1988 UMBULAN 0858-9115-2932
7/15/1976 UMBULAN 0812-8229-5277
10/14/1980 SUKASENENG 0858-1126-4499
1/29/2004 RANCASENENG 0856-9437-7306
1/18/1971 UMBULAN 0812-8229-5277
7/7/1989 SUMURBATU 085210516169
10/5/1992 SUKASENENG 08551975004
2/23/1989 SUKASENENG 085210946695
9/16/2002 CIKEUSIK 085710525756
12/16/2004 CIKADONGDONG 0857-8043-2439
10/25/2003 UMBULAN 0896-8611-5440
03-01-1988 CIKEUSIK 081314142256
10/10/1973 UMBULAN 0857-7350-0549
3/5/1999 CIKEUSIK 0852-8063-2354
17-02-1978 NANGGALA 0821-1189-3181
6/17/2003 CIKEUSIK 0852-8051-7373
5/18/2002 CIKEUSIK 0852-1578-9118
26-03-1981 CIKIRUHWETAN 0812-9547-2368
02-09-2000 SUKAWARIS 0812-1896-9714
7/1/1982 SUKASENENG 0852-1695-4804
12/2/1983 NANGGALA 0812-9652-9779
9/16/1982 UMBULAN 0896-8611-5440
7/1/1994 NANGGALA 0812-9652-9776
12/27/2003 CIKEUSIK 0858-8084-0071
7/15/1985 CIKEUSIK 0816-4606-1709
7/22/1994 SUKAWARIS 0821-1813-2620
5/18/2005 SUKASENENG 085217366187
09-041985 CIKIRUHWETAN 085280526783
28-03-1977 UMBUL;AN 08777316983
8/8/1993 UMBULAN 0812-2438-8125
Kepesertaan BPJS (tulis 'Ya'
Dosis I
pada kolom yang sesuai)
Tanggal Tanggal
BPJS Non Merek Vaksin***
BPJS PBI Screening Pemberian No. Batch
Non PBI Anggota
Vaksinasi
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/08/2021 24200121
CORONAVAC 30/09/2021 9/30/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 02-09-2021 24003121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 9/2/2021 24003121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 8/26/2021 24004521
CORONAVAC 30/09/2021 30/08/2021 24003121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 9/2/2021 24003121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 7/5/2021
CORONAVAC 30/09/2021 8/23/2021 24200121
CORONAVAC 30/09/2021 8/5/2021 24003121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 30/09/2021 24200121
CORONAVAC 30/09/2021 8/26/2021 24004521
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
16219309685597
16219309685597
16219309685597
16219309685597
16219309685597
16219309685597
16219309685597
162119303686689
162119303686689
162119303686689
162119303686689
162119303686689
162119303686689
16219309687313
'16219309687313
'16219309687313
'16219309687313
'16219309687313
'16219309687313
16219309476245
16219309476245
16219309476245
16219309476245
16219309476245
16219309476245
16219309476245
16219309476245
'16219309687001
'16219309687001
'16219309687001
'16219309687001
'16219309687001
'16219309687001
'16219309687001
'16219309687001
'16219309687001
16219309681993
16219309681993
16219309681993
16219309681993
16219309681993
16219309681993
16219309680901
16219309680901
16182994688229
16219309680901
16219309680901
16219309680901
16219309680901
16219309680901
16182994688229
16219309680901
16219309680901
16219309680901
16219309685897
16219309685897
16219309685897
16219309685897
16219309685897
16219309685897
16219309685897
16219309685897
16219309685897
16219309685897
16182994687605
16182994687605
16182994687605
16182994687605
16182994687605
162119303686689
'16219309687313
16182994688229
16219309680901
16219309680901
16182994688229
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3602210705040001 ACIH. S P
2 3601044508950001 RIA HASTUTI P
3 3601045509850001 SITI AISYAH P
4 3601044502660001 ITI P
5 3601045605780001 CARTINI P
6 3601045009840002 KASMI P
7 360104611278001 DASNIAH P
8 3601044201770001 CASMINAH P
9 3601044107630334 KARNITI P
10 3601045204890001 RUSYANTI P
11 3601045312990001 EVA NOVITA P
12 3601044612880001 NURODIAH P
13 3601045805900001 NISA HAMIDAH P
14 3601044107550069 WARSINAH P
15 3601040905900002 NASIR L
16 3601045207870002 ISRI P
17 3601045709980002 SUSI LIAWATI P
18 36010407730317 RAKIMAN
19 3601044607830002 INAH P
20 3601040307860001 DATAM L
21 1611071502920001 HASANUDIN L
22 3601045468010005 RISKA AUDINA P
23 3601042506800001 RUSTAM L
24 3601041510850002 ACEP. S L
25 3601044106890001 NURLELA P
26 3601040305700002 RASJANA L
27 3601042210000003 M. TOMI L
28 360104440650003 WARTINI P
29 SRI MULYAWATI P
30 3601045904070002 SELVI ASMARA P
31 3601041102000007 RIAH P
32 3601041305780001 NURYANA L
33 3601045706640002 RAMEH P
34 36010441070234 SARMI
35 360104010720071 DARTA L
36 MAMAT L
37 3601040303700003 KARIM L
38 3601042211020004 FAIZAL RAMDANI L
39 3601042104730002 KARSADI L
40 3601040107810218 KAMAD L
41 3601044107810233 RATINI P
42 3601044707770001 ONASIH P
43 3601042007350003 MISRA L
44 3601040807020004 ROHMAT SAPUTRA L
45 3601044705040005 IIS MELANTIKA P
46 3601045506030002 RITA AMELIA P
47 3601042407030003 FIRMANSYAH L
48 3601042507020004 M. RAEHAN L
49 3601045705930003 NURLELA P
50 3202292205930003 ANDI KURNIA L
51 3601045105920001 TATI HARYATI P
52 3601044104620001 ROHATI BT SAJUKI P
53 3601044103660001 DASIYH P
54 3601046809950003 RITA P
55 3601044408600003 SARIAH P
56 3601046501810003 RANITA P
57 3601035507990001 IRMA FATMAWATI P
58 3601045002700002 ROYATI P
59 360104010770119 KARSONO L
60 3601042602030002 M. TOBRIANSYAH L
61 3601032308820001 AMRAN L
62 3601044107880199 JAMI'AH P
63 3601046006790002 SALINAH P
64 3601040107720016 IPIN L
65 3601044507020001 AYUNI P
66 3601046803920001 SITI ROMLAH P
67 360104012960002 ARIPAN L
68 3212150501920003 KURNADI L
69 3601040107950022 MASDI L
70 3601044305820001 SITI HODIJAH P
71 360104491267002 DAKEM P
72 3601040107750240 ATEP L
73 3601045705010002 AHISA FEBRIANTI P
74 3601044603820002 LOMRAH P
75 3601044903800001 SUTINAH P
76 3601044309690001 RUMSINAH P
77 3601045002810002 SANAH P
78 3601041208790002 ACE L
79 3601044604800002 JUARSIGH P
80 3601044102630003 RIAH P
81 3601040203930001 HAFIDIN L
82 M. SYAHRUL HIDAYAT L
83 360104091190002 DADANG L
84 36010407960153 BENDI L
85 3601044402830001 RASTINI P
86 3601044107620017 UPEN L
87 3601041707720004 BUDI SUTRISNO L
88 3601044107810017 ASMI P
89 3601045002740002 NUNUNG P
 90 3601040108720002 UDIN L
91 18106051080010 AANG. J L
92 3602090503010001 AGI L
93 3601041208930009 JUNED L
94 3601040308010002 ANGGI ALFARIJI L
95 3601044107830066 MARIAM P
96 3601062410000004 SHANDY RAZWAL L
97 3601040105920003 KOMARUDIN L
98 3601046711030001 ATIN SAFITRI P
99 3601044607040002 LINA P
100 3601044204000001 DESI SAPITRI P
101 360104410030007 LILIS P
102 3201021208750015 JUNAIDI L
103 MAMAN SUDARMAN L
104 MA'MUN L
105 3601044107850293 SANTI P
106 3601040708060005 M. SARIPUDIN L
107 3601044107030180 ALDA ARISTAMA P
108 3601045802830002 ETI P
109 3602016609030001 RISMA AYU LANDARI P
110 DEDE SUHAEFI L
111 3601044910970002 LUSIANA ADELIA P
112 360209250697000 USMAN L
113 3601040404790004 SYUKUR KURNIAWAN L
114 3601046602990002 RUMINI P
115 3601040107850208 SAPI'I L
116 3602010508960008 SUPRI L
117 1801091609020003 KIKI SANJAYA L
118 1806021409680002 WAHYU WIJAYANTO L
119 3601040703000008 RULI PATRIYASAN L
120 HENDRA
121 YUDI
122 KRISNA L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

21-01-2006 KATAPANG 085659674773

18-08-1995 CIKEUSIK 085216085817
15-08-1995 CIKEUSIK 081299125566
05-02-1966 CIKEUSIK 081316931604
16-05-1978 RANCASENENG 081282273858
08-10-1980 CIKEUSIK 085703083389
21-12-1976 UMBULAN 081517026297
02-01-1977 SUKASENENG 085283234524
01-07-1965 UMBULAN 085214150497
02-04-1989 BABAKAN CIBALIUNG082312285598
15-09-1999 UMBULAN 081617631743
06-12-1988 SUKASENENG 081383433483
18-05-1996 PEMATANG SEMPUR085774663776
01-07-1955 LANSIA CIKEUSIK 085283862932
09-05-1990 SUKAWARIS 085217105542
09-02-1983 UMBULAN 081574578236
17-09-1989 SUKASENENG 081315849914
01-07-1973 SUKASENENG 085693542079
06-07-1983 UMBULAN 085218566558
25-05-1983 SUKASENENG 087882232529
15-02-1992 RANCASENENG 083135104701
14-08-2001 CURUGCIUNG 085881781831
25-06-1980 CIKEUSIK 085254245799
15-10-1985 SUMURBATU 081215244676
05-04-1989 SUKAWARIS 081282010284
03-05-1970 SUKASENENG 085283234524
22-10-2000 RANCASENENG 081992944359
13-09-1986 UMBULAN 085773507361
13-11-1983 SINAPEL 085215596672
19-04-2007 UMBULAN 085773507361
11-02-2000 CIKEUSIK 085283862032
13-06-1978 CIKEUSIK 081218167077
17-06-1977 UMBULAN 085773507361
01-07-1953 UMBULAN 085211929200
01-07-1962 UMBULAN 085211929200
08-05-1981 CIKEUSIK 08380439518
03-03-1970 SUKASENENG 085810903439
22-11-2002 CIKEUSIK 085714065140
21-04-1973 SUKASENENG 085811264499
01-08-1979 SUKASENENG 085283153624
01-07-1981 SUKASENENG 085217137732
07-07-1977 SUKAWARIS 085814489607
20-07-1975 SUKAWARIS 085866761684
08-07-2002 CIWET 085719922305
07-05-2004 UMBULAN 085814397902
21-09-2003 UMBULAN 085887391701
24-07-2003 CIWET 085691568580
25-07-2002 HUNIBERA 081318034080
17-05-1993 SUKAWARIS 085811380486
22-05-1993 SUKABUMI 085811380486
17-11-1992 CIKEUSIK 081646061709
25-06-1971 SUKAWARIS 081313614804
17-11-1967 SUKAWARIS 081313614804
28-09-1995 SUMURBATU 085319519048
04-08-1960 LANSIA SUKAWARIS 085319519048
12-09-1977 SUKASENENG 087741687044
15-06-1999 SUKASENENG 085771613886
10-02-1976 UMBULAN 085211929200
24-04-1970 SUKASENENG 081288893682
26-02-2003 UMBULAN 081584688712
23-08-1982 SUKASENENG 085705642544
01-07-1988 UMBULAN 085771430045
24-03-1977 SUKASENENG 081288893682
01-07-1970 SUKAWARIS 085866761684
05-07-2002 SUKASENENG 085886172704
22-11-1992 UMBULAN 085211929200
15-01-1989 SUKASENENG 085886172704
05-01-1992 CURUGCIUNG 081214323797
06-12-1994 SUMURBATU 081511179029
03-05-1982 RANCASENENG 082120609501
09-12-1967 SUKASENENG 085283234524
01-07-1975 UMBULAN 085860108846
17-05-2001 CIWET 085773383984
06-03-1982 UMBULAN 085773330441
09-03-1980 SUKASENENG 085216583023
03-09-1969 SUKAWARIS 087876014898
10-02-1981 SUMURBATU 085773383984
12-08-1979 SUMURBATU 085773383984
06-04-1980 SUKAWARIS 085693480849
01-02-1963 KANSIA SUKAWARIS 085894541336
02-03-1993 SUKAWARIS 085738261938
10-02-1982 HUNIBERA 081291815634
09-11-1990 RANCASENENG 082150455466
01-07-1996 NANGGALA 085771919362
04-02-1983 SUKAWARIS 085714949296
01-07-1962 SUKAWARIS 085866761684
17-07-1972 KAB. TUBAN 085776873832
01-07-1981 SUMURBATU 085880513354
10-02-1974 SUKAWARIS 085894541336
02-02-1968 SUKAWARIS 085894541336
05-10-1990 LAMPUNG SELATAN 083896494767
05-03-2001 BANJARSARI 081574920384
12-08-1993 TANJUNGAN 085692891451
03-08-2001 CIWET 085885188621
UMBULAN 081617126573
24-10-2000 LAMPUNG SELATAN 089524408796
19-08-1990 SUMURBATU 083878417005
27-11-2003 SUMURBATU 085893307069
06-07-2004 CIWET 085710491981
08-01-2002 NANGGALA 085782134722
01-03-2003 NANGGALA 085212816396
12-08-1975 SUKAWARIS 081318396161
14-04-2005 CIWET 081296472383
08-06-1971 CIWET 085894185420
06-03-2005 CIKEUSIK 085780318705
07-08-2006 UMBULAN 085894828301
01-07-2003 CIWET 083879481071
18-02-1983 UMBULAN 085773758212

03-01-1999 SUBANG 085781330423

09-10-1997 RANCASENENG 085891470094
BANJARSARI 083819332601
04-04-1979 MUARA 2 085311588155
26-02-1999 NANGGALA 08583624580
01-07-1985 SUKASENENG 085214107378
05-08-1996 MALIMPING 081296472383
16-09-2002 LAMOUNG 081297871816
14-09 SINAR BANTEN 081273570729
13-06-2000 MUNJUL 081517740480

SUKAMULYA
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

CORONAVAC 30-08-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 06-09-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-09-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-09-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 06-09-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-09-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 02-09-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 23-08-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 26-08-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 05-07-2021
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24003121
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC -06-09-2021
CORONAVAC 06-09-2021
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 23-08-2021
CORONAVAC 23-08-2021
CORONAVAC 8/2/2021
CORONAVAC 06-09-2021
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 19-08-2021
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 06-09-2021
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 26-08-2021
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 06-09-2021
CORONAVAC 04-10-2021 04-10-2021 24004521
CORONAVAC 06-09-2021
CORONAVAC 06-09-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 06-09-2021
CORONAVAC 02-08-2021
CORONAVAC 06-09-2021
CORONAVAC 06-09-2021
CORONAVAC
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
04-10-202 24003121 161829975366149
16182997536149
04-10-202 24003121 161829975366149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
04-10-202 24003121 16182997536149
16182997536149
16182997536149
04-10-202 24003121 16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
04-10-202 24003121 16182997536149
16182997536149
16182997536149
04-10-202 24003121 161829975D1 D TEMPAT LAIN
16182997536149
04-10-202 24003121 16182997536149
16182997536149
16182997536149
16182997536149
16182997536149
16182994671677
16182994671677
04-10-202 24003121 16182994671677
16182994671677
16182994671677
16182994671677
04-10-202 24003121 16182994671677
16182994671677
16182994686981
16182994686981
16182994686981
16182994686981
16182994686981
16182994686981
16182994686981
16182994686981
16182994686981
04-10-202 24003121 16182994686981
16182997329465
16182997329465
16182997329465
16182997329465
16182997329465
16182997329465
16182997329465
16182997535525
16182997535525
16182997535525
16241817632100
16241817632100
16241817632100
16241817632100
16241817632100
16241817632100
16241817632100
16241817632100
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
04-10-202 24004521 16246017648164
04-10-202 24004521 16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
16246017648164
04-10-202 24004521 16246017648164
 04-10-202 24004521 16246017648164
04-10-202 24004521 16246017648164
04-10-202 24004521 162460176D1 POLSEK CIKEUSIK
16246017648164
16246017648164
16246017648164

16246017648164
16246017648164
16246017648164
16246017648164
04-10-202 24004521 16246017648164
16246017648164
16246017648164
04-10-202 24004521 16246017648164
16246017648164
16246017648164
04-10-202 24004521 16246017648164
16246017648164
16246017648164 D1 D TEMPAT LAIN
04-10-202 24004521 162460176D1 POLSEK CIKEUSIK
16246017648164
04-10-202 24004521 162460176D1 POLSEK CIKEUSIK
04-10-202 24004521 162460176D1 POLSEK CIKEUSIK

04-10-202 24004521 162460176D1 D TEMPAT LAIN

04-10-202 24004521 162460176D1 D TEMPAT LAIN
04-10-202 24004521 162460176D1 POLSEK CIKEUSIK
04-10-202 24004521 162460176D1 POLSEK CIKEUSIK
04-10-202 24004521 162460176D1 D TEMPAT LAIN
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044506730003 RAWEN P
2 3601044101020013 EPA P
3 3601044810800004 ASTI P
4 3601044307600001 ROHANAH P
5 3601045503690001 SURTINI P
6 3601045512970002 CASINAH P
7 3601044702850007 HETI P
8 3601044107880189 DARUNI L
9 3601044102900014 ANI P
10 3601045504600001 SAIKAH P
11 3601046508700001 CARIWEN P
12 3601040105620003 SAKUM P
13 3601045108840001 TINI P
14 3601045003930004 SAROH P
15 3601045210680003 WARTI P
16 3601044107780367 TAWI P
17 3601045503650002 SUBEKAH P
18 3601044902850001 ASNAH P
19 3601044107790177 ASPAH P
20 3601044107950200 SULASIH P
21 3601041010700001 AAM P
22 3601045110820005 KUSNI P
23 3601046006810002 OMOH SETIAMAH P
24 3601044107660124 DARPI P
25 3601044407650002 ODAH P
26 3601044901840001 LAELA P
27 3601044807870002 ACIH P
28 3601041011900004 CECENG B ASTAR L
29 3601042809950002 HAMAMI L
30 3601044107810172 TARIAH P
31 3601041304000002 HENDI IRAWAN L
32 3601045010800003 ARNI P
33 3601041502970001 ROHMAT FAUZI L
34 3601044506650003 JUMI P
35 3601045307780001 EROH P
36 3601042408960003 DADIH L
37 3601044107900239 SARINIH P
38 3601044307830001 ETI P
39 3601045111930002 CASMI P
40 3601044806780002 WASTIRI P
41 3601044104990005 EVA MASPUPAH P
42 3601044108850019 KULSUM P
43 3601044102900014 ANI P
44 3601046205930001 DIAH LISMAYANTI P
45 3601044107790116 CARNISEM P
46 3601045104980002 AAS ROLANI P
47 3601044409900002 ROHAYATI P
 Kepesertaan BPJS (
'Ya' pada kolom ya

Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP BPJS
ok Umur
tahun) PBI

05/06/1973 SUKAMULYA 08773749688

01/01/2002 SUKAMULYA 085891029497
08/10/1980 SUKAMULYA 085887771775
03/07/1960 SUKAMULYA 08558167254
15/03/1969 SUKAMULYA 085887771775
15/12/1997 SUKAMULYA 085773749688
07/02/1985 SUKAMULYA
01/07/1988 SUKAMULYA 081572637612
01/02/1990 SUKAMULYA 085887771775
15/04/1960 SUKAMULYA 085887771775
17/04/19771 SUKAMULYA 085887771775
01/05/1962 SUKAMULYA 081383712017
1108/1983 SUKAMULYA 081222128803
08/03/1994 SUKAMULYA ''
12/10/1968 SUKAMULYA 085316022109
01/07/1973 SUKAMULYA 085887771775
15/03/1965 SUKAMULYA 085714379670
09/02/1985 SUKAMULYA 085887771775
01/07/1979 SUKAMULYA 085861173916
25/11/1993 SUKAMULYA 081511920535
10/10/1970 SUKAMULYA
11/09/1985 SUKAMULYA 085887771775
20/06/1981 SUKAMULYA 085710525737
01/07/1966 SUKAMULYA 085212578868
04/07/1965 SUKAMULYA 0856195711685
09/01/1984 SUKAMULYA
23/07/1985 SUKAMULYA 085887771775
10/11/1990 SUKAMULYA 085891029497
28/09/1995 SUKAMULYA 085693500695
12/03/1984 SUKAMULYA
13/04/2000 SUKAMULYA 085716565079
10/10/1980 SUKAMULYA 085887771775
30/03/1998 SUKAMULYA 085774700826
05/06/1965 SUKAMULYA 085887771775
13/07/1978 SUKAMULYA
24/08/1996 SUKAMULYA 085887771775
01/07/1990 SUKAMULYA 085813580147
01/07/1978 SUKAMULYA 085773746204
11/11/1993 SUKAMULYA 085691857993
08/06/1978 SUKAMULYA 085695268290
10/04/1999 SUKAMULYA 085710765417
24/07/1990 SUKAMULYA
01/02/1990 SUKAMULYA
22/05/1993 SUKAMULYA
01/07/1979 SUKAMULYA 081315826631
18/12/2005 SUKAMULYA
04/09/1990 SIKAMULYA 085887771775
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Tanggal
Merek Tanggal Tanggal Pemberi
BPJS Non Vaksin*** Screening No.
Pemberian No seri an
Non PBI Anggota Batch
Vaksinasi Vaksina
si
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021
CORONAVAC 04/10/2021
CORONAVAC 04/10/2021
CORONAVAC 04/10/2021
CORONAVAC 04/10/2021 04/10/2021
CORONAVAC 04/10/2021 04/09/2021
CORONAVAC 04/10/2021 04/09/2021
Dosis 2

No. KET
No Seri
Batch
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 36010440690001 SUSI SUSANTI P

2 3601044203770002 SITI MASTUROH P
3 36010460801030003 SITI NURBAYA P
4 3212054303000002 TUNIROH P
5 360104530700001 KARTI P
6 3601044203830001 IJAH P
7 3601045408840001 SUMINAR P
8 3601044205990007 ANI RAHMAWATI P
9 3601044107780366 WARTEM P
10 3601040809990004 ADE HERMAWAN L
11 3601041605820003 ASEP L
12 3601044107760042 TIWIL P
13 3601045702010004 ATI MARYATI P
14 3601044107760247 ASTIWEN P
15 3601045111040005 MASTRIAH P
16 36010401010100005 HELMI SYAHPUTRA L
17 BACIH P
18 3601044107020036 RIKO L
19 360104540920001 RISKA P
20 3601086209930001 SANTI P
21 360104406650003 SRI AYUNI P
22 3273070811890004 ADANG SURYANA L
23 3601042312620001 SARLI L
24 360104470980001 SANIAH P
25 3601044304820002 KASTINAH P
26 360104040390004 M. ANWAR L
27 3601044108030002 MITA. A P
28 3601042512990002 MARSAN L
29 3601044101810006 MARNI P
30 3601042811030001 WARYO L
31 360104601720003 DAKIM L
32 NENG LAURA P
33 3601040204870002 ARIF L
34 RANTISAH P
35 3601045111960001 WARTINI P
36 3601040307970001 KARDI L
37 3601046809920002 SITI NOOR ROHMAH P
38 3601040903860004 MUDI L
39 3601044807280001 TETI ROHAYATI P
40 3601040107520009 PAYUMI L
41 3601031210020001 TONI L
42 TAHYAT L
43 3601040507000002 RIO FIRMANSYAH L
44 CINDY APRILIA P
45 UJANG ADIWINARA L
46 3602214202020008 YELIS AMELIA P
47 3601044803050004 SINDY ANGGRAENI P
48 1609142502720001 ABUN L
49 3601046619800002 SUMARNI L
50 3601040911820004 NADI L
51 3601134810010002 SUPRIATI NINGSIH P
52 3601045104890001 HARYATI P
53 3601046008790003 KASTEM P
54 3601044904030002 RINDIYANI P
55 3601045017900012 ETI P
56 3601044107790155 BAI P
57 3601045509820002 BADRIAH P
58 3601040406010005 MUHAMAD ROBI L
59 3601045604030003 SITI NURHAENI P
60 3602064304850005 NURIDA P
61 3601045608840001 IYUS L
62 3601040107870040 SADIK L
63 3601044704010007 SITI RATU RITA P
64 3601044109760002 YAYAH P
65 3601045506790002 SUNENGSIH P
66 3601041011730001 SUYONO B KASMA L
67 3601035701880002 NENENG P
68 3601040612010002 SANA ARIS SUSANTO L
69 3601045404880001 SUWARSIH P
70 3601040708020004 AMADIN L
71 3601044402770001 ISAH P
72 3601044105750001 SAENAH P
73 3601044107870105 JUMI LESTARI P
74 3601044701870015 SAKEM P
75 3601024304770008 RUMINAH P
76 3601041207080007 SAPRUDIN L
77 NOPELA AMELIA P
78 3601044304780001 SAMI P
79 3601041504880003 CASWAN L
80 3601044408780002 AAM P
81 3212062409810001 WASNA L
82 360104209010002 ADI MAULANA L
83 3601044107750200 CARSINI P
84 3601036005850004 MIMIN P
85 3601040705000003 GIGIN ROHMAN L
86 MAD USUP L
87 360104121210004 WILI PRANOWO L
88 3601040803800003 SARIAN L
89 3601046105760003 RASEM P
90 3601045703840001 JUMINAH P
91 3601044107960067 NOK RUSTINAH P
92 3601044107910005 EKA SEPTI A P
93 360104620472003 RANI P
94 3601044107030159 DIANA ROTIN P
95 3601045003030003 SINT[A AMELIA L P
96 3601044806790006 WATIAH P
97 32090104057800017 SUPARTO L
98 3601044406010004 NOK YUYUN K P
99 360100304890003 RENDI PRATAMA L
100 ENENG HENI P
101 3601045108950003 SITI MULYANAH P
102 HERMAN L
103 3601042612860001 NANO L
104 3601040102820004 IWAN L
105 3601041008800003 KHOLIL AZIS L
106 3601041305740001 H ADE S L
107 3601040107530108 NURYATI P
108 3601044404020001 SITI ROHANIAH P
109 RASIDI L
110 3601045005050047 CUCUM SUMIATI P
111 3601045211040002 WIDAYANTI P
112 3601044105880001 ATIN P
 Kepesertaan BPJS (tu
'Ya' pada kolom yan
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS
ok Umur
tahun) PBI

01-01-1991 UMUM UMBULAN 081646061904

04-10-1979 UMUM UMBULAN 085770623315
28-01-2003 REMAJA UMBULAN 085780298961
03-03-1993 UMUM RANCASENENG 085778987114
01-07-1968 UMUM SUKASENENG 081280859045
02-03-1983 UMUM SUKARENDAH 08566761684
01-01-1985 UMUM SUKASENENG 081511868594
07-05-1999 UMUM NANGGALA 087781158440
11-03-1978 UMUM SUKASENENG 085719806578
25-09-1999 UMUM UMBULAN 081511943421
16-05-1982 UMUM SUKASENENG 081242216990
01-07-1976 UMUM SUKAWARIS ;081315543448
17-02-2001 UMUM CIKEUSIK 081314193293
17-04-1971 UMUM GADEL 085781350412
02-02-2003 REMAJA SUKASENENG 085211766723
01-01-2001 UMUM SUKASENENG 081314193293
07-05-1980 UMUM SUKAWARIS 085780310880
01-05-2002 UMUM SUKAWARIS 082118114302
21-09-2002 UMUM CIKEUSIK 085773490468
20-07-1991 UMUM MUNJUL 081285297178
04-08-1965 UMUM TAMBELAK 082133847212
08-11-1989 UMUM BANDUNG 087823300921
23-12-1962 UMUM SUKASENENG 085215993088
07-09-1981 UMUM SUKASENENG 08561437426
03-04-1984 UMUM SUKASENENG 085779190120
13-07-1969 UMUM BATUJAYA 087748103030
01-08-2003 REMAJA PARKOS 085717827861
25-12-1999 UMUM PARKOS 085814019613
05-03-1984 UMUM SUKAMULYA 085282532483
26-11-2003 REMAJA SUKASENENG 085695264302
06-01-1972 UMUM SUKASENENG 081219942110
23-09-2003 REMAJA SUKASENENG 081390244095
02-04-1987 UMUM SUKAWARIS 081291590273
01-05-1992 UMUM SUKAMULYA 0858987771775
07-11-1997 UMUM UMBULAN 082312395313
09-02-1993 UMUM PARKOS 085695793307
28-09-1992 UMUM CIWET 081295098109
14-10-1986 UMUM NANGGALA 085310128042
10-07-1978 UMUM TANJUNGAN 085882906450
01-07-1952 LANSIA CIKAREO 08781646069
11-08-2002 UMUM CIBALIUNG ;085283848518
29-04-1974 UMUM SUKAMULYA 085887771070
05-07-2000 UMUM NANGGALA 083898746406
04-04-2003 REMAJA CIKEUSIK 085773882842
10-05-1993 UMUM SUKAMULYA 085718763865
02-09-2002 UMUM PARUNG PANJANG 085882802732
08-03-2005 REMAJA SUKASENENG 085714979231
10-11-1954 UMUM SUKAMULYA 082371488315
25-10-1996 UMUM SUKASENENG 085283153624
09-11-1982 UMUM CIREBON 085222396872
08-10-2001 UMUM CIKEUSIK 085692729338
30/11/1991 SUKASENENG 085772730626
06/08/1982 UMBULAN 081617631743
09/04/2003 SUKAWARIS 085773751886
10/11/1979 SUKAWARIS 082110991132
06/07/1976 UMBULAN 085719761210
15/09/1982 CIKEUSIK 085217285847
04/06/2001 CIKEUSIK 082126382960
16/04/2003 CIKEUSIK 085798850573
03/04/1985 NANGGALA 085771913320
16/08/2984 UMBULAN 081280590524
01/07/1992 SUKAWARIS 085866761684
07/04/2001 UMBULAN 085770621296
01/09/1982 SUKASENENG 085718978737
15/06/1979 SUKASENENG 085813109170
10/11/1973 CIKEUSIK 081219835775
17/10/1988 CIBALIUNG 085311917173
08/12/2001 SUKAWARIS 085693152692
14/04/1988 CIKEUSIK 085718978737
07/08/2002 UMBULAN 081280590524
04/02/1977 CIKEUSIK 085950861170
01/05/1977 PAMATANG S 085213478363
12/05/1987 GADEL 087773344342
07/10/1987 CIKEUSIK 085864154877
03/04/1977 SUKAWARIS 081318396161
12/07/2008 SUKAWARIS 082315836761
11/10/2001 SUKAWARIS 085780319880
03/04/1978 SUKAWARIS 081315543448
15/04/1988 SUKASENENG 085780880508
04/08/1978 CIKEUSIK 081281929309
24/09/1981 SUKASENENG 082114615673
24/09/2001 NANGGALA 085882813650
01/07/1975 SUKASENENG 085864154877
20/05/1985 CIHANJUANG 08159595933
18/11/2000 SUKASENENG 085810907340
04/08/1989 SUKARESMI 085219074183
12/12/2001 SUKASENENG 085211766723
04/02/1980 SUKAMULYA 085282532483
21/05/1976 SUKASENENG 081219946210
UMBULAN 08562955383
02/01/1995 SUKAWARIS 081281828032
29/09/1990 SUMURBATU 082246746259
22/04/1972 SUKASENENG 085695264302
12/04/2002 CURCI 085889513867
09/05/2002 SUKAWARIS 081316929748
08/06/1979 NANGGALA 085213029972
04/05/1978 NANGGALA 081314963647
04/06/2001 CIWET 085781206196
03/04/1989 SUMUR 081413410443
15/06/1980 CIKUJANG 081583273860
11/08/1995 PARUNGKOKOSAN 085216735159
16/05/1977 CIKUJANG 08158273860
26/12/1986 RANCASENENG 085691786554
01/02/1982 SUKASENENG 085891152912
10/08/1990 SUKASENENG 085886172704
13/05/1974 SUKAWARIS 085719021174
09/02/1980 CIKEUSIK 085719069873
08/04/2002 CIKEUSIK 085778182923
06/05/1982 SUKAMULYA 081321070015
10/05/2005 CIKEUSIK 05691309458
12/11/2004 CIKEUSIK 085694722925
17/08/1988 SUKASENENG 081326482531
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi

CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248

CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 08-09-2021 08-09-2021 24005221
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
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CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 06-09-2021 06-09-2021 2021081511
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 20-08-2021 20-08-2021 24003121
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-09-2021 07-09-2021 2021081511
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 1624817647248
CORONAVAC 07-10-2021 07-10-2021 24004521 16246817647872
CORONAVAC 07-10-2021 07-10-2021 24004521 16246817647872
CORONAVAC 07-09-2021 07-09-2021 2021081511
CORONAVAC 23-08-2021 23-08-2021 24003121
CORONAVAC 07-10-2021 07-10-2021 24004521 16246817647872
CORONAVAC 08-09-2021 08-09-2021 2021081511
CORONAVAC 07-10-2021 07-10-2021 24004521 16246817647872
CORONAVAC 07-10-2021 07-10-2021 24004521 16246817647872
CORONAVAC 07-10-2021 07-10-2021 24004521 16246817647872
CORONAVAC 09-09-2021 09-09-2021 2021081511
CORONAVAC 07-10-2021 07-10-2021 24004521 16261622608489
CORONAVAC 07-10-2021 07-10-2021 24004521 16261622608489
CORONAVAC 09-09-2021 09-09-2021 2021081511
CORONAVAC 08-09-2021 08-09-2021 16261622608489
CORONAVAC 07-10-2021 07-10-2021 24004521 16261622608489
CORONAVAC 02-09-2021 02-09-2021 24003121
CORONAVAC 08-09-2021 08-09-2021 2021081511
CORONAVAC 09-09-2021 09-09-2021 24003121 16261622608489
CORONAVAC 09-09-2021 09-09-2021 2021081511
CORONAVAC 08-09-2021 08-09-2021 2021081511
CORONAVAC 07-10-2021 07-10-2021 24004521 16261622608489
CORONAVAC 26-08-2021 26-08-2021 240202021
CORONAVAC 07-10-2021 07-10-2021 24004521 16261622608489
CORONAVAC 07/10/2021 07/10/2021 24004521 16246817632568
CORONAVAC 07/10/2021 07/10/2021 24004521 16246817632568
CORONAVAC 07/10/2021 07/10/2021 24004521 16246817632568
CORONAVAC 07/10/2021 07/10/2021 24004521 16246817632568
CORONAVAC 07/10/2021 07/10/2021 24004521 16246817632568
CORONAVAC 07/10/2021 07/10/2021 24004521 16246817632568
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CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
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CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607085
CORONAVAC 07/10/2021 09/09/2021 24200121 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492086908
CORONAVAC 07/10/2021 30/08/2021 24004521 16261492086908
CORONAVAC 07/10/2021 06/09/2021 2021081511 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492086908
CORONAVAC 07/10/2021 15/07/2021 24003921 16261492086908
CORONAVAC 07/10/2021 09/09/2021 2021081511 16261492086908
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
CORONAVAC 07/10/2021 16/08/2021 24200121 16261622605837
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CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
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CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622605837
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 06/09/2021 2021081511 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261492084380
CORONAVAC 07/10/2021 06/09/2021 2021081511 16261492084380
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607397
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607397
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607397
CORONAVAC 07/10/2021 23/08/2021 24005121 16261622607397
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607397
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607397
CORONAVAC 07/10/2021 080/9/2021 2021081511 16261622607397
CORONAVAC 07/10/2021 09/09/2021 2021081511 16261622607397
CORONAVAC 07/10/2021 07/10/2021 24005121 16261622607397
CORONAVAC 07/08/1988 17/08/1988 24005121 16261622607397
 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

07-10-2021 24004521 1624817647248 D1 D SUKABUMI

07-10-2021 24004521 1624817647248 D1 D POLSEK

07-10-2021 24004521 1624817647248

07-10-2021 24004521 1624817647248

07-10-2021 24004521 16246817647872 D1 D POLSEK

07-10-2021 24004521 16246817647872 D1 D POLSEK

07-10-2021 24004521 16246817647872 D1 D POLSEK

07-10-2021 24004521 16246817647872 D1 D POLSEK

07-10-2021 24004521 16261622608489 D1 D POLSEK

07-10-2021 24004521 16261622608489 D1 D POLSEK
07-10-2021 24004521 16261622608489
07-10-2021 24004521 16261622608489 D1 D POLSEK
07-10-2021 24004521 16261622608489
07-10-2021 24004521 16261622608489
07-10-2021 24004521 16261622608489

07-10-2021 24004521 16261622608489

 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601042906750002 TODI L
2 3601044101920001 EMA ELMAWATI P
3 3601044107670032 HENAH P
4 3601045606960001 SITI MARYATI P
5 3601045005960002 SOLEHA P
6 1571011908710121 TINAH P
7 3601032410600001 RONI L
8 3601044806570001 WANAH P
9 3601042603770002 WARLI L
10 3601040511830002 UMAR L
11 3601042804960005 ANGGI SURYA. M L
12 3601044107810003 MISNI P
13 3601045504650001 ANAH ROHAYATI P
14 3601044905780001 IDAH HAYATI P
15 3601046212970003 VINA VIANI P
16 360104550420002 KARINAH P
17 1404152005610001 DARNA L
18 3601045004810002 SUTARI P
19 3601044107830374 KARIMAH P
20 3601045504800004 MARYATI P
21 3601046501910001 KURIANI P
22 3601044712980005 ARUM P
23 360104640870001 RIRIN YAYAH. F P
24 3601041003880003 EMAN L
25 3601044107880105 ANISA P
26 3601044705730003 LASMINI WATI P
27 3601040509980001 SANIM L
28 3601044908030003 DEFIT P
29 360104540570004 BUNGA ANGGRAENI P
30 3601045505940004 ELAWATI P
31 3601044304070001 MEGA DWI SELVIANI P
32 3601046708060001 MARYATI P
33 ALDA LAILA P
34 3601040108010005 SAPRUDIN L
35 3601045606060006 SHILVI AYU P
36 3601044401970002 ERIKA LISMAWATI P
37 3602215802060002 YENI P
38 3601040807010001 M. MASRI L
39 YUYUN P
40 3601044508840002 NURBAETI P
41 3602216407060003 SHINTIA MAHARANI P
42 TARMI P
43 3603305605260005 SANTIAH P
44 3601045611060001 ANA YOLASARI P
45 3602215605060002 JAHROTUNNISA P
46 KARSAN L
47 3601045202780001 RATINAH P
48 3601041102040001 SANA L
49 3602216505060001 SULIANTI P
50 360104250668002 MAJA L
51 3174101308050006 FANDY MAULANA L
52 360104460990001 RITA RISMAYANTI P
53 3601044207050015 SITI NURHASANAH P
54 3602212709060005 BAYU RAMDANI L
55 3601044103860004 MARNI P
56 3601041404070001 RAHDIAN. M L
57 SUHDI L
58 3601044405050001 HANAWATI P
59 ITA P
60 DASPAN L
61 3602214912070001 NURLIA P
62 360104110392005 KALIM L
63 3601045312930001 HERLINAH P
64 3601046609730001 PIAH P
65 ADE HAETAMI L
66 UMINAH P
67 360205002750003 SUHENAH P
68 3601045111050005 TIA P
69 ARIL P
70 3601040301070001 IMAN SAHIB L
71 3601042204030001 FAJAR L
72 OMIH P
73 3601040407040010 WAWAN. K L
74 3601041508050002 M. RIZKI L
75 3602010906030001 M. RISQI L
76 3601045611690001 SANI P
77 3601040106990002 ALWI L
78 3601040504030001 EDI L
79 3601040304880001 ADITYA TRI. M L
80 3601040807060005 HARIS L
81 360221530950002 ROHENAH P
82 3601041511050001 DIMAS AJI L
83 ANGGI L
84 36010341102070003 REHAN ADI. S L
85 360104010060006 JAJANG. N L
86 3601040210040002 RIYAN. F L
87 3602014703070001 ASMI RANDA P
88 3601041003060005 ARIF. S L
89 3601040904860002 FAISAL. P L
 90 3601047011060001 IKA SUSILAWATI P
91 3602212605050001 DEDE WAHYU. S L
92 3601040502040001 ADIT PRATAMA L
93 3601044902800002 SUHAETI P
94 3601046511900001 NURSITA P
95 360221640860002 JARSINAH P
96 3601046010040003 WINDA SARI P
97 3601045005060001 DARSITI P
98 ARPAN L
99 3601045001900002 ENENG SURYANI P
100 360104460270001 EMAH P
101 360104010750228 ARMA L
102 ASMA ASIKIN L
103 3601042207060005 AMIN NURJAYA L
104 RUMSAH P
105 36010428010000002 BUDI UTOMO L
106 SITA P
107 3601040201060005 HERMAWAN L
108 3601042001060001 DEDE ABEL L
109 3601040304060003 ISHAK HANAFI L
110 3601041504070005 ERIK L
111 3601041810110064 ADITIA. F L
112 1809054210060003 NIA RAMADHANI P
113 3601042402060001 ARYA YUDISTIRA L
114 3602217004000003 NENG NURASIH P
115 3601047009060002 NURAINI P
116 3601045003070002 NURHAENI P
117 3601041410110043 M. RIDWAN. M L
118 360104625050002 KARINA. J P
119 3211224508040001 AKHMA JASON. A L
120 3601042907060003 M. ZIDAN L
121 360104607070001 M. NIKI ILHAM L
122 3601040610060002 M. IIN . N P
123 3601041104750003 SURHANI L
124 3601042312040002 M. AJID L
125 3601042108040001 SUNARTO L
126 3601044106050002 RISNA RISTIANA P
127 3602212007040001 ROHMAN. M L
128 3601042203060003 ANTON L
129 3602214204060004 SILPI P
130 3601044210050001 SITI HALIMAH P
131 36010412030500003 IKBAL L
132 3601042208060005 M. CEPI L
133 3601040503750001 SANTANA L
134 3601040207050018 MUSTOFA L
135 360104420503008 NITA ATSILA L
136 3601040705080001 SIDIK L
137 ALDI MAULANA L
138 SOFIYAN L
139 3601040106060009 PAHRI PAUJI L
140 3601040107040016 WAHIDIN L
141 3602212708040004 RIZAL. F L
142 ZAENAL. H L
143 360104010700308 GILANG RAMADAN L
144 3601046007060007 INDI. N P
145 3601047003070001 LINDA P
146 3601045041050002 FITRI NURSIFAH P
147 360221108080002 M. ARSUDIN L
148 3601042512050001 YOGI ISKANDAR L
149 36010408070600003 M. RIFKI L
150 3602214412030001 INAH INAYAH P
151 ANDRIAWAN L
152 ADI MAULANA L
153 ARYA L
154 360104640660001 NURJANA L
155 3601044502060003 CINDY ANATASYA P
156 3601041007400007 AGUNG. S L
157 3601045205050004 SITI PATIMAH P
158 SERA YUDHISTIRA P
159 3602217008050003 HASARI P
160 3601046705920002 JUMSI P
161 3601042212050002 AANG L
162 3602210201070007 BENI L
163 3602216003060002 ENI. A P
164 TIA LESTARI P
165 WAHYUDIN L
166 3601044405050002 DISNA P
167 3601046705050001 SITI MARHAMAH P
168 SITI MARYAM P
169 3601044808040001 SITI KHALIFAH P
170 SRI AYU P
171 JUITA AYU. P P
172 3601046508050004 NIA AGUSTINA P
173 IBNU. H L
174 SITI MARHAMAH P
175 DUDY SAEFUL L
176 3601041503050002 NENDY AJI L
177 SITI RAHMAWATI P
178 3602211208091720 DIDIN L
179 36010446014001 KARLINA P
180 3601045005050003 SINDI ANITA P
181 3601041301060001 JEPRI MAULANA L
182 3601041705050001 DIMAS L
183 3601042711050002 NUR SUPYANI L
184 36010445050003 ILAH ROHILAH P
185 360104710103002 MARNI P
186 3601044204040001 NURDIAN APRILITA P
187 TASRIAH P
188 3601045407100003 IIS LISTA P
189 3602210508790003 JUJUN JUNAEDI L
190 3601046503060003 AGNIA P
191 3601042106050002 M. REHAN FAUZI L
192 3601041702060001 M. DODI L
193 3602214405040009 LILIS FAUZIAH P
194 3601046906050005 HERMAWAN L
195 3601046912040002 AYU ASTUTI P
196 3601044502050008 ESIH P
197 3601044310050001 RISMA. R P
198 3601042512020002 JEJE L
199 DEDE SURYATI P
200 3601044707040009 JUEDAH P
201 62090642020500002 NURYANI P
202 3601046211050002 CARSELY P
203 3601034306050008 SELPI. R P
204 3601036810060002 PITRI AULIA P
205 SATI'AH P
206 3601045505050002 RATIH ASTUTI P
207 36010458050001 PIKA P
208 3601040311050002 KIKI MAULANA L
209 360104610105005 SITI MAESAROH P
210 360104490450004 YANI SAFITRI P
211 3601046609040003 SITI SUSANTI P
212 3601041410050002 TARI KHOMSIAH P
213 3601046205050005 REVALINA P
214 SOLIYAWATI P
215 M. ILHAM L
216 3602214905040004 NURAENI P
217 3601041204020005 SARMIN L
218 M. ADING L
219 3601044207040013 NURUL FATIMAH P
220 M. LINGGA L
221 3601045210060002 SULISTIAWATI P
222 DANU SAPUTRA L
223 SARNI P
224 SITI JULEHA P
225 3601040311050001 AMIR MAULANA P
226 3671037009060002 MUNA ESA. A P
227 SELAMET L
228 3601042707040003 DENI AKBAR L
229 3602210102060001 ARIP L
230 3602212806040003 SIDIK PERMANA L
231 3602211107050005 PERDI L
232 MUHIDIN L
233 360104060405001 DENTA PRIATNA L
234 MEY WULAN P
235 NIA DANIATI P
236 3671082108040004 SUNAN P
237 3601045704040001 APRILIA P
238 3602210807030002 UMRI L
239 RIPALDI L
240 REZA. A L
241 3601045010040008 SAPITRI P
242 3601040703040001 RIKI LUKMAN L
243 3601045203030006 OPIH OLIVIA P
244 3601044107050012 YANTI P
245 3602210206020006 JEJEN L
246 3601045705040002 TITIN SURYANI P
247 3602210106030001 JAENUDIN L
248 3602212311990001 AGUS JALIYUDIN L
249 3601044101050007 RISKA REGINA P
250 IPAT PATMAWATI P
251 3601084412720002 JEPRI L
252 3601046007040002 ANI MAHARANI P
253 3601045507000002 AMELIA PUTRI P
254 AHYATI P
255 36010352207040002 LINA. N P
256 3601044304040002 LIA APRILIA P
257 ADISAH P
258 REZA. S L
259 3602210511030001 ALFARINA. F P
260 3601040810060001 MUKTI. H L
261 3601045008030001 ASNAH MELITA P
262 360104450704003 NURYATI P
263 IKE KUSUMA L
264 3601044401040002 MIRNAH P
265 FAJAR ARIFIN L
266 3601021104060003 M. SURNALI L
267 3601042812040003 CANDRA. S L
268 RIRIN AMELIA P
269 INDRIYANA L
270 YUDA KOSASIH L
271 3601042209030001 TARMUDI L
272 3601041710030001 JUJUN L
273 3601041002040006 TANDIKO FIRDAUS L
274 RASINAH P
275 SARDI L
276 ARI. L L
277 HUMAEDI L
278 360209020505005 RIKI MAULANA L
279 DERRY. I L
280 BANGBANG L
281 RUDI ARYANTO L
282 360209207040001 REZA TRI L
283 HAMDALAH L
284 ENOK P
285 M. ARIF L
286 KHOIRUL L
287 3601040107680264 DARSIYAH L
288 3601045008750006 SATIAH P
289 3601045504760002 DARSIEM P
290 36010401010880002 HERI IRWANTO L
291 3203201501940003 DADAN L
292 3601041201720004 ASMADI L
293 3601045011970008 NOPI ZAHRA O P
294 3601045405820006 YATI P
295 36010323308780002 SUPARMAN L
296 3601040104010003 CARIMAH P
297 3601040703980001 ADI DIANTO L
298 3601044106810003 KARWI KURNIASIH P
299 3601044107780334 RATMI P
300 3601040604850002 NURYANTO L
301 3601044212900003 DESTARI P
302 CASYANDI L
303 3601042610800001 RUSJA L
304 3601044107880105 ANISA P
305 3601045307830003 IJU P
306 36010744107860005 EROH P
307 3602214803050003 NURHASANAH P
308 3601042610030001 WAHYU L
309 3602216703070003 NINA FAHMAWATI P
310 3601045811050001 ANGELINA P
311 3601044209010002 FITRIANI P
312 3601044511030008 KARINAH P
313 3601045006040001 PADLAH P
314 3601046905600093 SELA ANDRIANI P
315 3602215302140002 SITI AISYAH P
316 3601044501990004 ITA JULIAWATI P
317 35010845001050004 RISMA ARYANI P
318 360109846206060001 YANTI NURHAYATI P
319 ELINAH P
320 9201075003060003 ODILIA AGUSTINA P
321 3601044107510020 SAMSIAH P
322 3601044708860002 WASRI P
323 3602212408160005 ADE FATMA OKTAVIA P
324 3601044107001232 WIWIN DAMAYANTI P
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 Umur Kelomp
INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

29-06-1975 UMUM RANCASENENG 087772603792

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REMAJA
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02-08-2004 REMAJA CIKEUSIK 085773667215
03-07-2005 REMAJA PARKOS 085714775794
04-01-2004 REMAJA SUKAMULYA 085773210411
13-03-2005 REMAJA CIKARANG 082116695154
REMAJA CIKEUSIK 085921591810
28-12-2004 REMAJA CIKEUSIK 082124621773
26-06-2004 REMAJA CIKEUSIK 085219422163
20-06-2003 REMAJA SUKAMULYA 085283233972
10-11-2004 REMAJA CIKEUSIK 082113222482
12-01-2004 REMAJA SUMURBATU 085773210462
17-10-2003 REMAJA CIBEREM 085695397089
10-02-2004 REMAJA RANCASENENG 085217115741
20-12-2004 REMAJA CIKEUSIK 082310410904
16-05-2005 REMAJA SUKAMULYA 085782070064
22-09-2003 REMAJA CIKEUSIK 085781444323
03-09-2004 REMAJA CURUGCIUNG 0856941590549
02-05-2005 REMAJA CURUGCIUNG 085714774608
02-04-2005 REMAJA SUKASENENG 081382339998
19-02-2004 REMAJA SUKASENENG 081280312800
19-11-2004 REMAJA CIGALIH 08582815053
20-07-2004 REMAJA CURUGCIUNG 08569526420
02-07-2005 REMAJA CIKEUSIK
25-12-2004 REMAJA SUKAWARIS 085714949296

23-06-2005 REMAJA CIKEUSIK

15/05/1968 SUKASENENG 085891029400
10/08/1975 INDRAGIRI HILIR 085273152099
15/04/1976 SUKASENENG 081280547008
01/01/1991 SUKAWARIS 081280549266
04/06/1992 UMBULAN 081585994043
12/01/1972 SUKASENENG 085319084526
10/11/1997 CIKEUSIK 085770972948
14/05/1982 SUKASENENG 081280561255
23/08/1978 CIBINGBIN 085763662106
01/04/2001 CIKEUSIK 081280547008
07/03/1998 CIKEUSIK 085891029400
01/06/1981 SUKASENENG 085814205884
25/01/1971 SUKASENENG 083879448033
06/04/1985 CIKEUSIK 085212693476
02/12/1990 SUKAWARIS 083871494582
03/02/1982 SUKASENENG 085217367949
26/10/1980 RANCASENENG 082311161441
01/07/1988 CIKEUSIK 083185587791
13/07/1983 SUKASENENG 081280561255
14/08/1978 SUMURBATU 081517817705
08/03/2005 PARUNG PANJANG 085781455237
12/04/2004 NANGGALA 081295006158
27/03/2007 SMKN CKS 085693505494
18/11/2006 SMKN CKS 081316679664
02/09/2001 RANCASENENG 085609550248
05/11/2003 SMKN CKS 085693513890
10/04/2006 SMKN CKS 085774961427
29/05/2006 SMKN CKS 085718255078
19/01'/2006 SMKN CKS 085779562623
01/01/2000 CURUGCIUNG 085691947983
10/05/2005 SMKN CKS 085695850308
22/06/2006 SMKN CKS 083856819814
01/07/1984 SUKASENENG 085715440359
10/07/2006 SMKN CKS 0812198806084
13/12/1970 LANSIA SUKAWARIS 081294918047
07/08/1986 SUKASENENG 085219331233
17/10/2005 SMKN CKS 085694956656
05/01/1999 CIKEUSIK 081510566885
15/05/1996 SUKASENENG 081311481848
06/12/1980 SUKASENENG 085773219335
01/07/1968 SUKASENENG 081311481848
26/12/1992 SUKAWARIS 0812974918047
05/01/2000 SUKASENENG 085719450119
10/10/2006 SMKN CKS 085718733617
19/03/2006 SMKN CKS 085715282226
24/09/2006 SMKN CKS 081511865926
17/07/2007 SMKN CKS 083895095589
02/07/9782 SUKAWARIS 085718763904
12/05/2005 SMKN CKS 081316931004
14/084/2007 SMKN CKS 081210625622
01/07/1973 SUKAWARIS 081210914096
27/05/2006 SMKN CKS 085810132506
02/03/2006 SMKN CKS 085721569290
14/01/1995 RANCASENENG 085624601956
19/05/2006 SMKN CKS 085695293036
01/07/1971 KUBANG PANCAL 08558165467
04/05/1996 RANCASENENG 085899932842
09/10/2000 RANCASENENG 085695388224
084/07/2005 RANCASENENG 085697826958
04/03/2002 SMKN CKS 085779054285
10/12/2003 SMKN CKS 0852832341711
25/03/1978 RANCASENENG 085891154110
02/08/2004 RAKNCASENENG 085695393577
27/06/2005 SMKN CKS 08588216296
24/04/2006 SMKN CKS 081210508291
03/06/2007 SMKN CKS 085781626544
13/04/2004 SMKN CKS 085217869951
27/03/2006 SMKN CKS 082130513730
17/08/2003 SMKN CKS 081646061722
11/07/2004 SMKN CKS 08569985267460
08/08/1994 JAKSEL 081214631347
23/06/2006 SMKN CKS 08569351831
29/10/2005 SMKN CKS 085880005371
14/08/2006 SMKN CKS 08124654739
21/11/2004 SMKN CKS 085717629609
02/05/2002 SMKN CKS 085810907310
05/09/2006 SMKN CKS 085714231059
10/08/2006 SMKN CKS 085607334089
11/01/2006 SMKN CKS 085773208670
11/03/2005 SMKN CKS 085602365818
28/04/2007 SMKN CKS 085773236692
14/08/2001 SMKN CKS 085773504165
02/07/1979 SMKN CKS 081911166732
25/03/2006 SMKN CKS 085813386384
10/03/1977 SMKN CKS 085312826846
20/07/2006 SMKN CKS 085182134719
08/02/2006 SMKN CKS 085810876539
18/10/1975 SUKASENENG 081292833438
04/08/2006 SMKN CKS 081584375332
13/01/2000 SMKN CKS 085693542198
21/09/2005 SMKN CKS 085695851906
13/03/1958 SUKASENENG 085216272097
13/04/2006 SMKN CKS 085719445613
11/08/2005 SMKN CKS 085691095219
12/07/2005 SMKN CKS 085817515622
08/02/2005 SMKN CKS 081298786736
06/04/2003 CIPENDEUY 08578035589
07/08/2006 SMKN CKS 085781330391
15/03/2005 SMKN CKS 082125756855
01/07/2006 SMKN CKS 08136633040
02/05/2006 SMKN CKS 085773883409
11/04/2007 PEMATANG SEMOUR 085891029466
06/01/2006 SMKN CKS 085782980835
22/089/2006 SMKN CKS 085715817679
09/03/2006 SMKN CKS 08231059553
29/01/2005 SMKN CKS 081281279688
03/08/2006 SMKN CKS 081382869674
05/06/2007 SMKN CKS 085889199277
07/09/2004 SMKN CKS 081584376612
02/04/2005 SMKN CKS 085710509034
23/01/2006 SMKN CKS 085311558297
05/02/2006 SMKN CKS 085890550031
20/06/2006 SMKN CKS 085714550785
05/12/2005 SMKN CKS 085697591978
13/09/2005 SMKN CKS 085770972363
20/10/2003 SMKN CKS 085212733084
28/02/2006 SMKN CKS 085282387723
06/02/2007 SMKN CKS 085283236065
25/09/2006 SMKN CKS 081617456684
17/10/2006 SMKN CKS 085703083385
07/11/2006 SMKN CKS 0858131091964
10/10/2005 SMKN CKS 081413316392
06/02/2006 SMKN CKS 081213176153
10/12/2005 SMKN CKS 081310368918
25/01/2005 SMKN CKS 081280313424
25/06/2007 SMKN CKS 085782266758
05/01/2005 SMKN CKS 085773227563
SMKN CKS 085641080905
02/07/2005 SMKN CKS 085892954713
27/02/2006 SMKN CKS 08587129024
10/05/2004 SMKN CKS 085218566904
01/11/2005 SMKN CKS 085779062026
15/01/2005 SMKN CKS 085776899413
11/01/2005 SMKN CKS 081584357053
28/08/2004 SMKN CKS 082113208015
08/11/2005 SMKN CKS 081280315704
18/09/2005 SMKN CKS 085772730649
04/01/2006 SMKN CKS 085695397115
20/06/2006 SMKN CKS 085770620571
05/05/2006 SMKN CKS 083891226561
01/11/2002 SMKN CKS 085691159051
27/05/2007 SMKN CKS 085710515902
04/12/2005 SMKN CKS 085694162825
29/07/2005 SMKN CKS 085691137599
23/09/2005 SMKN CKS 085691158985
29/12/2004 SMKN CKS 085776131226
15/06/2004 SMKN CKS 085710502854
15/06/2004 SMKN CKS 081511046651
16/09/2005 SMKN CKS 085780952576
25/07/2005 SMKN CKS 085759794062
05/05/2005 SMKN CKS 0815282126932
13/07/2004 SMKN CKS 083874731814
07/08/2005 SMKN CKS 085891152728
18'05/2004 SMKN CKS 081280797838
05/11/2005 SMKN CKS 085693620149
29/11/2004 SMKN CKS 085695114136
29/08/2005 SMKN CKS 085782644531
03/02/2004 SMKN CKS 083823663844
09/06/2006 SMKN CKS 085811459883
13/10/2005 SMKN CKS 082378501180
25/07/2005 SMKN CKS 085782269380
30/07/2005 SMKN CKS 081295091435
27/08/2004 SMKN CKS 085880250388
11/05/2005 SMKN CKS 0858992626447
03/06/2005 SMKN CKS 085695176364
07/07/2004 SMKN CKS 085811288740
24/10/2004 SMKN CKS 081363193228
09/07/2004 SMKN CKS 085215995176
08/07/2004 SMKN CKS 085894531637
29/05/2004 SMKN CKS 085718763289
17/01/2005 SMKN CKS 082125842307
07/05/2006 SMKN CKS 081295089224
04/06/2004 SMKN CKS 081282773360
15/12/2005 SMKN CKS 085692380046
01/01/2005 SMKN CKS 085774965096
13/10/2004 SMKN CKS 085871616766
26/01/2005 SMKN CKS 085701728100
04/08/2005 SMKN CKS 081315195599
30/04/2006 SMKN CKS 085710142033
14;01/2006 SMKN CKS 085780503724
24/11/2004 SMKN CKS 082315367848
01/12/2005 SMKN CKS 085646787166
01/02/2005 SMKN CKS 081213437344
26/09/2004 SMKN CKS 085776901372
23/11/2005 SMKN CKS 085695203520
09/02/2004 SMKN CKS 085882816204
01/11/2004 SMKN CKS 081310662956
01/01/2004 SMKN CKS 085810876788
13/05/2006 SMKN CKS 085283234127
24/07/2004 SMKN CKS 085891153667
10/09/2003 SMKN CKS 085646087225
03/09/2004 SMKN CKS 083865168840
10/03/2005 SMKN CKS 085778986747
05/03/2005 SMKN CKS 081282809073
15/04/2005 SMKN CKS 083848554479
20/03/2004 SMKN CKS 085782648609
09/05/2005 SMKN CKS 0813984982073
01/12/2004 SMKN CKS 085719069818
02/02/2004 SMKN CKS 085211406447
24/09/2004 SMKN CKS 085780232044
18/05/2003 SMKN CKS 081511927548
24/02/2004 SMKN CKS 085254245799
03/04/2003 SMKN CKS 085218780591
24/01/2005 SMKN CKS 082113240196
21/11/2004 SMKN CKS 085694383384
11/03/2004 SMKN CKS 085695384486
15/03/2004 SMKN CKS 08571851521
20/10/2004 SMKN CKS 085311995227
31/05/2005 SMKN CKS 083533272129
30/08/2003 SMKN CKS 085692758634
17/04/2004 SMKN CKS 0859102608977
24/01/2004 SMKN CKS 081617339745
03/03/2004 SMKN CKS 081513086341
20/12/2003 SMKN CKS 085718708409
20/05/2004 SMKN CKS 085779569031
12/02/2005 SMKN CKS 085781660561
28/08/2003 SMKN CKS 081311665975
22/10/2004 SMKN CKS 085774961398
13/07/2004 SMKN CKS 085782648634
30/08/2004 SMKN CKS 082123167119
10/02/2005 SMKN CKS 085811947061
05/04/2004 SMKN CKS 085782645068
21/07/2003 SMKN CKS 085714776071
04/09/2004 SMKN CKS 089638965530
04/07/2005 SMKN CKS 085772229698
08/08/2002 SMKN CKS 085891791962
23/01/2004 SMKN CKS 085773238346
20/11/2004 SMKN CKS 085624586356
05/11/2004 SMKN CKS 085695274127
12/02/2004 SMKN CKS 085697593256
01/03/2003 SMKN CKS 0856975397112
14/04/2005 SMKN CKS 0857852680743
17/06/2003 SMKN CKS 081280547768
10/11/2004 SMKN CKS 085819839116
14/05/2005 SMKN CKS 081296605083
14/03/2004 SMKN CKS 085212667586
23/07/2004 SMKN CKS 085694058157
25/10/2005 SMKN CKS 085781350435
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberia No. Batch
PBI Non PBI Anggota n
Vaksinasi

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CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 15-07-2021 15-07-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 08-07-2021 08-07-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 13-09-2021 13-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 11-10-2021 11-10-2021 202108171F
CoronaVac 09-09-2021 09-09-2021
CoronaVac 09-09-2021 09-09-2021
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 13/09/2021 24200121
CORONAVAC 11/10/2021 11/10/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 20408171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 13/09/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 16/08/2021
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 13/09/2021 2021081511
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 13//09/2021 24200121
CORONAVAC 11/10/2021 13/09/2021 24200121
CORONAVAC 11/10/2021 13/09/2021 24200121
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 13/09/2021 2021081511
CORONAVAC 11/10/2021 11/10/2021 202018171F
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 13/09/2021 24200121
CORONAVAC 11/10/2021 02/09/2021 24003121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 11/10/2021 20218171F
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 09/09/2021 240022211
CORONAVAC 11/10/2021 09/09/2021 24002221
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 07/09/2021 2021181511
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/10/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24005121
CORONAVAC 11/10/2021 01/09/2021 24001421
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 10/08/2021 24004521
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 13/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24100121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 13/09/202` 2021081511
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 13/09/2021 24200121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/10/2021 202198171F
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 11/09/2021 202108171F
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 09/09/2021 24003121
CORONAVAC 11/10/2021 11/09/2021 20210871F
CORONAVAC 11/10/2021 09/09/2021
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24200121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24200121
CORONAVAC 11/09/2021 09/09/2021 24200121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 24003121
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 204100121
CORONAVAC 11/09/2021 11/09/2021 02108171F
CORONAVAC 11/09/2021 11/09/2021 202108171F
CORONAVAC 11/09/2021 09/09/2021 204100121
 Dosis 2

Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi

11-10-2021 24005121
11-10-2021 24005121

11-10-2021 24005121

11-10-2021 24005121

11-10-2021 202108171 SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F DI MTSN
11-10-2021 202108171F
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F MTSN
11-10-2021 202108171F POLSEK
11-10-2021 202108171F POLSEK
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171
11-10-2021 202108171
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F
11-10-2021 202108171F
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F

11-10-2021 202108171F
11-10-2021 202108171F

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F
11-10-2021 202108171F
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F

11-10-2021 202108171F SMKN 5 PDG

11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
11-10-2021 202108171F SMKN 5 PDG
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11-10-2021 11-10-2021 202108171F D1 D PARUNGSARI

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11-10-2021 202108171F SMKN 5 PDG
NO No. Ticket NIK Nama Penerima Vaksin

1 3602216804910001 DEPIAH
2 3601040803690002 ADE SUTARNA
3 3603031808760008 SUPRIADI
4 3601041205830001 SURDIN
5 3216062504680012 MARIYUS
6 3601045401830002 MARNI
7 360104610586 KOMARIAH
8 3601041510900001 KARTOYO
9 3601041911840001 MUGA
10 36010447117600001 HJ. TUNAH
11 3601045308820001 ROHANIAH
12 3601045011800007 WASIH
13 3601041310640001 MARSA
14 '3601046601740001 ASIAH
15 3601045302970006 DIANA KHOMSIAH
16 '3601045604910003 SITI SEWI
17 3601044305880006 KENAH SUKAENAH
18 36010453310560001 HALIMAH
19 3601045204840004 SUHAYATI
20 3601040107920036 CAHYONO
21 3601215309980002 POPY SUCIATI
22 3601044305860001 SITI NUR ASIAH
23 3601040020001 ALDI RENALDI
24 3601044306770002 RASINAH
25 3601046003900001 AENI. A
26 3601046803830001 ENCUK
27 3601046109870001 TI'AH
28 3601045812000001 DISA. R
29 3601046311000001 YESI ANDRIANI
30 3601040108720003 RAPUDIN
31 317316307800010 NURHAENI
32 3601044602860004 NINING
33 3601046711780001 ENI
34 3601044901980004 SARAH ITA
35 360040107660053 SONYA SUNARYA
36 3601045011800006 ENAH
37 3601044510920007 JUHARIAH
38 3602215401900001 JUMROH
39 3601042301740001 H. KUSNADI
40 3601045204700002 CIAH
41 3601045402730001 TIAH
42 3601045011820005 ROHAYATI
43 3601044808900001 HETI
44 3601044809810003 ETI
45 3601045010810001 YANAH
46 3601044107760055 SUMINAH
47 360104411810002 TANIA
48 3601044107040010 NOVI. T
49 360104307580001 SARJA
50 3601040107650030 KASNADI
51 3601046311730001 EROH ROHAYATI
52 3204175601730003 NUR HASANAH
53 3601044107850382 SANTI
54 3601046810800002 SUMIYARSIH
55 3601046612850001 SITI KOYAH
56 3601044806750003 CERWI
57 3601045006900006 MARYAMAH
58 3601044701850007 ISAH
59 3601045303800001 OTIH
60 3601044607690002 SUARSIH
61 3601040107980074 H. HAMDANI
62 3601046804740001 SARPI
63 3601034304000003 KALSUM
64 3601044610860005 SAEM
65 3601045401930002 ENI
66 3601120107930079 DEDE MUNANDAR
67 3601042402820001 MISRA
68 3601046309850003 MARSINAH
69 3601044509600002 KECA
70 3601041708600002 ASMAR
71 3601045504870001 MAEMUNAH
72 3601045812940001 PIPIH
73 3601044607890004 IDA
74 3601044401680003 SAROH
75 3601044711890005 AMINAH
76 3601045009910001 NONIH
77 3601045010820002 DARMI
78 3601040107770138 WAKIR
79 3601040107620020 MAHAD
80 36010344107730401 IIS AISAH
81 3601041708000001 ARIP SARIPUDIN
82 3601044611020001 WIDIYA
83 3601041011680004 KARMAN
84 3601045506830003 EMI
85 3601045604830003 NURHASANAH
86 JUMALI
87 36010449128800003 EEN
88 3601045807840005 TINI
89 3601041902970002 DEDE W
90 3601041204850001 ABDUL MUNIF
91 3601045109750001 RASIH
92 3601046103690001 SUNARIAH
93 3601045602810002 TIRAH
94 3601040303780001 MULYADI
95 3601045404900002 ASNI
96 3601041305990002 KASIM
97 3601044405930001 IIN IRNAWATI
98 3601044107700176 BAYI
99 SUTIAH
100 3601044107860046 TASMI
101 3601041810670001 SOFWAN
102 3601045101680002 ARNI
103 3601044107750049 SARHENAH
104 3601045606770002 TINI. K
105 3601044201830004 JUNIAH
106 3601046104710001 KOYAH
107 3601045501930001 TUMINI
108 360104578900003 NURLELA
109 3601045707020007 RUSITA
110 3601042204880004 RASWDI
111 3601046703680002 ENONG
112 3601044203800002 EMUN
113 3601046007880002 TETI JUNAETI
114 3601044405760003 NURHASANAH
115 3601045402630001 WATI
116 3601045203710001 BAYI
117 3601046701830001 TIRAH
118 3601045508790002 SANEHA
119 3601045009920005 ENOK
120 3601045403590001 DASKEMI
121 3601041007850002 SAMUN
122 3602215504010005 PUTRI NUR FATIAH
123 3601046401830001 WIWIN
124 3601042709880001 NASMA
125 36001044207830010 RUSTINI
126 3601041003690001 KARNA
127 3601044304840002 RUMSAH
128 3601045812010002 ELSA
129 3601045211800004 SURNAH
130 3601041208660002 SUNI
131 3601045604750001 ICAH
132 3601041209800005 ISRA
133 360104410760025 SUPIHAT
134 3601044406910005 TITIN
135 '3601046504660001 ERAH
136 3601045405930002 YULYANTI
137 3601046501700002 IYAH
138 36010467920002 ELSA
139 3601041603810001 LILI
140 3601042007950001 ENCEP. S
141 3601044102920004 SULANAH
142 3601045407850001 SURINI
143 3601045110660001 CUCUM
144 3601046206630001 TURINIH
145 3601046005550001 NARWATI
146 3601044107710277 JUMSITI
147 3601045703900001 NUNI
148 '360104410940001 LILI. S
149 3602165208850001 YENI
150 3601044107770133 SOPIAH
151 3601044107460040 ABSAH
152 3601044703000003 SITI SUTIRAH
153 3601041208820004 JA'I
154 3601044102740001 HEMI
155 3601044801880002 ADE. S
156 '3601044102020001 PIPIT. M
157 3601040109040003 FAIZ. F
158 3601041203610002 MARTA
159 3601040107740129 SAEMAN
160 3601041412780001 RASID
161 360104470468000 MIMAH
162 3601045212810001 TUTI
163 3601045708770003 MARFU'AH
164 3601047005980001 DESY
165 3601044310810005 ASMI
166 3601044311800002 RASTI
167 3601045405940001 IPAH
168 ARMAH
169 3601045207700004 RESIH
170 3601054107940055 NANI
171 3601044107760251 LILIS
172 3601044203850005 LISNAWATI
173 3601040107010268 AGI S
174 3601045404640001 WARSIH
175 3601045103720001 LAMRAH
176 360104010776021 MASJA
177 M. NAWAWI
178 SUKAESIH
179 LINA HERLINA
180 RANTI
181 SARHANI
182 SARI
183 SUKMANAH
184 IMAS
185 RIAWATI
186 SUHETI
187 AMAH
188 ADI
189 NUNUNG
190 AMINAH
191 KODIR
192 36022160080001 JUNARIAH
193 3601045008940004 TIAH
194 IDRIS
195 3601046003870004 TINI SUHARTINI
196 3601046508060002 SELSA
197 3601046703810001 TATI
198 3601045108960005 SURNI
199 3601047005030001 ENENG KASIH
200 3601045511750001 LAEHA
201 KANTI
202 CARINI
203 DEVI
204 CASPIN
205 SOPIAH
206 DARYEM
207 ETI HANDAYANI
208 TARSIH
209 ELIS
210 MUSRIATI
211 MISNAH
212 SUKENAH
213 CARDI
214 DESI ANDINI
215 ILHAM
216 IIS. I
217 SUKRI
218 TUAH
219 3601041708020006 ABDUL ROHMAN
220 UDIN
221 DEDI
222 BERI IRAWAN
223 LOMRI. S
224 SANAH
225 3601041708040003 ELSA
226 KASMURI
227 SARNAH
228 LINA MARLINA
229 360104510770003 DEDEH. K
230 MARNI
231 SUNAYAH
232 HARYATI
233 M. GOZWATUL
234 MUMUN
235 DESI ANDINI
236 FAHNI DENIVAN
237 DARSINIH
238 RODIAH
239 SARNI
240 SUBIYAH
241 3601042910890001 IMAN
242 SAWI
243 TITA
244 M. ALI
245 CASMIN
246 3601045309870001 ENO RURIAN
247 YAYAH
248 SITI JULEHA
249 JAJA SUNARJA
250 WARNI
251 RUMSAH
252 ITA ROSITA
253 RAPIK
254 NURHAYATI
255 SOLIHIN
256 ETI
257 NAN RASINAN
258 ROBIN
259 ALI PURNOMO
260 M. ANTON
261 KUMAEDI
262 ZAINAL ARIFIN
263 SANUSI
264 LINA.A
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI
ok Umur
tahun)

P 28-04-1991 UMUM POLSEK

L 08-03-1969 UMUM POLSEK
L 18-08-1976 UMUM POLSEK
L 12-05-1983 UMUM POLSEK
L 25-04-1968 UMUM POLSEK
P 07-05-1981 UMUM POLSEK
L 21-05-1986 UMUM POLSEK
L 15-10-1990 UMUM POLSEK
L 19-11-1984 UMUM POLSEK
P 12-10-1971 UMUM POLSEK
P 13-08-1983 UMUM POLSEK
P 10-11-1980 UMUM POLSEK
L 05-08-1978 UMUM POLSEK
P 06-12-1976 UMUM POLSEK
P 13-02-1997 UMUM POLSEK
P 16-04-1991 UMUM POLSEK
P 03-05-1986 UMUM POLSEK
P 08-08-1973 UMUM POLSEK
P 15-05-1986 UMUM POLSEK
L 03-06-1991 UMUM POLSEK
P 13-09-1998 UMUM POLSEK
P 03-05-1986 UMUM POLSEK
L 27-03-2002 UMUM POLSEK
P 03-06-1977 UMUM POLSEK
P 02-05-1992 UMUM POLSEK
P 08-08-1975 UMUM POLSEK
P 21-09-1987 UMUM POLSEK
P 18-12-2000 UMUM POLSEK
P 23-11-2000 UMUM POLSEK
L 01-08-1972 UMUM POLSEK
L 08-07-1989 UMUM POLSEK
P 08-05-1985 UMUM POLSEK
P 27-11-1978 UMUM POLSEK
P 09-01-1998 UMUM POLSEK
L 07-08-1963 UMUM POLSEK
P 10-11-1973 UMUM POLSEK
P 05-10-1992 UMUM POLSEK
P 14-01-1990 UMUM POLSEK
L 23-01-1974 UMUM POLSEK
P 12-04-1970 UMUM POLSEK
P 14-02-1973 UMUM POLSEK
P 10-11-1982 UMUM POLSEK
P 08-08-1990 UMUM POLSEK
P 08-09-1981 UMUM POLSEK
P 10-10-1981 UMUM POLSEK
P 01-07-1976 UMUM POLSEK
P 14-11-1981 UMUM POLSEK
P 20-08-2003 UMUM POLSEK
L 04-10-1954 LANSIA POLSEK
L 01-07-1965 UMUM POLSEK
P 23-11-1973 UMUM POLSEK
P 16-01-1973 UMUM POLSEK
P 01-07-1985 UMUM POLSEK
P 28-10-1998 UMUM POLSEK
P 26-12-1985 UMUM POLSEK
P 08-06-1975 UMUM POLSEK
P 10-06-1990 UMUM POLSEK
P 07-01-1985 UMUM POLSEK
P 13-03-1980 UMUM POLSEK
P 06-07-1969 UMUM POLSEK
L 07-07-2000 UMUM POLSEK
P 28-12-1979 UMUM POLSEK
P 03-04-2000 UMUM POLSEK
P 06-10-1986 UMUM POLSEK
P 14-01-1995 UMUM POLSEK
L 20-11-1999 UMUM POLSEK
L 24-02-1982 UMUM POLSEK
P 23-09-1985 UMUM POLSEK
L 05-09-1960 UMUM POLSEK
L 17-08-1960 UMUM POLSEK
P 15-04-1987 UMUM POLSEK
P 15-02-1994 UMUM POLSEK
P 05-07-1989 UMUM POLSEK
P 04-01-1968 UMUM POLSEK
P 07-11-1989 UMUM POLSEK
P 10-09-1991 UMUM POLSEK
P 19-05-1985 UMUM POLSEK
L 01-07-1977 UMUM POLSEK
L 01-07-1962 UMUM POLSEK
P 01-07-1973 UMUM POLSEK
L 28-09-2002 UMUM POLSEK
P 08-11-2002 UMUM POLSEK
L 15-01-1970 UMUM POLSEK
P 15-06-1983 UMUM POLSEK
P 16-04-1983 UMUM POLSEK
L 09-03-1970 UMUM POLSEK
P 09-12-1980 UMUM POLSEK
P 18-07-1984 UMUM POLSEK
L 27-08-1997 UMUM POLSEK
L 12-04-1985 UMUM POLSEK
P 11-09-1975 UMUM POLSEK
P 21-03-1969 UMUM POLSEK
P 16-02-1981 UMUM POLSEK
L 03-03-1978 UMUM POLSEK
P 14-04-1990 UMUM POLSEK
L 22-08-2001 UMUM POLSEK
P 04-05-1993 UMUM POLSEK
P 01-07-1970 UMUM POLSEK
P 15-11-1977 UMUM POLSEK
P 01-07-1986 UMUM POLSEK
L 19-10-1967 UMUM POLSEK
P 11-01-1968 UMUM POLSEK
P 01-07-1975 UMUM POLSEK
P 16-06-1977 UMUM POLSEK
P 02-01-1983 UMUM POLSEK
P 21-04-1971 UMUM POLSEK
P 15-01-1993 UMUM POLSEK
P 17-08-1990 UMUM POLSEK
L 17-07-2002 UMUM POLSEK
L 22-04-1988 UMUM POLSEK
P 27-03-1968 UMUM POLSEK
P 02-03-1980 UMUM POLSEK
P 08-10-1986 UMUM POLSEK
P 17-04-1976 UMUM POLSEK
P 07-03-1977 UMUM POLSEK
P 12-09-1971 UMUM POLSEK
P 27-01-1983 UMUM POLSEK
P 15-08-1979 UMUM POLSEK
P 10-09-1992 UMUM POLSEK
P 14-08-1959 LANSIA POLSEK
L 10-01-1982 UMUM POLSEK
P 15-04-2001 UMUM POLSEK
P 24-01-1983 UMUM POLSEK
L 27-09-1988 UMUM POLSEK
P 02-07-1983 UMUM POLSEK
L 04-02-1969 UMUM POLSEK
P 07-04-1985 UMUM POLSEK
P 18-12-2001 UMUM POLSEK
P 12-11-1969 UMUM POLSEK
P 12-08-1986 UMUM POLSEK
P 05-04-1975 UMUM POLSEK
L 12-09-1980 UMUM POLSEK
P 01-07-1957 UMUM POLSEK
P 04-06-1991 UMUM POLSEK
P 25-04-1966 UMUM POLSEK
P 14-05-1993 UMUM POLSEK
P 25-01-1970 UMUM POLSEK
P 27-06-1992 UMUM POLSEK
L 18-03-1981 UMUM POLSEK
L 12-03-1993 UMUM POLSEK
P 01-02-1992 UMUM POLSEK
P 01-01-1985 UMUM POLSEK
P 11-01-1996 UMUM POLSEK
P 22-06-1986 UMUM POLSEK
P 20-05-1955 UMUM POLSEK
P 05-01-1991 UMUM POLSEK
P 17-03-1990 UMUM POLSEK
L 01-01-1994 UMUM POLSEK
P 12-08-1985 UMUM POLSEK
P 10-06-1977 UMUM POLSEK
P 01-07-1946 LANSIA POLSEK
P 07-03-2000 UMUM POLSEK
L 12-08-1982 UMUM POLSEK
P 01-02-1974 UMUM POLSEK
P 09-01-1982 UMUM POLSEK
P 05-06-2002 UMUM POLSEK
L 01-09-2004 REMAJA POLSEK
L 12-09-1961 UMUM POLSEK
L 01-07-1974 UMUM POLSEK
L 04-02-1960 UMUM POLSEK
P 17-08-1966 UMUM POLSEK
P 12-12-1981 UMUM POLSEK
P 17-08-1977 UMUM POLSEK
P 30-05-1998 UMUM POLSEK
P 03-10-1981 UMUM POLSEK
P 03-11-1980 UMUM POLSEK
P 14-05-1994 UMUM POLSEK
P 27-05-1965 UMUM POLSEK
P 12-07-1970 UMUM POLSEK
P 01-07-1977 UMUM POLSEK
P 01-07-1976 UMUM POLSEK
P 02-03-1985 UMUM POLSEK
P 26-03-2001 UMUM POLSEK
P 26-07-1966 UMUM POLSEK
P 11-03-1972 UMUM POLSEK
L 01-07-1976 UMUM POLSEK
L 17-08-1992 UMUM POLSEK
P 06-07-1978 UMUM POLSEK
P 09-12-1986 UMUM POLSEK
P 03-09-1994 UMUM POLSEK
L
P 17-01-1985 UMUM POLSEK
P 23-04-1981 UMUM POLSEK
P 03-09-1977 UMUM POLSEK
P 21-01-1999 UMUM POLSEK
P 14-01-1985 UMUM POLSEK
P 14-02-1979 UMUM POLSEK
L 16-02-1983 UMUM POLSEK
P 17-08-1980
P 04-11-1968
L 19-01-1982
P 20-08-1962 UMUM POLSEK
P 10-08-1994 UMUM POLSEK
L
P 21-02-1987 U POLSEK
P 25-08-2006 REMAJA
P 27-03-1981
P 11-08-1996
P 01-06-2003 REMAJA
P 04-07-1975
P 16-02-1991
P 15-08-1984
P 25-08-1984
L 26-01-1971
P 17-12-1978
P
P 10-05-1986
P 04-07-11987
P 05-02-1989
P 19-01-1974
P 13-03-1977
P 27-11-1980
L 01-02-1971
P 06-09-2001
L 01-03-1995
P 02-01-1996
P 07-02-1976
L 25-06-1974
L 17-08-2002
L 25-10-1974
L 20-09-1968
L 11-12-1993
L 05-06-1975
P 25-06-1980
P 17-08-2003
L 08-07-1979
P 20-05-1977
P 10-09-1997
P 11-07-1972
P 03-02-1974
P 01-08-1979
P 27-05-1975
L 01-09-1999
P 12-06-1985
P 24-02-1995
L
P 22-03-1973
P 12-04-1989
P 16-11-1966
P
P 19-08-1989
P 21-07-1975
P 16-09-1991
L 03-08-1983
L 02-07-1989
P 13-10-1987
P 02-01-1980
P 15-12-1985
L 07-11-1983
P 03-11-1964
P 17-11-1970
P 08-04-1980
L 06-08-1996
P 30-08-1984
L 11-04-1955
P 01-07-1978
L 20-04-1976
L
L
L 11-02-1995
L 10-01-1948
L 01-07-1986
L 23-05-1977
P 06-05-1983
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota
CIWET
CIWET 082178114378
TIGARAKSA
TANJUNGAN 085779055238
SUMBERJAYA
CIWET
MUARA 081297591923
SUKAMULYA
TANJUNGAN
TANJUNGAN
CIWET 087709862447
CIWET 085773225768
CIWET 085861602085
CIWET 085861602085
SUKAWARIS 083113036015
CIWET
CIWET 083875405905
CIWET 085797472659
CIWET 081802170240
SUMURBATU
CIWET 085797472665
CIWET
TANJUNGAN
CIWET
SUKARAJA
CIWET 085692729134
TANJUNGAN
CIWET 083806636951
CIWET 085773227346
SUKAMULYA 085719024923
CIWET 085773674637
CIWET
CIWET
SUKAWARIS 081574778367
SUKAWARIS 087887132058
CIWET
CIWET 081316678484
CIWET 083899532057
CIWET 085212667580
CIWET 083891292381
CIWET 085894668812
CIWET 085893645813
CIWET
SUKAWARIS 085249935278
CIWET
SUKAWARIS
CIWET
CIWET 085811970277
CIWET 08212278560
SUKAWARIS 085775396947
SUKAWARIS 082149935278
CIWET 082114180310
CIWET 085891087501
SUKAWARIS 0812949779317
SUKAWARIS
SUKAWARIS
CIWET 082315684527
CIWET 085885591060
SUKAWARIS
CIWET 08581439752
SUKAWARIS 085654439170
CIWET 085212667580
SUKAWARIS 083819339053
CIWET 082315684527
CIWET 083848122793
LABUAN
CIWET 01574280090
SUKAWARIS 085249935278
CIWET
CIWET 083806563689
SUKAWARIS 08214995278
CIWET
SUKAWARIS
CIWET 085714261748
CIWET 085890744018
SUKAWARIS
SUKAWARIS 085718763904
SUKAWARIS 082149935278
SUKAWARIS
CIWET
TANJUNGAN 085774847454
CIWET
SUKAMULYA 081574349137
TANJUNGAN 085249935278
CIWET 087773084523
SUKAWARIS
CIWET 081585793293
SUKAWARIS
SUKAWARIS 085249935270
SUKAWARIS
SUKAWARIS
CIWET
SUKAWARIS
SUKAWARIS 085249935278
SUKAWARIS
SUKAWARIS
SUKAWARIS 08167197951
SUKAWARIS 085249935278
SUKAWARIS
SUKAWARIS
SUKAWARIS
CIWET
SUKAWARIS
CIWET
CIWET 083841238729
CIWET 085894656821
CIWET 08781942378
SUKAWARIS 082149935278
SUKAWARIS
SUKAWARIS 085654439170
CIWET 083891292381
CIWET 085894686591
SUKAWARIS

CIWET
SUKAWARIS 082149935278
CIWET 085885591060
CIWET 081296603019
CIWET
CIWET
SUKAMULYA 087855407865
MUARA 2 087887319037
CIWET
TANJUNGAN 085891597670
CIWET
SUKAMULYA
CIWET
CIWET 085693560646
CIWET
CIWET 085714063167
SUKAWARIS
SUKAMULYA
SUKAWARIS

CIWET
PARKOS 085891580786
CIWET
CIWET 085794156311
PARKOS
PARKOS
CIWET 087773965393
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET 085890744018
TANJUNGAN
CIWET 085215218363
CIWET 085714063167
CIWET
CIWET
CIWET 085773647850
CIWET 08787319037
CIWET
SUKAWARIS 085697806552
TANJUNGAN
CIWET 085332502517
CIWET 085885591060
SUKAMULYA
CIWET
CIWET
CIWET
MALIMPING
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
SUKAWARIS
SUKAMULYA
JAMBU KARYA
SUKAWARIS
CIKADU
SUKAWARIS

CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET

CIWET
MUARA 2
CIWET
CIWET
CIWET
CIWET
TANJUNGAN
TANJUNGAN
CIWET
CIWET
CIWET
MUARA 2
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
TANJUNGAN
CIWET
CIWET
CIWET
SUKAMULYA
SUKAWARIS
CIWET
TANJUNGAN
CIWET
SUKAWARIS
SUKAWARIS
CIWET
TANJUNGAN
CIWET
CIWET
NANGGALA
MUARA 2
CIWET
CIWET
CIWET
CIWET
SUKAMULYA
CIWET
CIWET
SUKAWARIS
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
BABAKAN BANDUNG
CIWET
SUKAWARIS
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
CIWET
UMBULAN
NANGGALA
MUARA 2
CIWET
CIWET
CIWET
 Dosis I Dosis 2
Merek Tanggal Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 01-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 23-08-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 03-07-2021 13-10-2021 20218171F
CoronaVac 03-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 09-08-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 09-08-2021 13-10-2021 20218171F
CoronaVac 03-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 03-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 01-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 03-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 19-08-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-09-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 01-07-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 19-08-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 23-08-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 20218171F
CoronaVac 13-10-2021 13-10-2021 20218171F
 KET
No Seri

PKM CKS
PKM CKS
SUKAWARIS

PKM CKS

PKM CKS

PKM CKS
PKM CKS

PKM CKS
PKM CKS

PKM CKS
PKM CKS

MTSN 6

PKM CKS
PKM CKS

PKM CKS
NO No. Ticket NIK Nama Penerima Vaksin

1 3601040902080004 M. ARIF
2 3601046107080002 AMELIA
3 3601041507070001 SYEHBUDIN
4 360104570400001 MIRNAWATI
5 360104680990002 ASTINI
6 360327510170001 ADELIA
7 3601046301830002 IROH
8 360103710750001 RUSDI. S
9 ;36010402007060012 WAHYUDIN
10 360104490980002 NOVI FEBRIANTI
11 3601045406070001 DINDA. Y
12 3601044107490035 NACIH
13 3601044501080005 WINDA LAURA
14 3601044908060003 SITI NURANI
15 3601041302050003 HENDRI. M
16 3601044510080003 RANTIAH
17 3601040207070005 SAEPUL
18 3601045702080005 SITI ROHENAH
19 3601046210060003 SITI RADA
20 360104450080002 IKA AULIA
21 3601042802070003 FRENGKY CHANIAGO
22 3601045410070006 NIA DWI, S
23 3601042003080001 MULYA WIGUNA
24 360105510980002 ENENG
25 360104120610001 ELA TRESHANA
26 3601044407070003 YULIANTI
27 3602214210070004 ELSA RAMADANI
28 3601041204090005 HERYANTO
29 323613550680002 HESTI SUSILAWATI
30 3601042503070003 JUJUN JUNAEDI
31 36010456060005 ANA AISYAH
32 3601046401080001 EUIS CAHYANI
33 3601046706010001 SUNARTI
34 360104060900002 CANDY PURNAMA
35 131206007060002 RISKI MATONDANG
36 3601042312060001 AGUNG LAKSONO
37 3601040701084186 NURSANAH
38 FATMAWATI
39 3601045001070007 SITI FADILAH
40 3601040812070005 SITI AYU. S
41 3601045808070003 SILVIANI
42 3601044703670001 WACIH
43 3601041109060005 AHMAD
44 360104070188186 KARNO
45 1506115807080001 SOPIA RAHMAWATI
46 3601046207070006 RAHMAWATI
47 3601046604070001 SITI RIA
48 MIA HANDAYANI
49 OTIH NABILA
50 360104651280002 UMAYAH. A
51 3601041103080044 M. ARIFIN
52 DIANA FEBRIANTI
53 3601042508070001 ALIF GUSTIANI
54 M. RIFIANSYAH
55 A. WIRA SATYA
56 NASIROH
57 DEVI RAMADANI
58 RENO
59 SAROH
60 AYU TRIYANTI
61 M. PAISAL
62 SITI NURHASANAH
63 ERLINA
64 DENI IRAWAN
65 M. FIKRI
66 ERLINA. DR
67 ANITA
68 3601044107990009 HERTI
69 FITRI AULIA
70 NURMAH
71 YANTI
72 DIDO
73 UNAY
74 SINTIA
75 JUWITA AYU
76 3601045004720002 RUPIAH
77 RAHMA HANIFA
78 EMAH INDRIANI
79 YUSUF SOPYAN
80 RAHMAT
81 VIANA
82 SITI KHOSIAH
83 NILA SARFI
84 ABDUL SUKIRNO
85 DEDE SOLEH
86 ELSA
87 CHOIRUL ANWAR
88 SOFIYAH
89 M. SAEFUL
90 LIA RAHMAWATI
91 INTAN JELIKA
 92 AGIH RAMADAN
93 SOVIANA DEWI
94 HAYATI NUPUS
95 SUSI. J
96 NADA HAMDI
97 DITA NANDA
98 3601044810090004 SISKA INDRIANI
99 3601041012770003 MADJANI
100 RIA ASTARI
101 WASTINAH
102 3601044207770003 CASMINI
103 M. FARIZ
104 ULFAH
105 TAWINAH
106 ANDARA
107 SURYADI
108 3601044406870002 YAYAH. H
109 CARYUM
110 SANI
111 SITI FADILAH
112 EUIANY
113 NANANG
114 3601044107630319 TAMIS
115 3601046005850002 SARNAH
116 3601044108930003 MUSNAH
117 3601045603790001 SUKAESIH
118 36010463407930001 YATI
119 3601042111070002 WAHYUDIN
120 3601040701730002 WACA
121 DWI JULIANTI
122 IIN AULIYA
123 RITA
124 SYIFA RISKA
125 3601046804750001 ROHANAH
126 MARDIAH
127 3601041408060001 SUPRIATNA
128 3601046001870001 SUHA
129 3601045907750001 SANATI
130 SARTONO
131 3601044104860007 ENCUM
132 SAWI
133 ERNAWATI
134 NENG UUN
135 SITI HELENA
136 DEDE KURNIAWAN
137 LILIS
138 NOPI
139 REWI
140 RISYANA WAHYU
141 SUTAMI
142 VINA YULIASARI
143 ONTAN
144 DARTO
145 ALDI
146 NAJWA AYU
147 AI NUROHMAH
148 360104510280005 SUARTI
149 3601041809920001 LUMRI
150 RIANTO
151 INA. R
152 RIYANI
153 EVA FAUZIAH
154 AINUN DWI
155 PUTRI KARTINI
156 36010450108800001 TARSIH
157 3601045404710001 HJ. TARNI
158 3601044107650091 RASNI
159 PINA
160 M. TOLIB
161 RIKI. G
162 TITIN
163 JARSITI
164 SURNI
165 4601044104050003 NANDA
166 3601044306050003 RIFDA ZULFIA
167 ESIH
168 3601044801910 IYOH
169 3601044501760002 ROHMAH
170 3601044404060001 NOVITASARI
171 MARYAM
172 SARNIMAH
173 ENDI
174 3601040105040002 KAFIYUDIN
175 CARSINAH
176 IMAS
177 ITA YULIANTI
178 SURYANI
179 SITI NURAISAH
180 PUTRI. N
181 JUANDA
182 ANDI. C
183 BEBEN
184 MELFA. N
185 SUHATI
186 OOM
187 LISMA AMELIA
188 JUMI
189 RESI PRI. O
190 LUKI RASTA
191 EEN
192 JONIANTO
193 SUTINI
194 NENI
195 SUMARNA
196 LABAS. S
197 DARSIH
198 SUMYATI
199 CARINIH
200 3601045408030004 WATI CITRA
201 1606044107020039 JULIA SUCITRA
202 3601040612790003 SUKARTA
203 HANI FADILAH
204 3601032606010001 DIDIN SUNGKAWA
205 3601031707880004 ATEP P. S
206 SADIAH
207 3602206005800002 ROHAENAH
208 3275060603880009 M. NURDDIANSYAH
209 3601046403050001 SISKA
210 3601045912020001 SARNI
211 3601040602810002 ROSAD
212 WARTINI
213 3601041507000003 SAHRA
214 3601045010670002 NANI
215 TASKA
216 3601044612020003 FITRIANI
217 3601045203960007 ERAH
218 3601041708050005 SUPIANI
219 3601041101870002 DAMIN
220 SUTARJO
221 ADE ROHAYATI
222 ETI
223 3601041501830002 UJA TONIK
224 SUHANDI
225 KARNA
226 ASTAM
227 AFEN
228 KARIA
229 3601047008080001 SITI MELISA
230 ASEP HADIAN
231 3601046904070001 OLIVIA
232 3601046907060001 SITI JAOZAH
233 3601046712060002 MITA MIRANDA
234 3601044008060044 SITI NURINA
235 3601044708060005 SITI NURASIAH
236 3601044305080005 SOFI
237 3601040211060001 ERMAN YOGA
238 3601045004070001 LASTRI
239 3601045312070001 HERNI CAHY[A
240 3601044107070027 HAYATI
241 3601044910060002 RAHMAWATI
242 3601046702080001 TATIANA SYAFIRA
243 3601047094070003 ALESY[A SUKEMAN
244 3601046602070002 FAUZIAH
245 3601043107070001 REGA ANGGARA
246 3601044207007008 MILA FAUZIAH
247 3601045103850004 SUNTI
248 3601041203060003 RIDWAN
249 3601046061080003 POPI PUSPITASARI
250 3601041309070001 SUPRANI
251 3601042402060002 ARNAH
252 3601044708060006 SITI KHODIJAH
253 3601042904070001 FAZRIANSYAH
254 3601042506080001 TAMRIN
255 3601042109920001 TIBI FAUZI
256 3601045307060001 SHINTA
257 3603051608760002 M AGUS MUSLIM
258 3601045210060003 YANTI
259 3601043012890001 BUSTOMI
260 3601040403020003 RAHMAT
261 3601040207050013 JASRIP
262 3601044301080002 ANITA
263 360104520670001 ONAH
264 3601044206080006 RANI YULIANI
265 3601044212080001 DEST[I ANDINI
266 3601044603080001 NURHESTI
267 MUHCLISH
268 3601044207060005 UTANI
269 3601047101000001 ERVINA
270 1804250709920002 ENDI
271 HARIS MAULANA
272 3601046910070002 ANIS KHOIRUNNISA
273 3601046401070003 DEDE RANI
274 3601041709800001 CARPENDI
275 3601044501080007 SITI MARYAM
276 3601040408960001 MUHAMAD ROIS
277 3601040107780231 DARKINAH
278 3601046106080003 DECA YUNIAR
279 3601042104610002 APUD
280 3601044103760001 EDAH
281 3601041209060003 M SELAMET[
282 3601047004090006 SEKAR
283 3601044107080020 JUWITA KOMALA
284 3601045407070003 WULAN AYU
285 3601041805060002 M ABDULLAH
286 3601045209070001 SITI DIANA
287 3601041802080001 FIKRI FEBRIANSYAH
288 3601042912080003 REFI ALIF M
289 ANISA WAHYUNI
290 3601042308060005 AHMAD JUNAEDI
291 3601046203090001 AULIA DIFAH
292 3601044511080001 ICA NURKHOLISAH
293 3601040901080005 YANDI
294 3601047003080004 DINI AULIA
295 3172024710070006 OKTALIA
296 3601045302580002 RUMINAH
297 NURUL
298 3601040302080001 AHYANI K
299 3601044107920072 RARIDAH
300 ANDINI DWI ANJANI
301 3601040701082110 MARLINA
302 3601044205090004 NENG PUPUT
303 NASILA RIANA
304 RENI SAH KOSNI
305 3601044810080001 DELA NURLATIFAH
306 3601044309090001 INDAH
307 AHYANI
308 3601044204080003 TIARA
309 3601044603080001 FARHAN FAUZAN
310 3601040508080001 IRPAN
311 3601045203090004 INTAN NURAENI
312 3601041505090001 PERDI
313 3601040604090001 RIPA
314 3601044812080002 ADHANA MUSRIPAH
315 3212061508080002 SATRIA HERDINU
316 3601044107760108 ARWITI
317 3601044504000001 LUSI ANDRIYANI
318 3601044104070004 RISKA
319 NUNING
320 3601046012810001 SUKENI
321 3601045805750001 JUNAH
322 3601045402320002 SANTI
323 3601041308800001 ANAS
324 3601040701810002 KARNO
325 36010441077690083 TANISAH
326 3601041206090003 FERI HASANUDIN
327 3601041105080001 FERLI
328 KOKOM
329 3602212912080001 M FAHRUL EOJI
330 3601047005850002 DALILAH
331 M ILHAM
332 3601045010920001 METI
333 3601040109770001 NURITO
334 3601040706680001 DUDUNG
335 3601044106710002 TARSIH
336 3601041202700003 CASTAM
337 3601415403050003 SITI SUSANTI
338 3601041101120003 M KHALIF NASTORI
339 3601040103920003 WARYUDI
340 3601041502840006 AMSUDIN
341 3601045709820002 CARINIH
342 3601045307730003 SUTINIH
343 3601040307770002 ABDUL KOHAR
344 9110052511060001 IRFAN BAIHAQI
345 SARTIAH
346 3601044702690001 WASTIAH
347 3601044409040001 SILVI
348 3601045110900003 SUMIYATI
349 3601041007780005 SARJA
350 3601040410950006 ROHIM
351 3601040107730332 DARSIM
352 3601047107020001 EVA J
353 360104600306001 RIKA
354 3601047004690001 ERMAH
355 3601045405050003 SELA
356 360104520680001 NIAH
357 3601040806040001 NURSYUF ADHIFI
358 RANDI
359 3601040107840109 TIRAH
360 JUIN
361 3601044107620034 JUNARIAH
362 360104512840004 JAMSIAH
363 3601044107580114 CARTINIH
364 3601046107080001 SISKA
365 3601045110730002 CASEM
366 3601044710710002 UCU
367 3601045212000006 IYOT
368 3601044607060002 MELIAWATI
369 3601046705060003 ANGGI
370 3601044711050002 IKLIMAH
371 3601045804060002 SITI N
372 3601045102500003 ONAH
373 INAH
374 3601044301600002 APIAH
375 3601040407740003 SUKRANI
376 3601046601660001 UMINAH
377 3601045501750001 SARNAH
378 3601044603760001 LOMRAH
379 3601044107780250 SAMPENAH
380 3601046312080002 LENIYAWATI
381 360104408750001 SARINAH
382 361046310060001 FITRI WULANDARI
383 3601041301830001 ANDRI
384 360104407060006 PEBRIYANTI
385 3601045906120001 PERDIANSYAH
386 3601044906050002 RIZKI AYUNINGTIAS
387 3601042506060001 ARIP
388 3601045708000002 YEYEN
389 3601045408080001 SRI MEGA S
390 360104420670006 SUHENAH
391 ENENG SAENAH
392 3601045604040003 RENI
393 3601044405830001 ISAH
394 3601044901830002 SARHETI
395 3601044107880110 EEN
396 3601044107760179 SARNAH
397 3601045509820003 UMRAH
398 3601044107900145 SARMINAH
399 3601045507830004 MARNIH
400 3601041007800004 APING
401 3601046502870001 INAH
402 3601045504760003 SARNI
403 3601044703830001 SUHERNI
404 3601044810950002 SITI MAESAROH
405 3601045709770001 MUMUN
406 3601042710040001 M RONI AL PATIH
407 3601040602540001 SURATMOKO
408 3601045204940003 RENNY APRILIANTI
409 3601045510870004 UNING
410 TARSEM
411 3601044108750003 ISAH
412 3601044107690057 CAINI
413 36010461005010001 YUYUN
414 3601042012740002 TARNADI
415 3601045706750002 NENIH
416 3601040504930002 HERU
417 3601046711730002 RUMI
418 3601041111560001 HUMAEDI
419 3601041409700002 CASNO
420 3601040604040002 M HASANUDIN
421 3601134110670001 KARTINI
422 3601044107630096 IDAH
423 3601045204040002 SITI MAEMUNAH
424 3601044806730004 SUKARSIH
425 3601045508830004 ENJUN
426 3601045505800006 KARSINI
427 3601040207810001 SADAR
428 3601045003680001 SARIAH
429 3601044107650032 KASPIAH
430 3601040107700171 RATIM
431 3601042805030004 SURTARDI
432 3601041711030002 RISQON
433 317350309941004 PANGESTU WIGIATMOKO
434 '3601046410950001 AYU LESTARI
435 3601040809000004 ANDI
436 3601040103030010 MOH AJAT
437 3601046006020003 LINA
 Umur
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JK Pekerjaan* (18-59 INSTANSI
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L 05/08/2008
P
L 05/15/2009
P 06/04/2009
P 08/12/2008
L 15/08/2008
P 01/07/1976
P 10/03/2000
P 01/04/2007
P 19/05/1980
P 20/12/1981
P 02/12/1980
P 14/02/1982
L 08/08/1980
L 07/01/1981
P 07/01/1974
L 12/06/2009
L 12/02/2009
P 14/03/1982
L 29/12/2008
P 30/05/2985
L 17/08/2008
P 10/10/1992
L 01/09/1977
L 07/06/1968
P 01/06/1971
L 12/02/1970
P 14/03/2005
L 29/04/2009
L 13/06/1994
L 15/02/1984
P 17/09/1982
P 13/07/1973
L 03/07/1977
L 25/11/2006
P 01/03/1984
L 15/07/1976
P 04/09/2004
P 11/10/1990
L 10/07/1978
L 04/10/1995
L 05/08/1973
P 31/07/2002
P 20/05/2006
P 30/04/1969
P 14/05/2005
P 12/06/1980
L 08/06/2004
L 01/05/2005
P 20/04/1984
L 01/07/1960 LANSIA
P 01/07/1962
P 04/04/1980
P 15/01/1965
P 21/07/2008
P 11/10/1973
P 07/10/1971
P 12/12/2000
P 06/10/2005
P 27/05/2006
P 07/11/2005
P 18/05/2006
P 11/02/1985
P 12/05/1990
P 01/01/1985
P 04/07/1974
P 26/01/1966
P 15/01/1975
P 06/03/1976
P 01/07/1978
P 29/11/2006
P 01/05/1984
P 23/10/2006
L 13/01/1983
P 22/02/2006
L 21/04/2006
P 09/06/2005
L 25/06/2006
P 17/08/2000
P 14/08/2008
P 02/06/1970
P 06/07/1980
P 27/09/2004
P 04/05/1983
P 09/10/1983
P
P 01/07/1976
P 15/09/1982
P 05/08/1988
P 15/07/1980
L 20/08/1970
P 25/02/1987
P 15/04/1976
P 07/03/1986
P 08/10/1995
P 17/09/1977
L 27/10/2004
L 06/02/1951
P 12/04/1992
L 15/10/1987
P 01/07/1968
P 01/08/1975
P 01/07/1969
P 21/05/2001
L 20/12/1974
P 17/06/1975
L 05/04/1993
P 27/11/1973
L 11/11/1956
L 14/08/1970
L 08/08/2005
P 02/10/1967
P 01/07/1965
P 12/04/2004
P 06/06/1973
L 17/08/1982
P 15/05/1980
L 02/07/1986
P 10/03/1968
P 17/10/1965
P 03/05/1958
L 28/05/2003
L 17/11/2003
L 03/09/1994
P 24/10/1995
L 08/09/2000
L 01/02/2004
P 20/06/2002
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS Non
PBI Non PBI Anggota
SUKALAKSANA 08567833678
CIKEUSIK 085774963330
CIKEUSIK 085697572261
SUKASENENG 081382566697
SUKAMULYA 085773749081
SUKAMULYA 085695382155
COWET 081295074877
PEMATANG SEMPUR 08531045376
PEMATANG SEMPUR 08531045376
CIKEUSIK 081514568055
CIKEUSIK 085871616755
CANGKORE 085782135187
UMBULAN 085714776316
SUKASENENG 085810907338
CIKEUSIK 083808269990
PEMATANG SEMPUR 083874365262
CIKEUSIK 085775202843
RANCASENENG 085776131059
NANGGALA 085715496808
CIKEUSIK 085773758501
SUKASENENG 085710509805
SUKASENENG 081514562644
CIKEUSIK 081280312643
LAMPUNG BARAT 082310885434
CIKEUSIK 081282809039
SUKAMULYA 081517322198
KATAPANG 086773236689
KARANG SAMBUNG 081285858261
PEKALONGAN 081212679966
LEUWIBALANG 085774961361
CIKEUSIK 085776131139
LEUWIBALANG 0865718568663
NANGGALA 081511868408
PEMATANG SEMPUR 081317119754
CURUGCIUNG 085861173881
NANGGALA 085782135131
LEUWIBALANG 08150284029
CIKEUSIK 085813586108
CIKEUSIK 085770675462
SUKALAKSANA 085218230242
CIKEUSIK 085813586155
PEMATANG SEMPUR 081382598068
LEUWIBALANG 085882501930
PEMATANG SEMPUR 085718270190
CIKEUSIK 083871877197
CIKEUSIK 0852174123230
CIKEUSIK
SUMURBATU
CIKEUSIK
SUKASENENG
CIKEUSIK
RANCASENENG
KENDAL
CIKEUSIK
CIKEUSIK
PEMATANG SEMPUR
LEUWIBULED
CIKEUSIK
CIKEUSIK
CANGKORE
LEUWIBALANG
CIKEUSIK
CIKEUSIK
CIKEUSIK
KATAPANG
PEMATANG SEMPUR
NANGGALA
BABAKAN CIBALIUNG 085810876764
CIKEUSIK
SUKAMULYA
CIKEUSIK
SUKASENENG
CIKEUSIK
RANCASENENG
CIKEUSIK
SUKASENENG 085773758340
CIDAHU
CIKADONGDONG
CIKEUSIK
CIKEUSIK
CIKEUSIK
CIKEUSIK
CIKEUSIK
PEMATANG SEMPUR
CIKEUSIK
SUKAMULYA
SUMURBATU
NANGGALA
CIKEUSIK
KATAPANG
SUKASENENG
NANGGALA
CIKEUSIK
NANGGALA
NANGGALA
RANCASENENG
NANGGALA
CURUGCIUNG
CIKEUSIK
PEMATANG SEMPUR
CIKEUSIK
KARANG SAMBUNG
UMBULAN
SUKAMULYA
RANCASENENG
NANGGALA
SUKASENENG
SUKASENENG
KARANG SAMBUNG
PEMATANG SEMPUR
KATAPANG
CIKEUSIK
SUKASENENG
SUKASENENG
TANJUNGAN
CURUGCIUNG
UMBULAN
TANJUNGAN
CIKADONGDONG
UMBULAN
NANGGALA
KATAPANG
CITEREP
CENGKOK
TANJUNGAN
CIKEUSIK
CIDAIMAH
SUKASENENG
SUKASENENG
PEMATANG SEMPUR
SUKAMULYA
SUMURBATU
SUMURBATU
CIKADONGDONG
SUMURBATU
CIKADONGDONG
CIBANGKONOL
GUNUNG SAHARI
SUKAWARIS
CIKADONGDONG
PEMATANG SEMPUR
SUKAWARIS
UMBULAN
CIKEUSIK
CIKEUSIK
CIWET
KATAPANG
TANJUNGAN
SUKAMULYA
CIKEUSIK
CIKEUSIK
RANCASENENG
UMBULAN
NANGGALA
NANGGALA
PEMATANG SEMPUR
CIKEUSIK
CIKEUSIK
SUKAMULYA
PEMATANG SEMPUR
NANGGALA
GUNUNG BATU
PASIR NANGKA
CIKADONGDONG
CURUGCIUNG
RANCASENENG
CITEREP
CIKDONG
CIKDONG
UMBULAN
SUKAMULYA
SUKAMULYA
CITARUM
UMBULAN
CIKEUSIK
PARUNG PANJANG
CIKDONG
CIKEUSIK
CIKEUSIK
CIKEUSIK
CIKDONG
CIKAREO
CIKDONG
CIKEUSIK
CIPAAS
CIKDONG
CIKEUSIK
CIKDONG
CIKEUSIK
CIKDONG

CIKDONG
CIKDONG
CIKDONG
TANJUNGAN
CIKEUSIK
CIKEUSIK
SUKASENENG
SUKAMULYA
NANGGALA
SUMATRA SELATAN
SUKAMULYA
SUMURBATU
SUKAMULYA
CIHANJUANG CBL
CIPAAS
CILONGGRANG
BEKASI
CIKEUSIK
CIKEUSIK
CIKDONG
SUKASENENG
CIKEUSIK
SUKASENENG
CIKEUSIK
CIKDONG
SUKASENENG
CIKDONG
SUKASENENG
SUKASENENG
CIKEUSIK
UMBULAN
CIBEREUM
SUMURBATU
PEMATANG SEMPUR
SUKAMULYA
CIKDONG
SUKAWARIS
MTSN CKS 085718724928
MTSN CKS 085214030879
MTSN CKS 085775165459
MTSN CKS 08564238061
MTSN CKS 085880004669
MTSN CKS 085810907338
MTSN CKS 085695268367
MTSN CKS 081382566697
MTSN CKS 085624601932
MTSN CKS 085880005416
MTSN CKS 085319358131
MTSN CKS 085215944414
MTSN CKS 085773647851
MTSN CKS 085778279515
MTSN CKS 085772730720
MTSN CKS 085217834496
MTSN CKS 085715407680
MTSN CKS 0813`9536394
MTSN CKS 085624586374
MTSN CKS 085211641455
MTSN CKS 085719219693
MTSN CKS 085860730697
MTSN CKS 085772728881
MTSN CKS 085873277662
MTSN CKS 087813003914
MTSN CKS 085875797190
MTSN CKS 085880075159
MTSN CKS 085718236092
MTSN CKS 085217406664
MTSN CKS 085310658171
MTSN CKS 085819533810
MTSN CKS 082312396078
MTSN CKS 085624970439
MTSN CKS 085283710811
MTSN CKS 0857119865133
MTSN CKS 081315915572
MTSN CKS 085694542761
MTSN CKS 087870826352
MTSN CKS 085884397302
MTSN CKS 085779061536
MTSN CKS 081513672119
MTSN CKS 085219530855
MTSN CKS 085810134101
MTSN CKS 085210852418
MTSN CKS 085719069873
MTSN CKS 081511868594
MTSN CKS 085782266128
MTSN CKS 085810157110
MTSN CKS 085773883429
MTSN CKS 085773227501
MTSN CKS 081584772533
MTSN CKS 085211788238
MTSN CKS 085810910252
MTSN CKS 085779562224
MTSN CKS 083848445490
MTSN CKS 083812700806
MTSN CKS 085216585298
MTSN CKS 085719064013
MTSN CKS 085281130532
MTSN CKS 081318377474
MTSN CKS 085773491631
MTSN CKS 083813032597
MTSN CKS 081545977489
MTSN CKS 085715410031
MTSN CKS 085695268475
MTSN CKS 085691137614
MTSN CKS 085892000128
MTSN CKS 085670620519
MTSN CKS 085779561142
MTSN CKS 085280255811
MTSN CKS 085890125872
MTSN CKS 081318013757
MTSN CKS 085880004783
MTSN CKS 085891007652
MTSN CKS 081584565976
MTSN CKS 085782260610
MTSN CKS 085694570407
MTSN CKS 085212404559
MTSN CKS 085212930771
MTSN CKS 085216176782
MTSN CKS 085782266710
MTSN CKS 085810132437
MTSN CKS 085773889716
MTSN CKS 085779161372
MTSN CKS 085773225663
MTSN CKS 085121346809
MTSN CKS 08239733686
MTSN CKS 085773757862
MTSN CKS 085717239109
MTSN CKS 081315543509
MTSN CKS
SUKAWARIS 085773166705
CIRIRGI 085880005449
CIKEUSIK 085217869951
TANJUNGAN 085775271453
MTSN CKS 085695148627
PEMATAMG SEMPUR 081584362099
MTSN CKS 085212401212
MTSN CKS 082312750064
SUKAMULYA 085694275843
MTSN CKS 085894532003
SUKASENENG 085288993818
MTSN CKS 085213108877
CIKEUSIK 085210829917
SUKAWARIS 085695336912
SUKAMULYA 081617125303
MTSN CKS 081517322198
UMBULAN 081517322198
KRAGILAN 081513672093
MTSN CKS 081297935349
UMBULAN 081282437762
TANJUNGAN 085776128303
SUKASENENG 085218265625
CILEUNGSIR 081314567312
SUKASENENG 085218265625
MTSN CKS 081347890824
CIKADONGDONG 085218782122
SUKASENENG 087888159282
CIKADONGDONG 085693636529
SUKAMULYA 085883000566
SUKAMULYA 081617125303
CIKADONGDONG 085775041075
SUKASENENG 085714221341
MTSN CKS 085283753557
MTSN CKS 085787418280
SUKAMULYA 085883000566
MTSN CKS 085814304785
GN PUNTANG 085774316217
MTSN CKS 085891806454
MTSN CKS 081511407890
GUNUNG BATU 085817951846
CITEREUP 085213477334
NANGGALA 085216099226
CIKADONGDONG 082184397832
CIKEUSIK 081293432113
SUKASENENG 085715854492
PAMATANG SEMPUR 081282626324
CIKEUSIK 083899878258
PARKOS 085894692529
UMBULAN 081316931617
MTSN CKS 083807187150
MTSN CKS 081385562893
MTSN CKS 085779570690
CIBEREUM 085779455069
CIKADONGDONG 085782767753
CIKADONGDONG 085774395854
CIKEUSIK 082261132013
CIKADONGDONG 081511757223
CIKADONGDONG 085778277597
CIKADONGDONG 085718256061
CIKADONGDONG 083813032597
UMBULAN 081311282496
CIKADONGDONG 083813032597
MTSN CKS 08558169691
SUKAWARIS 085773225554
CIKEUSIK 085779061564
MTSN CKS 085813109196
CURUGCIUNG 085695153348
CIKEUSIK 085781350474
CIKADONGDONG 085721886560
KP SAWAH 082125677082
GN BATU 085774393854
CIKADONGDONG 081511865846
CIKADONGDONG 085881531141
CIKADONGDONG 058781667091
CIKADONGDONG 085779561230
CIKADONGDONG 085715251675
CIPAAS 08575545061
CIBEREUM 085773895409
CIKADONGDONG 082324158398
PEMATAMG SEMPUR 085210827056
SUKAMULYA 082310248930
CIKADONGDONG 081283541681
SUKAMULYA 085887771070
GUNUNG BATU 085776131104
SUKASENENG 085695061170
SUKASENENG 085719019233
CIKEUSIK 085782490905
CIKEUSIK 081397660184
LEUWIBALANG 085775554474
SUKAMULYA 085887771070
PEMATAMG SEMPUR 085715094330
SUKAMULYA 085311558162
PEMATAMG SEMPUR 085282258664
SUMURBATU 085920064379
RANCASENENG 087873188272
SUKAMULYA 085886486982
NANGGALA
CIRIRGI 085273176118
CIKADONGDONG 081511152059
CIKEUSIK 085694608910
UMBULAN 085894828861
PEMATAMG SEMPUR 085210827056
CIKEUSIK 085891255722
CIKEUSIK 085717347159
CIKEUSIK 085773883429
CIKADONGDONG 085695413700
BATU JAYA 085770304125
CIKADONGDONG 085773078954
CIKEUSIK 082115427349
SUKAWARIS 085891279185
CIKEUSIK 085714775992
CIKADONG 085711620631
CIKADONGDONG 085892792521
KEBUN JERUK 083892661988
UMBULAN 085891152280
CIKADONGDONG 085770825675
CIKADONGDONG 085772730563
CIKEUSIK 0856172P6202
 Dosis I Dosis 2
Merek Tanggal Tanggal Tanggal
Vaksin*** Screening Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
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 KET
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D1 WANASALAM
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 '3601042512080008 MIRANTO L
2 3601044208030001 SITI MAESAROH P
3 3601045408030002 ALISAH P
4 360104150560003 HASAN BISRI L
5 3601046210800001 INAH P
6 3601046110810001 SANAH P
7 3601044910450001 NONONG P
8 3601041607700004 UWENDA L
9 3601040107890205 HERMAN L
10 3601045706970006 MERIYANTI P
11 3601045208070003 WINDI P
12 ;3601040702050001 YEANDI L
13 3601041204990009 AGI PUJI. H L
14 36010450010700093 ALDA NURAIDA P
15 3601044207060010 RANI RAHAYU P
16 3601044611070001 ESTI WULANDARI P
17 ARSID L
18 3601046071870001 KARMI P
19 3601044107580108 ROKAYAH P
20 3601042411070002 IKHSAN MAULANA L
21 3601046304140002 AMANDA P
22 ;'3601045012040006 MEGA ASTRIA P
23 360104671070004 SAPITRI P
24 3601045202070001 NIRMALA P
25 3601044207070020 NUR RAFILAH P
26 3601046510830002 ROIDAH P
27 3601042204970001 CARSONO L
28 3601045706730001 ATI SARNITI P
29 3601040306940003 ANDI L
30 3601046311070001 UFITRIANI P
31 3601044107770112 SUMSARI L
32 3601046808070001 ROHAYATI P
33 3601044107700111 ENCIH P
34 3601041010070001 EGI M. S L
35 3601041712070003 ANDRE L
36 3601044910800006 ODAH P
37 3601040809070001 DONI HERMAWAN L
38 3601031010060002 DAPIN RAMADANI L
39 3601045009750001 WARTI P
40 3601045208600001 MARKINAH P
41 3601040102070007 KARNITA P
42 3601041707780003 TONI L
43 360104020980002 SALDANI L
44 3601046104800004 SAMINAH P
45 3601046306020001 ROSPITA P
46 3601046001840001 MIMIN P
47 3601045410070005 ONI L.L L
48 3601043012050001 HENDRI L
49 3601040212060001 WAWAN L
50 3601040108050001 M. ARDIANA L
51 3601040302060001 ROBI L
52 360104101040003 USNADI L
53 3601040107630177 DARKUM L
54 3601044804750003 RASINAH P
55 3601044605660002 KANAH P
56 3601042005930002 RUSNADI L
57 3601042912060001 REJA L
58 3601044103080003 ERLINA P
59 3601044911070001 NOLA AULIA P
60 3212244101810033 RALEM P
61 3601042707070001 RIZA ARIFQI L
62 3601044602700002 SUTARSIH P
63 3601013005070001 RIDWAN L
64 3601040107080026 KIKI L
65 3601041405080002 HALIKA ILHAM L
66 3601045711040001 NANI SURYANI P
67 3601043011070003 RISKI L
68 3601042103720001 LAMAN L
69 TRI AYU CAHYA P
70 360104107080019 MILA P
71 3601046408080004 RASINAH P
72 3601040203080001 M. TORIK L
73 3601040803940002 J. FIRMANSYAH L
74 ELIN L
75 2601040312990002 ARSAD L
76 3601044209730002 WULANDARI P
77 3601045206010001 LENI MARLINA P
78 360104620290001 SANI P
79 3601047003080003 EKA P
80 360104054711070002 NOVI ANDINI P
81 3601046806730001 RUMSINAH P
82 3601044107510209 ROKANI P
83 3601046201080002 SARTUMI P
84 3601045601990006 EKA PITRIA. S P
85 360104521020003 SARTUMI P
86 3601044606830002 DARMINIH P
87 3601042610450001 MUKHLAS L
88 3601044906080002 RATINAH P
89 3601044510070002 LELA P
90 3601045002080002 WIWIN P
91 3601040303730001 KARNADI L
 92 3601046102790001 ROHANI P
93 3601040107680199 RISWAN L
94 3601044812080003 SRI WULANDARI P
95 3601042802050002 INDRA L
96 3601040110090001 SATRIA L
97 3601045108000003 AGISTA L
98 3601045709770001 RATNA P
99 3601040105740003 WARDINIH L
100 3601042007080001 FAJAR L
101 3601041809080005 NAUVAL L
102 3601041311020001 INDRA L
103 360104500870002 NUNUNG P
104 3601041006000001 SAPRUDIN L
105 3601040107060001 NURKARIM L
106 RIANTO L
107 TASINAH P
108 3601042705040002 MUHAMMAD L
109 3601040303090002 ERMAWAN L
110 3601044107760049 WARTINEM P
111 ROFIQ L
112 3601044107700165 RASITI P
113 3601046409750001 UPIT P
114 3601041205800005 ULUNG L
115 3601042403780002 RASDIN L
116 ISEM P
117 IRANA P
118 IRMA P
119 MELISA P
120 NURAIDA P
121 360104480670003 SITI ROHMAH P
122 360104060280004 SAYUTI L
123 3601044682090001 DIKI L
124 3601040107750062 SANUDIN L
125 360104410790263 SURYANAH L
126 3601042211940003 RISMAN P
127 3601042410990001 DIDI L
128 3601044107760221 KARTI P
129 MAULANA L
130 JUMIATI P
131 3601041710940007 NURHASAN L
132 IROH P
133 3601041901040001 GUNTUR L
134 TITIN P
135 3602020405910001 MIRHAD L
136 2601042509000003 HADA L
137 ARSIH P
138 GINANJAR L
139 3601046002000004 RITA APRIANTI P
140 3601044808970001 DEDE JULFAH P
141 3601046706840002 TITIN P
142 DULHADI L
143 ANI P
144 3601045807840001 SUTARAH P
145 360104030820001 SURYA L
146 3601030207770008 JOHIM L
147 3601043101080001 WAHYUDIN L
148 LENARA P
149 3601046408755001 AMINAH P
150 3601044401030001 SINDI M. A P
151 DAYI
152 SUHERNI P
153 3601046008970003 NARSIYAH P
154 3601047006040002 ANISA AGUSTIN P
155 3601044107890174 DAMINAH P
156 3601041612910001 KARMI
157 3601045507810002 KARTINAH P
158 MAENIAH P
159 SYUHANDA L
160 RUSTANA L
161 LILIS P
162 3601044809000001 NURIYAH P
163 3601045104020004 SURNAH P
164 3601045505920004 RISNAWATI P
165 3601040107810147 WARDAM L
166 ANGGRAENI P
167 3601040107600103 CILUNG L
168 HANI P
169 3601045011960001 EPON P
170 SRI LESTARI P
171 KOTIJAH P
172 3601041403870004 SUNADI L
173 3601044502800002 WARTEM
174 3601044907780002 SITI SOPIAH P
175 3601045010810002 SUMIYATI P
176 ITA P
177 3601044107050113 MURTIAH P
178 HERI L
179 TINI P
180 3601044107750268 IPAH SARIPAH P
181 EEM P
182 DIRWANTO L
183 3601046607030001 KOMARIAH P
184 WASLIM L
185 TATA L
186 ANI P
187 3601044204820006 EMI P
188 DILAH P
189 KODIJAH P
190 KAPIDIN L
191 RIMA P
192 SUMARNI P
193 YOYOH P
194 3601044501850001 TITIN P
195 ERNA P
196 NENI P
197 3601041308730001 SANTANA L
198 SAKRI L
199 EMUN P
200 SAENI P
201 CECE L
202 DASMI P
203 3601044103030010 UNAH P
204 3601041011820005 SAMA P
205 GUSTIANA L
206 SUHARYA L
207 3601040107670025 NURHANA P
208 3601042803870003 SADI WIGUNA L
209 3601045311030005 NURUL P
210 3601040911840001 TORI L
211 3601041201070001 RYAN L
212 3601044701030006 MARYAM P
213 MARSID L
214 3601044411920002 YULI SITI P
215 3601040808770006 DENI L
216 3601045503740001 TURAH P
217 3601041107620002 KARTAWI L
218 3601041708010007 SALSA P
219 OCAH P
220 3601040107670024 NANANG L
221 IMAM L
222 3601044701810010 RISKA P
223 3601041507950003 AMRI L
224 3601045507750006 SAMIAH P
225 3601040207800012 CARITA L
226 3212103005080008 NAGATA
227 3601044207860010 CARINI P
228 3601046208710001 BEDAH P
229 IIN P
230 INA P
231 3601044107940116 YOVI L
232 3601045404850001 ACIH P
233 3601044107890199 IDAH P
234 ERNA P
235 WIWIN P
236 JUMANAH P
237 JANAR L
238 3601044302010002 WIDIANTIKA P
239 3601040305000001 MULYANA L
240 ADE L
241 ERNI P
242 3601044406040001 TIA FERAWATI P
243 3601045007820002 SUMINAR P
244 3601024809910001 HERLINA M P
245 3601044175500030 TARINIH P
246 3601044102680003 SUANAH P
247 3601040109810001 SANDRA P
248 3601040507030006 NURPALA P
249 3601044111070001 RASTINIH P
250 3601046708070004 GITA AGUSTINA P
251 3601044703070001 SITI YULLYA P
252 3601040405700005 NURDIN L
253 3601045102770005 ROHAYATI P
254 3601045206990003 PIKA SALSABILA P
255 TATI P
256 3601044908090007 AIDA PITRIAH P
257 3601045310080001 NARULITA P
258 3601046601890001 NARISKA P
259 3601044107530052 RAMINIH P
260 3601042704900001 ANDI WIJAYA L
261 3601045107070009 ENO MELODIANA P
262 3601041310040001 YADI FIRMANSYAH L
263 3601044107910114 KASTINIH P
264 3601045603070002 SITI AISYAH P
265 3671106010060001 RAHMA FITRIYANI P
266 3601044107060027 SAMINAH P
267 3601044110070001 FITRIYANI P
268 3601044205050000 RASNIYAH P
269 3601045207800003 RATINI P
270 3601044207070001 SITI NURASIAH P
271 3601046702000002 SITI NURLELA P
272 3212211204750005 TARJUKI L
273 3601040706080001 M YANTO ALPAJRIL L
274 3603181012060009 NURYANA P
275 3601040208710002 SUTARNA B RASTAI L
276 3601042509070001 ANDI MAULANA L
277 3601043110700001 DERI SYAHRUDIN L
278 3601042510750001 RUCITA P
279 3601041001070007 SUPRIADI L
280 3601044107780300 RASMI P
281 3601041207010005 YUDI L
282 3601046010070001 WANDI L
283 3601042909060002 M FIKRI RAMADAN L
284 3601044811760002 RANI P
285 3601041504070001 MUHAMAD SUHADA L
286 2601041507070006 IJOY L
287 3601041402080002 VIOLA P
288 3601040107080025 IRWAN L
289 3601040511710001 AMING L
290 3601042209090001 NABIL RAHMADAN S L
291 3601044107850362 RATINI P
292 3601044104720002 MISNAH P
293 3601045103080003 MAYA LESTIANI P
294 3601045608080003 AYUM AGUUSTIN P
295 3601044201690001 MARYAM P
296 37601045003760006 RUKAYAH P
297 3601040503670001 KADINI P
298 3601040802700001 SARTA L
299 3601045008070006 FISKA ADETIA P
300 3601044111080002 WITRI P
301 3601046104830002 ELAH P
302 3601046610080001 SIPA ANDINI P
303 3601045702080007 NYMAS MEYLANI P
304 360104507770001 SARMI P
305 SITI NURAINI P
306 3601041702080001 REPI AZHARI L
307 3601040107680199 RISWAN L
308 3601046008090001 FITRI ANDRIYANI P
309 3610446099200033 RASNI P
310 3601065808910001 SUNENI P
311 3601045004070003 RINDA P
312 3601040107050035 REHAN L
313 3601045802920002 CARSITI P
314 3601044109740003 CARMINI P
315 3601046510020001 NUR HIDAYATUN NISA P
316 3602090405630003 SUKRISMAN L
317 3601042212080002 DANI L
318 3601046412050002 NAZWA P
319 3601044809650002 DASNI P
320 3601040711080003 JAMALUDIN L
321 3601041507800013 ENDI L
322 3601040401080004 ANANG HERMANSYAH L
323 3601046908090001 RASYA RAMADANI L
324 3601044806090001 MIRA P
325 3601044807090001 SITI WULAN P P
326 3601044208810001 HAYATI P
327 3601040901090002 DIKA FAUJI L
328 3202096505890010 LIA YULIANI P
329 3601041710940007 NURHASAN L
330 360104017580229 ATMAJA L
331 3601040107050003 AGUNG KHAERUDIN L
332 3601044507880002 DIAN RIANA P
333 3601040905090003 WANDI L
334 3601044107940128 SITI JUHARIAH P
335 3602096104910001 HENI APRILIA P
336 3601046808890001 YULIAWATI P
337 3601044607070006 ROBIAH P
338 3601046701690002 MISNAH P
339 3601042007020001 ESA P
340 3601046006970001 SUNDARI L
341 3601046193780001 SUMINAH P
342 3601044207050022 NAILAH ARDAENAH P
343 3601044507020002 DEDE ANJANI P
344 3601046505650002 HADIJAH P
345 3601045408840002 ERAWATI P
346 3601045302010001 SITI DAMINIH P
347 3601046402810004 CARTEM P
348 3601045104020004 SURNAH P
349 3601045808020005 ITA PURNAMA SARI P
350 3203021804940003 SUPRIADI L
351 3601044806030006 AAN P
352 3601040107810195 CASRIAH P
353 3601041311010002 MUHAMAD RIZKI L
354 3601044305810002 NURESIH P
355 3173014603850021 RODIAH P
356 3601045507800016 TUNIAH P
357 3601044601720001 MARSINAH P
358 3601045903600001 SUNATI P
359 3601040603680002 KARSA L
360 3601046702920001 KARWINIH P
361 3601046903910002 IMAS MAESAROH P
362 3601046411740001 KOKOM KOMALASARI P
363 3601045507000001 RADIF LESMANA L
364 3601044107730234 ROKISAH P
365 3601045507070004 KARSAH P
366 3601044210020005 YANI OKTAPIANI P
367 3601045103950003 KANITI P
368 MARYANI P
369 3601044107830368 MASKUNI P
370 3601045904850003 NURIAH P
371 3601034108040004 RITA PUSPITASARI P
372 3601045706860002 IIN HERLINA P
373 360144107610126 TARMI P
374 3601044202860002 UMRIAH P
375 3601040107640035KASIML L
376 3601045106700003 TATING P
377 3601045207810003 R ROKMAH P
378 3601046709960004 TITI IRIANTI P
379 3602215603910004 DEDE SARTIKA P
380 3601040205990002 DIAN H P
381 3601044804750002 TARISEM P
382 3601046108870005 ROSNAH P
383 3601044812730001 TARSIH P
384 3601045211730001 MARSANAH P
385 3601041003700003 ASIM P
386 3601046607920002 UUN K P
387 3602210207750013 SUPARJO L
388 321222221100001 BAHRUDIN L
389 3212227105020001 ELSY CINTIYA P
390 3601044701810010 RISKA P
391 3601084509050001 EVA MULYANI P
392 3601045312810001 ELAH P
393 3601045002730004 SUMIRAH P
394 3601045211960001 DEWI P
395 3601041001920003 HUSEN B L
396 3601045211020003 MARAH P
397 3601045703740002 UNAH P
398 3601040107800095 ENANG L
399 3601045707890002 EMAH P
400 360142212980004 AGUNG AJAT L
401 3601045406920001 NENG DERI L
402 3601041003730003 ADUNG L
403 3601045506790000 DARWINAH P
404 3601045306010002 ALIYUDIN L
405 3601046017900002 ANAH P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

25-12-2008 REMAJA CIKEUSIK 082125045188

12-07-2003 REMAJA SUKAMULYA 083896985058
14-08-2003 REMAJA NANGGALA 085695153398
13-09-1986 UMUM SUMURBATU 082157619398
15-10-1963 UMUM CIKEUSIK 085218581863
21-10-1981 UMUM CIKEUSIK 085211986514
09-10-1945 LANSIA SUKAWARIS 081646081797
15-07-1963 UMUM CIKEUSIK 085311639972
01-07-1989 UMUM CIKEUSIK 082310343603
17-06-1997 UMUM CIKEUSIK 085693542361
02-06-2007 REMAJA CIKEUSIK 085719069882
03-06-2006 REMAJA RANCASENENG 085775202866
12-04-1999 UMUM SUMURBATU 085773115899
10-01-2007 UMUM NANGGALA 085774607057
28-05-2007 REMAJA CIKEUSIK 085694239397
08-11-2007 REMAJA CIKEUSIK 085718256115
20-04-1950 LANSIA SUKAMULYA 085887771070
04-09-1987 UMUM SUKASENENG 081511865874
01-07-1958 LANSIA SUKASENENG 085313337273
24-11-2007 REMAJA SUKASENENG 081284559813
23-04-2005 REMAJA CIKEUSIK
10-12-2004 REMAJA CIKEUSIK
27-11-2007 REMAJA CIKEUSIK
12-02-2007 REMAJA SUKASENENG
02-07-2007 REMAJA CIKEUSIK
25-10-1983 UMUM CIKEUSIK
22-04-1997 UMUM CIKEUSIK
17-06-1975 UMUM RANCASENENG
6/9/1994 UMUM SUKASENENG
23-11-2007 REMAJA CIKEUSIK
01-07-1977 UMUM SUKASENENG
28-08-2007 REMAJA CIKEUSIK
05-04-1980 UMUM CIKEUSIK
10-10-2007 REMAJA CIKEUSIK
17-12-2007 REMAJA SUKASENENG
09-10-1980 UMUM SUMURBATU
08-09-2007 REMAJA SUKASENENG
10-10-2008 REMAJA CIBALIUNG
10-09-1975 UMUM CIKEUSIK
12-08-1960 LANSIA CIKEUSIK
02-07-2007 UMUM CIKEUSIK
05-07-1977 UMUM NANGGALA
02-09-2008 REMAJA CIKEUSIK
21-03-1982 UMUM NANGGALA
03-06-2002 UMUM CIKEUSIK
20-08-1985 UMUM CIKEUSIK
14-10-2007 REMAJA SUMURBATU
30-12-2005 REMAJA CIKEUSIK
12-12-2006 REMAJA CIKEUSIK
21-08-2007 REMAJA SUKASENENG
03-08-2007 REMAJA CIKEUSIK
10-10-2006 REMAJA CIKEUSIK
01-07-1963 UMUM CIKEUSIK
08-04-1975 UMUM CIKDONG
06-05-1966 UMUM CIKDONG
20-05-1993 UMUM RANCASENENG
29-12-2006 REMAJA RANCASENENG
01-03-2008 REMAJA CIKEUSIK
09-11-2007 REMAJA CIKEUSIK
01-10-1981 UMUM CIKEUSIK
27-07-2007 REMAJA CIKEUSIK
06-02-1973 UMUM CIKDONG
30-05-2007 REMAJA CIKEUSIK
21-09-2008 REMAJA CIKEUSIK
14-05-2008 REMAJA SUKASENENG
17-11-2004 REMAJA CIKDONG
30-11-2007 REMAJA CIKEUSIK
21-03-1972 UMUM NANGGALA
20-01-2009 REMAJA CIKEUSIK
21-05-2008 REMAJA SUKASENENG
24-08-2008 REMAJA SUKASENENG
04-03-2008 REMAJA CIKEUSIK
01-03-1994 UMUM NANGGALA
03-07-2008 REMAJA CIKEUSIK
03-12-1999 UMUM NANGGALA
02-05-2008 REMAJA CIKEUSIK
12-06-2001 UMUM SUKASENENG
22-02-2009 REMAJA CIKEUSIK
30-03-2008 REMAJA SUMURBATU
07-11-2007 REMAJA CIKEUSIK
298-05-1973 UMUM CIWET
01-07-1981 UMUM CIKEUSIK
12-03-2008 REMAJA SUKASENENG
16-01-1999 UMUM RANCASENENG
12-10-1972 UMUM CIKEUSIK
06-06-1983 UMUM CIKEUSIK
26-10-1945 LANSIA SUKAWARIS
09-06-2008 REMAJA SUKASENENG
05-10-2007 REMAJA CIKEUSIK
10-02-2008 REMAJA CIKEUSIK
11-02-1976 UMUM CIKEUSIK
21-02-1979 UMUM CIKEUSIK
21-08-1971 UMUM CIKDONG
08-12-2008 REMAJA CIKEUSIK
28-02-2005 REMAJA CIKEUSIK
11-01-2008 REMAJA CIKEUSIK
11-08-2000 UMUM CIKEUSIK
20-03-1978 UMUM SUKASENENG
01-05-1974 UMUM RANCASENENG
20-07-2008 REMAJA CIKEUSIK
18-09-2008 REMAJA CIKEUSIK
05-08-2008 REMAJA CIKEUSIK
10-08-1970 UMUM SUKAMULYA
19-03-2008 REMAJA SUKASENENG
03-09-2006 REMAJA REMAJA CIKEUSIK
18-11-2007 REMAJA SUKASENENG
01-07-1975 UMUM CIKEUSIK
27-05-2002 UMU UMUM NANGGALA
03-03-2009 REMAJA CIKEUSIK
01-07-1977 UMUM SUKAWARIS
/'14-09-2009 REMAJA CIKEUSIK
12-04-1974 UMUM CIKEUSIK
24-09-1975 UMUM RANCASENENG
12-05-1980 UMUM CIKDONG
28-10-1976 UMUM CIKEUSIK
10-03-1987 UMUM CIKEUSIK
23-04-2009 REMAJA CIKEUSIK
29-10-2008 REMAJA SUKASENENG
28-07-2009 REMAJA CIKEUSIK
23-02-2009 REMAJA CIKEUSIK
08-06-1997 UMUM CURCI
06-02-1978 UMUM UMBULAN
06-02-2009 REMAJA CIKEUSIK
01-07-1975 UMUM SUKAWARIS
11-11-1999 UMUM CURCI
22-11-1994 UMUM CIKEUSIK
20-10-1999 UMUM CIKEUSIK
18-01-1974 UMUM CIKEUSIK
12-12-2007 REMAJA LEUWIBALANG
14-08-2009 REMAJA CIKEUSIK
17-10-1994 UMUM RANCASENENG
11-11-1994 UMUM SUKAWARIS
14-02-2004 REMAJA CIKEUSIK
01-07-1973 UMUM CIKEUSIK
12-065-1994 UMUM UMBULAN
25--9-2000 UMUM PARKOS
12-01-1999 UMUM SUKAWARIS
10-02-2009 REMAJA CIKEUSIK
20-02-2000 UMUM CIKEUSIK
02-08-1997 UMUM CIWET
11-10-1985 UMUM NANGGALA
15-04-1982 UMUM CIKEUSIK
05-12-2005 REMAJA CIKEUSIK
18-07-1984 UMUM CIKEUSIK
03-06-1982 UMUM SUKAWARIS
15-03-1970 UMUM CIHANJUANG
31-01-2008 REMAJA SUKASENENG
05-02-2008 REMAJA LEUWIBALANG
04-08-1975 UMUM SUKAWARIS
04-01-2003 REMAJA SUKAWARIS
17-10-1969 UMUM SUKAWARIS
01-09-2000 UMUM SUMURBATU
20-08-1997 UMUM SUKAMULYA
30-06-2004 REMAJA RANCASENENG
01-07-1989 UMUM CIKEUSIK
10-01-1991 UMUM SUKASENENG
03-06-1977 UMUM CIKEUSIK
05-11-1973 UMUM CIKEUSIK
15-10-2008 REMAJA CIKEUSIK
10-12-1986 UMUM SUKAWARIS
15-04-1988 UMUM SUKAWARIS
08-09-2000 UMUM RANCASENENG
11-04-2002 UMUM PARKOS
15-05-1992 UMUM SUKASENENG
04-02-1975 UMUM SUKASENENG
15-07-1997 UMUM RANCASENENG
09-11-1974 UMUM UMBULAN
28-09-2003 REMAJA CIKEUSIK
09-07-1997 UMUM SUKAMULYA
08-06-2003 REMAJA CURCI
09-04-1986 UMUM CIKEUSIK
14-03-1987 UMUM SUKASENENG
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WANASALAM
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Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
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 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
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NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601021712650002 TARSAN L
2 3601040803940004 HENDRI S L
3 3601040207470001 KADIWAN L
4 3601045512010001 DESTRI P
5 DWI WICARSONO L
6 3601041006720001 SUTIKNO
7 3601044107630167 TARKEM P
8 WANDI L
9 36010441077700089 YOYOH P
10 3601044204720002 DAIMAH P
11 ARIAH P
12 AJI JANWAR L
13 3601044107780483 RUSINAH P
14 3601042001570001 SAUDI L
15 3601044107880204 KOMARIAH P
16 3601045190860003 KARYATI P
17 360104025980002 ROHENDI L
18 3601044302640001 ENOK DARSIH P
19 3601042910900001 JAENUDIN L
20 3601044612880000 RUSTINAH P
21 3601040701900008 MISBAK L
22 3601044910650002 WARTISEM P
23 KASIH P
24 3601045302860004 ENI MASIAH P
25 3601045210660001 TINAH P
26 36010409600002 NURSIN L
27 360104550840002 SITI HOLIPAH P
28 3601043112940001 ACEP SUPRIADI L
29 3601045501680002 RATIWEN P
30 3601040107780315 WASNA L
31 3601044107700041 TAWI L
32 ROKAH P
33 3601044108960003 ARNI P
34 3601045303890002 SITI AISIAH P
35 3601044305730001 CASRIAH P
36 3601044211780002 KASNITI P
37 3601040606000001 ABDUROHIM L
38 360104140880003 DARYADI L
39 3601044107850183 ROHEMI P
40 3601044403720007 NASRIN L
41 3601040209930001 SUKRI L
42 3601040909020005 KOMARUDIN L
43 360104050490001 DARYONO L
44 36010445111880001 DETI SUSILAWATI P
45 360104310590002 KUSDANI L
46 3601040107780250 JUANDA L
47 3601040502700004 EDI L
48 3601040406650001 SUANDA L
49 3601045503780001 TANI L
50 3601040211610001 WASKA L
51 ACE L
52 3601046710730001 AAN YULIANA P
53 3601045009850003 IMAS P
54 36010441040400041 NADIA P
55 3601040411010002 AHMAD HERMAWAN L
56 360104440830001 PATIMAH P
57 NURHANAH P
58 DASKIM L
59 HERNAWATI P
60 WARSIH P
61 AZIS L
62 3601046407020001 SARWI P
63 NENNA KURNIAWATI P
64 3601041610830004 SABIKIS L
65 360104526020002 PURNAWATI P
66 3601040508620005 SUMATA P
67 WIWIN P
68 3601044104750007 ENI P
69 IKE NONJELITA P
70 3601046206990002 ANISA P
71 36010441071860026 KASIH P
72 3601044103780001 JUHA P
73 36010142408010001 MUHAMAD RENDI L
74 3601046012830001 KOYAH P
75 3601040507030007 ARIPUDIN L
76 HANAFI, ST L
77 LULU N P
78 ROHENAH P
79 ASEP L
80 KOKOM P
81 3601046406670001 AMINAH P
82 3601044107830071 ARNAMAH P
83 3601040802930005 WAWAN L
84 3601045707920007 ELIS P
85 AISAH P
86 JUHE P
87 RUSLIANA L
88 SITI FATIMAH P
89 ROSITI P
90 ARNI P
91 RIRIN P
92 SARIAH P
93 RIKI L
94 ARMAN L
95 RATIMAH P
96 EENG ROHENDI L
97 RUKMANA L
98 ATIFAH P
99 ADI YANTO L
100 SITI SUMINAR P
101 3601044510760004 PATONAH L
102 3601044912990001 GITA FITRIANI P
103 3601041308990002 DADAN NURKHOLIS L
104 WAWAN WASTINI P
105 3601045011930001 NURHAYATI P
106 3601042701930001 ACA KUSUMA P
107 3601040207940003 SURYANTO L
108 3601040507860002 DAVID ARMARTA L
109 3601040501750001 RUMDANI L
110 360104410760019 HAYATI P
111 TASLIM L
112 3601040112890001 EMPIN L
113 360104670790006 NURHASANAH P
114 3601044107550077 DANIMAH P
115 3601046306900001 RUNIAH P
116 3601042707550001 SARWAN L
117 3601044808840002 ARI YANTI P
118 3601046403040001 PITRIANI P
119 3601044107730101 SUNARSIH P
120 3601044403810001 SARTIAH P
121 3601044609860001 JULEHA P
122 3601045304630002 WARCI P
123 3601040303680002 SARONI L
124 3601044507790005 HJ. NANI SURYANI P
125 3601040207950003 SABAR L
126 3601046807960002 KURIAH P
127 3212310703870002 SUTRISNO L
128 3601040511990001 BUDI L
129 3601045506740003 NURYATI P
130 3601045011900001 RITA ANGGRAINI P
131 3601040912060001 RESTU AZMI P
132 3601041404750003 GANDA L
133 3601045211850002 KUDSIAH L
134 3601044108680002 MUNASIH P
135 3601040204770005 SUDIN L
136 3601040103870001 SOLEH HUDIN L
137 SAEFUL ANWAR L
138 3601040909090001 SUHARDI L
139 3601040909990015 AGUS SOPYAN L
140 3601042303740001 DEDI JUNAEDI L
141 3601044103960005 NURYANTI P
142 3601045011810001 ADE SUPRIATNA L
143 3601045709010005 DEA KARTIKA P
144 3601042807510001 ACUT P
145 3601041002820002 UMAR L
146 3601044107840026 MIRAH P
147 FAJAR NURMALIK L
148 3601044107950232 ANI P
149 3601045003980004 SAENAH R P
150 3602211112990001 INDRA LESMANA L
151 3601040611780001 ASKIM L
152 3601040202050002 HERDIKI L
153 3601172102790002 SARKUM L
154 360104050791000 DIDI ERLANGGA L
155 3601045007700006 MAESAROH P
156 3601046008020004 SAMSIAH P
157 3601044107890015 FITRIYANA P
158 3601044306580001 BAI P
159 3602214109000002 MARNI P
160 3602216111040001 SUNAETI P
161 3313021708700001 PARNO L
162 3601040104730002 SALIM L
163 3601047108820001 AMINAH P
164 3601046807990004 RINI ANDRIANI P
165 3601040702000006 ENDI L
166 3601044808020002 MARDIANTI P
167 3601046009630002 MARIAM P
168 DARTA L
169 3601041803920001 ARMIN WIJAYA L
170 3601045705020001 DEVIANA SAGITA P
171 3601044107920001 ATIK P
172 3601041505890002 SAEPUDIN L
173 3601041006850006 USMAN L
174 3601044402790002 ADE ROHANAH P
175 3173062505790014 FERDIYAN L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

17-12-1965 UMUM CIWET

08-08-1994 UMUM CIWET
LANSIA CIKEUSIK
19-12-2001 UMUM CIKEUSIK
20-10-1977 UMUM CIKEUSIK
10-06-1972 UMUM CIKEUSIK
01-07-1963 UMUM CIKEUSIK
28-06-1984 UMUM CENGKARENG
01-07-1977 UMUM CIKDONG
02-04-1972 UMUM CIKEUSIK
11-06-1972 UMUM CIKEUSIK
20-01-2005 REMAJA CENGKARENG
01-07-1978 UMUM SUKASENENG
20-01-1957 LANSIA CIKEUSIK
01-07-1988 UMUM CIKEUSIK
22-11-1986 UMUM CIKARET
02-05-1998 UMUM SUKASENENG
03-02-1964 UMUM CURCI
22-11-1990 UMUM SUKASENENG
06-12-1988 UMUM CIKEUSIK
07-01-1990 UMUM CURCI
09-10-1965 LANSIA CIKEUSIK
01-07-1988 UMUM SUKASENENG
13-02-1986 UMUM CIKEUSIK
12-10-1966 UMUM SUKAWARIS
04-09-1960 UMUM SUKAWARIS
15-08-2004 REMAJA SUKAWARIS
02-03-1995 UMUM CIKEUSIK
15-01-1968 UMUM SUKASENENG
01-07-1982 UMUM SUKASENENG
11-11-1977 UMUM RANCASENENG
14-04-1988 UMUM RANCASENENG
01-08-1992 UMUM CIKEUSIK
13-03-1989 UMUM CIKEUSIK
03-05-1973 UMUM RANCASENENG
02-11-1978 UMUM SUKASENENG
06-06-2000 UMUM CIKEUSIK
14-04-1988 UMUM RANCASENENG
01-07-1985 UMUM RANCASENENG
04-03-1972 UMUM RANCASENENG
23-07-1992 UMUM SUKASENENG
09-09-2002 UMUM CIKEUSIK
05-04-1979 UMUM RANCASENENG
11-11-1989 UMUM CIKEUSIK
31-05-1992 UMUM SUKAWARIS
04-07-1998 UMUM CURCI
05-02-1970 UMUM SUKAWARIS
04-06-1961 UMUM SUKAWARIS
05-06-1979 UMUM CIKEUSIK
02-11-1961 UMUM CIKEUSIK
07-05-1944 LANSIA TELUK BINTUNI
23-08-1975 UMUM SUKAWARIS
10-09-1989 UMUM CURCI
01-04-2004 REMAJA RANCASENENG
04-11-2001 UMUM RANCASENENG
04-07-1983 UMUM CURCI
18-11-1994 UMUM CIKEUSIK
01-07-1971 UMUM CIKEUSIK
03-01-1995 UMUM CIKEUSIK
01-07-1975 UMUM CIKEUSIK
31-07-1983 UMUM CIKEUSIK
24-07-2002 UMUM CIKDONG
19-07-1985 UMUM SUKASENENG
16-10-1983 UMUM RANCASENENG
12-06-2002 UMUM CIKDONG
05-08-2002 UMUM CIKEUSIK
15-08-1991 UMUM SUKAWARIS
01-04-1975 UMUM SUMURBATU
07-11-2003 REMAJA SUKAWARIS
22-06-1999 UMUM SUMURBATU
01-07-1986 UMUM SUMURBATU
01-03-1978 UMUM SUKAWARIS
24-08-2001 UMUM SUKASENENG
20-12-1981 UMUM CITEREP
UMBULAN
10-06-1982 UMUM SUKASENENG
18-08-2003 REMAJA SUKAWARIS
02-10-1976 UMUM SUKAMULYA
10-02-1985 UMUM G. PUNTANG
28-04-1977 UMUM CIWET
24-06-1967 UMUM CIKEUSIK
01-07-1983 UMUM CITEUREP
23-04-1988 UMUM CIKDONG
17-07-1992 UMUM SUKAWARIS
17-03-1972 UMUM SUKAWARIS
19-04-1975 UMUM MALANGSARI
10-04-1984 UMUM CIKEUSIK
01-08-1996 UMUM UMBULAN
07-02-1985 UMUM UMBULAN
12-02-1982 UMUM TANJUNGAN
26-06-1984 UMUM BEKASI
01-01-1964 UMUM RANCASENENG
02-07-2001 UMUM TANJUNGAN
11-02-1982 UMUM SUKAWARIS
01-07-1968 UMUM SUKASENENG
01-02-1976 UMUM CIWET
14-08-2000 UMUM KADIRI
05-01-1984 UMUM SUKASENENG
22-02-1992 UMUM CIKEUSIK
13-05-1996 UMUM SUKAMULYA
05/10/1976 CIKEUSIK
09/12/1999 CIWET
13/08/1999 SUKAWARIS
25/06/1994 CIKEUSIK
06/03/1982 SUKASENENG
CIKADONGDONG
07/09/1972 CIKEUSIK
05/07/1986 SUKAWARIS
05/01/1975 CIKADONGDONG
12/07/1971 SUKAWARIS
01/07/1963 SUKAWARIS
01/12/1989 SUKAWARIS
27/07/1994 SUKAWARIS
01/05/1955 LANSIA CIKEUSIK
23/06/1990 CIKEUSIK
27/07/1955 LANSIA CIKEUSIK
08/08/1995 CIKEUSIK
14/03/2005 CIRIRGI
01/01/1980 RANCASENENG
04/03/1981 SUKASENENG
06/09/1986 CIKEUSIK
13/04/1963 CIKEUSIK
03/03/1968 SUKASENENG
05/07/1979 JAKARTA
29/09/1995 CIKEUSIK
28/07/1996 SUKASENENG
04/04/1988 SUKASENENG
20/06/1999 CIKEUSIK
15/06/1974 CIKEUSIK
27/03/2000 SUKAMULYA
09/12/2006 CIKEUSIK
14/04/1975 BATUJAYA
12/11/1985 SUKAWARIS
01/08/1968 CIKEUSIK
02/04/1977 BANJAR
01/03/1987 SUKAWARIS
12/05/1998 RANCASENENG
09/09/1959 CIKEUSIK
09/09/1999 SUKAWARIS
23/03/1972 SUKAWARIS
15/07/1998 SUKASENENG
06/07/1980 CIBANGKONOL
17/09/2001 CITARIK
28/07/1951 SUKAWARIS
10/02/1987 CIKADONGDONG
01/07/1985 CITTEREUP
04/04/1999 CIWET
01/07/1995 UMBULAN
10/03/1998 CIKEUSIK
15/12/1998 KATAPANG
06/11/1975 CIKEUSIK
12/03/1999 RANCASENENG
21/02/1979 CIWET
25/08/1985 CIAPUS
10/7/1970 SUKAWARIS
2/08/2002 CIKEUSIK
20/11/1990 CIKEUSIK
03/06/1958 UMBULAN
17/11/2003 PARUNG PANJANG
08/07/2002 KATAPANG
17/08/1970 KARANG ANYER
01/04/1973 SUKAWARIS
31/08/1982 RANCASENENG
28/07/1999 SUKAWARIS
07/02/2000 TANJUNGAN
08/08/2002 SUKAWARIS
20/09/1963 RANCASENENG
13/08/1987 UMBULAN
18/03/1992 RANCASENENG
17/05/2002 CIWET
22/02/1992 RANCASENENG
15/05/1989 CIKADONGDONG
10/06/1985 NANGGALA
06/07/1983 CIWET
25/05/1979 CIWET
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi
0852278876568 CORONAVAC 25-10-2021 25-10-2021
082278876568 CORONAVAC 25-10-2021 25-10-2021
085774956492 CORONAVAC 25-10-2021 25-10-2021
085774956492 CORONAVAC 25-10-2021 25-10-2021
081280191191 CORONAVAC 20-09-2021
081280191191 CORONAVAC 20-09-2021
085777151511 CORONAVAC 23-09-2021
082246670026 CORONAVAC 20-09-2021
081574870471 CORONAVAC 25-10-2021 25-10-2021
085860730651 CORONAVAC 23-09-2021
085697596550 CORONAVAC 27-09-2021
085861145044 CORONAVAC 20-09-2021
081292548912 CORONAVAC 27-09-2021
085695203486 CORONAVAC 27-09-2021
085210474720 CORONAVAC 23-09-2021
081584368612 CORONAVAC 27-09-2021
081513086748 CORONAVAC 23-09-2021
081283773335 CORONAVAC 25-10-2021 25-10-2021
085282259156 CORONAVAC 20-09-2021
082310248431 CORONAVAC 27-09-2021
085813104930 CORONAVAC 25-10-2021 25-10-2021
085218581863 CORONAVAC 23-09-2021
085776862558 CORONAVAC 27-09-2021
085217038504 CORONAVAC 25-10-2021 25-10-2021
085866761684 CORONAVAC 25-09-2021
085866761684 CORONAVAC 25-10-2021 25-10-2021
085866761684 CORONAVAC 25-10-2021 25-10-2021
085778240072 CORONAVAC 25-10-2021 25-10-2021
0852195222672 CORONAVAC 25-10-2021 25-10-2021
085771000711 CORONAVAC 25-10-2021 25-10-2021
085216426413 CORONAVAC 25-10-2021 25-10-2021
085782266359 CORONAVAC 27-09-2021
085691130992 CORONAVAC 25-10-2021 25-10-2021
08558664474 CORONAVAC 14-09-2021
085773229835 CORONAVAC 25-10-2021 25-10-2021
085891255722 CORONAVAC 14-09-2021
083893086196 CORONAVAC 25-10-2021 25-10-2021
085782266359 CORONAVAC 27-09-2021
085217367949 CORONAVAC 27-09-2021
085603041869 CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 27-09-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 08-07-2021
CORONAVAC 23-09-2021
CORONAVAC 13-04-2021
CORONAVAC 14-09-2021
CORONAVAC 14-09-2021
CORONAVAC 14-09-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 14-09-2021
CORONAVAC 27-09-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 06-08-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 27-09-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 27-09-2021
CORONAVAC 27-09-2021
CORONAVAC 08-09-2021
CORONAVAC 22-09-2021
CORONAVAC 27-09-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 16-08-2021
CORONAVAC 27-09-2021
CORONAVAC 08-09-2021
CORONAVAC 15-09-2021
CORONAVAC 25-10-2021 25-10-2021
 CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 27-09-2021
CORONAVAC 20-09-2021
CORONAVAC 25-10-2021 25-10-2021
CORONAVAC 27-09-2021
CORONAVAC 13-07-2021
CORONAVAC 05-07-2021
CORONAVAC 16-09-2021
085776131210 CORONAVAC 25/10/2021 20/09/2021
085219677096 CORONAVAC 25/10/2021 25/10/2021
081213548064 CORONAVAC 25/10/2021 25/10/2021
083875337107 CORONAVAC 25/10/2021 27/09/2021
085790409189 CORONAVAC 25/10/2021 27/09/2021
085882158248 CORONAVAC 25/10/2021 25/10/2021
085282389365 CORONAVAC 25/10/2021 25/10/2021
085775005616 CORONAVAC 25/10/2021 25/10/2021
081296603546 CORONAVAC 25/10/2021 25/10/2021
083151495925 CORONAVAC 25/10/2021 27/09/2021
083871494582 CORONAVAC 25/10/2021 27/09/2021
085866761684 CORONAVAC 25/10/2021 23/09/2021
085866761684 CORONAVAC 25/10/2021 25/10/2021
083151383852 CORONAVAC 25/10/2021 25/10/2021
083897453556 CORONAVAC 25/10/2021 27/09/2021
085891255722 CORONAVAC 25/10/2021 14/09/2021
081219979044 CORONAVAC 25/10/2021 25/10/2021
081280854082 CORONAVAC 25/10/2021 25/10/2021
085213350380 CORONAVAC 25/10/2021 25/10/2021
081280851981 CORONAVAC 25/10/2021 25/10/2021
082324149390 CORONAVAC 25/10/2021 25/10/2021
082310248431 CORONAVAC 25/10/2021 25/10/2021
081310328804 CORONAVAC 25/10/2021 25/10/2021
082122982088 CORONAVAC 25/10/2021 27/09/2021
085319140438 CORONAVAC 25/10/2021 27/09/2021
081310328804 CORONAVAC 25/10/2021 27/09/2021
081310328804 CORONAVAC 25/10/2021 27/09/2021
085774685987 CORONAVAC 25/10/2021 25/10/2021
085864161401 CORONAVAC 25/10/2021 25/10/2021
085775261692 CORONAVAC 25/10/2021 16/09/2021
085218572656 CORONAVAC 25/10/2021 20/09/2021
085210926520 CORONAVAC 25/10/2021 27/09/2021
08578886747 CORONAVAC 25/10/2021 25/10/2021
08558160728 CORONAVAC 25/10/2021 14/09/2021
082292589733 CORONAVAC 25/10/2021 14/08/2021
085383736443 CORONAVAC 25/10/2021 25/10/2021
083115548604 CORONAVAC 25/10/2021 27/09/2021
085714976099 CORONAVAC 25/10/2021 27/09/2021
085695360903 CORONAVAC 25/10/2021 05/08/2021
085893089429 CORONAVAC 25/10/2021 25/10/2021
082113959226 CORONAVAC 25/10/2021 25/10/2021
081511696063 CORONAVAC 25/10/2021 27/09/2021
085718271832 CORONAVAC 25/10/2021 25/10/2021
085217105542 CORONAVAC 25/10/2021 25/10/2021
085775056830 CORONAVAC 25/10/2021 25/10/2021
085210534710 CORONAVAC 25/10/2021 27/09/2021
082214202108 CORONAVAC 25/10/2021 27/09/2021
085891154475 CORONAVAC 25/10/2021 25/10/2021
081906158219 CORONAVAC 25/10/2021 25/10/2021
085695026280 CORONAVAC 25/10/2021 27/09/2021
0857732375293 CORONAVAC 25/10/2021 25/09/2021
083812360212 CORONAVAC 25/10/2021 25/10/2021
085240852296 CORONAVAC 25/10/2021 25/10/2021
082149662272 CORONAVAC 25/10/2021 11/8/2021
08989373144 CORONAVAC 25/10/2021 25/10/2021
085714776092 CORONAVAC 25/10/2021 27/09/2021
085215786615 CORONAVAC 25/10/2021 25/10/2021
085892626665 CORONAVAC 25/10/2021 25/10/2021
08569517865854 CORONAVAC 25/10/2021 23/09/2021
081511947119 CORONAVAC 25/10/2021 25/10/2021
085385412777 CORONAVAC 25/10/2021 05/07/2021
083818222424 CORONAVAC 25/10/2021 25/10/2021
085779570694 CORONAVAC 25/10/2021 25/10/2021
081295097769 CORONAVAC 25/10/2021 25/10/2021
085719816583 CORONAVAC 25/10/2021 25/10/2021
081385546278 CORONAVAC 25/10/2021 27/09/2021
085787255329 CORONAVAC 25/10/2021 25/10/2021
085782266299 CORONAVAC 25/10/2021 25/10/2021
083877913754 CORONAVAC 25/10/2021 25/10/2021
087888033064 CORONAVAC 25/10/2021 25/10/2021
'085787255329 CORONAVAC 25/10/2021 25/10/2021
085778070251 CORONAVAC 25/10/2021 25/10/2021
081511406461 CORONAVAC 25/10/2021 25/10/2021
083841424781 CORONAVAC 25/10/2021 27/10/2021
087773432162 CORONAVAC 25/10/2021 27/10/2021
Dosis I Dosis 2
Tanggal
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi
202108145H
202108145H
202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
202108145H
25-10-2021 202108145H
202108145H
 25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
25-10-2021 202108145H
2400121
202108145H
202108145H
24200121
24200121
202108145H
202108145H
202108145H
202108145H
202108145H
24200121
202108145H
202108145H
202108145H
24200121
24003121
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
2400121
24200121
24200121
24200121
202108145H
202108145H
2400121
24005121
24200121
202108145H
202108151I
24002521
202108145H
24200121
24200121
24003121
202108145H
202108145H
24200121
202108145H
202108145H
202108145H
24200121
24200121
202108145H
202108145H
24200121
20210845H
202108145H
202108145H
24200521
202108145H
24200121
202108145H
202108145H
24200121
202108145H
24003921
202108145H
202108145H
202108145H
202108145H
24200121
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
202108145H
24200121
24200121
 KET

POLSEK CIKEUSIK

POLSEK CIKEUSIK
CURCI
POLSEK CKS
POLSEK CKS
POLSEK CKS

POLSEK CKS
KEC. CURUG
NO No. Ticket NIK Nama Penerima Vaksin JK

1 2171116811069010 AYUNDA P
2 3601040309070001 GALUH MAULANA L
3 3601041501070004 M. RIVAL L
4 3601042010070001 JUMADI L
5 3601046808070001 DEVI AGUSTIN P
6 3601045002070002 ERNI MUPLIHAT P
7 360106008050001 DINI P
8 3601041709060004 AFNAN L
9 3601040701089633 AMEL P
10 3601041001050002 ERWIN L
11 3601044701070004 EMPAI AULIAWATI P
12 3601041002170002 FEBBY ADRIANSYAH L
13 3601040103070004 PAIZAL PAHMI L
14 3601045504060001 MIRAWATI P
15 3601040204080008 FELIK ALDO H L
16 3601046206070005 RATMI PUTRI I P
17 3601044612070001 REVI P
18 3601040910060002 RIA GUNAWAN P
19 3601042009060001 SAMSUL L
20 3601042603070002 RIO FIRMANSYAH L
21 3601046406070001 SITI NESI P
22 3601044107030118 SUTINAH P
23 3601040401040002 WALIDIN L
24 3601045002060004 SAROH P
25 3601041910060001 AZMI P
26 3601040506060003 GARDA L
27 3601041501070003 M. RIAN L
28 3601041207070001 ARIFIN ILHAM L
29 3601041510060004 DIMAS L
30 3601040403080002 HASAN L
31 3601046001070004 DIANA AULIA P
32 36010409070001 JEJEN HERMANSYAH L
33 3601041806060004 M. IQBAL L
34 3601045002070001 ERNA P
35 3601044103070004 RESTI PUTRI P
36 3601045607090001 MAELANI APRIYANI P
37 3601046910070001 MILA ANDRIANI P
38 3601044906070003 SITI MUTIAH P
39 3601042610060003 SAMIAJI L
40 3600144706090001 WIDIA P
41 3601041307060001 RIANATA P
42 3601044608000002 SITI KHAIROH P
43 3601042101070002 RIFKI L
44 3601041709070001 SOFIYANALUBIS L
45 36010405050003 YOGA SAPUTRA L
46 3601042205080001 SAEPUDIN L
47 3601042303060001 FIKRI L
48 3601046707080001 DESI RATNASARI P
49 360104111070003 DAYAT L
50 3601045708080006 CHIKA AGUSTIN P
51 3601045407090001 DEWI P
52 3601047005080001 IMAS NATALISA P
53 3601044112080002 LENI P
54 3601040111080002 ISMAN L
55 3601043010070001 M. HENDRI L
56 3601044101070010 SITI PATIMAH P
57 3601044702080001 SULISTIAWATI P
58 3601046902080001 SOPI PITRIYANI P
59 3601044310060004 WULAN P
60 3601044602060002 YULI P
61 3601044302080001 MELDA P
62 3601040812070002 MARSEL. H L
63 3601041205080005 RAKA L
64 3601044308080005 AIRIN LIA. A P
65 3601046806080004 ALIVIA P
66 3601040107070002 ROHMAN L
67 3601044106080007 ANIH MITALIA P
68 360104142080001 RENO. A L
69 3601046205090001 ALYA TUNISA P
70 3601041105080004 IRMAN L
71 3601040410060003 ERDI SUPYANI L
72 3601045301080001 HAJIZAH DAMAYANTI P
73 3601040111060007 SARNA L
74 3601045009080003 HENI MAHARANI P
75 3601046806080003 HERLINA P
76 3601040610080001 M. RANGGA L
77 3601045008070004 HONIFAH P
78 3601041504080001 JIMMY APRIYANA L
79 3601045602080005 ELA LSTARI P
80 3601042812080002 M. QIAN L
81 3601046607090002 MURNIAH P
82 160320407070004 HANI HELMALIA P
83 36010145006080002 LATIFAH P
84 3601045606080002 SITI JUNAENI P
85 3601047103090001 NENTI P
86 3601045502050002 WAHYUNI SAPITRI P
87 3601040811080001 ADITYA L
88 360104505080003 YERNI P
89 3601044507090002 CIKA RAMADANI P
90 3601045801090002 SITI LIRIK RISKA P
91 3601112107080001 LEDI HERMAWAN L
92 3601041309080001 SODIK L
93 3601041507090001 TESA HADI L
94 601041506090006 RIDWAN L
95 3601041602080002 AHMAD SAEPUDIN L
96 3601044212080002 SITI NURPADILAH P
97 3601042005090003 M. RIZKI L
98 3601041501090004 M. JAKARIA L
99 3601045107080007 LELA KOMALASARI P
100 3601045811080001 SADIAWATI L
101 3601042501080002 MUHAD L
102 3601040701050010 RIDO L
103 3601046701080001 CISTO WANARO L
104 36010410051070001 NENDI L
105 3601081503950002 CEPY SUHENDRA L
106 3601041703070001 GEMPAR BRATA L
107 3601041204800005 APUD L
108 3601040107630357 PIPIR L
109 3601041007660001 SAHADI L
110 3601044701700008 WARSIH P
111 3601040107730365 EDI HANAFI L
112 360104410753220 WARYI P
113 3601041007820010 SUNARTA L
114 3601045106990004 CUCUM NURYANTI P
115 3601044107780407 IYUT HANIFAH P
116 3601044402900012 KASTI P
117 3601044107840189 SAMIAJI P
118 3601044107760244 KAMAH P
119 3601045101530002 DASINIH P
120 3601044107870162 NURSIH P
121 3601042012070003 LANI L
122 3601044108780005 NURBAYITI P
123 3601041504090001 JAMANI L
124 3601044602960003 INDAH LESTARI P
125 3601041007020002 IRAWAN L
126 3601044107720094 ATI P
127 3601045005770001 ERAH P
128 3601044306710001 SANARI P
129 3601042103680002 AENUDIN L
130 3601044702860003 UMSINAH P
131 3601040107930248 LUKMANUDIN L
132 3601044107670106 ASRI P
133 3601045004860004 KAMINAH P
134 3601049197670071 SAKRA L
135 3601045705670001 UNAYAH P
136 3601046003800001 RUBIAH P
137 3601044710870002 RUSTINI P
138 3601045508830005 CUCU KOMALASAI P
139 3601040607910004 DUDI L
140 3601044107840214 TINI P
141 3601044107870129 MURYATI P
142 3601041710930001 HANDRIK TRI HARYANA L
143 3601040412730002 SARMEDI L
144 3601040107730361 SUKARIA L
145 3601044104900008 ANIS P
146 3601044706800002 YATI P
147 3601044602810002 SUPINAH P
148 360104107680072 SUKAENI P
149 3601042106680001 ASWAD L
150 3601044107870152 MASRI P
151 3601045505849992 KAYAH P
152 360128520550001 IYOH P
153 3601044107770139 RUMSI P
154 3601044107560121 SARIAH P
155 3602085186930002 JUJUN P
156 3601044107780445 JALIS P
157 360104410778401 MIMIN P
158 3601045107850004 MUMUN P
159 3601044305770001 ARMAH P
160 3601044704830004 KARTINI P
161 3601044204830003 SUKAESIH P
162 3601044107620076 SACI P
163 3601044608800003 TARMI P
164 3601044504720003 SANAH P
165 3601040107630355 KATAM L
166 3601044411830001 TARMENI P
167 3601044107730412 PATMAWATI P
168 36011044107130026 SAWI P
169 3601044107780402 ASIH P
170 3601040107630361 TABRI L
171 3601045001810004 RATNA P
172 3601046108820002 IROH P
173 3601044706870003 SUNARTI P
174 3601046105830001 ARWI P
175 3601040107790161 MUTIAH P
176 3601041002890001 TATANG L
177 3601044101000016 SITI NUR ASIYAH P
178 3601045006890002 UUM UMYATI P
179 3601044402960004 AAS SELPIYANI P
180 3601045102620003 ROHANAH P
181 20-06-1985 SARIM L
182 3601044408880002 LILIS P
183 3601044107860238 MARYAM P
184 DEDE L
185 3601045006910005 YULIANTI P
186 3601045407780001 ARMI P
187 3601040702610001 SARMI L
188 3601044701740001 SANTI P
189 3601044107780392 EROH P
190 360104410740135 TASINGKEM P
191 36010450010000893 ASNI P
192 3601041106570002 MUNAH P
193 3601044701720001 LILIS P
194 3601044107680306 SERAH P
195 3601044208800003 ANI P
196 3601047103920001 IRMA Y P
197 3601044107730368 RASTIWEN P
198 3601044107730358 SURHENAH P
199 3601044710860004 NURSIH P
200 3601044107800267 SURNIAH P
201 3601044709520003 SANAH P
202 3601044107760239 CATINIH P
203 3601044107930244 SUMINAR P
204 3601040107780380 WIRYO L
205 3601046106830001 SOPIAH P
206 3601041005030001 APID L
207 3601046006850003 ARSAN P
208 3601045010000001 DINI MARDINI P
209 3601045403870004 SAHATI P
210 3601040107650190 ARMAN WIJAYA L
211 3601045207780002 HERI SOPYANI P
212 3601040107670088 SARPAH P
213 3601045102860006 WARKEM P
214 3601044305820005 HERTI P
215 3601044107530232 ARSIH P
216 3601044107709158 ENOL P
217 3601045210850003 ATI P
218 3601044712990005 SITI MAESAROH P
219 3601040107840172 MASRI L
220 3601042103810001 WIRJAYA L
221 3601040907780002 BOIN L
222 360104410994005 TURSINIH P
223 3601045507080012 YANTI P
224 3601044107910295 MAEMUNAH P
225 3601044107780447 RACIAH P
226 3601044107790130 SIHA P
227 3601040802970004 DEDEN L
228 JAMSI P
229 WARNI P
230 M. RUMANI L
231 AJAT L
232 3601044510820004 SUMYATI P
 Kepesertaan BPJS (
'Ya' pada kolom ya
Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP BPJS
ok Umur
tahun) PBI

28-11-2006 REMAJA UMBULAN 081380199520

27-07-2007 REMAJA SUKAMULYA 085771308692
15-01-2007 REMAJA UMBULAN 085774961442
20-10-2007 REMAJA UMBULAN 085774961442
28-08-2007 REMAJA UMBULAN 0878374312122
17-02-2007 REMAJA UMBULAN 087837432722
20-08-2005 REMAJA UMBULAN 081517969570
17-09-2006 REMAJA UMBULAN 085892746992
24-03-2007 REMAJA SUMURBATU 081585776144
09-06-2006 REMAJA UMBULAN 085771309692
07-01-2007 REMAJA SUMURBATU 085773525426
13-02-2007 REMAJA SUMURBATU 085773237548
04-03-2007 REMAJA UMBULAN 085778986763
15-04-2006 REMAJA UMBULAN 085591806122
02-04-2008 REMAJA UMBULAN 085782263027
22-06-2007 REMAJA RANCASENENG
15-07-2007 REMAJA SUKAMULYA 081351495919
09-10-2008 REMAJA UMBULAN 085810739093
23-10-2007 REMAJA SUKAMULYA 081617677602
26-03-2007 REMAJA RANCASENENG 085694942254
24-06-2007 REMAJA UMBULAN 081511870276
34-06-2009 REMAJA UMBULAN
04-01-2004 REMAJA UMBULAN 085281760576
10-02-2009 REMAJA SUMURBATU 085861049682
19-10-2006 REMAJA SUMURBATU 085811462015
17-04-2004 REMAJA UMBULAN 085811296105
15-01-2007 REMAJA UMBULAN 085883382005
12-07-2007 REMAJA CIWET 085778066943
15-10-2006 REMAJA SUMURBATU 085714771921
04-03-2008 REMAJA UMBULAN 085891154452
20-01-2007 REMAJA UMBULAN 082128756787
09-07-2007 REMAJA RANCASENENG 085894177325
18-06-2006 REMAJA UMBULAN 085282389360
17-02-2007 REMAJA UMBULAN 085882165273
10-12-2007 REMAJA UMBULAN 085882165273
01-04-2008 REMAJA RANCASENENG 085217857664
29-10-2007 REMAJA UMBULAN 085217857664
09-06-2007 REMAJA UMBULAN 085695264393
26-10-2006 REMAJA UMBULAN 085778987215
27-05-2007 REMAJA UMBULAN 082125756736
19-12-2006 REMAJA RANCASENENG 085778987215
08-08-2008 REMAJA SUMURBATU 082125756563
21-01-2007 REMAJA UMBULAN
27-09-2007 REMAJA SUKAMULYA 085718271298
05-05-2005 REMAJA UMBULAN 082213486621
22-05-2008 REMAJA UMBULAN 085779055092
08-10-2007 REMAJA UMBULAN 085283234460
23-07-2008 REMAJA RANCASENENG 085894828926
07-08-2007 REMAJA UMBULAN 081284438082
17-08-2008 REMAJA UMBULAN 081231414057
16-07-2009 REMAJA RANCASENENG 081231414057
30-05-2008 REMAJA UMBULAN 082125756817
01-12-2008 REMAJA UMBULAN 082125756817
01-11-2008 REMAJA SUMURBATU 081511754450
30-10-2007 REMAJA RANCASENENG
01-01-2007 REMAJA UMBULAN 081284438082
07-02-2008 REMAJA UMBULAN 082125756848
29-02-2008 REMAJA UMBULAN 085722049137
03-10-2006 REMAJA SUMURBATU 08581282972
22-07-2008 REMAJA UMBULAN 082125756805
03-02-2008 REMAJA RANCASENENG 082125756641
08-12-2002 UMUM UMBULAN 085719435981
12-05-2008 REMAJA SUKAMULYA 081284438082
03-08-2008 REMAJA SUMURBATU 085881196609
28-06-2008 REMAJA SUMURBATU 085711304710
15-12-2007 REMAJA UMBULAN 085772728771
01-06-2008 REMAJA UMBULAN 083891278381
14-02-2008 REMAJA UMBULAN 085777728771
22-05-2009 REMAJA SUKAMULYA 081210558217
11-05-2008 REMAJA SUMURBATU 082125756638
04-10-2006 REMAJA UMBULAN 082125756638
13-01-2008 REMAJA UMBULAN 085719063972
01-11-2006 REMAJA SUMURBATU 081284438082
10-09-2008 REMAJA UMBULAN 085711394518
28-06-2008 REMAJA UMBULAN
06-10-2008 REMAJA RANCASENENG 081284438082
0-08-2007 REMAJA UMBULAN 081284438082
15-04-2008 REMAJA UMBULAN 085894533656
16-02-2008 REMAJA RANCASENENG 081284438082
28-12-2008 REMAJA RANCASENENG 08124236174
26-07-2009 REMAJA UMBULAN 085695267307
01-07-2007 REMAJA RANCASENENG 085694587210
10-06-2008 REMAJA RANCASENENG 081284438082
16-06-2008 REMAJA RANCASENENG 085891581358
31-02-2009 REMAJA UMBULAN 085861599183
15-09-2007 REMAJA SUKAMULYA 085773225931
08-11-2008 REMAJA UMBULAN 082372422721
05-05-2008 REMAJA UMBULAN 085892626494
05-07-2009 REMAJA UMBULAN 081574883922
18-01-2009 REMAJA UMBULAN 082125756712
21-07-2008 REMAJA UMBULAN 081574883922
13-09-2008 REMAJA UMBULAN 081474883922
15-07-2009 REMAJA UMBULAN 085283861983
15-06-2009 REMAJA UMBULAN 081574883922
16-02-2008 REMAJA SUKASENENG 082312399266
02-12-2008 REMAJA UMBULAN 083808959694
20-05-2009 REMAJA UMBULAN 08212288027
15-01-2009 REMAJA UMBULAN 081284438082
11-07-2008 REMAJA SUMURBATU 081511690534
18-11-2008 REMAJA RANCASENENG 082312399266
25-01-2008 REMAJA SUMURBATU 085718719605
13-07-2007 REMAJA UMBULAN 085892634393
27-01-2008 REMAJA UMBULAN 085892623493
10-05-2007 REMAJA UMBULAN 081284438082
10-02-1996 UMUM UMBULAN 081284438082
17-03-2007 REMAJA CIWET 085773905557
12-04-1980 UMUM UMBULAN 081365080234
02-06-1968 UMUM UMBULAN 081369236854
10-07-1986 UMUM UMBULAN 081510566872
07-01-1970 UMUM UMBULAN 085311380053
10-10-1969 UMUM UMBULAN 085693161310
01-07-1953 LANSIA UMBULAN 087884605173
10-07-1982 UMUM UMBULAN 087872003873
10-06-1997 UMUM GEDUNG HARTA 085715400029
06-02-1978 UMUM UMBULAN 085693161310
04-02-1990 UMUM UMBULAN 085311513793
01-07-1984 UMUM UMBULAN 085311513793
01-07-1976 UMUM UMBULAN 085715400029
11-01-1953 LANSIA UMBULAN 081365080234
01-07-1987 UMUM UMBULAN 085892626494
20-12-2007 REMAJA SUKAMULYA 08581119386
01-08-1978 UMUM UMBULAN 085280006401
18-07-2007 REMAJA SUKAMULYA 085871218993
06-02-1996 UMUM UMBULAN 085773647879
27-07-2004 REMAJA UMBULAN 085693636909
01-07-1972 UMUM UMBULAN 085715700029
10-05-1973 UMUM UMBULAN 085214013934
03-06-1971 UMUM UMBULAN 085772729389
21-03-1968 UMUM UMBULAN 085214013934
07-02-1986 UMUM UMBULAN 085886162050
16-06-1994 UMUM UMBULAN 083815275916
15-02-1962 UMUM UMBULAN 085213478358
10-04-1986 UMUM UMBULAN 08578223079
17-07-1963 UMUM UMBULAN 081517020520
17-05-1967 UMUM UMBULAN 085716451386
20-03-1980 UMUM UMBULAN 085718255127
01-08-1985 UMUM UMBULAN 081511690491
15-08-1993 UMUM SUMURBATU 085283236129
07-12-1992 UMUM UMBULAN 081318024055
01-07-1983 UMUM UMBULAN 081365080234
01-07-1987 UMUM UMBULAN 081645456790
26-10-1993 UMUM CIKEUSIK 085691159039
04-12-1978 UMUM UMBULAN 085882165477
01-07-1973 UMUM UMBULAN 082111972265
01-04-1990 UMUM UMBULAN 085810910014
10-06-1981 UMUM UMBULAN 083890245272
06-02-1981 UMUM UMBULAN 081511865843
01-07-1968 UMUM UMBULAN 08570758811
21-06-1968 UMUM UMBULAN 085891807119
17-08-1989 UMUM UMBULAN 081513085783
15-05-1984 UMUM UMBULAN
12-05-1965 UMUM UMBULAN 081912465940
01-07-1977 UMUM UMBULAN 085710509754
01-07-1956 LANSIA UMBULAN 085216773398
11-06-1993 UMUM UMBULAN 085882165477
06-04-1974 UMUM UMBULAN 083804056209
01-07-1978 UMUM UMBULAN 082111972265
11-07-1985 UMUM UMBULAN 081912466225
03-05-1977 UMUM UMBULAN 083899139109
07-04-1987 UMUM UMBULAN 085781086743
02-04-1969 UMUM UMBULAN 081369236854
01-07-1961 UMUM UMBULAN 085282388695
06-08-1980 UMUM UMBULAN 081511690491
05-04-1972 UMUM UMBULAN 081369236854
01-07-1965 UMUM UMBULAN 085283712380
04-11-1983 UMUM UMBULAN 083819820302
01-07-1973 UMUM UMBULAN 081318024055
01-07-1963 UMUM UMBULAN 085710509754
09-06-1977 UMUM UMBULAN 085810876863
01-07-1963 UMUM UMBULAN 085283712380
10-01-1981 UMUM UMBULAN 085710509754
15-04-1982 UMUM UMBULAN 081645456790
07-06-1987 UMUM UMBULAN 083899139109
21-05-1983 UMUM UMBULAN 085774957944
01-07-1979 UMUM UMBULAN 085711364881
10-02-1980 UMUM UMBULAN 085711364881
01-01-2000 UMUM UMBULAN 081213479441
10-06-1989 UMUM UMBULAN 085773525426
04-02-1998 UMUM UMBULAN 085886821886
11-02-1962 UMUM UMBULAN 085782263094
24-06-1986 UMUM UMBULAN 0852112132743
04-08-1988 UMUM UMBULAN 085893924536
01-07-1986 UMUM UMBULAN 0857194232041
081511865843
10-06-1991 UMUM UMBULAN 085778220398
03-06-1973 UMUM UMBULAN 085778212536
07-02-1961 UMUM UMBULAN 085778212536
07-01-1974 UMUM UMBULAN 0812966-7377
01-07-1978 UMUM UMBULAN
01-07-1974 UMUM UMBULAN 085776129312
20-07-2001 UMUM UMBULAN 085891156179
11-06-1957 LANSIA UMBULAN 085718255127
12-06-1982 UMUM UMBULAN 081511865843
01-07-1968 UMUM UMBULAN 085810876863
02-08-1980 UMUM UMBULAN 081511865843
31-03-1992 UMUM UMBULAN 085779570597
01-07-1973 UMUM UMBULAN 085216922091
01-07-1973 UMUM UMBULAN 083899139109
07-10-1986 UMUM UMBULAN 085695202270
01-07-1980 UMUM UMBULAN 085718246865
07-09-1952 UMUM UMBULAN 085738045182
01-07-1976 UMUM UMBULAN 081511865843
27-05-996 UMUM UMBULAN 081290966779
26-06-1970 UMUM UMBULAN 085894539177
21-06-1983 UMUM UMBULAN 085694726404
09-07-2003 REMAJA UMBULAN 081296607377
20-06-1986 UMUM UMBULAN 08521246547
10=-10-2000 UMUM UMBULAN 085216922091
12-04-1990 UMUM UMBULAN 0857382118419
01-07-1965 UMUM UMBULAN 085778182854
12-07-1978 UMUM UMBULAN 085770147702
01-07-1967 UMUM UMBULAN 085311380053
18-12-1988 UMUM UMBULAN 085211982463
03-05-1982 UMUM UMBULAN 085319298908
20-07-1953 LANSIA UMBULAN 085719474516
01-07-1980 UMUM UMBULAN 081617677846
03-05-1994 UMUM UMBULAN 081511407830
07-12-1999 UMUM UMBULAN 085882165313
22-07-1985 UMUM UMBULAN 08578229265
21-03-1980 UMUM UMBULAN 085718646723
09-07-1978 UMUM UMBULAN 085781350409
01-09-1994 UMUM UMBULAN 08138293419
15-07-2001 UMUM UMBULAN 083899139163
07-08-1983 UMUM UMBULAN
19-06-1977 UMUM UMBULAN
01-07-1970 UMUM UMBULAN
08-02-1997 UMUM UMBULAN
01-07-1967 UMUM UMBULAN
21-07-1980 UMUM UMBULAN
09-08-1999 UMUM UMBULAN
17-11-2000 UMUM UMBULAN
13-10-1982 UMUM UMBULAN 085694956630
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi

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 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi
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 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601354107800128 NURMI P
2 36010350107780302 SUKMA WIJAYA L
3 3601040404620001 KADMINAH L
4 3207281204890003 IJANG IRPAN L
5 3601042504790001 WARYA L
6 3601044606010002 ROBIAH P
7 3601044107680160 CARTI P
8 3601044107700123 CARWEN P
9 360104410790082 ARSAWI P
10 360104591290002 NURHAYATI P
11 360104201860001 TRISNO L
12 3601045910250001 SUBIAH P
13 3601045809740001 JAHANAH P
14 3601046903930002 HENI P
15 3601044401830001 YOYON L
16 3601044507740003 DARPIAH P
17 3601044204660001 AMINAH P
18 3601045508490001 JARTI P
19 3601044306830001 CARNATI P
20 3601044702680003 ICIH P
21 3601046108870007 SARMINAH P
22 3601040107020229 ARJAM L
23 3601044207020007 CAHYANI L
24 3601046101010001 NITA RANI P
25 3601045701020001 RIKA YANI P
26 3601044609760002 RASTINAH P
27 3601044107780225 CASYATI P
28 3601041210780001 JULI L
29 360104415850266 KARINIH P
30 360104410768027 DARINI P
31 3601040107830167 SUKIRMAN L
32 3601045011690001 EEN HERMAWATI P
33 3601044107730207 DASMI P
34 360104410850022 NARSIH P
35 36010451029200001 SARINAH P
36 3601045503700002 ANI P
37 3601046009770001 RASTI P
38 3601044709900005 AMSIAH P
39 3601040607940004 DEDI SELAMET L
40 360104831630001 ASIH P
41 360104410740050 MISNAH P
42 3601044601780005 MASNAH P
43 3601044110780002 IRAH P
44 360104570410001 NASMI P
45 3601046405860002 ARNAH P
46 3601045910890001 TATI P
47 3601044509600001 JUNAH P
48 3601044107690053 NINGRAT P
49 3601040207040028 NANI SAPUTRA P
50 3601045301070003 SITI NENGSIH P
51 3601044712890002 LINA P
52 3601044208770001 RIUMINAH P
53 3601044205700001 ASINAH P
54 360104170720001 SUTRISNO L
55 3601046008070003 AYU LESTIANA P
56 3601044201700004 MURNASIH P
57 3601041501980001 AZIS. A L
58 3601044207990002 ITA ELIANTI P
59 3601044107730317 CASMI P
60 3276026502040005 SITI AISYAH P
61 3601041004700004 SAMAN L
62 3601041303850002 SAHANAH P
63 36010445078830005 TINAH P
64 3601046001750003 ATIAH P
65 3601044302730001 TUNI P
66 3601044107740114 WASTI P
67 3601044107820090 ASTI P
68 3601044107620037 RUHETI P
69 3601044211750001 RATINAH P
70 3601045210600001 MARSIH P
71 3601044102970004 SITI HAERIAH P
72 3601044202800003 JUMINAH P
73 3601044705890001 UMAH P
74 3601044107740047 MASNI P
75 3601046811800001 LISNA P
76 3601046107780004 JUMANAH P
77 3601045401800002 KOLIDAN P
78 3601044107550054 SALAMAH P
79 3601045103420002 TARINIH P
80 36010407010006 BAHRUL MAULANA L
81 360104107640014 KAMSARI L
82 3601040911760001 TASIM RIZKI L
83 3601044706990012 UNASIH P
84 3601044107850221 RISKA P
85 3601044504660001 WARTINI P
86 360104550800012 NAPIAH P
87 3601045405930001 KASIROH P
88 3601041001720005 SAMAD L
89 3601042303850001 WARGANI L
90 3601046610850001 TIAH P
91 360104580850001 SUHAENAH P
92 3601045211850003 KASIH P
93 3601044211920002 ROMDONAH P
94 3601045005670003 ASNITI P
95 3601044107750193 EMAR P
96 3601045512790001 DASEM P
97 360104430700003 SAR'AH P
98 3602094210900007 ETI P
99 3601044903950003 SUMINI P
100 3601043010000002 RAHMAT L
101 3601045507890004 SAETI P
102 3601040810720001 TAWEN P
103 3601045407700003 SAETI P
104 3601044107920084 TARSINIH P
105 3601044908876007 ARMI P
106 3601044205000005 MIA WAHYUNI P
107 360104430470004 UMINAH P
108 3601044107030126 ANGGA FERISOI L
109 3601044107930224 YATI P
110 3601044107780307 RUSMANAH P
111 360104410781015 ICIH P
112 360104490380003 ITI P
113 360104410720100 ATEM P
114 3601045406000001 SELA BATIA P
115 3601045910820003 NURHASANAH P
116 360104091760003 RABAN L
117 3601044308950001 TUTI P
118 3601044107940071 NIA MILAWATI P
119 3601044107250008 SITI HODIJAH P
120 3601042209570001 RASITA P
121 3601045003680003 KARYEM P
122 3601044504880008 JURIYAH P
123 36010452037500002 ATIAH P
124 SUTIAWATI P
125 3601045112700005 SUKRIAH P
126 3601044807700002 KARSIAH P
127 360104410760061 NURHAMAH P
128 36010424030001 WARLAN L
129 3601040107820067 KARIAYA L
130 3601044702090002 ARSITI P
131 3601044905870002 IYUM P
132 3601040107000137 DIANA YUSUP L
133 360104550980003 ANAH P
134 3601045904920005 YATI OKTAVIA P
135 36010441017830183 SITI HADIZAH P
136 3601044107700208 HENAH P
137 36010452039800005 HERLINA P
138 3601046810990001 ABDUL RAHMAN L
139 3601044804780002 UMSIAH P
140 360104470780001 WARSITI P
141 3601044112590001 ERAH P
142 360104410773030 RATITAH P
143 360104460450003 ARSINAH P
144 360104482660002 UTI P
145 3212241304990002 DEDE BAGUS L
146 3601044410520001 SUMINAH P
147 36010411830001 ACENG TARKANI L
148 SARDI L
149 3601044411700001 MARYATI P
150 3601043005980002 WARNOTO L
151 3601044601610002 CICIN P
152 360104417940163 SUMARNI P
153 3602046007700002 IYAH P
154 3602044708880004 DARNI P
155 3601044107840226 MASNI L
156 3601040107530102 CASIMAN L
157 3601045070730002 SARNI P
158 3601040107920265 RUSTONO L
159 3601043010030002 SUTA RAHMAT R L
160 3601044107850130 SAPIAH P
161 3601042407020001 ARI ERNAWAN L
162 3601041105830001 SUHARNA L
163 3601040107710164 DARSIM L
164 3602214205510001 JASIH P
165 3601046503850001 SUHELAN P
166 3601044107780443 PATIMAH P
167 3601045203840003 ISAN MAESAROH P
168 3601044107730430 SUNENTI P
169 3601044107850157 SUMNARNI P
170 3601044705840002 ARTI P
171 3601044107730356 SAYANTI P
172 3601044309800005 AYATI P
173 3601045804770002 ROHATI P
174 3601045909700004 SATINAH P
175 3601040106970004 INE MARLINA P
176 3601040401860004 WARSONO L
177 3601044107870063 ROHIMAH P
178 3601046406820001 RUMSINAH P
179 3601044607960008 MAESAROH P
180 3601044402840003 ELIS P
181 3601044804930006 ISNI P
182 360104650770004 SAETI P
183 3601046703060001 RIKA ADIYANTI P
184 3601046407830002 NENGSIH P
185 3601044610920004 UMIYANI P
186 3601044107690051 CASINAH P
187 3601044605700004 SURYATI P
188 3601044307060005 YESI JULIANTI P
189 3601044807060003 YULIA ARISTY P
190 3601044107850171 ASIH P
191 3601044504900005 WASTINI P
192 3601045105790001 RASIH P
193 3601044107830227 KARMI P
194 3601045001080003 NAYISILA P
195 3601040502870003 SARIM P
196 3601044801900004 KAPINIH P
197 3601040107700074 RASIDI L
198 3601044107550032 DARTEM P
199 3601041412660001 SUJAYA L
200 3601042708790002 DENIAH BT P
201 3602211397840001 ASEP SUPIANI L
202 360104231280002 IWAN S L
203 CARNI P
204 3601044701890003 ANAH P
205 3601044107660026 ENOH P
206 3601042501700002 KADMA L
207 3601047012840003 EHA P
208 3601044107860060 SATIAH P
209 3601045504780001 NURHAYATI P
210 3601047012890001 HENI P
211 3601045507800015 KARTIYEM P
212 3601044101890010 EMI P
213 3610452037400001 JUHETI P
214 3601044107750185 RANIAH P
215 3601042401940001 DIDI SUPRIADI L
216 3601045311800002 AYU ASIH P
217 3601044107600070 MARINAH P
218 3601044205870001 RAMINAH P
219 3601041208330001 SUP SUPRIATNA L
220 3601040904770001 DIDIH L
221 3601045111830001 BEBEN L
222 3601041311970001 SANAJAYA L
223 3601046205840001 TUNI P
224 3601045403870003 ARSIH P
225 3601040107630147 TAMIN L
226 3601046803710001 ASTI P
227 3601045703730003 MIMIN P
228 3601044101980008 WASTIRAH P
229 3601047012820001 PATIMAH P
230 3601046510750001 ASTI P
231 3601047004830002 SAENAH P
232 3601041506690002 MAMAK L
233 3601044107760156 NURMI P
234 3601044406920004 WILIH MAESYAROH P
235 3601044107630587 SAMINAH P
236 3601044107900208 NANI P
237 3601045504790001 ENTIM P
238 3601046012880002 HASANAH P
239 3601045905920002 JUMROH P
240 3601044107930207 UNAYAH P
241 3601045109870003 ENENG ETI P
242 3601045311870001 WARSIH P
243 3601046704610002 ASMINAH P
244 3601044107630136 ARSIAH P
245 3601044107660149 ASMAH P
246 3601041007730007 KADIMAN L
247 3601044412950010 NOVI WIDURI P
248 3601042001030010 CASNA ADI GUNA L
249 3601040107650140 KEMA P
250 3601047103840002 ELA P
251 3601034512900001 ANAH P
252 3601044107740089 JASIH P
253 3600104611930001 NURATI P
254 3601044205590003 DANI P
255 3601044107800124 MULYANI P
256 3601045911890001 MASNAH P
257 3601044410360003 BAYI P
258 3601044102840003 ENENG RUMSAH P
259 3601047011830003 TITIN P
260 3601044107780289 ATIK P
261 3601044105700005 SUMYATI P
262 3601040102000014 HENKI PERMANA L
263 3601044107730330 WARJEM P
264 3601044107800183 SARTINAH P
265 3601044210750005 NARSIH P
266 3601041501720001 NASIRIN P
267 3601045204710001 RUMANAH P
268 360104202700002 WARIS L
269 3601044107770060 SUKANAH P
270 3601045103780008 INAH P
271 3601044107650148 EEM P
272 3601044908820003 SANAH P
273 3601046309780001 ASMINAH P
274 3601046102020002 IKE DWIYANTINI P
275 3601044308870003 KARTI P
276 3601045502690002 SARINAH P
277 3601044107860153 SARPI L
278 3601044707030003 ELISAH P
279 3601044104800007 BAYI P
280 3601046604870003 SURNI P
281 3601046707820003 TATI P
282 3601046004730001 JUBAEDAH P
283 3601044107840100 SARMINAH P
284 3601046209880001 SANTI P
285 3601042810010002 M BAHRI L
286 3601044303750001 JUMINAH P
287 3601040107550026 RASMITA P
288 3601044107800141 SARIBAH P
289 3601044107750289 RASTINAH P
290 3601040611650002 ASMAN L
291 HJ SITI WASIAH P
292 3601042103730001 ALI L
293 3601045409650001 RASIH P
294 3601044107780290 SULAMSAH P
295 3601046605890001 SARIMAH P
296 3601045210810001 JUNI P
297 3601044107830365 RATINAH P
298 3601044608750002 MARNI P
299 3601044304750001 AMSIH P
300 3601040801040002 ROBI L
301 3601044308760002 SARTI P
302 3601044107540031 KADIEM P
303 3601045103750002 SATI P
304 3601046511820001 RASMINIH P
305 3601044307720002 TARISAH P
306 3601044107490038 SAWIAH P
307 3601044107670055 TUSINAH P
308 3601040107920092 NENI TRIANA P
309 3601040701030003 SUPYANA L
310 3601046007580004 TRISNA NENGSIH P
311 3601044107870007 JUBAEDAH P
312 3601045812030001 NITA P
313 3601045402710002 RUMSINAH P
314 3601044107780195 ASNI P
315 3601044107150003 RAMINAH P
316 3601044107540030 SAWINGKEM P
317 360104424750002 SIRKEM P
318 3601044107900114 YATI HARYATI P
319 3601044107830108 RATNA P
320 360104410780157 KOKOM P
321 3601044107840217 JAHROH P
322 3601044107570044 JASMI P
323 3601043101020001 ABDUL RAHMAT L
324 3601044805650001 ONIH P
325 3601044809870002 JANAAH P
326 3601045001800001 EDAH P
327 3601046501790001 YATI P
328 3601034403950001 SURNI P
329 3601044107720114 TARSIH P
330 3601044102960003 HERNI P
331 3601045684910006 EMI P
332 3601046606680001 SADIAH P
333 3601041405000003 KUSWANDI L
334 3601044407920005 AISAH P
335 3601044407740002 ARTI P
336 3601044107850354 ENI P
337 3601044410780138 DARSIH P
338 3601044605850008 NUNUNG P
339 3601044409920001 ALIH P
340 3601044604030008 ARNYATI P
341 360221551890001 ASNATI P
342 3601040107890154 AGUS L
343 3601045008480002 SARAH P
344 3601044401730001 SUHA P
345 3601045805770001 EMAH P
346 3601040107710004 EDI L
347 3601044402780004 MURHALI P
348 3601044202680001 SARIAH P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur Kelomp sesuai)
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI
01-07-1990 UMUM CIKEUSIK 085694527923
18-07-1976 UMUM CIKEUSIK 085694527973
04-04-1962 UMUM CIKEUSIK 085283234195
12-04-1989 UMUM CIHARALANG 085755093079
04-07-1979 UMUM CIKEUSIK 085719008219
06-06-2001 UMUM CIKEUSIK 085640729116
01-07-1968 UMUM CIKEUSIK 081317462540
01-07-1970 UMUM CIKEUSIK 085216746430
01-07-1969 UMUM SUKASENENG 085794437643
27-06-1990 UMUM CIKEUSIK 085219529672
28-11-1987 UMUM NANGGALA 085695268479
19-10-1975 UMUM SUKASENENG 085778182988
18-09-1974 UMUM SUKASENENG 085882800560
29-03-1993 UMUM SUKASENENG 081585670648
04-01-1983 UMUM SUKASENENG 085775138360
05-07-1974 UMUM CIKEUSIK 085640729116
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04/12/1986 SUKASENENG 081513668961
17/06/1986 NANGGALA 0857838722092
24/06/1982 NANGGALA 085710140942
06/07/1996 NANGGALA 085710605467
04/02/1984 NANGGALA 085777374529
08/04/1993 NANGGALA 081287701281
25/07/1977 NANGGALA 085289878194
27/03/2006 CIKEUSIK 085773490979
24/07/1983 NANGGALA 085691154272
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01/07/1969 NANGGALA 083813522190
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17/07/1981 NANGGALA 083813522190
05/04/1990 NANGGALA 085280517334
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01/07/1983 NANGGALA 083815602955
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30/12/2021 NANGGALA 085213557782
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30/12/1989 NANGGALA 081511899205
15/07/1980 CIKEUSIK 085695409549
01/01/1989 NANGGALA 081213381070
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28/03/1971 SUKASENENG 085719097717
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30/12/1982 NANGGALA 085893756942
25/10/2975 CITARUM 085283329304
04/07/1982 NANGGALA 085217563622
15/06/1969 SUKASENENG 085215420708
01/07/1974 CIKEUSIK 085891255722
04/06/1992 NANGGALA 085219331282
01/07/1963 NANGGALA 082297768800
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15/04/1979 CIRIRGI 085776131246
20/12/1988 CIKEUSIK 085880004167
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13/11/1987 CURUGCIUNG 085714303942
27/04/1961 NANGGALA 085773227451
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20/11/1978 PARKOS
07/11/1980 NANGGALA 081511899205
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30/11/1983 NANGGALA 085891605386
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19/05/1980 CURUGCIUNG 085798853216
09/12/1982 CURUGCIUNG 085882158492
23/09/1978 NANGGALA 085882158492
24/04/2001 CIWET 087813006372
03/08/1987 CURUGCIUNG 085771905716
15/02/1969 CURUGCIUNG 085771905716
01/07/1986 CURUGCIUNG 085882158492
31/05/2003 RANCASENENG 085649936022
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26/04/1987 CURUGCIUNG 085692188720
27/04/1982 RANCASENENG 085711867204
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28/10/2001 RANCASENENG 085782266442
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14/09/1965 CURUGCIUNG 085893693100
01/07/1978 CURUGCIUNG 085860730736
29/05/1989 CURUGCIUNG 085693846700
12/10/1981 SUKASENENG 081382598060
01/07/1983 CIKEUSIK 085775202726
06/08/1975 NANGGALA 085711038584
03/04/1965 BUNGUR GEDE 085893963110
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03/08/1976 NANGGALA 085692651838
01/07/1954 LANSIA TANJUNG SARI 085695268248
11/03/1975 NANGGALA 085773227451
25/11/1982 RANCASENENG 085891154421
06/10/1976 SUKASENENG 087772431697
01/07/1949 NANGGALA 085718788190
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05/10/1989 RANCASENENG 085714984202
12/04/2002 CIKEUSIK 085782134866
20/07/1958 RANCASENENG 085216602963
01/02/1987 NANGGALA 085695268248
18/01/2000 CANGKORE 081398827188
14/02/1971 NANGGALA 085697188445
01/07/1978 NANGGALA 081511868387
01/07/1957 LANSIA NANGGALA 085810142852
01/07/1954 NANGGALA 085711038584
02/01/1975 TANJUNG SARI 085711038584
20/12/1990 NANGGALA 085773227451
01/07/1983 NANGGALA 085219331283
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01/07/1982 SUKASENENG 083148346119
01/07/1957 NANGGALA 085219331282
31/01/2001 SUKAMULYA 085770149958
08/05/1965 NANGGALA 085810132784
08/09/1987 SUKASENENG 085282259087
10/01/1980 PARKOS 08558664464
23/12/1979 SUKASENENG 085694137012
04/03/1995 TANJUNG SARI 085773227457
01/07/1972 CIKEUSIK 085891255722
10/07/1995 CIKADONGDONG 085779569008
16/04/1991 SUKASENENG 082310578162
26/06/1968 CIKADONGDONG 085886161934
14/05/2000 CIKEUSIK 085213305080
04/07/1992 UMBULAN 085692654485
04/07/1974 CURUGCIUNG 085219822524
01/07/1985 BARENGKOK 08216070232
01/07/1984 CURUGCIUNG 085772149544
06/05/1985 CIKEUSIK 085215981077
04/09/1993 SUKASENENG 085219423844
04/04/2002 SUKASENENG 085718256174
03/01/1986 CURUGCIUNG 085697580866
01/07/1989 CURUGCIUNG 085894754550
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04/01/1972 NANGGALA 085770147680
18/05/1977 BENGER 085770147681
01/01/1971 PARKOS 085820104931
04/02/1978 PARKOS 081381318022
03/02/1968 NANGGALA 085770147680
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri
Anggota
Vaksinasi
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 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

28-10-2021 202108445H

28-10-2021 202108445H

28-10-2021 202108445H

28-10-2021 202108445H P0LSEK CKS

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 28-10-2021 202108445H
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28-10-2021 202108445H RANCASENENG

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28-10-2021 202108445H

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28-10-2021 202108145H
 Nama Penerima
NO No. Ticke NIK JK Pekerjaan*
Vaksin

1 3601044107720073 TUMI P
2 3601045010780003 DARIH P
3 3601044406840007 SAROH P
4 3601045703930003 JANIAH P
5 3601045507490001 INDRIYANI P
6 3601045201640001 ANAH P
7 36020149040002 NITA AMELIA P
8 3601044206710001 SUKESIH P
9 3601045307070002 SITI MAESAROH P
10 3601042407980003 NURDIN L
11 36010441077400036 JUMANAH P
12 360104410600099 ASNI P
13 3601044304570001 RANATI P
14 3601044108650008 ARWINAH P
15 3601045007790002 ENIP P
16 3601045105910003 SITI AISAH P
17 3601041708880001 AGUS MULYADI L
18 3601041012610001 SUKARJA B. M L
19 3601041706020003 NURDIN L
20 3601046807807620001 AKEM P
21 3601045012630001 SAINAH P
22 3601040507840005 SUKARNA L
23 3601045311500002 MANI P
24 3601044805700001 TARIMAH P
25 3601044107790048 HANA P
26 3601045212560001 MARSITI P
27 3601044704840002 ROHENI P
28 3601045607780002 EMAH P
29 3601044107 RAMSAH P
30 36010448708920002 TITIN P
31 3601046608720002 SAMUNAH P
32 360104431070001 ANI P
33 3601045705720002 JUARSIH P
34 36010401030092 NURSAMAN L
35 3601044504760004 SANATI P
36 3601044107630296 CARSINIH P
37 3601045108050001 RINAH P
38 3601046003810001 MUNAH P
39 3601044708770005 SOLIHA P
40 3601044403800004 SARMI P
41 ERUM P
42 3601045702030001 FATIMAH P
43 3601044107800014 PONAH P
44 360104670280001 EDAH P
45 3601040107780242 SUHENDRA L
46 3601044504750001 KUNIROH P
47 3601044206900004 ARSINAH P
48 360104010720083 SAMA B WASMAN L
49 3601044707560001 RAYEM P
50 3601045002830007 SUTINAH P
51 360104410780157 KASWI P
52 3601044208750002 IYAH P
53 3601045410800003 RANTINAH P
54 3601044209000001 SITI RUKAYAH P
55 3601044107840224 ACIH P
56 3601045010930001 FATMAWATI P
57 3601044507760003 TATI P
58 3601041710710003 KADIS L
59 3601045603960003 NURHAYATI P
60 3601044107680067 ENCUN SUHARNIAH P
61 360104611800002 ROBIAH P
62 3601040409700001 ODI L
63 360104448790003 TATI P
64 3601047005840003 SITI ASIAH P
65 3601044605930007 RAMAH P
66 3601044507800012 JASTI P
67 3601044505390003 MARNI P
68 3601044707950007 NITA P
69 3601040107690046 DULHADI L
70 3601045206040001 JUNARIAH P
71 36010404020003 SONI L
72 3601045701750001 SANAH P
73 3601046811790001 DEWI P
74 3601045309720001 NURIAH P
75 36010407730317 RAKIMAN L
76 3601044107700098 UMAEROH P
77 CARMEN P
78 3601044406800003 SANAH P
79 36010441077352415 SANI P
80 3601044409800004 SITI JUMROH P
81 3601044107740070 CASNI P
82 3601041502070004 RIDO ALJABAR L
83 360104210990004 JUMALI L
84 3601045308650002 RATEM P
85 3601040805930004 KASTURI P
86 3601044412770002 SAPIAH P
87 3601041902670001 WARKIM L
88 3601045402890001 IDA MASTUROH P
89 3601044403780004 JASTI P
90 3601046301010002 ERISA P
91 NOVI MARLIANI P
 92 3601044107900036 INAH P
93 36501044007800006 MINI P
94 3601044107650157 SUPINI H P
95 3601044107720069 RATINAH P
96 3601040511790001 ADE SAMSUDIN L
97 3601044107750240 ENUR P
98 3601044100779016 TIAH P
99 3601045912820001 NENGSIH P
100 3601044107800163 HERNI P
101 36010450088800002 IIS SISMAYANTI P
102 3601044107920192 SUKRIAH P
103 36010447018900001 EROH P
104 360104570493006 MARNAH P
105 3601044106860002 EVA P
106 360104150770006 WAHIDIN L
107 360104520000337 KASTEM P
108 36010443850005 EEM P
109 3601044107780421 JASTI P
110 360104806940002 SUMA'AH P
111 3601044108820004 SANAH P
112 3601045267910001 UPIT FITRIYANI P
113 3601046008730002 JURIAH P
114 360104410770111 TAWI P
115 3601045007360001 LILIS P
116 3601041304060001 MAULANA YUSUP L
117 3601040905770001 RUSMAN L
118 360104500380004 ADE P
119 3601041106020008 MULYANA L
120 EEN P
121 3601041402660001 SURNAYIM P
122 3601044605720001 RUMEH P
123 3601044201890004 JUMHATI P
124 3601046507920004 ERNA P
125 3601045507650004 ASENG
126 3601044306770001 SURMAH P
127 3601040808990007 WARNA WIJAYA L
128 3601040904660001 SUMA L
129 360104410730291 WARSINAH P
130 3601044107800144 MARSAH P
131 3601040107880238 RASWAN L
132 360104446890004 ANIH P
133 3601036301090001 RINA YUNIAR P
134 360103650060001 LISDA YUNIAR P
135 3601044208780002 ANAH P
136 3601044701960006 SANAMAH P
137 3601044207790009 SUKMANAH P
138 3601044107760214 TIMOH P
139 360104430910004 SARNATI P
140 3602076008800001 IIN P
141 3601044107850224 AHATI P
142 3601043705650002 DARSINAH P
143 3601046018670001 AMIN L
144 3601044310890002 SARWI P
145 3601044206900002 ERNA P
146 360104517880002 ARNI [
147 360104410860005 ARSIH P
148 3601042001620001 JANA L
149 3601044210050004 PIHA KHOLIPAH P PELAJAR
150 3601042307750002 CARMAN L
151 3601045507700003 IJAH P
152 3601046101070001 SOFWAH NAYLA P
153 3601044107680262 TARMINIH P
154 3601044211820003 MARWIAH P
155 360104410770170 SARPEN P
156 36010420027800001 EPI SUNAEPI L
157 3601044506900003 RASINAH P
158 3601045401850003 ARSIH P
159 3601044107530199 NARTI P
160 3601045507510001 SUNARI P
161 1611075606960002 HERNAWATI P
162 3273125305060013 HESTI P
163 360104431082000 TIKA P
164 3601046510030002 NOVA OKTAVIANA P
165 3601044207880006 KAMINAH P
166 3601047012700001 SURNI P
167 3601044107650151 MURSIH P
168 360104510790003 SOPIAH P
169 1611071502920001 HASANUDIN L
170 3601044503770004 KANTI P
171 3601044705600002 SANARI P
172 3601044307830002 IMAS P
173 3601044107430031 SURNAH P
174 3601044711680003 SUMARNI P
175 3601044107730215 HASAN L
176 3601044107480101 SANI P
177 3601040107580219 DARPIN L
178 3601044709670003 OJAH P
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190 3601040107670081 ARJA L
191 3601040904040001 BILLY BIMA N L
192 3601041104820004 PULUNG L
193 360104010780223 RASID L
194 3601041005900002 ANDI L
195 3601045012630001 SAINAH P
196 3601044702880004 SARMINAH P
197 3601044107880158 IIS P
198 360104461950002 AMOY P
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200 3601044808880006 SITI JUBAEDAH P
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204 3601041403040003 SAHRUL L
205 3601045307790002 JUMI P
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207 3601044107960272 SUNIMAH P
208 3601045506860004 SARTI P
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211 3601044605770004 SARNI P
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216 3601044207830008 FATIMAH P
217 3601044107680127 RUMSITI P
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227 3601044107920156 NASWEN P
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241 3601044110890001 SONIA PAUJIAH P
242 36010461068750003 IKA NURWATI P
243 3601046403920002 NITI P
244 3601044101870003 KARNITI P
245 3601044701600006 SUKMINAH P
246 3601045210730003 AMI P
247 3601042901800002 MASDUKI L
248 3601044107780332 DADANG L
249 3601044107950187 TINAH P
250 3601045205880002 SRI ERNAWATI P
251 3601045104780002 SARINAH P
252 3601041407840001 UCON L
253 3601044107890195 ALIAH P
254 3601044908960002 INAH P
255 3601045506840001 NARWEN P
256 3601044206790001 NARSIH P
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260 3601044107740111 SANI P
261 3601044107780351 WASKEM P
262 3601040110670001 SUARNA L
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264 3601044100900005 YUYUN P
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267 3601045506770001 TINI P
268 1305104712730001 DARINAH P
269 3601045601780001 ASMINAH P
270 3601044705700002 SUMYATI P
271 3601045005820001 ADE ROHMAH P
272 3601040107730315 RANITA P
273 3601044107680268 RASEM P
274 3601044707800004 UMU KULSUM P
275 3601045205790003 INAH P
276 3601045603840001 MASNAH P
277 3601046005980004 IMAS MAELANI P
278 3601046605000003 DIAN SAPITRI P
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280 3601046004870001 MARIAH P
281 360104206600002 MISNAH P
282 3601046605860000 IMAS MASLIAH P
283 3601044107880197 JUMI P
284 360104403850003 YANAH P
285 3601044701900006 JANAH P
286 3601041503830003 HASAN L
287 3601044701880000 AMYAH P
288 3601040212020003 AAN TRIANA L
289 3601044107880199 JAMIAH P
290 3601044102740002 ICAH P
291 3601045002820001 IIN P
292 3601044107780158 SUARSIH P
293 3601045507850009 SUKEMI P
294 36010441076900057 RUSMIAH P
295 3601042307850002 DANI L
296 3601044107700160 SARI P
297 360104570803000 LIA SAPITRI P
298 360104611278001 DASNIAH P
299 3601040107930245 RUJANI P
300 3601044107770122 YANAH P
301 3601045509750001 OMAH P
302 3601044707830002 ICIH P
303 3601044107670056 INTEN P
304 3601045707640002 SAMINAH P
305 3601044707750003 ETI P
306 3601044102370004 SUKRIAH P
307 3601045510850002 NURHAYATI P
308 3601044512770001 WARTEM P
309 3601044310880004 SURHEMAH P
310 3601044107730171 RASMINAH P
311 3601041011530002 PARDIN L
312 3601040107700172 JUMRI ARYADI L
313 360104010580004 SARMAN L
314 3601044705860003 RASKINAH P
315 3601044310850006 NIAH P
316 3601046701910005 SARINAH P
317 360127608870001 ARSAENAH P
318 3601040107640034 KARTONO L
319 3601044101920008 ETI P
320 3601045108750001 PIAH P
321 3601044107660074 TARWINAH P
322 3601044184270001 TIJAH P
323 3601044310850007 BAYI P
324 3601040107650087 SOLEMAN L
325 3601040105740001 ATA L
326 3601044102900010 RANISAH P
327 3601040904040001 BILLY BIMA. N L
328 3601044107890084 SUENAH P
329 3601044107810105 KAMINAH P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur Kelomp sesuai)
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI
01-07-1972 UMUM CIKEUSIK 085212817706
10-10-1978 UMUM CIKEUSIK 085718271268
04-06-1984 UMUM SUMURBATU 085215993149
17-03-1993 UMUM SUMURBATU 081231202820
02-06-1997 UMUM CIKEUSIK 085891580785
12-01-1964 UMUM SUKASENENG 083848555476
09-03-2004 REMAJA CIKEUSIK 085892752953
02-06-1971 UMUM SUKASENENG 081218434741
16-04-2008 REMAJA CIKEUSIK 085782266712
24-07-1998 UMUM NANGGALA 085777566897
01-07-1979 UMUM NANGGALA 085717893263
01-07-1960 UMUM CIKEUSIK 085697609152
03-04-1963 UMUM CIKEUSIK 085782266712
01-05-1965 UMUM NANGGALA 085710140948
10-07-1979 UMUM CIKEUSIK 081646061709
11-05-1991 UMUM NANGGALA 085773486340
17-08-1988 UMUM CIKEUSIK 085215986143
10-12-1961 UMUM CIKEUSIK 081511757246
17-06-2002 UMUM CIKEUSIK 085883201650
28-07-1962 UMUM SUKASENENG 081317454597
10-12-1963 UMUM CIKEUSIK 081317454597
05-07-1984 UMUM NANGGALA 081293511059
02-03-1965 UMUM CIKEUSIK 085216097523
08-05-1970 UMUM SUKASENENG 082155500460
01-07-1979 UMUM NANGGALA 081219418136
12-06-1965 UMUM NANGGALA 085710525598
07-04-1984 UMUM NANGGALA 085717565218
16-07-1978 UMUM CIKEUSIK 085211986593
01-07-1965 UMUM CURCI 081585739084
07-08-1972 UMUM SUKASENENG 081511401972
26-08-1975 UMUM NANGGALA 085710506250
03-10-1978 UMUM NANGGALA 083107982856
17-05-1972 UMUM NANGGALA 085771969147
01-07-1953 LANSIA NANGGALA 085762187721
05-04-1976 UMUM CURCI 08568533462
01-07-1963 UMUM SUKASENENG 085247976571
11-08-1985 UMUM NANGGALA 085719604013
30-06-1984 UMUM NANGGALA 085281457620
07-08-1977 UMUM NANGGALA 081517707611
10-06-1979 UMUM CURCI 0O85624436891
20-08-1962 UMUM SUKASENENG 085887771775
04-01-2003 REMAJA NANGGALA 085219822493
01-07-1997 UMUM NANGGALA 085219822493
07-02-1980 UMUM CIKEUSIK 085776131255
01-07-1978 UMUM CIKDONG 085772740923
05-04-1973 UMUM SUKASENENG 085283293895
02-06-1980 UMUM NANGGALA 085711038527
02-03-1974 UMUM SUKASENENG 082297972807
07-07-1956 LANSIA SUKASENENG 083848555490
10-02-1983 UMUM NANGGALA 085762188211
01-07-1981 UMUM SUKASENENG 082297972807
02-08-1975 UMUM NANGGALA 081289662799
14-10-1980 UMUM SUKASENENG 085811264499
02-09-2000 UMUM SUKAWARIS 981218969714
01-07-1984 UMUM NANGGALA 085283753515
05-07-1993 UMUM SUKASENENG 085715799439
05-07-1976 UMUM SUKASENENG 085707761924
17-10-1971 UMUM CIKEUSIK 081382598068
16-03-1996 UMUM SUKASENENG 085283048197
03-08-1969 UMUM SUKAWARIS 083856591955
24-11-1980 UMUM NANGGALA 081511862698
04-09-1970 UMUM SUKASENENG 081511406402
04-06-1979 UMUM NANGGALA 085216915259
30-05-1984 UMUM NANGGALA 085691309487
06-05-1993 UMUM NANGGALA 081218970552
05-07-1980 UMUM NANGGALA 085773746244
06-02-1973 UMUM CIKEUSIK 085752346447
07-07-1995 UMUM NANGGALA 081380166250
06-08-1964 UMUM NANGGALA 085774504127
13-10-1976 UMUM NANGGALA 08567262788
04-04-2002 REMAJA CIKEUSIK 082112308076
17-01-1975 UMUM CURCI 085781660146
28-11-1979 UMUM LEUWIBALANG 082111488673
13-09-1972 UMUM CURCI 085880005356
01-07-1973 UMUM SUKASENENG 085693542079
01-07-1970 UMUM NANGGALA 082312012315
01-07-1983 UMUM SUKASENENG 085891581116
04-06-1980 UMUM CURCI 085219518807
01-07-1975 UMUM UMBULAN 085788263409
04-09-1980 UMUM SUKASENENG 085695274298
01-07-1974 UMUM CIKEUSIK 085219869442
15-02-2007 REMAJA CIKEUSIK 085283848031
21-09-1991 UMUM SUKASENENG 085773236660
SUKASENENG 08521260364
08-05-1993 UMUM SUKASENENG 085770705747
04-12-1977 UMUM SUKASENENG 085216915430
19-02-1967 UMUM SUKASENENG 085216915430
14-02-1989 UMUM NANGGALA 085774595417
04-03-1978 UMUM SUKASENENG 085217286273
23-01-2001 UMUM CIKEUSIK 081280547095
21-03-2002 UMUM NANGGALA 081511959181
01-07-1991 UMUM SUMURBATU 085773238350
06-07-1970 UMUM UMBULAN 085849127656
01-07-1965 UMUM SUKASENENG 083189488059
01-07-1972 UMUM NANGGALA 085782134800
29-11-1976 UMUM UMBULAN 081285872222
01-07-1975 UMUM CURCI 085894404496
01-07-1979 UMUM UMBULAN 0859165033
19-12-1984 UMUM UMBULAN 081574914834
11-02-1980 UMUM CIKEUSIK 085774965003
10-08-1989 UMUM UMBULAN 085714235058
01-07-1992 UMUM CURCI 08568533462
07-10-1979 UMUM UMBULAN 085797472670
117-04-1993 UMUM UMBULAN 085894837427
01-06-1986 UMUM UMBULAN 085714235058
15-07-1977 UMUM UMBULAN 085247203930
12-03-1973 UMUM UMBULAN 081284910678
03-10-1985 UMUM NANGGALA 085762187721
01-07-1978 UMUM UMBULAN 085894827427
08-06-1994 UMUM UMBULAN 085778220408
01-08-1982 UMUM UMBULAN 085710721516
12-06-1992 UMUM NANGGALA 083856599422
20-08-1973 UMUM SUKAMULYA 085714235058
15-10-1962 UMUM CIKEUSIK 085891377188
16-04-1984 UMUM SUKAMULYA 085788362643
13-04-2001 UMUM SUKASENENG 085691054502
09-05-1977 UMUM SUKAWARIS 087772297092
10-03-1983 UMUM SUKAWARIS 087772297092
11-06-2002 UMUM SUKASENENG 081511757204
01-03-1980 UMUM CIKEUSIK 085773227505
02-01-1968 UMUM UMBULAN 0812984910678
03-01-1970 UMUM SUKASENENG 085691054502
02-01-1989 UMUM NANGGALA 08129652779
24-07-1992 UMUM CIKEUSIK 085781549469
15-07-1965 UMUM SUKASENENG 085894828214
03-06-1977 UMUM UMBULAN 085718733515
13-07-1999 UMUM CIKEUSIK 085694527923
09-04-1966 UMUM CIKEUSIK 083169794278
04-10-1988 UMUM SUKASENENG 085773757707
01-07-1980 UMUM NANGGALA 081513086342
12-09-1987 UMUM CIKEUSIK 085773757707
12-11-1991 UMUM CURCI 081519632544
23-01-2009 REMAJA CIBINOMG 085810903563
25-10-2006 REMAJA CIBINGBIN 085283753583
02-08-1978 UMUM NANGGALA 085762187721
07-01-1976 UMUM CURCI 081519632544
02-07-1979 UMUM CURCI 085773226518
01-07-1976 UMUM CURCI 081519632544
02-10-1991 UMUM NANGGALA 085651017165
20-08-1980 UMUM UMBULAN 085218187326
01-07-1985 UMUM CURCI 081519632544
17-05-1965 UMUM NANGGALA 085720506330
06-01-1987 UMUM CURCI 08568533462
03-10-1988 UMUM NANGGALA 085762187721
02-06-1990 UMUM CURCI 085861171561
26-04-1990 UMUM NANGGALA 085310128042
01-08-1986 UMUM NANGGALA 085162187721
20-01-1962 UMUM CIKEUSIK 085779566898
10/2/2005 CITARIK 085772730614
7/23/1980 PERMATANG SEMPUR 085718271268
7/6/1982 SUKASENENG 085770130594
1/21/2007 CIKEUSIK TIMUR 081316178585
7/1/1968 SUKASENENG 085281760531
7/27/1987 SUMURBATU 085282258649
10/10/1980 CIKEUSIK 082310863978
2/11/1978 CIKEUSIK 085777547891
6/5/1990 CIKEUSIK 085773239346
1/14/1985 CIKEUSIK 081646061709
7/1/1953 KIARA JANGKUNG
7/15/1951 CIKDONG 085781667073
6/16/1996 SUMATRA SELATAN 085778987163
5/13/2006 BANDUNG 085778984364
10/3/1982 NANGGALA 085762187721
10/25/2003 BATU JAYA 089686115440
7/2/1982 CITARIK 081280813689
12/30/1950 NANGGALA 085774965086
7/1/1965 CURUGCIUNG 085772748923
8/1/1999 UMBULAN 085287491857
2/15/1992 SERANG 083135104701
3/5/1977 CIKEUSIK 085776131255
5/7/1960 SUKASENENG 087842839302
7/3/1983 CIKEUSIK 085892059453
7/1/1953 NANGGALA 085216099216
11/7/1968 SUKASENENG 085775315705
7/1/1973 CIKEUSIK 085860730765
7/1/1948 UMBULAN 085782266217
7/1/1958 SUKASENENG 085810913622
6/26/1970 CIKEUSIK 085860730765
10/4/1995 NANGGALA 085773406340
4/21/1951 CURUGCIUNG 08568533462
2/10/1989 NANGGALA 081572076936
6/10/1998 CITARIK 085211397298
4/10/1966 CURUGCIUNG 085710929811
 7/11/1978 CURUGCIUNG 085714508965
7/1/1985 SUKASENENG 085281760531
9/27/1961 CURUGCIUNG 081517027779
10/18/1982 SUKASENENG 085717563849
1/17/1974 SUKASENENG 085216097523
8/14/1962 SUKASENENG 081317454597
7/1/1967 CURUGCIUNG 085217253030
4/9/2004 RANCASENENG 085711830115
4/11/1982 CIKEUSIK 085719437061
2/7/1995 SUKASENENG 081218434741
5/29/1990 CURUGCIUNG 081511412519
12/10/1963 CIKEUSIK 081317454597
2/7/1988 CURUGCIUNG 085773226518
7/1/1988 NANGGALA 085810132826
12/6/1995 NANGGALA 083107982856
1/11/1990 CIKDONG 085782625457
8/8/1988 NANGGALA 0852160999216
12/28/1989 NANGGALA 085810910008
2/13/1975 NANGGALA 085695409639
7/1/1963 SUKASENENG 081511406388
3/14/2004 NANGGALA 081289662813
7/13/1979 NANGGALA 085882801979
10/3/1968 NANGGALA 082214752255
7/1/1996 NANGGALA 085310128042
6/15/1986 NANGGALA 085647898640
7/12/1984 NANGGALA 085210708052
5/5/1990 CURUGCIUNG 085887578004
5/6/1977 NANGGALA 083107982856
7/1/1968 SUKASENENG 081514562643
7/1/1968 NANGGALA 085773624240
8/2/1968 NANGGALA 08577362424
7/1/1983 NANGGALA 085281457620
7/2/1983 CIKEUSIK 085779161107
7/1/1968 NANGGALA 085715268496
5/1/1989 NANGGALA 085283753574
4/2/1965 CURUGCIUNG 08568533462
8/21/1985 NANGGALA 085213872575
1/20/1978 NANGGALA 085810132437
4/1/1966 SUKAWARIS 085777477316
7/5/1970 SUKASENENG 08571906987
10/12/1994 NANGGALA 085216915259
9/26/1999 SUKAWARIS 085861602035
9/5/1999 NANGGALA 081314681535
 5/11/1992 SUKASENENG 085247976571
4/16/2008 SUKASENENG 086976449501
7/1/1973 SUKASENENG 083848555476
9/23/1984 NANGGALA 085764740593
7/5/2002 SUKASENENG 085886172714
4/7/1998 SUKASENENG 085778218929
7/1/1973 SUKASENENG 085210952945
11/6/1970 SUKASENENG 085219517810
1/15/1989 SUKASENENG 085886172704
7/1/1973 SUKASENENG 082110991533
10/31/1996 SUKASENENG 085215786585
1/6/1981 NANGGALA 085691096273
10/3/1984 NANGGALA 085773624240
7/1/1983 SUKASENENG 085210968173
6/5/1989 SUKAWARIS 085773225516
8/26/1989 UMBULAN 087774705761
3/24/1992 NANGGALA 082125723754
1/1/1987 SUKASENENG 081388902075
1/7/1960 NANGGALA 085692436292
10/12/1975 RANCASENENG 085213557782
1/29/1980 SUKASENENG 085281760531
7/1/1978 SUKASENENG 085219655965
1/26/1996 SUKASENENG 087780660782
5/12/1988 RANCASENENG 081386326158
4/11/1978 SUKASENENG 085707761924
7/14/1984 SUKAWARIS 085773225516
7/1/1989 CIKEUSIK 085772740102
8/9/1988 SUKASENENG 085781660659
6/15/1984 SUKASENENG 085774961481
6/2/1979 NANGGALA 081280540756
6/24/1993 SUKASENENG 081514562643
11/8/1978 CIKEUSIK 085216919699
5/9/1970 CIKEUSIK 082112308076
7/1/1974 CIKEUSIK 082112308076
7/1/1978 SUKASENENG 081514562643
10/1/1967 CURUGCIUNG 085781549477
7/4/1982 SUKASENENG 085282259068
3/6/1981 CIKEUSIK 085217257248
2/1/1993 SUKASENENG 087842839302
7/2/1967 SUKASENENG 085219822442
6/15/1977 CIKEUSIK 085211397298
12/7/1973 SUKASENENG 085710509805
1/16/1978 UMBULAN 085773486339
 5/7/1974 SINAPEL 085319359630
5/10/1982 CIKEUSIK 081646061709
7/1/1973 SUKASENENG 085219655965
7/1/1968 CIKEUSIK 085210709108
7/7/1980 SUKAWARIS 085283235002
5/12/1979 NANGGALA 085782134800
3/16/1984 CURUGCIUNG 085770147690
5/20/1998 RANCASENENG 085693476819
5/26/2000 RANCASENENG 085711768526
10/14/1980 CURUGCIUNG 0856533462
4/20/1987 NANGGALA 085693476855
6/2/1960 NANGGALA 085773624138
5/26/1986 UMBULAN 082310343599
7/1/1988 UMBULAN 085894827427
3/4/1985 CURUGCIUNG 0857816608151
1/7/1990 UMBULAN 085719761012
3/15/1980 UMBULAN 085213454583
9/26/1994 UMBULAN 085849155226
12/2/2022 RANCASENENG 085691399495
7/1/1988 UMBULAN 085771430045
2/1/1974 NANGGALA 082113371744
6/22/1982 SUKAWARIS 085777477316
7/1/1985 NANGGALA 0857621187721
NANGGALA 085715268496
7/1/1973 CIKEUSIK 085888063310
7/23/1985 CIKEUSIK 0838703045601
7/1/1970 PERMATANG SEMPUR 085819518692
31/01/2003 CURUGCIUNG 081617679157
12/21/1976 UMBULAN 081517026297
5/14/1993 UMBULAN 082114311822
10/4/1980 UMBULAN 085287658857
9/15/1975 CIRIRIGI 081511757204
7/7/1983 CURUGCIUNG 085697744841
7/1/1976 NANGGALA 085717563941
7/17/1964 UMBULAN 085711432768
8/7/1985 CURUGCIUNG 081519632544
2/1/1987 NANGGALA 081213359176
15/10/1985 CIKEUSIK 082312750064
12/5/1977 CIKEUSIK 085773494580
10/3/1988 NANGGALA 085773624290
7/1/1973 NANGGALA 085717563941
11/10/1953 CURUGCIUNG 08129157601
7/9/1970 SINAPEL 085319359630
 1/1/1958 NANGGALA 085762187721
4/12/1985 SUKASENENG 085775202746
10/3/1985 NANGGALA 085762187721
1/27/1991 NANGGALA 085880004609
8/8/1975 NANGGALA 081380166250
7/1/1962 CIKEUSIK 085710509810
1/1/1992 NANGGALA 085717563941
8/11/1975 CIKEUSIK 085894404505
7/1/1966 PERMATANG SEMPUR 085779566898
4/1/1957 SUKAWARIS 085866761684
10/3/1985 NANGGALA 085773624240
3/17/1965 NANGGALA 082312012315
5/1/1974 NANGGALA 085762187721
06-02-1991 UMUM NANGGALA 085216099216
09-04-2004 REMAJA RANCASENENG 085711830115
01-07-1989 UMUM NANGGALA 08521699216
01-07-1981 UMUM NANGGALA 081380166250
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri
Anggota
Vaksinasi
CORONAVAC 08-07-2021
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 08-09-2021
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 13-09-2021
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 30-09-2021
CORONAVAC 30-09-2021
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 23-09-2021
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CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 05-08-2021
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 23-08-2021
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 08-09-2021
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
26-08-2021
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CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
CORONAVAC 01-11-2021 01-11-2021 202108145H
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CoronaVac 01/11/2021 10/4/2021 211004521
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CoronaVac 01/11/2021 10/4/2021 21004521
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CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145
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CoronaVac 01/11/2021 01/11/2021 202108145 H
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CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
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CoronaVac 01/11/2021 10/4/2021 24005121
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CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 9/16/2021 24005121
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 9/7/2021 2021081511
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CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 8/23/2021 24200121
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
CoronaVac 01/11/2021 01/11/2021 202108145 H
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi
01-11-2021 202108145H

01-11-2021 202108145H
01-11-2021 202108145H

01-11-2021 202108145H
01-11-2021 202108145H

01-11-2021 202108145H

01-11-2021 202108145H

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01-11-2021 202108145H

01-11-2021 202108145H
 11/1/2021 202108145 H

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11/1/2021 202108145 H

11/1/2021 202108145 H
11/1/2021 202108145

LANSIA

LANSIA
LANSIA
 LANSIA

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11/1/2021 202108145 H

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LANSIA

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11/1/2021 202108145 H
NO No. Ticke NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601040107690073 JUANDA L
2 YUNENGSIH P
3 3601041206870008 SARHANI L
4 3601044104870002 BAYI P
5 ASMAH P
6 3601044703990003 SITI MARIAH P
7 3601046503990001 ENOK JUNENGSIH P
8 3601044210670002 SANTI P
9 3601042004550001 ROHADI L
10 3601045109700003 MAYUNAH P
11 3601046103870001 JUHETI P
12 3601040107990052 IRWANTO. L L
13 3601044810820002 ERUM P
14 3601041410620001 UHEN L
15 3601044510760001 SAIRAH P
16 3601045511030004 LASTIA P
17 3601046009040002 INTAN PUSPITASARI P
18 3601046310700002 AMAH P
19 3601040606770005 DEDI KARSADI L
20 3601040107800050 TARWIN L
21 3601040203930001 HAFIDIN L
22 3601046206870001 SUTI P
23 3601042004830004 JAMALUDIN L
24 3601045205600001 IROH P
25 3601046510820001 ENI P
26 3601045107620001 MAESAROH P
27 3601045703830002 NURHAYATI P
28 EUIS RESMANA P
29 3601044303750002 SANTI P
30 3601045850001 EHA P
31 3601046911890002 CICIH SUKAESIH P
32 3601045412680001 ARTI P
33 360104640970001 LILIS P
34 3601041109900001 NURHASANAH P
35 3601044104810001 EROH P
36 3601045504030003 EVA TARIA P
37 3601042106300001 SAMAWI L
38 3601044610790006 HOLIPAH P
39 3601045310920001 EEN APRIANI P
40 3601045403770001 SUNAH P
41 3601040107740001 CECEP L
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44 3601043001880001 IMAN L
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 92 3601045511840002 MASNI P
93 3601044104860010 TUNAH P
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136 3601046302840001 MISNAH P
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179 360104510890005 NARSIAH P
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218 3601045008920004 YUNENGSIH P
219 360104470372001 ARTIAH P
220 36010507027700004 TUKI L
221 360104621180001 SAMAAH P
222 3601046210750001 ARMAH P
223 1801100107690028 SAMAD L
224 3601044308870001 ATI P
225 12711090900001 HARTONO L
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227 360104069530001 SAMAUN L
228 3601046808600001 ARWI L
229 ARYATI P
230 3601044606920001 TATI HARTATI P
231 3601047009800001 ARIAH P
232 3601045711880002 EMAY P
233 3601045209860001 MASAYU FADLAH P
234 RANAH P
235 3601045106810001 ROHAYATI P
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237 3601045506680002 MARSAH P
238 3601045003760002 MAENAH P
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240 3601045612700001 RANA P
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242 3601047112520001 ERUM P
243 3601041012780001 ENDANG L
244 3601045609900003 NURJAYANTI P
245 1809040028019005 RUMNAH P
246 3601046107630001 ICIH P
247 ROHANI P
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249 FAID L
250 3601024107740055 UJANG L
251 31750719086604 EKO L
252 3601045408770001 ISAH P
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260 3601046008930004 TITI P
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262 3601270503990003 CAHYADI L
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265 3601046706930001 HERTI P
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280 3601046007890002 IMAS P
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284 3601044401650001 NURIYAH P
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286 3601040708900001 NUNUNG A P
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299 3601045911650001 WARSIH P
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311 3601042402940001 SUNSNA L
312 3601045304790001 MARSIAH P
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318 3601045106950001 AAN HAYATI P
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320 360104010770022 KUSNO L
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322 3601044101840001 WASIH P
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325 3601045003890001 ENI P
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329 3210062610030001 RIZAL SLAMET L
330 3601045211850001 HILFAH L
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333 3601030904900001 DAMAN L
334 3601045905730001 UMSIAH P
335 3601046002910006 KARINAH P
336 3601046708720001 SARI P
337 3601041212700002 ADE APIH L
338 3601044506970001 SITI WAHYUNI P
339 3601045906840001 MAE P
340 3601046505980004 RODIAH P
341 3602210305880004 INANG L
342 3601044507840008 DIAH P
343 3601045806670001 SENA P
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345 3601046003030001 ANTI SULASTRI P
346 3601044509900001 WANAH P
347 3601045009800001 YANTI P
348 3601044508770005 ROROH ST ROHILAH P
349 3601046504980003 ITI P
350 3601047005720001 HAMNAH P
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353 3601045912720001 RATNA P
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355 3601044509690001 SUNARSIH P
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359 3601040108730007 TINI P
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394 3601044705840004 KESIH P
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404 3601044112850005 SAPIAH P
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407 3601044606890005 ERNA P
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410 36010427030300003 SUHERMAN L
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412 3601046108800001 METI P
413 3601045604990002 ENAT RATNASARI P
414 3601044107950228 ATIKAH P
415 3601045604810001 ROKAYAH P
416 3601045103860007 YANTI P
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418 3601044602810003 ARSIH P
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455 3601045907650001 SAWI P
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476 3601040104860009 AMONG L
477 3601040605780001 ARSAMIN L
478 3601040388830001 ROHMAN L
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480 3601044107840005 WARSINI P
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482 3601040107920070 SARMAN L
483 3601044807850003 ACIH P
484 YAYAH P
485 3601042606850001 WAWAN L
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487 3601046109820002 GUPIT P
488 3601044701780002 ETI P
489 3601044506810002 CUCUM P
490 36010454029300001 ROSIAH P
491 3601045305840001 YANI P
492 RASPI P
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496 3601045409840001 ARSAH P
497 3601044812720001 NASIAH P
498 OJON L
499 3601044908830001 MASNAH P
500 JUTI P
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502 SARNITI P
503 3601046906720001 SUKMI P
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506 36010445029900004 SUCI P
507 3601046808720002 ENENG P
508 SAMI P
509 3601044102680001 SURNI P
510 UNEH P
511 3601046512960002 ARUM W P
512 360104410980001 MASIROH P
513 3601041102750004 SANIRA L
514 3601044501840001 SARNAH P
515 3601046503680001 KARNAH P
516 UMSI P
517 3601046005780001 AMI P
518 3601046705870004 MANAH P
519 3602211708870005 AGUS NASRUDIN L
520 3601044794900007 ARSAH P
521 3601046005950008 ASIH P
522 3601043004850004 ATA L
523 3601041010850001 ISNEN P
524 3601044611820001 SUANAH P
525 3601040705800001 SARMAN L
526 3601044102720006 LAMINAH P
527 3601044807780002 SAIDAH P
528 3601046108770001 SURNI P
529 3601044207920002 ROHANIAH P
530 3601041404930001 RIDI L
531 3601045704680001 NENGSIH P
532 3601044208980001 OMAH P
533 3601045212020001 SONIA P
534 3601041708760005 MAS'UD L
535 3601044712820002 MARNAH P
536 360104570490006 IYAH P
537 3601044901650001 SAENAH P
538 360104640680001 NATI P
539 3601045602570002 SUKMARI P
540 3601044412770001 WARSIH P
541 3601044408890003 MISNAH P
542 3601041705950001 SARDI L
543 3209090107630064 DASTA L
544 3601044107830007 SAMUNAH P
545 36010455006740001 NENIH P
546 3601042404730001 DEDI P
547 3601045105105940001 YETI P
548 3601045712820001 ATIN P
549 3601046509680001 ASMAH P
550 3601040605960001 DEDE L
551 3601040908940003 SUBANDI L
552 3601044412840001 YEYEN P
553 3601046111690001 IYUM P
554 3601046007720001 ERI P
555 36010455027210004 UPI P
556 3601044507820001 CICIH P
557 3601046706990001 ANIS MARLINDA P
558 3216216601070005 AISYAH YUSNIAH P
559 3601044207920001 KARNAH P
560 3601040607790002 YUSRI L
561 3601040401880001 MISTA L
562 3601040107690095 JUANDA L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI
01-07-1969 UMUM CIBARAHMI 085773305131
12-01-1985 UMUM TANJINGAN 085693581336
12-06-1978 UMUM TANJINGAN 083892659129
01-04-1987 UMUM SUKAWARIS 085319519048
18-04-1968 UMUM TANJINGAN 085774595549
07-03-1999 UMUM SUKAWARIS 08577896830
05-05-1999 UMUM CIWET 083812674404
TANJUNGAN 081295093751
20-04-1955 LANSIA TANJUNGAN 081517360177
16-12-1966 UMUM TANJUNGAN 081517360177
21-05-1989 UMUM CIKUJANG 085891152219
11-12-1999 UMUM SUKAWARIS 085880240569
08-10-1982 UMUM TANJUNGAN 085691872757
10-08-1964 UMUM TANJUNGAN 085719275636
05-10-1976 UMUM TANJUNGAN 085719425952
15-11-2003 REMAJA TANJUNGAN 085781055597
20-09-2004 REMAJA TANJUNGAN 085882795486
23-10-1970 UMUM TANJUNGAN 085691875205
06-06-1977 UMUM TANJUNGAN 085691872751
23-10-1975 UMUM SUKAWARIS 085866761684
02-03-1993 UMUM SUKAWARIS 085738261938
01-01-1986 UMUM TANJUNGAN 085892643133
20-04-1983 UMUM SUKAWARIS 085813548881
12-05-1960 LANSIA TANJUNGAN 081513961336
16-09-1982 UMUM TANJUNGAN 082139630272
14-10-1968 UMUM SUKAWARIS 081387125484
27-03-1967 UMUM TALANCA 085716521378
23-03-1989 UMUM TANJUNGAN 085886172310
07-05-1982 UMUM SUKAWARIS 085693533967
18-05-1985 UMUM TANJUNGAN 081210914127
29-11-1989 UMUM TANJUNGAN 085779158872
19-03-1972 UMUM TANJUNGAN 085774694535
05-08-1986 UMUM TANJUNGAN 081286509891
30-12-1992 UMUM TANJUNGAN 085718763192
01-04-1981 UMUM SUKAWARIS 085283233851
15-04-2003 UMUM TANJUNGAN 085720321049
02-07-1973 UMUM TANJUNGAN 085697596483
06-10-1979 UMUM TANJUNGAN 08589411196
24-08-1992 UMUM TANJUNGAN 085774545992
14-03-1977 UMUM TANJUNGAN 08573164741
04-04-1974 UMUM TANJUNGAN 085214063622
23-03-1987 UMUM SUKAWARIS 085694089782
15-04-1973 UMUM TANJUNGAN 08567331661
20-07-1990 UMUM TANJUNGAN 08577496167
06-12-1996 UMUM SUKAWARIS 082123554454
09-01-2001 UMUM TANJUNGAN 081517392595
13-04-1980 UMUM TANJUNGAN 085885456681
18-08-1972 UMUM TANJUNGAN 085814510777
10-03-1986 UMUM SUKAWARIS 085694277628
09-08-1978 UMUM TANJUNGAN 085890738087
03-01-1997 UMUM TANJUNGAN 085714805728
10-05-1985 UMUM TANJUNGAN 081280960006
14-12-1995 UMUM UMBULAN 085693645957
10-02-1987 UMUM TANJUNGAN 085280006353
25-07-1981 UMUM TANJUNGAN 081314490315
16-03-1980 UMUM TANJUNGAN 085954244827
11-02-1983 UMUM SUKAWARIS 085866761684
04-02-1986 UMUM TANJUNGAN 082123158331
01-07-1991 UMUM TANJUNGAN 081514562749
30-12-1988 UMUM TANJUNGAN 085210710635
24-04-2004 REMAJA SUKAWARIS 085774324168
09-12-1990 UMUM TANJUNGAN 085691863498
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Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal Tanggal
BPJS Non Merek Vaksin*** Screening
Pemberian No. Batch
Non PBI Anggota
Vaksinasi
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 Dosis 2
Tanggal KET
No.
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11/1/2021 202108145 H
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044107910206 INASIH P
2 3601044107830427 SATINAH P
3 3601044603900003 SATINAH P
4 ANAH P
5 3601035503740001 EMAH P
6 3601044201760001 TATI P
7 3601044303720001 ROHMAH P
8 3601046505750001 AMAH P
9 NURYATI P
10 3601042108850001 KIMONG L
11 360104506050001 RISKA P
12 3601045001810001 LULU P
13 3601044101000010 ONIP ULFA P
14 3601040104750002 USUP L
15 3601044107740028 SUAMAH P
16 3601044507410001 RUMINAH P
17 SARINAH P
18 3601046506800002 JUNAENI P
19 601044804780001 IYOM P
20 3601042701010001 TARSAN L
21 3601040604780003 ASMAN L
22 3601044107710111 EPON P
23 3601041102070002 KARMANTO L
24 3601045203670001 DEDEH P
25 ANAH P
26 3601045504860001 TITI P
27 360104410783443 NURIAH P
28 3601045108920002 NIA P
29 3601044107660147 SURNI P
30 ELAH P
31 RASIMAN L
32 3601045104600001 AMIRAH P
33 3601044708470001 SUSIYANTI P
34 3601045807950004 RANISAH P
35 3601044406950001 HERTI P
36 3601045206800003 ITI ATIKAH P
37 3601040204720001 CAMING L
38 3601045006010006 AAS ROLANI P
39 JALI P
40 TISNA L
41 3601044107730409 SARMAN L
42 MURTI P
43 3601044107740025 KARIAH P
44 RASTI P
45 3601044107670038 HALIMAH P
46 SITI AMINAH P
47 360104426750001 ARISAH P
48 3601043011790002 NURIDI L
49 3601041807010001 SUPARNO L
50 3601045403890002 KUTRI P
51 3601040107990326 RUSJANG L
52 3601045011950006 ASMINAH P
53 ADE P
54 SURYADI L
55 3601045688600001 CARMI P
56 3601044108640002 SARNAH P
57 3601046504950001 ANISAH P
58 3601042506630002 MARGONO L
59 SARNAH P
60 3601044107750088 ISAH P
61 ERUS MINAH P
62 3601045107950001 MELAWATI P
63 PIAH P
64 3601045111550001 KARTINI P
65 3601044204840003 ADAH P
66 3601046906840001 SARIAN P
67 3601040712830002 DEDE AIRLANGGA L
68 EMUR P
69 3601045501820002 SUMARNI P
70 3601040705790001 SARTU L
71 3601044102800001 AWEN P
72 3601044902830001 LENI P
73 IKAH P
74 3601046002860002 RASMI P
75 IRJA LENI L
76 ISAH P
77 HASANAH P
78 3601044107830153 MARIS P
79 3601044107670113 SARINAH P
80 360204455810004 SARWI P
81 KAJAR P
82 36010442017570002 SARWI P
83 JUNESIH P
84 3601044405750002 ARSIH P
85 ASMI P
86 3601044903870001 YATI P
87 3601044107090218 ARNAH P
88 3601045509740001 EMET P
89 EPI L
90 3601046104780001 TONAH P
 91 3601044107890180 ANIS P
92 3601025606910001 SITI ROMLAH P
93 3601044109900001 RUNASIH P
94 DESI SAKAUNI P
95 ROMSIH P
96 AMAH P
97 3601045702800003 DASIMAH P
98 3601044407800005 SARI P
99 3601041012650001 KAMSANI L
100 3601044308720001 SARINAH P
101 3601044107710147 TALEM P
102 360104010640064 WASTA L
103 360104471680002 SUARTI P
104 3601041006800007 WARTIM L
105 PIAH P
106 3601041608610001 AMING L
107 ASNAH P
108 3601041302800001 M. AKHYAR L
109 TARIYAH P
110 3601044112880003 SUHETI P
111 KARTINI P
112 360104501900006 YEYEN P
113 KANAH P
114 3601044403780001 ASIH P
115 3601044607840003 ARMAH P
116 3601044301700001 WATI P
117 3601044703850002 SUHELAH P
118 3601045804720003 RUMANAH P
119 3601044507780002 MURSIH P
120 3601040207040029 ANWAR L
121 SUMANTRI L
122 3601041502750004 RUKMAN L
123 RATINI P
124 3601040108850001 ROHNI SETIANA L
125 SAMSUDIN L
126 3601044107710001 SAINAH P
127 3601040705880001 UJANG L
128 3601045007890002 MINAH P
129 3601044107850351 SANA'AH P
130 3601044304870002 SARNI P
131 TATI P
132 3601041811890002 MUKTAR L
133 UNI P
134 360104002790006 SAHRUDIN L
135 3601040108000006 ASMA WIJAYA L
136 ARMASI P
137 360104610800001 DARNITI P
138 3601045908800001 ARTI P
139 RUMSIAH P
140 3600144610080001 LINDA FITRIANI P
141 SUEMI P
142 3601046412080001 RATIH P
143 3601045705630002 WATI P
144 SARMUNAH P
145 ROSITA P
146 3601044201090006 AMELIA P
147 3601044705800001 TINAH P
148 360104603070001 NUR AISAH P
149 3601044309800004 MUTI P
150 3601046004070003 SURNAH P
151 RUMANAH P
152 3601044507070004 INTAN P
153 360104420730001 ASIPAH P
154 EJANG L
155 360104520750001 UMI P
156 ENTIN P
157 360104520760001 AMI P
158 EDI L
159 3601045905070005 PATIMAH P
160 3601045401060007 MILA P
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 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

12-03-1991 UMUM UMBULAN 085770727383

01-07-1983 UMUM UMBULAN 085280255980
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SUKAMULYA 08558167254
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01-07-1974 UMUM PARKOS 085718763701
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09-02-1983 UMUM PARKOS 085695147573
PARKOS 085695601202
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13-07-1995 UMUM SUKAMULYA 081617125303
28-08-1986 BUMIL PARKOS 085773491652
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29-04-2008 REMAJA SUKAMULYA 081617125303
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18-04-1972 UMUM PARKOS 088809993326
05-07-1978 UMUM TANJUNGAN 085714197806
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 13-02-2000 UMUM SUKAMULYA 08518243812
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19-05-2007 REMAJA SUKAMULYA 082164164997
14-01-2006 REMAJA PARKOS 085719069997
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02-04-1962 UMUM PARKOS 085697077440
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04-01-1982 UMUM PARKOS 085891580704
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08-04-1996 UMUM PARKOS 083808892232
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13-07-2007 UMUM SUKAMULYA 085811460045
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09-11-1981 UMUM PARKOS 081517741755
10-03-2009 UMUM PARKOS 081511863878
01-07-1991 UMUM PARKOS 085691627132
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11-06-1992 UMUM PARKOS 085718510912
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01-02-1988 UMUM PARKOS 085694590490
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14-07-1970 UMUM PARKOS 085697591987
26-07-1987 UMUM PARKOS 085891580722
14-06-2009 UMUM SUKAMULYA 081511863909
21-02-2008 UMUM SUKAMULYA 085780503739
25-08-2008 UMUM PARKOS 085774964794
12-05-1982 UMUM PARKOS 085883190949
28-06-1985 UMUM PARKOS 085774958735
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27-01-2007 UMUM PARKOS 085852138954
01-07-1983 UMUM PARKOS 085891580722
01-07-1966 UMUM PARKOS 085894197932
27-08-2007 UMUM SUKAMULYA 085810913740
17-01-2008 UMUM SUKAMULYA 085774964794
22-05-1986 UMUM PARKOS 085719017072
04-03-1983 UMUM PARKOS 085694723659
08-06-2002 UMUM PARKOS 085718724730
01-03-1980 UMUM PARKOS 08571892420
12-01-1980 UMUM PARKOS 083710524584
07-07-2007 UMUM SUKAMULYA 085715509338
27-08-1981 UMUM PARKOS 085752268861
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23-02-2007 UMUM SUKAMULYA 085715509338
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

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 Dosis 2

Tanggal KET
No.
No seri Pemberian No Seri
Batch
Vaksinasi
03-11-2021 202108145H
03-11-2021 202108145H POLSEK MERAK
03-11-2021 202108145H POLSEK CKS

03-11-2021 202108145H
03-11-2021 202108145H
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601044107790001 SAWI P
2 36010442077700057 SANIJAH P
3 3601045011800010 SUNIAH P
4 360104608860002 ISNANI P
5 3601044107820159 SAMAH P
6 3601044107820169 TARSIH P
7 UNAH P
8 3601042701900001 MASNUR L
9 36010441077804 RUMSIAH P
10 3601044405780006 ARSINAH P
11 3601045802830002 EIL L
12 3601046403910001 DAMRI P
13 3601041906340001 SUPARDI L
14 3601040107750001 TOHIR L
15 3601044403830003 KUSNIAH P
16 360104240884001 SAPRI L
17 3601044107630324 JARMAH P
18 3601044806670001 IMI L
19 360127410780036 IJAH P
20 1571044812930001 ROBIYANTI P
21 3601045911780001 ROROH P
22 3601046416040002 KARTIKA P
23 3601046007590001 SAMIRAH P
24 3601044107650002 MURNI P
25 3601045508800005 SAROH P
26 3601044205860001 NENIH P
27 3601045903650001 MARNAH P
28 3601045212720001 KARITEM P
29 3601062901770001 REDI L
30 3601041917000001 SAWI P
31 3601046407000001 EROH P
32 360104707860003 MURSIH P
33 ROHEMAH P
34 36010441980006 SARTINAH P
35 3601046202820001 NARCAH P
36 3601034706800003 DILAH P
37 UMINAH P
38 TARDI L
39 3601045508700002 DINI P
40 TARJO L
41 360104530480000 NENSIR P
42 3601040204600006 MISRA L
43 3601046502690003 ANI P
44 ARSITI P
45 ROHETI P
46 360104650860001 RUMINIH P
47 3601044107920132 NUNUNG P
48 3601044107630187 JUARAH P
49 36010414088000001 EPI L
50 3601044127800006 WASRI P
51 36010460098900003 MIMI P
52 3601020121060003 AGUS SAPUTRA L
53 3601045103820005 TARMINI L
54 RASIH P
55 3601045509820002 BADRIAH P
56 3601041902720001 MUKRI L
57 360104410772002 SUKARNAH P
58 3601041809930001 ASEP L
59 360104400960001 RASTA L
60 360104480678002 WASTIRI P
61 360104010773033 DURAKMAN L
62 3601040107900214 AHMAD L
63 3601036005850004 MIMIN P
64 3601044502770001 JUHE P
65 TAUFIK L
66 3601040107900316 DARMA L
67 3601046612970002 CINTA DEWI P
68 3601044604940002 EPA P
69 3601045401830004 KAMAH P
70 36010441090001 UTIAH P
71 3601044107760002 ASWI P
72 NENTI P
73 3601041102810007 SUKARDI L
74 36010460060004 NURHAYATI P
75 3601044512960001 TUTI P
76 SOLEMAN L
77 3601044107800066 SAYAH P
78 360104010950092 YUSRI L
79 360104410380036 RASINI P
80 3601040107790132 MEMED L
81 36010471100200004 DIAH P
82 SUENAH P
83 3601044203800004 MINAH P
84 3601044244540001 ASINAH P
 85 TANIH P
86 SURATMI P
87 3601046103040001 AYU KARTIKA P
88 3601044107850012 NARMI P
89 3601044107560105 MAE P
90 UPIT P
91 3601046006760005 INAH P
92 3601044205780002 RAMEN L
93 3601041602700002 BAHRUDIN L
94 36010410507750014 WAHYUDI L
95 360040609040009 TARWAWI L
96 KASNI P
97 3601046006530001 ARSIH P
98 3601044211860003 SANIMAH P
99 MURTI P
100 3601045610840001 SANI P
101 360104160400002 NAMIN L
102 SAROH P
103 3601041507610003 KARYANI P
104 3601041007800002 KURNATA L
105 RUDI PRAYOGA L
106 3601040332600001 ADE SUHERLI L
107 3601044501970001 RESTI P
108 3601044102620002 RUMINIH P
109 TATI P
110 360104474040001 DARSIH P
111 3601040104850003 SAKIM L
112 3601046704830003 SARNI P
113 36010441076017 MASNUAN P
114 3601044306850001 MAESAROH P
115 DERI L
116 3601046708990003 SITI AISAH P
117 3601044807670001 KASNAH P
118 3601044107620007 WARYEM P
119 3601044107650082 KOMARIAH P
120 360104548900002 SAMAH P
121 3601045808920005 CASIROH P
122 3601044309770001 IROH P
123 CASMUI L
124 3601046801900001 RUMANAH L
125 36010402-4690002 SURIAH P
126 360104584790001 MARA P
127 3601046310980004 ELIS P
128 36010441070234 SARMI P
129 YUMAH P
130 3601040107630117 DARPAN L
131 CARMA L
132 360104495940003 MARNI P
133 36010441080417 SANTI P
134 3601046207890001 AMINAH P
135 3601044403790002 RUKAYH P
136 YUYUN. Y P
137 3601260752900005 ABUN L
138 3601045708770004 ASINAH P
139 3601044107790077 RASTINI P
140 3601044107870105 JUMI LESTARI P
141 360104052840001 ANDI L
142 3601046006750001 HJ. ENENG SANAH P
143 3601040706050002 AHMAD L
144 360104470980001 SANIAH P
145 3601044107800003 EROH P
146 3601044107750112 TARSIMIH P
147 360104510700002 ENTIN P
148 3601044603780005 ETI P
149 360104150480003 CASWAN L
150 3601044107600071 SARINAH P
151 3601044209890007 ROHAYATI P
152 WARKIM L
153 3601044701200007 SAWI P
154 360104031530001 EDI L
155 3217975011790021 ABSAH P
156 3601044107790070 NIRAH P
157 SARNITA L
158 360104410760249 JARTI P
159 360221540699003 MIRNAWATI P
160 3601044607740003 SANAH P
161 LAMRAH P
162 3601041203730002 CALAM CULLES P
163 3601044104870006 JUJU P
164 3601040107760117 CARSIDI L
165 3601044411020003 SUMARNI P
166 OCAH P
167 SARNIAH P
168 3601043012700002 BAI L
169 3601046505840001 RATINI P
170 36010444108300002 NARSIH P
171 32090104057800017 SUPARTO L
172 YANTI P
173 3601046005460003 ATI P
174 3601044104810002 AMINAH P
175 360104501550001 KUSMANAH P
176 360104460630001 SARNI P
177 301045002990011 NIA DANIATI P
178 RATIH P
179 3601046911830001 NIA DANIATI P
180 3601046311870001 EROS P
181 360104121890002 AHMAD L
182 3601040610860001 ENDANG L
183 3601042700001 AJAT L
184 360104610990001 NENIH P
185 3601045112820002 MARNI P
186 DASMI P
187 AMAH P
188 3601044107790150 IYUM P
189 360104410779014 YATI P
190 SAMINIH P
191 3601040303700003 KARIM L
192 3601044806790006 WATIAH P
193 36010403850001 JAELANI L
194 3601045705800007 AISAH P
195 36010410779115 SARHATI P
196 3601044102820004 MASRIAH P
197 360104570278000 AMAH P
198 3601046301850002 DASIMAH P
199 36010407630315 HAMDAN L
200 360221170480004 ENDI L
201 3601045606760001 ARNI P
202 360104010790037 LENI P
203 360104520060002 SARNIAH P
204 3601044107820148 MARINAH P
205 360104250512030001 SUNTANA L
206 360104417770022 ARNISAH P
207 360104532050001 MELA EMELIASARI P
208 360104051940001 ROFIUDIN L
209 3601044506640002 AYUHA P
210 3601044401820001 ATIN P
211 36010441750003 ENCUM P
212 UCU P
213 NENENG P
214 EPON L
215 3601044108080013 SITI P
216 3601044507800009 OMAH PO
217 360104070700001 SODIKIN L
218 3607045803670001 ASMA P
219 36010454990004 LIYAS TUTI P
220 3601046093820004 LILIS P
221 3601044107800191 ANONG P
222 36010401711740001 SUKAESIH P
223 3601042602030001 M. TOBRI L
224 3601044207890006 ENENG P
225 SUPIADI L
226 3601041011580005 ENDI L
227 36010422110800002 NUSRUL L
228 3602216811940001 JUMRAH P
229 360104410780010 ASTI P
230 3601044407500003 DARIAH P
231 36010455278600009 TITI P
232 3601044406830003 SARIAH P
233 DANESIH P
234 3601044101850009 ACIH P
235 3601075503990001 ENIS P
236 ARIPIN L
237 RATINAH P
238 3601046705860003 SUNETI P
239 WARKEM P
240 ITOH P
241 360104012768260005 SUKAD L
242 36010457098800002 RODIAH P
243 3601044107850231 SOBARIAH P
244 TOYIBAH P
245 SAWN P
246 360104410791022 SANIS P
247 360104232860001 KASINIH P
248 3601044107790114 LAMRAH P
249 3601045603730001 ELIS P
250 3601044104070010 NARTI P
251 360104103750001 ROHMAN L
252 36010400482005 ANA P
253 3601044107600001 IKAH P
254 360104410860007 ECIH P
255 3601040107950206 ICUT P
256 JUNAH P
257 ACIH P
258 MAEMUNAH P
259 3601044107810083 JANAH P
260 UUN P
261 RUDI MULYADI L
262 360103410792018 SUMYATI P
263 AYI P
264 HERI KUSNADI L
265 360104410790022 SAMINAH P
266 3601044102810002 ENIS P
267 360104413880001 PSANIRI P
268 NURAENI P
269 3601045508050002 SARKAMAH P
270 DIAN P
271 3601045406530001 NAWI P
272 3601046280040002 ANISYAH P
273 3601044405920001 HETI P
274 MINAH SANJAYA P
275 36010441778040001 WASTIAH P
276 3601041207870002 KAMAD L
277 360104523550004 CASWI P
278 3601040711840001 MISRA L
279 M. HENDI L
280 3601044107670125 TIAH P
281 3601044608890001 MURNIATI P
282 3601040107730125 KATONI L
283 RANITI P
284 36010444060200002 RINA P
285 3601044611550001 SARINAH P
286 NARPAH P
287 36010457008200009 ROPIAH P
288 360104232980002 BUDI L
289 3601046310820001 WATIAN P
290 3601040107530098 SUMARTA L
291 3601040107950255 JAYA L
292 36010466020001 AAN DARWATI P
293 AMAH P
294 3601042610010002 ABDUL KARIM L
295 ROSANTI P
296 3601041001810007 ASIARI L
297 360104678830001 SUMYATI P
298 BANI L
299 IWIN L
300 36010411898001 AAN DARWATI L
301 360104420400001 DESI SAPITRI P
302 3601040107860284 JAPEN L
303 3601044607860007 SITI P
304 3601040204750005 ROJUDIN L
305 360104710365001 MARSAH P
306 3601040107780227 SADAM L
307 KADMAH L
308 SARMAN
309 36010407900104 JUNAEDI L
310 UJANG L
311 360104200640002 AHMAD KUSAERI L
312 KARSONO L
313 RIZKY L
314 TUTI P
315 WARTINI P
316 360104050700002 RIO FIRMANSYAH L
317 3601041004890002 KURDI L
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323 36010417120700002 RAHMAT L
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326 36010420057007 CARWAN L
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332 3601040205770002 SARPIN L
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338 3601040601860003 YANTO L
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341 3601046204090001 ENUR P
342 RUSTAM L
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344 WATI P
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347 3601045002700002 ROYATI P
348 3601044107760242 TASINI P
349 3601040107820128 ANDI L
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351 3601044107870134 ANISYAH P
352 3601045807850003 RODIAH P
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355 3601041007830001 SUMA L
356 3601041207720004 JUHANA L
357 3601042807830001 ADIT L
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364 3601045101620001 ICIH P
365 3600146607570001 MIRSAH P
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387 3601044601780006 KARTEMI P
388 3601045904850001 EMAH P
389 3601045201840003 RAMAT P
390 3601044708770002 KARSIH P
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396 360104610490003 ROHILA P
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398 36010466119300014 ASIH LESTARI P
399 3601044107920103 JUMSI P
400 3601041004680004 ENDIN SUPRIATNA L
401 3601045202030002 DEVITA SARI P
402 3601041206800002 TASWADI L
403 3601040508830005 SACA HERDIANA L
404 3601044903730001 NENGSIH P
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406 3601044308690001 MARI P
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410 3601040107570021 SUHEBI L
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412 3601044107740034 RUMSAH P
413 3672020808020005 ANDRIAN KASPARI L
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416 3601045707840001 SAMSIAH P
417 SAMUDI L
418 EDI L
419 3212054303000002 TUNIROH P
420 HAWEN P
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422 3601040108730005 AROHMAN L
423 SARJA P
424 3601124808010002 KARLINA P
425 3601045706640002 RAMEH P
426 3601041204040009 EDO DERMAWAN L
427 3601044107730046 HANMAWATI P
428 RUSTAMI L
429 RASMAN L
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431 3601044311710001 UCIH P
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433 3601045605780001 CARTINI P
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441 3601044701930007 MASNI YULIANTI P
442 3601040101650001 SURYAD L
443 3601042701860001 BASRI L
444 KARDI L
445 3601045307830001 TITI P
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447 3601045012670002 KASTINI P
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449 3601046606750001 WINAH P
450 SANAAH P
451 3601040301660002 MASKA P
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453 3601044107810193 SURINAH P
454 EMIN L
455 3601043012980003 SUTTANI L
456 3601044703860005 RINAH P
457 3601046202840001 SITI P
458 ARTA L
459 3601046305850001 SAMI P
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461 3601044107720108 SURNI P
462 3601044107760247 ASTIWEN P
463 3601041905040003 RIPAL L
464 3601044107680161 WARCI P
465 360104511056001 ETI NURHAYATI P
466 3601044107130023 AMAH P
467 3601044107790010 MURTI P
468 3601046203700001 SANECA P
469 3601044107630131 KATIMAH P
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473 3601044107730074 KARMINAH P
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475 3601041112820001 TASMAN L
476 360104550900001 ESIH P
477 CUCU NURHAYATI P
478 3601045808760001 UNAYAH P
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480 WASKIM L
481 3601040204730004 SA'I L
482 3601045806810002 ONAH P
483 3601044204790002 BAYI P
484 3601044107830460 ITI P
485 HERTI P
486 3601040101950010 KOMAR L
487 3601040307730001 SANUSI L
488 3601044102840004 IYAM L
489 CARTONO L
490 3601045007910001 WARSINI P
491 3601046406040001 SAENAH P
492 3601044809890002 MISNAH P
493 ROSID L
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499 3601045104830001 NURYATI P
500 3601046008000011 TINAH P
501 3601046509940002 INA AMELIA P
502 3601044107820046 ENONG NURAENI P
503 3601046510960001 ERNI SUHERNI P
504 3601044511730003 DASINIH P
505 360104460690001 JUHAETI P
506 3601046402970002 ERNAWATI P
507 3601040107730296 SARNIAH P
508 3601046104650001 EROH P
509 3601041008800003 KHOLIL AZIZ L
510 ARSIH P
511 3601042804010001 RIYANTO L
512 3601044103750008 BAYI P
513 3601044203650001 SARWI P
514 3601046609800002 CASTINI P
515 3601041503020007 ISMA P
516 3601044402980004 IIN P
517 3601044107840006 JARSAH P
518 3601045003990007 RESTI P
519 3601041011640001 WASID L
520 3601044709030005 IWI P
521 3601040203780002 BADRI L
522 3601045510870003 APIPAH P
523 3601044101800004 KESIH P
524 3601045802930003 ROHMAH P
525 3601046010660001 ARNAI P
526 3601044101840011 ETI ERNAWATI P
527 3601041506900002 HASAN MAHRUDIN L
528 3601042811820001 WARNA L
529 3601274107880090 MINAH P
530 3601045709720001 MAE P
531 3601045407630001 SUMYATI P
532 3601045205040001 SINDIYANTINI P
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535 3601042003990001 HENDRI JAYAKUSUMA L
536 3601046008850007 NITA P
537 3601042606570001 JAHURI L
538 3601041007870001 EPUL L
539 3601041506900001 LEMAN L
540 3601045407720001 ENAS L
541 36010405058500009 OMBI SAPUTRA L
542 3601040207710003 ENDANG L
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563 3601046008630001 EMTAN P
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568 3601041207720001 MANGSUR L
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573 3601041307930001 SUHERSIH P
574 3601045306980002 SUSANTI P
575 3601041111000004 SRI WAHYUNI P
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581 3601045009870001 NIAH L
582 3601047006880001 NURSIH P
583 3601046802820005 SACI P
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585 3601045106770001 ENGKOM P
586 3601045405990006 TETI RIYANTI P
587 3601041206960006 MULYANA L
588 3601042805080002 ADITIA L
589 3601041109000006 ROY DIKI L
590 3601044211870004 KARTINI P
591 3601045709520001 ASMINAH P
592 3601044107850002 KOYAH P
593 3601276512910002 ERNI NURLITA P
594 3601044406920011 ELAH P
595 3601044207680005 RUMSIH P
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597 3601045101790001 NENGSIH P
598 3601351805760002 MAULANA SAHRI L
599 3601040905850004 RADI L
600 3601044207880002 YATI L
601 3601044205590001 SUKMARIAH P
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604 3601044805860001 UNAH P
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613 3601045107780001 UMINAH P
614 3601044303930004 GINA P
615 3601045804640001 JANI P
616 3601046707940001 ROSITA YULIANTI P
617 3601041704900001 KURDI L
618 3601044110770001 WINAH P
619 3601044107730002 SARIPAH P
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624 3601040706070001 SATRIO L
625 3601042006900009 SUANDI L
626 3602014111800001 EROS P
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628 3601044707860001 ATINAH P
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630 3601044606850001 KURNIAH P
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632 3601045001890007 NASIH P
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634 3601040403800003 SARNA L
635 3601046307630001 SENI P
636 3601046307840001 SUNTIAH P
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638 3601040206650003 NURMAN L
639 3601044812020001 ALPIAH P
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643 3601046107770001 KAMSAH P
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645 3601044407750003 DARMINIH P
646 3601045306820001 WARSIH P
647 3601044508940003 CUCUM P
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653 3601044107860220 ARINAH P
654 3601046204980002 IIS MUNAWATI P
655 3601042107810001 OMAN L
656 3601045605900004 NENGSIH P
657 3601046304680001 CARITEM P
658 3601070708060005 SARIPUDIN L
659 3601046108050293 SANTI P
660 3601045107790003 NARPEN P
661 3601044102910007 MAESAROH P
662 3601044107790138 RUMINIH P
663 3601044107780214 NOSAH L
664 3217050107910189 ONENG P
665 3601045009800002 MUROH P
666 3601044107860225 NAHRIAH P
 Umur
Pekerjaan* Kelompok Umur INSTANSI Alamat
(18-59 tahun)

08-11-1980 UMUM SUMURBATU

02-07-1985 UMUM CIKEUSIK
10-11-1980 UMUM RANCASENENG
24-08-1986 UMUM RANCASENENG
11-04-1987 UMUM UMBULAN
01-07-1982 UMUM UMBULAN
06-07-1954 LANSIA UMBULAN
11-07-1991 UMUM CIKEUSIK
01-07-1982 UMUM UMBULAN
04-01-1980 UMUM NANGGALA
18-02-1983 UMUM UMBULAN
24-03-1991 UMUM TANJUNGAN
19-06-1954 LANSIA CIKEUSIK
01-07-1975 UMUM TANJUNGAN
05-08-1984 UMUM CIKEUSIK
24-08-1984 UMUM TANJUNGAN
01-07-1965 UMUM UMBULAN
08-06-1967 UMUM UMBULAN
07-01-1993 UMUM TANJUNGAN
08-12-1993 UMUM RANCASENENG
19-11-1978 UMUM TANJUNGAN
24-10-2004 REMAJA RANCASENENG
20-07-1959 LANSIA CIKEUSIK
01-07-1965 UMUM SUMURBATU
15-08-1950 UMUM SUMURBATU
02-05-1986 UMUM TANJUNGAN
19-03-1965 UMUM NANGGALA
12-12-1972 UMUM SUKASENENG
29-01-1977 UMUM PANIMBANG
19-10-1970 UMUM SUMURBATU
14-07-1990 UMUM NANGGALA
07-07-1986 UMUM NANGGALA
17-03-1979 UMUM NANGGALA
01-09-1980 UMUM NANGGALA
22-02-1982 UMUM TANJUNGAN
03-06-1986 UMUM NANGGALA
10-05-1975 UMUM NANGGALA
06-07-1962 UMUM SUKASENENG
15-08-1970 UMUM CIWET
17-02-1980 UMUM SUKAWARIS
13-04-1980 UMUM SUMURBATU
02-04-1960 UMUM CURCI
25-02-1969 UMUM NANGGALA
21-03-1982 UMUM NANGGALA
02-10-1979 UMUM NANGGALA
25-08-1965 UMUM SUKAMULYA
15-08-1991 UMUM CURCI
01-07-1983 UMUM NANGGALA
14-08-1980 UMUM CURCI
01-07-1984 UMUM NANGGALA
20-09-1989 UMUM NANGGALA
21-06-1988 UMUM CIWET
18-03-1982 UMUM RANCASENENG
01-07-1983 UMUM UMBULAN
15-09-1982 UMUM CIKEUSIK
19-02-1972 UMUM UMBULAN
19-02-1981 UMUM SUMURBATU
18-09-1979 UMUM TANJUNGAN
10-09-1960 UMUM SUKAMULYA
08-06-1978 UMUM SUKAMULYA
01-07-1973 UMUM SUKASENENG
01-07-1962 UMUM CURCI
20-05-1985 UMUM CIHANJUANG
05-02-1977 UMUM SUMURBATU
05-03-1999 UMUM CIKEUSIK
04-03-1991 UMUM RANCASENENG
26-12-1997 UMUM UMBULAN
06-04-1994 UMUM UMBULAN
14-01-1983 UMUM UMBULAN
07-05-1990 UMUM SUKASENENG
30-06-1977 UMUM SUMURBATU
14-03-2004 REMAJA NANGGALA
11-02-1981 UMUM SUKASENENG
SUKASENENG
05-12-1996 UMUM SUKAWARIS
28-07-1994 UMUM CIKEUSIK
01-07-1980 UMUM CIWET
07-12-1995 UMUM RANCASENENG
14-12-1961 UMUM NANGGALA
01-07-1979 UMUM UMBULAN
31-10-2002 UMUM CIWET
01-07-1982 UMUM CURCI
02-03-1985 UMUM CURCI
06-10-1963 UMUM CURCI
15-05-1964 UMUM SUKASENENG
06-09-2003 REMAJA CIKEUSIK
21-03-2004 REMAJA SUMURBATU
02-05-1980 UMUM SUKAWARIS
19-01-1953 LANSIA UMBULAN
30-06-1950 LANSIA UMBULAN
20-06-1976 UMUM SUMURBATU
10/3/1981 UMUM SUKAMULYA
06-07-1972 UMUM UMBULAN
15-07-1975 UMUM CIKEUSIK
06-09-2004 REMAJA SUKASENENG
01-07-1978 UMUM RANCASENENG
20-06-1953 LANSIA CIKEUSIK
12-03-197 UMUM NANGGALA
12-01-1977 UMUM UMBULAN
16-06-1984 UMUM UMBULAN
15-11-1974 UMUM TANJUNGAN
12-10-1969 UMUM CURCI
21-05-1977 UMUM SUMURBATU
03-06-1980 UMUM UMBULAN
06-08-1993 UMUM SUKAWARIS
03-12-1960 UMUM CIKEUSIK
27-09-1997 UMUM SUKASENENG
12-07--1973 UMUM CIKEUSIK
12-01-1988 UMUM NANGGALA
07-04-2004 REMAJA SUKAWARIS
28-05-1985 UMUM SUKAWARIS
27-04-1983 UMUM CIWET
01-07-1976 UMUM CIKEUSIK
03-06-1985 UMUM CIWET
13-08-1987 UMUM SUKAMULYA
27-08-1999 UMUM SUMURBATU
08-07-1967 UMUM UMBULAN
01-07-1962 UMUM NANGGALA
01-07-1965 UMUM NANGGALA
14-11-1989 UMUM SUMURBATU
18-08-1992 UMUM NANGGALA
03-09-1977 UMUM CURCI
13-11-1990 UMUM DUREN SAWIT
28-01-1990 UMUM UMBULAN
02-04-1969 UMUM NANGGALA
18-04-1979 UMUM NANGGALA
23-10-1998 UMUM NANGGALA
01-07-1953 LANSIA UMBULAN
10-05-1990 UMUM NANGGALA
10-10-1963 UMUM NANGGALA
11-02-1970 UMUM RANCASENENG
09-05-1994 UMUM NANGGALA
01-07-1978 UMUM UMBULAN
22-07-1989 UMUM NANGGALA
04-03-1974 UMUM NANGGALA
21-04-2003 REMAJA RANCASENENG
07-02-1990 UMUM CIKUJANG
14-02-1978 UMUM NANGGALA
01-07-1977 UMUM CIKEUSIK
12-05-1987 UMUM UMBULAN
05-02-1984 UMUM UMBULAN
20-06-1975 UMUM CIWET
02-08-1965 UMUM UMBULAN
07-09-1981 UMUM SUKASENENG
01-01-1980 UMUM RANCASENENG
01-07-1975 UMUM NANGGALA
11-07-1980 UMUM UMBULAN
06-03-1978 UMUM CIWET
15-04-1988 UMUM SUKASENENG
01-07-1966 UMUM CIKEUSIK
02-09-1989 UMUM CIWET
13-02-1970 UMUM UMBULAN
07-10-1963 UMUM UMBULAN
03-11-1953 LANSIA PS. ASEM
10-11-1979 UMUM NANGGALA
06-07-1983 UMUM NANGGALA
01-07-1968 UMUM UMBULAN
01-07-1976 UMUM UMBULAN
01-02-1998 UMUM UMBULAN
06-07-1974 UMUM UMBULAN
01-07-1982 UMUM UMBULAN
18-10-1973 UMUM UMBULAN
01-04-1980 UMUM CURCI
08-08-1976 UMUM CIKEUSIK
04-11-2002 UMUM CIKEUSIK
01-07-1984 UMUM UMBULAN
04-08-1994 UMUM UMBULAN
30-12-1971 UMUM CURCI
25-03-1984 UMUM UMBULAN
04-10-1989 UMUM SUKAMULYA
04-05-1978 UMUM NANGGALA
10-03-1992 UMUM CIKEUSIK
20-05-1976 UMUM UMBULAN
01-04-1981 UMUM CURCI
01-07-1950 LANSIA CIWET
006-06-1963 UMUM CIWET
10-02-1999 BUMIL SUMURBATU
13-06-2006 REMAJA TANJUNGAN
29-11-1987 UMUM TANJUNGAN
23-11-1987 UMUM TANJUNGAN
17-01-1991 UMUM TANJUNGAN
14-05-1989 UMUM TANJUNGAN
27-09-1997 UMUM TANJUNGAN
05-10-1995 UMUM TANJUNGAN
11-12-1982 UMUM TANJUNGAN
05-03-1980 UMUM KUMBERJAYA
01-07-1972 UMUM UMBULAN
07-01-1979 UMUM UMBULAN
01-07-1979 UMUM UMBULAN
04-03-1970 UMUM UMBULAN
03-03-1970 UMUM SUKASENENG
08-06-1979 UMUM NANGGALA
03-10-1985 UMUM UMBULAN
17-05-1980 UMUM UMBULAN
05-02-1978 UMUM SUKASENENG
01-02-1982 UMUM CURCI
17-02-1978 UMUM UMBULAN
23-01-1985 UMUM UMBULAN
01-07-1968 UMUM SUKASENENG
17-04-1985 UMUM UMBULAN
18-06-1976 UMUM SUMURBATU
01-07-1994 UMUM SUMURBATU
12-09-1980 UMUM SUKAMULYA
01-07-1980 UMUM CURCI
25-02-2003 REMAJA SUKASENENG
01-07-1977 UMUM SUMURBATU
25-02-2005 REMAJA CIKEUSIK
05-10-1994 UMUM CIKEUSIK
05-06-1964 UMUM CIKEUSIK
UMUM CIKEUSIK
01-11-1976 UMUM SUMURBATU
08-03-1985 UMUM SUMURBATU
12-09-1974 UMUM CIKEUSIK
09-11-1982 UMUM SUKASENENG
10-08-2008 REMAJA LEUWIBALANG
05-07-1990 UMUM CURCI
07-01-1970 UMUM SUKASENENG
18-03-1967 UMUM SUMBERMUKTI
16-04-1999 UMUM CIKEUSIK
20-03-1983 UMUM NANGGALA
01-07-1980 UMUM CURCI
09-11-1974 UMUM UMBULAN
26-02-2003 REMAJA UMBULAN
02-07-1989 UMUM CIKEUSIK
24-01-2002 UMUM NANGGALA
10-11-1958 LANSIA CURCI
22-11-2008 REMAJA NANGGALA
28-11-1994 UMUM CURCI
01-07-1972 UMUM NANGGALA
04-02-1975 UMUM CIKEUSIK
15-07-1986 UMUM CIKEUSIK
14-09-1983 UMUM NANGGALA
10-10-1973 UMUM UMBULAN
01-01-1985 UMUM CURCI
07-09-1997 UMUM CIKEUSIK
SUMATERA SELATAN
01-07-1979 UMUM CURCI
27-05-1986 UMUM UMBULAN
23-03-1973 UMUM CIKEUSIK
01-07-1957 UMUM NANGGALA
01-02-1968 UMUM CURCI
06-07-1985 UMUM NANGGALA
03-02-1993 UMUM CURCI
10-12-1989 UMUM TANJUNGAN
01-07-1954 LANSIA SUKASENENG
05-07-1985 UMUM CURCI
23-12-1986 UMUM RANCASENENG
01-07-1979 UMUM UMBULAN
07-09-1977 UMUM SUKASENENG
01-04-1987 UMUM NANGGALA
01-03-1979 UMUM CURCI
10-04-1982 UMUM CURCI
01-08-1976 UMUM NANGGALA
01-07-1984 UMUM NANGGALA
01-07-1991 UMUM CURCI
11-02-1988 UMUM NANGGALA
01-04-1996 UMUM NANGGALA
02-06-1992 UMUM CURCI
01-07-1981 UMUM NANGGALA
06-05-1981 UMUM UMBULAN
27-10-2004 REMAJA SUMURBATU
01-07-1992 UMUM NANGGALA
03-11-1971 UMUM RANCASENENG
CIWET
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29-04-2003 REMAJA SUKASENENG
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21-04-1990 UMUM TANJUNGAN
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10-04-1968 UMUM CIKEUSIK
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18-04-1964 UMUM TANJUNGAN
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21-07-1977 UMUM TANJUNGAN
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23-07-1963 UMUM TANJUNGAN
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22-04-1998 UMUM CIKEUSIK
21-07-1981 UMUM NANGGALA
16-05-1977 UMUM RANCASENENG
23-04-1966 UMUM SUKASENENG
UMUM UMBULAN
 UMUM CIKEUSIK
11-07-1979 UMUM CIKEUSIK
01-02-1997 UMUM SUKASENENG
01-07-1979 UMUM UMBULAN
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10-04-1988 UMUM CIKEUSIK
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

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085866761604 CoronaVac 04/11/2021 04/11/2021
085773624138 CoronaVac 04/11/2021 04/11/2021
085779060197 CoronaVac 04/11/2021 04/11/2021
085882501947 CoronaVac 04/11/2021 04/11/2021
081527073103 CoronaVac 04/11/2021 04/11/2021
085319298908 CoronaVac 04/11/2021 04/11/2021
085211548556 CoronaVac 04/11/2021 04/11/2021
085281449143 CoronaVac 04/11/2021 04/11/2021
085779575934 CoronaVac 04/11/2021 04/11/2021
081511406434 CoronaVac 04/11/2021 04/11/2021
0881527073103 CoronaVac 04/11/2021 04/11/2021
082324153220 CoronaVac 04/11/2021 04/11/2021
085811513793 CoronaVac 04/11/2021 04/11/2021
082310247041 CoronaVac 04/11/2021 9/30/2021
085216099216 CoronaVac 04/11/2021 04/11/2021
083815151914 CoronaVac 04/11/2021 04/11/2021
085774161372 CoronaVac 04/11/2021 04/11/2021
082117974807 CoronaVac 04/11/2021 04/11/2021
085692729274 CoronaVac 04/11/2021 04/11/2021
085694537930 CoronaVac 04/11/2021 04/11/2021
085773507363 CoronaVac 04/11/2021 04/11/2021
085880004765 CoronaVac 04/11/2021 04/11/2021
085811288745 CoronaVac 04/11/2021 04/11/2021
083893090548 CoronaVac 04/11/2021 04/11/2021
085624925125 CoronaVac 04/11/2021 04/11/2021
081513468930 CoronaVac 04/11/2021 04/11/2021
085217277399 CoronaVac 04/11/2021 04/11/2021
085210132774 CoronaVac 04/11/2021 04/11/2021
081517290787 CoronaVac 04/11/2021 04/11/2021
085693760058 CoronaVac 04/11/2021 04/11/2021
085762187721 CoronaVac 04/11/2021 04/11/2021
085886172704 CoronaVac 04/11/2021 10/7/2021
081527073103 CoronaVac 04/11/2021 04/11/2021
081574284041 CoronaVac 04/11/2021 9/16/2021
085762187721 CoronaVac 04/11/2021 04/11/2021
085691636880 CoronaVac 04/11/2021 04/11/2021
CoronaVac 04/11/2021 9/30/2021
082188299334 CoronaVac 04/11/2021 04/11/2021
089616880995 CoronaVac 04/11/2021 04/11/2021
085717893246 CoronaVac 04/11/2021 04/11/2021
081514572157 CoronaVac 04/11/2021 04/11/2021
085779158835 CoronaVac 04/11/2021 04/11/2021
082113508337 CoronaVac 04/11/2021 04/11/2021
085693476648 CoronaVac 04/11/2021 04/11/2021
085770620879 CoronaVac 04/11/2021 04/11/2021
081295255569 CoronaVac 04/11/2021 04/11/2021
085710721583 CoronaVac 04/11/2021 04/11/2021
087727143243 CoronaVac 04/11/2021 04/11/2021
081514562748 CoronaVac 04/11/2021 04/11/2021
085780879543 CoronaVac 04/11/2021 04/11/2021
081318020755 CoronaVac 04/11/2021 04/11/2021
081574801315 CoronaVac 04/11/2021 04/11/2021
0851514562793 CoronaVac 04/11/2021 04/11/2021
085780879543 CoronaVac 04/11/2021 04/11/2021
085710517079 CoronaVac 04/11/2021
08977416758 CoronaVac 04/11/2021 04/11/2021
085894531791 CoronaVac 04/11/2021 04/11/2021
085714211686 CoronaVac 04/11/2021 04/11/2021
085738021772 CoronaVac 04/11/2021 04/11/2021
085691863468 CoronaVac 04/11/2021 04/11/2021
085773757735 CoronaVac 04/11/2021 04/11/2021
085777812289 CoronaVac 04/11/2021 04/11/2021
085776846015 CoronaVac 04/11/2021 04/11/2021
081511870151 CoronaVac 04/11/2021 04/11/2021
085894698812 CoronaVac 04/11/2021 04/11/2021
085717237082 CoronaVac 04/11/2021 04/11/2021
081290367226 CoronaVac 04/11/2021 04/11/2021
081290367226 CoronaVac 04/11/2021 04/11/2021
085813681351 CoronaVac 04/11/2021 04/11/2021
085813681351 CoronaVac 04/11/2021 04/11/2021
085779055213 CoronaVac 04/11/2021 04/11/2021
085891152166 CoronaVac 04/11/2021 04/11/2021
085841914936 CoronaVac 04/11/2021 04/11/2021
081514572157 CoronaVac 04/11/2021 04/11/2021
085832815053 CoronaVac 04/11/2021 04/11/2021
085710343586 CoronaVac 04/11/2021 04/11/2021
085770130635 CoronaVac 04/11/2021 04/11/2021
085770332414 CoronaVac 04/11/2021 04/11/2021
CoronaVac 04/11/2021 04/11/2021
085891152166 CoronaVac 04/11/2021 04/11/2021
081574895661 CoronaVac 04/11/2021 04/11/2021
081280313483 CoronaVac 04/11/2021 04/11/2021
081280549665 CoronaVac 04/11/2021 04/11/2021
082311238838 CoronaVac 04/11/2021 04/11/2021
081511330800 CoronaVac 04/11/2021 04/11/2021
0855776667511 CoronaVac 04/11/2021 04/11/2021
082312056972 CoronaVac 04/11/2021 04/11/2021
082312056972 CoronaVac 04/11/2021 04/11/2021
082312056972 CoronaVac 04/11/2021 04/11/2021
085283233989 CoronaVac 04/11/2021 04/11/2021
085283233989 CoronaVac 04/11/2021 04/11/2021
081322420731 CoronaVac 04/11/2021 04/11/2021
082312056972 CoronaVac 04/11/2021 04/11/2021
081223574505 CoronaVac 04/11/2021 04/11/2021
085714061285 CoronaVac 04/11/2021 04/11/2021
085714061285 CoronaVac 04/11/2021 04/11/2021
085694586498 CoronaVac 04/11/2021 04/11/2021
085694582358 CoronaVac 04/11/2021 04/11/2021
085780879543 CoronaVac 04/11/2021 04/11/2021
0858131669 CoronaVac 04/11/2021 04/11/2021
081318342591 CoronaVac 04/11/2021 04/11/2021
081219344804 CoronaVac 04/11/2021 04/11/2021
08589115266 CoronaVac 04/11/2021 04/11/2021
085779158813 CoronaVac 04/11/2021 04/11/2021
0852187858 CoronaVac 04/11/2021 04/11/2021
085218217858 CoronaVac 04/11/2021 04/11/2021
085891149059 CoronaVac 04/11/2021 04/11/2021
081296009062 CoronaVac 04/11/2021 04/11/2021
085710721583 CoronaVac 04/11/2021 04/11/2021
082310247004 CoronaVac 04/11/2021 04/11/2021
081237308129 CoronaVac 04/11/2021 9/30/2021
CoronaVac 04/11/2021 04/11/2021
085773757724 CoronaVac 04/11/2021 04/11/2021
085694230699 CoronaVac 04/11/2021 04/11/2021
081411151230 CoronaVac 04/11/2021 04/11/2021
085695396337 CoronaVac 04/11/2021 04/11/2021
081511856707 CoronaVac 04/11/2021 04/11/2021
081511856707 CoronaVac 04/11/2021 04/11/2021
085773757656 CoronaVac 04/11/2021 04/11/2021
0857737257656 CoronaVac 04/11/2021 04/11/2021
085710363805 CoronaVac 04/11/2021 04/11/2021
058773210389 CoronaVac 04/11/2021 04/11/2021
085773757656 CoronaVac 04/11/2021 04/11/2021
087887142329 CoronaVac 04/11/2021 04/11/2021
085770620894 CoronaVac 04/11/2021 04/11/2021
085282239361 CoronaVac 04/11/2021 04/11/2021
085773757724 CoronaVac 04/11/2021 04/11/2021
0838993712392 CoronaVac 04/11/2021 04/11/2021
085882445958 CoronaVac 04/11/2021 04/11/2021
085882445958 CoronaVac 04/11/2021 04/11/2021
085282259361 CoronaVac 04/11/2021 04/11/2021
085891152166 CoronaVac 04/11/2021 04/11/2021
083818167782 CoronaVac 04/11/2021 04/11/2021
081213103839 CoronaVac 04/11/2021 04/11/2021
085774595469 CoronaVac 04/11/2021 04/11/2021
085778224912 CoronaVac 04/11/2021 04/11/2021
085779390018 CoronaVac 04/11/2021 04/11/2021
085774013169 CoronaVac 04/11/2021 04/11/2021
085717238795 CoronaVac 04/11/2021 04/11/2021
085216587160 CoronaVac 04/11/2021 04/11/2021
085772833558 CoronaVac 04/11/2021 04/11/2021
081511870085 CoronaVac 04/11/2021 04/11/2021
085219529551 CoronaVac 04/11/2021 04/11/2021
087794461339 CoronaVac 04/11/2021 04/11/2021
081584369605 CoronaVac 04/11/2021 04/11/2021
081584369605 CoronaVac 04/11/2021 04/11/2021
085770971938 CoronaVac 04/11/2021 04/11/2021
085788900145 CoronaVac 04/11/2021 04/11/2021
085691649302 CoronaVac 04/11/2021 04/11/2021
CoronaVac 04/11/2021 04/11/2021
085212817706 CoronaVac 04/11/2021 04/11/2021
082312261236 CoronaVac 04/11/2021 04/11/2021
085319359550 CoronaVac 04/11/2021 04/11/2021
082131670845 CoronaVac 04/11/2021 04/11/2021
085697017899 CoronaVac 04/11/2021 04/11/2021
081511869607 CoronaVac 04/11/2021 04/11/2021
085893572182 CoronaVac 04/11/2021 04/11/2021
081528650462 CoronaVac 04/11/2021 04/11/2021
085718505147 CoronaVac 04/11/2021 04/11/2021
085694230699 CoronaVac 04/11/2021 04/11/2021
082188289334 CoronaVac 04/11/2021 04/11/2021
081411151230 CoronaVac 04/11/2021 04/11/2021
08577006262664 CoronaVac 04/11/2021 04/11/2021
085779158813 CoronaVac 04/11/2021 04/11/2021
085881649475 CoronaVac 04/11/2021 04/11/2021
085694236718 CoronaVac 04/11/2021 04/11/2021
085776131116 CoronaVac 04/11/2021 04/11/2021
08569264468 CoronaVac 04/11/2021 04/11/2021
085691321381 CoronaVac 04/11/2021 04/11/2021
085891260414 CoronaVac 04/11/2021 04/11/2021
085313117398 CoronaVac 04/11/2021 04/11/2021
085810913821 CoronaVac 04/11/2021 04/11/2021
081219721904 CoronaVac 04/11/2021 04/11/2021
085710499239 CoronaVac 04/11/2021 04/11/2021
085776131098 CoronaVac 04/11/2021 04/11/2021
085694653176 CoronaVac 04/11/2021 04/11/2021
085283040746 CoronaVac 04/11/2021 04/11/2021
085352831801 CoronaVac 04/11/2021 04/11/2021
081584367725 CoronaVac 04/11/2021 04/11/2021
085311379320 CoronaVac 04/11/2021 04/11/2021
085894828301 CoronaVac 04/11/2021 04/11/2021
085283444124 CoronaVac 04/11/2021
085779062028 CoronaVac 04/11/2021 04/11/2021
082114864848 CoronaVac 04/11/2021 04/11/2021
085280255695 CoronaVac 04/11/2021 04/11/2021
CoronaVac 04/11/2021 04/11/2021
085691144413 CoronaVac 04/11/2021 04/11/2021
085218946092 CoronaVac 04/11/2021 04/11/2021
085857747323 CoronaVac 04/11/2021 04/11/2021
Dosis I Dosis 2
Tanggal
Pemberi KET
No.
No. Batch No seri an No Seri
Batch
Vaksina
si
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24003121 ### 24203721
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24203721
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### 2.4E+07
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 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601040107760130 SUBARNA L
2 3601044701000008 KASI'AH P
3 3601040702880003 EVI JUNIAWATI L
4 3601044401930006 JUJU P
5 3601044104720001 UNEH P
6 3601045500330002 OLIPIA ULPAH P
7 3601045402880001 SITI JANAH P
8 36010444008610001 SUKATI P
9 3601045202880004 ARNITI P
10 3601040408900003 MAMAT L
11 3601040902930001 RAMAN L
12 360104504890002 SARTIKA P
13 3601040107740081 SARMAN L
14 3601042001800002 JAMALUDIN L
15 36010407640044 SAHLI L
16 360104071270001 HALIM L
17 3601041712680002 EDI L
18 3601044306930001 SACCI P
19 36010401076307 MADSALI L
20 3601041602660001 HAERUDIN L
21 360104070000007 SARDI L
22 3601044301770004 URSAH P
23 3601046100002 TATI HARYATI P
24 3601040700180 JAMA L
25 360104010772007 RASNAH P
26 3601042211820001 A. WAHYU L
27 3601042908010005 ANGGA SAPUTRA L
28 360104010650112 JAI L
29 360104010600064 ABDUROHMAN L
30 3601040408880001 DEDI L
31 321222608760001 NURYANAH P
32 360104130880003 ACUNG L
33 3601045010680001 SUHERIAH P
34 3601040604040008 M.YANA L
35 3601040112880001 HERUL L
36 3601042102760001 WAWAN L
37 3601040101450008 PULUNG L
38 36010447140001 ANAH P
39 3601041903780001 APIT L
40 3601080207770001 UJANG L
41 3601041512820001 OTOY L
42 3601040101060009 ADI PRATAMA L
43 3601045712670004 KOMARIAH P
44 3601044101950019 SYAMSIAH P
45 3601046310070001 MIA OKTAVIANI P
46 3601044108850001 DESTI P
47 3601044603680001 RUNIAH P
48 3602274802950001 SUNIA P
49 36010450830002 ISAH P
50 360104410778024 KUAN P
51 3601044704800001 EHA P
52 3601044708880001 SARNI P
53 360104410660085 DINA P
54 3601045509930003 LENI P
55 3601044682670001 HETI P
56 360104607000003 ARNIAH P
57 3601045208840006 RASMAH P
58 3601045703660001 AMINAH P
59 3601086304930007 RODIAH P
60 3601044107660100 BENAH P
61 360104592780001 MARIAM P
62 360104579680001 MAEMUNAH P
63 3601044112660001 SANIMAH P
64 3601044107580133 CUCUN P
65 36010441070001 IPAH P
66 3602215602990002 KAMINAH P
67 3601044611950001 AAS. M P
68 360104410763234 MARSAENAH P
69 3601045104880004 SUHENI P
70 36010459040200001 UNAH P
71 36010441018300002 SUMYATI P
72 36010452108030002 NURHAYATI P
73 3601045506900010 ASNAH P
74 3601046304780007 SUKESIH P
75 360108407950001 JARNAH P
76 36010463780001 EDAH L
77 360045512050003 YUYUN. Y P
78 3601044211640002 MARSAH P
79 36010457030006 SARTUNAH P
80 3601044402580002 ICE TRISNAWATI P
81 3602212710040001 ANIAH P
82 150809496770001 AMNAH P
83 3601044107790091 ITING P
84 360104410773025 JUMASIH P
85 SALIAH P
86 3601040807680001 ENDANG JUANDA L
87 ACIH P
88 3602214204920004 UNIS P
89 3601044306700001 SARMAENAH P
90 3601041609020002 RIZKY L
 91 3601044107760180 RASMAH P
92 360104410484002 BENAH P
93 3601040107410033 SARDI L
94 3601044401890004 NURIAH P
95 3601044610660001 MURTI P
96 3601044304990003 SUHERTI P
97 3601044610810002 MARKISAH P
98 3601045604910001 SITI SAROH P
99 360104421740001 ITING P
100 3601040107730256 SUKMA L
101 3601041006730002 YADI L
102 3601040701560003 SARHANI L
103 3601040603750001 JUHDI L
104 360104031260006 PIRMANSYAH L
105 3601045069800001 DINI ENDANG P
106 3601042306030001 IKBAL L
107 360104450850004 MAESAROH P
108 3601044804570002 ERAH P
109 3601044201830005 SAROH P
110 3601040107730241 TONI L
111 3601045007800009 SUHETI P
112 3601042106810001 TURHANI P
113 3601042007840002 SAEPUDIN L
114 36014017530142 KAMSUI L
115 3601044708050001 SINTA HAYATI P
116 3601044107810132 UTINAH P
117 3601040201920006 SUPARDI L
118 360142810860006 MARJUK L
119 3601042009600003 JAYA L
120 3601044103831002 UNAH / NASIH P
121 3601044107610063 SUKANAH P
122 3601040107620081 SAMAN L
123 3601044602930004 ROSITA P
124 360104270583002 ENDIN L
125 3601044601860002 KADMI L
126 3601040111740003 LAWI L
127 3601045008860003 GITA TENESA P
128 3601044406880005 MIMIN P
129 3602212501870001 HAERUDIN L
130 3601041103600001 H. ANIM L
131 360104902950002 TOHIM L
132 3601040410950001 MISRI P
133 3601042008720001 ATANG L
134 3601044601980004 MURSAH P
135 3601041208960004 ADRIA AGUNG L
136 3601040108710001 SUNARTA L
137 3601040205850004 TB. KIHAJAR L
138 3601042903940002 BENI FEBRIANI L
139 3602214905950003 ROPIHA L
140 3601041006850001 SATRIA L
141 3601042503830002 DEDE L
142 3601040204830006 OPAL L
143 3601040206870002 OYOK L
144 3212220104810001 SUKARI L
145 3601040107740084 BORI L
146 3601041467700001 WIRNA L
147 3601040107030115 NAIM MUZAKI L
148 360281802820004 ACIF L
149 3601040402700001 SATIM L
150 3601042311820001 JUMALI L
151 3601045003730001 TATI L
152 3601080207770003 UJANG L
153 360104481890002 SUNA'AH P
154 3601040106820001 MARSID L
155 3601040107700105 JIDI L
156 3601044103870002 SAEDAH P
157 3601040503870001 EMED L
158 3601045304780002 ANIMAH P
159 360104410104830006 MARWATI P
160 3601040310840001 SAMSUDIN L
161 3601044103790001 TITIN P
162 3601045006900001 MINAR P
163 3601044612870001 MARIAH P
164 3601045903820001 JURIAH P
165 3601045702790001 ODAH P
166 3601044108880006 NARTI P
167 3601045003680002 SUHENAH P
168 3601045209920003 SARNAH P
169 360104670430002 YATI P
170 3601044107870071 SAPRAH P
171 36010442019500005 NARSIH P
172 360104440380006 NENI P
173 3601044402780011 SU'AH P
174 3601044108900004 SANAH P
175 3601045002000006 ITA JUWITA P
176 3601044206720001 SAENAH P
177 3601045102770004 HALIMAH P
178 360104401700001 NURSIAH P
179 3601044107630231 KANIJAH P
180 3601045202910002 ASIH P
181 3601044104790008 MISNAH P
182 3601045601530001 SANAMAH P
183 3601044107630241 KENOY P
184 3601045005960007 MARYATI P
185 3601044107730246 UMROH P
186 3601045004920006 RUMI P
187 3601044801710003 TITI P
188 3601044107830268 IIN P
189 3601044112840001 SURTI P
190 3601044501840002 MULYANAH P
191 3601046606780002 RASMAH P
192 3601044702790002 ASMANAH P
193 3601044410690002 MIMIN P
194 3601044103000003 HENA KUSNAWATI P
195 3601044406650004 KARSIH P
196 3601044809780004 MAESAROH P
197 3601045609800001 BAI P
198 3601044210750002 JASTI P
199 3601045612040001 DIYAH P
200 3602214506940001 HERNI P
201 3601044107600063 NEMAH P
202 3602214808950002 NENIH P
203 3601044109800009 SARMAH P
204 3601041210010003 GUNAWAN L
205 3601044106840002 SAMAH P
206 3601044408740001 IKAH P
207 3601040103870004 ATO L
208 3602054705980006 IIS ISNAWATI P
209 3601040107640054 ISHALUDIN L
210 3601040803870001 SANTAWI L
211 3601045808980008 SARNITI P
212 3601045003620002 MASKAH P
213 3601044104630004 HAYATI P
214 3601040407700001 HERMAN L
215 3601041506900003 SARONI L
216 3601041007830009 UDIN L
217 3601042403850002 IMAM L
218 3601040810740002 ROHMAN L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur sesuai)
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI

17-10-1979 UMUM CIKDONG 085216587092

01-04-1997 UMUM CIKDONG 085776129424
13-06-1989 UMUM CIKDONG 085776131063
04-01-1993 UMUM CIKDONG 083880729828
01-04-1972 BUMIL CIKDONG 085779393910
07-08-2005 REMAJA CIKDONG 085715268336
14-02-1980 UMUM CIKDONG 085716206036
04-08-1961 UMUM CIKDONG 085216587092
12-02-1988 UMUM CIKDONG 085711038539
04-08-1990 UMUM CIKDONG 085893312034
09-02-1993 UMUM CIKDONG 085695397231
25-05-1992 UMUM CIKDONG 085217347358
01-07-1974 UMUM CIKDONG 081291682710
22-03-2000 UMUM CIKDONG 085894845343
06-07-1975 UMUM CIKDONG 085776131126
07-01-1975 UMUM CIKDONG 085770131054
17-12-1968 UMUM CIKDONG 08576129476
03-06-1993 UMUM CIKDONG 085772394366
01-07-1963 UMUM CIKDONG 085774771584
16-02-1966 UMUM CIKDONG 085882463941
07-08-2000 UMUM CIKDONG 081312909612
12-07-1986 UMUM CIKDONG 085891007652
21-10-2000 UMUM CIKDONG 081584357077
01-07-1986 UMUM CIKDONG 085719478576
10-06-1973 UMUM CIKDONG 0852116429590
12-09-1986 UMUM CURCI 081617278626
29-08-2001 UMUM RANCASENENG 085782134754
01-02-1979 UMUM CIKDONG 085695537046
14-08-1958 LANSIA CIKDONG 085882158280
04-08-1988 UMUM CIKDONG 085715268415
20-08-1976 UMUM INDRAMAYU 085315065758
13-07-1988 UMUM CIKDONG 085882158270
10-10-1968 UMUM CIKDONG 085711205227
06-04-2004 REMAJA CIKDONG 085771290483
01-12-1990 UMUM CIKDONG 085770130970
08-11-1977 UMUM CIKDONG 08558273778
01-01-1945 LANSIA CIKDONG 085691309492
01-07-1990 UMUM CIKDONG 085771289632
19-03-1978 UMUM CIKDONG 081511869541
07-07-1976 UMUM CIKDONG 085781667087
15-02-1982 UMUM CIKDONG 085890550080
01-01-2006 REMAJA CIKDONG 085691883258
11-12-1967 UMUM CIKDONG 085776875891
01-01-1995 UMUM CIKDONG 085890550080
12-10-1999 UMUM CIKDONG 085781667088
01-08-1985 UMUM CIKDONG 085778281387
06-03-1968 UMUM CIKDONG 085894845343
02-05-1995 UMUM CIKDONG 085781549476
15-08-1983 UMUM CIKDONG 085797175791
01-07-1978 UMUM CIKDONG 085776129437
07-04-1980 UMUM CIKDONG 081511869541
07-08-1988 UMUM CIKDONG 085691437292
01-07-1966 UMUM CIKDONG 085781667088
15-09-1993 UMUM CIKDONG 081295006289
06-12-1967 UMUM CIKDONG 082137066093
25-06-1996 UMUM CITEREUP 085810913651
12-08-1984 UMUM CIKDONG 085772730642
17-03-1966 UMUM CIKDONG 085890550084
16-08-1993 BUMIL CIKDONG 085883750704
01-07-1966 UMUM CIKDONG 085774318759
12-11-1980 UMUM CIKDONG 085695413668
17-09-1968 UMUM CIKDONG 085891151915
01-12-1966 UMUM CIKDONG 085718621202
01-07-1985 UMUM CIKDONG 085774393859
11-03-1987 UMUM CIKDONG 085781659741
16-02-1999 UMUM CIKDONG 085811121455
17-08-1996 UMUM CIKDONG 085817103688
01-07-1963 UMUM CIKDONG 085890550000
11-04-1988 UMUM CIKDONG 085283897762
19-04-2002 UMUM CIKDONG 085213950853
01-01-1983 UMUM CIKDONG 081574920391
16-08-2003 REMAJA CIKDONG 08565202938
15-06-1990 UMUM CIKDONG 085885158269
23-04-1978 UMUM CIKDONG 085213950853
08-07-1995 UMUM CIKDONG 085888253134
13-04-1987 UMUM CIKDONG 085782767753
15-12-2005 REMAJA CIKDONG 0857115260659
02-11-1964 UMUM CIKDONG 085882158269
17-05-1980 UMUM CIKDONG 085817951846
28-08-2001 UMUM CIKDONG 085351052102
20-01-2006 REMAJA CIKDONG 085772730628
09-06-1977 UMUM CIKDONG 085778279913
01-07-1979 UMUM CIKDONG 081318024370
01-07-1973 UMUM CIKDONG 081514459362
11-02-1985 UMUM CIKDONG 081292647098
08-07-1960 LANSIA CIKDONG
09-04-1983 UMUM CIKDONG 0855865467
02-04-1992 UMUM CIKDONG 085774393859
03-06-1970 UMUM CIKDONG 085779364639
16-09-2002 UMUM CIKDONG 085774393868
01-07-1976 UMUM CIKDONG 081291682710
01-04-1984 UMUM CIKDONG 085890550074
01-07-1956 LANSIA CIKDONG 085781659742
05-04-1985 UMUM CIKDONG 082399314991
06-10-1966 UMUM CIKDONG 085710750390
02-09-2000 UMUM CIKDONG 085781812564
06-10-1981 UMUM CIKDONG 085781812564
16-01-1974 UMUM CIKDONG 08567901594
02-11-1974 UMUM CIKDONG 085780198397
19-06-1970 UMUM CIKDONG 085695271072
13-05-1982 UMUM CIKDONG 085893694403
07-01-1956 LANSIA CIKDONG 085882763011
06-03-1975 UMUM CIKDONG 085894669544
03-10-1996 UMUM CIKDONG 085893721208
17-06-1998 UMUM CIKDONG 085777324378
23-06-2003 REMAJA CIKDONG 081574865990
05-10-1985 UMUM CIKDONG 081574865990
08-04-1957 UMUM CIKADONGDONG 085880729628
01-01-1983 UMUM CIKADONGDONG 085773646726
01-07-1973 UMUM CIKADONGDONG 085889297585
10-07-1980 UMUM CIKADONGDONG 085882501929
21-06-1981 UMUM CIKADONGDONG 085716006909
20-07-1985 UMUM CIKADONGDONG 085716206036
13-10-1940 UMUM CIKADONGDONG 085882762225
07-08-2005 UMUM CURUGCIUNG 085691154261
05-10-1982 UMUM CIKADONGDONG 085783386221
17-01-1992 UMUM CIKADONGDONG 085719437073
28-10-1986 UMUM CIKADONGDONG 085215129405
20-09-1960 UMUM CIBEUREUM 085817103688
01-03-1983 UMUM CIKADONGDONG 081514459362
13-03-1965 UMUM CIKADONGDONG 085882501980
01-07-1962 UMUM CIKADONGDONG 085778557053
06-02-1993 UMUM CIKADONGDONG 085710508643
07-02-1982 UMUM CIPAAS 081318024397
07-05-1988 UMUM CIKADONGDONG 085778557053
11-07-1980 UMUM CIKADONGDONG 085715270640
10-08-1987 UMUM CIKADONGDONG 085773756299
04-06-1988 UMUM CURUGCIUNG 085776131126
24-09-1986 UMUM KUBANG PANCAL 085772760186
11-03-1960 UMUM CIKADONGDONG 085718621202
09-02-1995 UMUM CIKADONGDONG 085710135917
06-08-1993 UMUM CIKADONGDONG 085776129565
01-07-1977 UMUM CURUG HANDAP 085777226195
12-06-1999 UMUM CIKADONGDONG 085711501459
12-08-1996 UMUM UMBULAN 083811512590
12-08-1971 UMUM NANGGALA 085215836872
02-05-1985 UMUM CIPAAS 085781667090
22-02-1994 UMUM CIKADONGDONG 081511868410
09-05-1995 UMUM CIKADONGDONG 085719437037
25-02-1998 UMUM CIKADONGDONG 085711038539
25-03-1983 UMUM CIKADONGDONG 085772394366
02-04-1983 UMUM CIKADONGDONG 085691309492
02-06-1987 UMUM CIBEUREUM 085777241879
01-04-1981 UMUM INDRAMAYU 085315065758
01-07-1974 UMUM CIKADONGDONG 085817103688
16-06-1979 UMUM CIBEUREUM 085710264516
09-09-2002 UMUM UMBULAN 085888640344
18-02-1982 UMUM CIKADONGDONG 085715268344
04-02-1970 UMUM CIKADONGDONG 085219241723
10-03-1992 UMUM CIKADONGDONG 085781549470
10-03-1973 UMUM CIKADONGDONG 085890550080
07-07-1967 UMUM CIPAAS 085781667087
08-09-1989 UMUM CIKADONGDONG 085776131126
01-06-1982 UMUM CIKADONGDONG 085882158269
01-07-1970 UMUM CIPAAS 085774964974
01-03-1987 UMUM CIBEUREUM 0858905500780
25-06-1985 UMUM CIKADONGDONG 085887058278
13-04-1978 UMUM CIBEUREUM 085776881531
01-07-1986 UMUM CIKADONGDONG 085817103688
03-10-1984 UMUM CIKADONGDONG 085882158281
01-03-1979 UMUM CIKADONGDONG 085797175809
10-06-1990 UMUM CIKADONGDONG 085211493231
06-12-1970 UMUM MURUY 085779455066
12-07-1978 UMUM CIKADONGDONG 081511406445
17-02-1979 UMUM 085695917505
01-08-1988 UMUM CIKADONGDONG 085213950853
10-03-1968 UMUM MURUY 082137066093
12-09-1992 UMUM CIPAAS 085772352754
27-04-1983 UMUM CIKADONGDONG 085884397330
01-07-1987 UMUM CIKADONGDONG
02-01-1995 UMUM CIKADONGDONG 083873769955
04-03-1980 UMUM CIPAAS 085694289245
04-02-1968 UMUM CIKADONGDONG 085691437292
01-08-1986 UMUM CIBEUREUM 085894669544
15-07-1998 UMUM CIKADONGDONG 085772730283
05-07-1991 UMUM CIKADONGDONG 085891161307
11-02-1977 UMUM CIKADONGDONG 085772249649
04-01-1970 UMUM MURUY 085693425905
01-07-1963 UMUM CIKADONGDONG 083873769955
12-02-1991 UMUM CIBEUREUM 085810876853
01-04-1979 UMUM CIKADONGDONG 08571050862
16-01-1953 UMUM CIKADONGDONG 085888253143
01-07-1963 UMUM CIKADONGDONG 085774338034
10-05-1996 UMUM CIBEUREUM 085716631502
01-06-1974 UMUM CIKADONGDONG 085212931851
10-04-1992 UMUM PEMATANG KARANG 081279331076
08-01-1971 UMUM CIPAAS 085695202938
01-07-1983 UMUM CIKADONGDONG 085778279913
01-12-1984 UMUM CIKADONGDONG 085882158269
05-01-1984 UMUM CIKADONGDONG 081318024370
26-06-1963 UMUM PEMATANG KARANG 085781812564
07-02-1983 UMUM CIBEUREUM 085715270640
04-10-1969 UMUM PAMATANG 081318024370
07-07-2002 UMUM GANG BATU 081617691774
04-06-1965 UMUM PEMATANG KARANG 085882158269
03-09-1978 UMUM GANG BATU 085817951846
03-04-1991 UMUM CIKADONGDONG 085691947960
02-10-1975 UMUM CIPAAS 085718000083
16-12-2004 UMUM CIKADONGDONG 085773895429
05-06-1994 UMUM CIKADONGDONG 085772352754
10-11-1959 UMUM CIBEUREUM 085716631502
08-08-1995 UMUM CIKADONGDONG 08571490040
01-09-1980 UMUM PEMATANG KARANG 081398116659
12-10-2001 UMUM NANGGALA 085779170051
01-06-1984 UMUM GANG BATU 081514459364
04-08-1974 UMUM CIPAAS 085772740474
01-03-1960 UMUM CIBEUREUM 085779455069
08-12-1998 UMUM CIKADONGDONG 085710750390
09-08-1965 UMUM CURUGCIUNG 085881657424
08-03-1987 UMUM CIKADONGDONG 085717347989
18-08-1998 UMUM PEMATANG KARANG 085772730541
10-03-1965 UMUM MURUY 085778068198
01-04-1963 UMUM CIBEUREUM 085882763011
04-07-1970 UMUM CIKADONGDONG 085781659712
14-08-1970 UMUM CIBEUREUM 08567901594
UMUM CIKADONGDONG 085781659742
27-01-1985 UMUM CIKADONGDONG 085882762993
08-10-1974 UMUM CIBEUREUM 085691935449
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Merek Tanggal Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri Pemberian
Anggota
Vaksinasi Vaksinasi

CORONAVAC 05-11-2021 05-11-2021 20210949H

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CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 03-07-2021 05-11-2021
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 13-09-2021 05-11-2021
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 13-09-2021 05-11-2021
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 13-09-2021 05-11-2021
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 13-09-2021 05-11-2021
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CORONAVAC 05-11-2021 05-11-2021 242203721
CoronaVac 05/11/2021 05-11-2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 202109149H
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
CoronaVac 05/11/2021 05/11/2021 24203721
Dosis 2

KET
No. Batch No Seri

242203721
242203721

242203721

242203721
242203721
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601041805790002 DURAJI L
2 360104070474001 ANAN L
3 3601044107810161 DASINGKEM P
4 3601044107730093 KASIDEM P
5 3601044911650001 BAYI P
6 3601045608720001 NARSIH P
7 3601045009600001 UMINAH P
8 3601045011970007 MIMIN P
9 3601041204000004 AGI FAUZI L
10 3601046601050001 TAMARA P
11 3601045508920003 SRI WATINAH P
12 3601044105760002 ARCI P
13 1409057008800001 SUNAINA P
14 3601046003930004 DAMEN P
15 3601044107750058 KAPSIAH P
16 3601040107560037 TARIPIN L
17 36010456080007 NIYAH P
18 3601044410780002 KUNIAH P
19 3601046204720001 SARINGKEM P
20 3601044107810056 RASEM P
21 360104150780008 SARYONO L
22 3601044107730116 YASYIAH P
23 3601044107660209 DARNI P
24 3601040104850009 ISNEN L
25 3601044109790001 SITI JULAEHA P
26 3601045809730001 SUTIAH P
27 3601044107760084 UMINAH P
28 3601044905780001 IDA HAYATI P
29 3601042708990002 SAEPUDIN L
30 3601040501730001 TARSAM L
31 3601045003690001 DASWI P
32 3601045106650003 ARNAH P
33 36010458-2760001 SAWATI P
34 3601044601820002 SUKMANAH P
35 3601045701630001 TARINAH P
36 3601044107730208 WARIAH P
37 3601044107810216 SARWI P
38 3601040107870178 RUDI L
39 360104427700002 MISTEM P
40 3601040201710001 KADIS L
41 3601044409770001 NURWITI P
42 3601045001730003 DEDEH P
43 3601041511650001 DASTI P
44 3601040207690004 WASTIM L
45 3601044304760001 BUMI P
46 3601042405720001 KARIDAH P
47 3601044505680001 SUKANTI P
48 3601045207770001 SITI PATIMAH P
49 3601040107900297 KARLIM L
50 3601045401680001 RUNENTI P
51 3600145107810005 DARNI P
52 3601044201730001 JUNIAH P
53 3601040205660001 SARMAN L
54 36010435006810002 DARTI P
55 3601040908000004 OMA L
56 3601040609970003 ARIFIN L
57 3601044307550001 TITI P
58 3601351205670003 SALMIN L
59 360104451760003 MASNI P
60 3601044107640068 SANITI P
61 3601044106400001 MARIAH P
62 3601044107800235 TARSIH P
63 360104904720001 WARTEM P
64 3601045708950001 YUNITA P
65 3601040207870008 DIDING L
66 3601040602950003 JUMAR L
67 3601044810000002 KASNAH P
68 3601045004670001 MUSLIHAT P
69 3601044109760002 YAYAH P
70 3601046708880004 HOTA P
71 3601041910740002 MUKTI L
72 3601040209740001 SARTIMI L
73 3601045608840001 IYUS L
74 3601045301770001 NARSIH P
75 3601040505820003 HENDI L
76 3601044106630001 WARMI P
77 360104510180001 RANITI P
78 3601044704820003 AMI P
79 3601044109760003 YAETI P
80 3601045108960004 DINI P
81 360104490920001 LATIKAH P
82 360104302620001 CARMA L
83 3601045011970008 NOPI P
84 3601044303940001 MARYANI P
 85 3601040812770001 DIDI L
86 3601045293680002 SITI P
87 3601040304700004 TARINGKM P
88 3601044107800274 SANAH P
89 3601045006850002 IROH P
90 36010468750001 ENCUM P
91 3601040304700004 TARINGKEM P
92 3601046507760004 NENI P
93 3601040107810045 NURMAN L
94 3601044210870001 TARKEM P
95 3601044810870004 SARIYAH P
96 3601042404980001 JUMALI L
97 3601041908670002 DARPIN L
98 360104261870001 NANO L
99 3601045504830004 MARAH P
100 3601044910990004 SARTINAH P
101 3601044107710175 JAMI L
102 3601041803710001 ADNA L
103 3601041805670001 SUPARTA L
104 3601045005740003 SANAH P
105 360104010940006 MASNI L
106 36010441077305616 ASMI P
107 3601046609730001 PIAH P
108 3601044105820001 AMSIH P
109 3601046102770002 BAYI P
110 3671050508020019 ARIPIN L
111 3601040708020004 AMADIN P
112 3601041006090001 MULYANA L
113 3601040107800270 HERI L
114 360104500194007 ISAH P
115 360201100477001 ROYANI L
116 360104804860001 DARINIH P
117 3601044107680304 RAMINIH P
118 3601045603770001 DARIYAH P
119 3602166007900002 NENGSIH P
120 360104420020004 KARTIKA P
121 36010416040003 LUTFI L
122 360104402560001 IYAH P
123 36010463070700001 SITI HATIPAH P
124 3601045112650004 SUNI P
125 36010458019710002 SAMI P
126 3601042201920001 IBING L
127 3601044303900002 JUHAYATI P
128 3523032609890001 MUSTAIN L
129 3601040307900002 SATRIA L
130 3601044107580116 SANIAH P
131 3601045203610001 EROH P
132 3601041695730001 SUKANAH L
133 3601045203860006 SUMYATI P
134 3601040107950165 KARYONO L
135 3601044106900003 RUMINAH P
136 36010426129300002 ADIT L
137 360104017920212 KUSNADI L
138 3601040701740006 HERI L
139 36010443076850001 SUTINAH P
140 3601045212040001 INDRI P
141 3601040608860002 ISNEN L
142 3601041203640001 USRI L
143 3601044112510002 IYOT P
144 3601040305880004 TATANG L
145 3601040101830001 RUSLI L
146 3601045409670001 SARNAH P
147 3601044601880001 KASMI L
148 3601046406800002 JUMINAH P
149 3601040706040005 M. ZAKI L
150 3601040101850004 IWAN L
151 3601041908940001 DARSONO L
152 3601042107650003 ASEN L
153 3601044107870130 SUPARIAH P
154 36010401053000002 TEDI L
155 3601045005670006 SAMINAH P
156 3601042002820002 UCU L
157 3601044507800017 JANATI P
158 3601040810060001 MUKTI. H P
159 3601041001910001 IMAN KOSIMAN L
160 3601045003030003 SINTA P
161 3601041303040001 NURJEDI L
162 3601044107810036 ENJUH P
163 3601040405700002 KARSUDIN L
164 3601044403960008 TUTI P
165 3601040701870003 DEDI L
166 3601040406630007 SURATNA L
167 3601044107780129 CARINIH P
168 3601040102920009 ADIN L
169 3601044107580207 RAMINAH P
170 3601040305680001 UDI L
171 3601041007810001 ARSUDIN L
172 3601044410810002 SURTINI P
173 3601040107500002 ASRAP L
174 36010442077000003 WALEM P
175 3601045209820001 UMYATI P
176 3601044808820003 YAYAH P
177 3601041318770001 WIRYO L
178 3601044406850003 WARTINI P
179 3601044203610003 RUMINAH P
180 3601045608990003 ETI P
181 360209170290001 SUBANDI L
182 3601046009860002 MURSIH P
183 3601045002600001 AMI P
184 360104100620001 KADI L
185 3601042512990004 DEVI PERMATASARI P
186 3601045207770004 INAH P
187 360104550740007 ROKMAH P
188 3601045210840001 CASIYEM P
189 3601040607860006 YUDI HERYANTO L
190 3601045507600006 WATI P
191 3601044902800002 SUHAETI P
192 36010410070300004 M. TARPIN L
193 3601045392590001 SAPRAH P
194 3601044700810002 BEDAH P
195 3601044703600001 SAPRAH P
196 3601045006810001 BAYI P
197 3601046012840002 WARNECI P
198 3601045405820006 YATI P
199 3601044107970221 SAINAH P
200 360104529080001 KARSIM L
201 3601044107590019 CASKEM L
202 3601045402900004 JANSAIH P
203 3601041609010001 NURALIM L
204 3601040112970001 SATIMANI L
205 3601045112910004 MASKAH P
206 3601040510950002 KHUSNI L
207 3601040810990001 MULYANA L
208 3601044501820001 MUMUN P
209 3601043005820001 DERI L
210 36010402030000004 AJID L
211 360104107590036 SENA L
212 360104107860191 TINAH P
213 3601046001840002 IRAWATI P
214 3601041102960002 ANTOON L
215 3601045507840005 DARSINIH P
216 3601040303910002 MISTA L
217 3601041307780001 JASUTA L
218 3601047012910003 ANIYAH P
219 3601043006030002 M. FAISAL L
220 360104112870001 YAYAH P
221 3601040309700001 ABAS SUTISNA L
222 36010445078520011 SUTINAH P
223 3601040307760001 HAMIM L
224 3601046011890001 AMAH P
225 360104511860001 SUARAN P
226 36010441007730326 SUKEMI P
227 3601044405850003 DARIAH P
228 3601042810000003 MAEDI L
229 3601045206790007 WATI P
230 3601045009720002 UUM P
231 3603180409040010 MAMAT L
232 3601044107780318 TARYAMI P
233 360104107830113 ERNAWATI P
234 360104102960010 ROHAMAH P
235 3601044701720002 UPEN P
236 1801182608050003 SARHANI L
237 3601044912020001 KARNAH P
238 3601041001650001 CASDA L
239 3601046606730002 SANIRAH P
240 3601046587820003 ETI P
241 360104010720071 DARTA L
242 36010402070390008 RESTU L
243 36010425080000005 AHMAD RIFAI L
244 3601045107870002 KARNI P
245 3601044612290001 ELAH P
246 36010444107690072 DARSIWEN P
247 '3601045101810002 SURNAH P
248 3601046005970001 SARNATI P
249 3601045403880005 ROSIDAH P
250 3601040302910003 SANDI L
251 360104410680006 ITI P
252 3601044107540063 ACIH P
253 3601044105770003 MIMI P
254 3601041307080001 SUHERMAN L
255 3601044404710002 BAYISAROH P
256 36010451026830004 DARIAH P
257 3601040610770001 OTONG L
258 3601040306910001 SAEPUDIN L
259 3601040107500072 SAMIN L
260 3601044205600004 JUHA P
261 3601040207690001 WIRNA L
262 3601044303600001 ASIDAH P
263 3601045101830005 SUNIATI P
264 36010467084400002 RUSNIAH P
265 3601045501860001 ODEH P
266 3601045605960003 LINAWATI P
267 3601045307810001 SAMAH P
268 360104020850001 UNIAH P
269 360104580300001 RAMAH P
270 3601046305430001 KARMAH P
271 3601044309360002 UPI P
272 3601044503850005 WINAH P
273 3601046105700001 SUMA'AH P
274 3601044604820001 MURTI P
275 360104531810001 ONAH P
276 3601045908970001 SITI MAESAROH P
277 3601046109790001 SADAH P
278 36010452057000002 SAMAH P
279 3601044107700073 CARNITI P
280 3601044107510063 WARINAH P
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 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

18-05-1979 UMUM RANCASENENG 085269962128

07-04-1974 UMUM CIKEUSIK 085697592199
01-07-1981 UMUM SUKASENENG 082120335150
01-07-1973 UMUM RANCASENENG 085211513756'
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12-04-2000 UMUM RANCASENENG 085773234577
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30-08-1980 UMUM KUTO CERENTI 081584367725
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27-09-1999 UMUM RANCASENENG 081210502909
05-01-1973 UMUM RANCASENENG 085891581109
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12-12-1969 UMUM CIKEUSIK 0852832318
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15-11-1965 UMUM CIKEUSIK 083873618781
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29-09-1974 UMUM CIKEUSIK 081617035905
05-05-1971 UMUM PARKOS 08577355574
12-07-1977 UMUM CIKEUSIK 08577355574
01-07-1987 UMUM CIKEUSIK 085864161425
13-01-1968 UMUM UMBULAN 085864161425
16-11-1988 UMUM SUKASENENG 085864161425
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02-06-1966 UMUM UMBULAN 085717531439
10-05-1981 UMUM UMBULAN 087872003873
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03-07-1955 LANSIA UMBULAN 085282376034
16-06-1965 UMUM SUKASENENG 085282376034
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01-06-1940 LANSIA UMBULAN 085283861718
06-07-1979 UMUM UMBULAN 085283861718
29-04-1972 UMUM RANCASENENG 085283861718
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Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

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CoronaVac 11/8/2021 2-09-2021 24003121
CoronaVac 11/8/2021 11/8/2021 24203721
CoronaVac 11/8/2021 11/8/2021 24203721
CoronaVac 11/8/2021 11/8/2021 24203721
CoronaVac 11/8/2021 11/8/2021 24203721
CoronaVac 11/8/2021 11/8/2021 24203721
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CoronaVac 11/8/2021 30-09-2021 24003121
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CoronaVac 11/8/2021
CoronaVac 11/8/2021 11/8/2021 24203721
CoronaVac 11/8/2021 11/8/2021 24203721
CoronaVac 11/8/2021 11-10-2021 202108171
CoronaVac 11/8/2021 11-10-2021 20408171F
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021
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CoronaVac 08-11-2021
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021 08-11-2021 24203721
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CoronaVac 08-11-2021
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CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
CoronaVac 08-11-2021 08-11-2021 24203721
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 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si

08-11-202 24203721

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08-11-202 24203721

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08-11-202 24203721

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08-11-2-2024203721

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08-11-202 24303721

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08-11-2021
08-11-2021

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08-11-2021

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08-11-2021

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08-11-2021
NO No. Ticket NIK Nama Penerima Vaksin JK

1 '3601040107000040 YADI SULISTIYO L

2 3601045508000006 CANI P
3 3601040107570012 SATRA L
4 3601044102800007 AMSAH P
5 3601041210790001 UJANG JAMALUDIN L
6 3601044206820004 SUKESIH P
7 3601044107430016 WAYEM P
8 3601044202940003 YATI P
9 3601040206770002 RAMANI L
10 3601044107830059 MURNA'AH P
11 3601045002870008 ENUR P
12 3601044107490002 SATUNAH P
13 3601044107630346 MARSAH P
14 3601045104000006 RITA P
15 3601042603750001 SUHANDI L
16 3601044107760033 HETI P
17 3601046003350002 JUHA P
18 3601044307990003 LILIS KHOSIAH P
19 3601044107810022 KARISAH P
20 3601045002450001 KECUN P
21 3601044107760032 SAKINAH P
22 3601046809950003 RITA P
23 3601045002750004 INEUNG P
24 3601044305770003 ERUM P
25 3601042010680001 ASMID L
26 3601044607300001 ASMINI P
27 3601040107430031 WARSA L
28 3601044107780011 KASMI P
29 360104107780031 ATIH P
30 360104010720002 SUPYA L
31 3601044107840021 NURHASANAH P
32 3601044107680055 KOCIH P
33 3601046609820001 IDAH P
34 3601044107340001 EEN P
35 3601044107780462 ECIH P
36 3601044609570001 SATIAH P
37 3601044512820001 SARNATI P
38 3601044305880007 YULIANA P
39 3601044107580033 ERAH P
40 3601045603920002 TARMI P
41 3601041807630001 A SUKARI L
42 SUCI LESTARI P
43 3601044107900194 SUMYATI P
44 360104443880002 BAI L
45 3601045502610001 PATIMAH P
46 3601045310800003 UUM P
47 3601044107880013 ROHENI P
48 3601044107710021 CARSINIH P
49 3601042412700001 RAIS L
50 3601044108000008 SANAH P
51 3601044107910049 EMI P
52 3501040107880027 HJ. ARSINAH P
53 360110440710007 NENG LELI P
54 36010451088900007 RATI P
55 3601044107820003 ROSMINI P
56 3601044107890005 ROHENI P
57 360104410750017 ELIS P
58 3601044107990002 AGUN L
59 3601046605860003 MARYAM P
60 3601040104630004 JUMAN L
61 3601044107810043 MISNI P
62 3601040902930002 DEDE P
63 3601042005790001 LOMRI L
64 3601045106950007 IDA ISAH P
65 3601044609820002 JENAB P
66 3601040107930003 M. PERI L
67 3601040208710001 KOMARUDIN L
68 3601044107720019 SAIAH P
69 3601040602550001 KARIM L
70 3601040501740001 RIYADI L
71 3601044409830003 SUKMANAH P
72 3601046008870002 NURSAH P
73 360104500489004 ENUR P
74 3601044107910003 EKA SEPTI P
75 3601044609780004 ASIH P
76 3601044107080458 SUMARNI P
77 3601044107630054 NARIAH P
78 3601042303810001 ROBIN L
79 3601044802980005 WARSINAH P
80 3601044503800008 HJ. SANIMAH P
81 3601044101850001 TRISNA P
82 3601045009030001 DINA AYU P
83 3601045504930001 SUHENI P
84 3601046004840003 ISAH P
85 3601044310840003 MARNI P
86 3601040211720001 ITA P
 87 3601046505850001 SAENI P
88 3601044107680050 KASWEN P
89 36010470100002 PUPU P
90 4601045202780003 AMINAH P
91 3601045008820005 IIS P
92 3601040608900003 AJAT L
93 3601042604750001 SUANTA L
94 3601046805730002 CICIH P
95 360104410730023 ISAH P
96 3601045909780002 ENENG P
97 3601044508770001 TITIN P
98 3601045205680006 EMIN P
99 3601046404740001 NYAI P
100 3601044210920001 HASANAH P
101 3601044701840003 WASIH P
102 3601045909830001 SAPTI P
103 3601044606830007 SANAH P
104 3601040107830038 BUDI L
105 3601045100090002 SITI JUBAEDAH P
106 3601043107590005 JUNAH P
107 3601046401800002 MARYATI P
108 3601044604690003 NEMAH P
109 3601046803690002 TATI P
110 3601044107738070 NURYATI P
111 3601045603780001 AMI P
112 3601044107570017 SAIDAH P
113 3601044107780041 METI P
114 3601044107810004 FATMAWATI P
115 3601040107760005 EMAN L
116 3601040111750001 TATA L
117 3601042006810007 IWAN L
118 360104550650001 ANAH P
119 3601041701870002 SUBROTO L
120 3601040504750001 MALI L
121 3601040602810004 IDRIS L
122 3601040107320003 MUKTAR L
123 3601040107680076 JANIM L
124 3601040107700021 TANA L
125 3601044107650026 JUHETI P
126 3601044205800002 ATIAH P
127 3601044107720003 AAM P
128 3601040107740005 JOHAR ARIPIN L
129 3601044311870003 ANI P
130 3601041010800008 E. KUSNADI L
131 3601040507610002 PENDI L
132 3601044305970001 NURUL. M P
133 ENI NURAENI P
134 CARSIM
135 3602214708930001 JUMHATI METI P
136 360104410760042 TIWIL P
137 3601044905650001 RASTINI P
138 360104410760007 DENAH P
139 3601044104620001 ROHATI P
140 3601040107740010 SUKARDI L
141 360104590840002 TINAH P
142 36010451128900001 ISNAAWATI P
143 3601044107900196 SARNAH P
144 3601044107790013 SAIMAH P
145 3601045003760004 KADMI P
146 3601044405810001 SURTINI P
147 360104410789158 RATNAWATI P
148 360104420500002 UMYATI P
149 3601045207870002 ISRI P
150 3601044107790011 WATI P
151 360104410550011 MARSIH P
152 360104410780043 WASRI L
153 360104504620003 NINING P
154 3601044107790160 TINI P
155 36010456009780005 KASWATI P
156 3601042407830001 OHIM L
157 3601041610580001 TASLIM L
158 3601044107680030 ARSAH P
159 3601044203700004 ARWANAH P
160 3601045890097008 RIZKI AMALIA P
161 3601044107210001 ASNAH P
162 3601046004860001 SANI P
163 3601040910770001 ADIK L
164 3601044107580035 SATIRAH P
165 3601046102710001 TASMINAH P
166 3601040107560022 SAWIN L
167 3601045006760004 UMINAH P
168 3205186406000001 SITI NENI P
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177 3601040107630004 ROHILAH P
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185 ADAH P
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188 360104701195001 ANISA PUTRI P
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200 3601044107720016 PARMANAH P
201 3601045205950002 RIKA P
202 3601040908890002 CAHEDI L
203 3601044103870010 TURINAH P
204 3601043004030004 SAHRUDIN L
205 3601044107750026 CARTI P
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214 360104150779002 ENGKOS L
215 3601042406930004 AMIN L
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220 3601044107570009 DEDEH P
221 3601040107730026 SUBAN L
222 3601042409610007 BUSTOMI L
223 3601041503900005 AANG L
224 3601040105680002 AHYUDIN L
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226 360104408600001 SUKMARIAH P
227 3601045810850003 TITA ROSITA P
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229 3601044107780001 YAYAN L
230 3601044107020005 IDA NURHAPIA P
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233 3601041004820008 EDI SUHAEDI L
234 3601042703810007 WARCIM L
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237 3601044107800036 RASKEM P
238 3601045112900007 TARIAH P
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240 3601044610750001 NENGSIH P
241 3601044506760004 MARYAM P
242 3601045205750003 TINAH P
243 3601045209800005 NIAH P
244 3601045001750001 RUMI P
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246 3601044107780447 RACIH P
247 3601046008700003 KASTEM P
248 3601044904800004 EMI P
249 3601046001620001 TINAH P
250 3601045904070002 SELVI P
251 3601044107810030 SAMSIAH P
252 3601044107630032 ISAH P
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254 3601044301740003 MUMUN P
255 NAYAH P
256 3601045509720003 RABA P
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266 3601044112800005 YANAH P
267 3601046206910001 NEWI P
268 3601044107550010 SARNITI P
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280 3601040107750043 KAMIM L
281 3601040205890001 TONI L
282 3601040107580228 MISNAR L
283 3601045701850001 ENENG RINI P
284 3601044107760009 KEKEM P
285 3601041712920005 ADE L
286 3601040912920001 ENDIN L
287 3601040107740008 AJID L
288 3601045102870005 RUMSAH P
289 3601044107650004 ARNAH P
290 3601040501720001 TATA SUPRIATNA L
291 3601045106780002 HENAH P
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293 3601045709830002 NENI P
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295 3601044603850006 KESIH P
296 3601044107650199 ROHANAH P
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299 3601045905780001 JUNAH P
300 3601040107840002 SUHERLAN L
301 3601044107710023 ROHATI P
302 3601044510920004 RASITOH P
303 3601044107860019 HAMIMAH P
304 3601044107480001 ENI LESTARI P
305 3601044111000001 LINDA SAFITRI P
306 3601040107730003 CAKRA L
307 3601044710500002 LAMRAH P
308 3601040501820007 DEDI L
309 3601044207840008 MARNI P
310 3601044806570001 WANAH P
311 3601040907680006 DANI L
312 3601046809920002 SITI NOOR ROHMAH P
313 3601044107950006 SIPA HAMBAMI P
314 3601045512460002 SITI MINARSIH P
315 3601044107750038 TARKEM P
316 3601044403950001 ROSYAWATI P
317 3601046007850003 TURINIH P
318 3601046003730001 BADRIYAH P
319 3601041606720002 TOHIRI L
320 3601045011790005 MARIAH P
321 3601045911020001 RINA FITRIYANI P
322 3601044107780007 MARNI P
323 1602114606820005 ANIS P
324 3601040107530017 ENTANG L
325 360104510650003 SATI P
326 3601045407600006 INAH P
327 3601040107530022 MUIH P
328 3602215803680001 SARAH P
329 3601044609730002 SANAH P
330 3601040609650001 SAMAD L
331 3601044107430004 DARSIPAH P
332 3601044107820029 SANYAAH P
333 3601045012850008 SARMINAH P
334 3601044710950001 MARNAH P
335 3601044709550001 ASNAH P
336 3601044410980007 LINDAWATI P
337 3601041902680002 TURA L
338 3601040202740001 SANIAH P
339 3601045010980002 ARUM NOVITASARI P
340 3601044107730068 LASNI P
341 3601046411700001 IYAH P
342 3601046204770001 ISAH P
343 3601045304650001 SITI HASANAH P
344 3601044107820190 RUMYATI P
345 3601045005800003 SURNI P
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347 36010406057800003 MADSOLEH L
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350 3601045210640001 JATI P
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352 3601040110800004 SARTA L
353 3601041207700001 AHMID L
354 36010408040001 SATRIA L
355 3601046909840001 UUM HUMAEROH P
356 3601041502860001 AMBARI L
357 3601045003900005 SAMINAH P
358 3601046004750002 JUNAH P
359 3601040107550010 ARSIM L
360 3601044610750002 SAROH P
361 3601042710620002 JAKARIA L
362 3601044607750003 MURTI P
363 3601041807550001 RAHMAN L
364 3601046002850004 MARHENI P
365 3601042906870001 HUSNI L
366 3213056704030004 IRNA ROSALINA P
367 3601044302050007 JUMI ROMHANI P
368 3213055207820027 ROSITA P
369 3601040107860283 ROHADI L
370 3601045404660001 SADAH P
371 3601045111780001 JUJU JUARIAH P
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376 3601045601010003 LUSIANA P
377 3601044911940002 TARNI P
378 3601046607880001 NINING MAIDA P
379 3601040807780001 YUSUP L
380 3601044203760001 ELIH P
381 3601040107500017 AMIR L
382 3601040107680071 SAPAI L
383 360104100767 HAPID L
384 3601045712790001 SARAH RISMAYA P
385 3601045102700002 SURTIAH P
386 3601024209830005 UTIN P
387 3601040912790002 SAMANAN L
388 3601041008490001 SUKANTA L
389 3601044107820026 SUMINIH P
390 3601041609710001 IDING L
391 3601042104750001 ABIDIN L
392 3601044107800057 SUNETI P
393 3601045312990001 EVA NOVITA P
394 3601041007540003 SUMINTA L
395 3601045411850001 SACIH P
396 3601040307800002 ARDI L
397 3601045504800004 MARYATI P
398 3601044107770008 EMI P
399 3601044712980007 SURYATI P
400 3601044109910002 DARSIAH P
401 3601046010790003 SAWIAH P
402 3601040107560002 ROPIK L
403 3601044105800001 ARTI P
404 3601045002900005 IIS KOKOM P
405 3601045012720002 SUHETI P
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410 3601044107880008 SAMI P
411 3601044701830002 SUMINAH P
412 360104410770015 SAWIANAH P
413 3601044107700003 SUMIARSIH P
414 3601041203900006 SUKAEDI L
415 3601040107550098 ARSUDIN L
416 3601045616680001 SITI P
417 3601045405810002 ENJEH P
418 3601046108580001 MUSPIROH P
419 3601040101940038 ELI L
420 3601044104690001 INAH P
421 3602214812860001 RISYA ROSDIANA P
422 3601044107710033 RUSNI P
423 3601045512690001 ETI P
424 3601040107520011 UTAR L
425 3601040107730042 ABAN L
426 360104650960001 IDA FARIDA P
427 3601045201690003 PARTI P
428 3601044105630002 ARTI P
429 3601040107790016 SARMIDI L
430 3601046310690001 SODAH P
431 3601044510790003 EEN P
432 3601046105010001 YUYUN P
433 3601046607910001 BISMA SUCI P
434 3601041103850001 NURIDIN L
435 3601044311850008 SENA P
436 3601044203770002 SITI MASTUROH P
437 3601041606770002 SUPYAN ROHMAN L
438 3601044611850001 SAAH P
439 3601044107740011 WANIAH P
440 3601045404960003 LIYAH F P
441 3601042405750004 TARLI L
442 3601044107500072 ENAH P
443 3601044602940002 TARSIH P
444 3601045804920001 NURLIA P
445 3601042008670001 NATA L
446 3601046001840003 SARNI P
447 3601046008730003 ARNITI P
448 360104410710002 ARSINAH P
449 3601044205820004 SAMI P
450 3601044107910007 ROSDIANA P
451 360104410758002 SARPINAH P
452 3601044107780066 CARMI P
453 36010401077780071 WARMA L
454 3601040101770013 MASDA P
455 36010441097780005 SANI P
456 3601045609800003 I'AH P
457 3601044912600002 MINAH P
458 360104010790005 HAMJAN L
459 3601045107770004 SITI P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

15-06-2000 UMUM SUMURBATU

15-08-2000 UMUM SUMURBATU
01-0701957 LANSIA SUMURBATU
01-02-1980 UMUM SUMURBATU
12-10-1979 UMUM SUMURBATU
02-08-1982 UMUM SUMURBATU
01-07-1943 LANSIA SUMURBATU
02-02-1994 UMUM SUMURBATU
02-06-1977 UMUM SUMURBATU
07-09-1980 UMUM SUMURBATU
10-02-1987 UMUM SUMURBATU
11-04-1965 UMUM SUMURBATU
01-07-1963 UMUM UMBULAN
11-04-2000 UMUM UMBULAN
26-03-1975 UMUM UMBULAN
14-08-1978 UMUM SUMURBATU
20-03-1935 LANSIA CIWET
12-12-2001 UMUM UMBULAN
01-07-1981 UMUM SUMURBATU
10-02-1945 LANSIA SUMURBATU
01-07-1983 UMUM SUMURBATU
28-09-1995 UMUM SUMURBATU
10-02-1975 UMUM SUMURBATU
03-05-1977 UMUM SUMURBATU
12-12-1990 UMUM SUMURBATU
06-07-1930 LANSIA SUMURBATU
01-04-1943 LANSIA SUMURBATU
01-07-1973 UMUM SUMURBATU
01-07-1978 UMUM SUMURBATU
21-07-1963 UMUM SUMURBATU
24-12-1984 UMUM SUMURBATU
01-07-1968 UMUM SUMURBATU
26-09-1982 UMUM SUMURBATU
01-01-1981 UMUM SUMURBATU
01-07-1978 UMUM SUMURBATU
06-09-1957 LANSIA SUMURBATU
05-12-1962 UMUM SUMURBATU
03-05-1988 UMUM CURCI
01-07-1958 LANSIA SUMURBATU
SUMURBATU
03-04-1954 LANSIA SUMURBATU
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01-07-1990 UMUM UMBULAN
04-03-1988 UMUM SUKAWARIS
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22-07-1965 UMUM SUMURBATU
01-07-1971 UMUM SUMURBATU
24-12-1970 UMUM SUMURBATU
01-08-2000 UMUM SUMURBATU
02-07-1988 UMUM SUMURBATU
01-07-1965 UMUM SUMURBATU
04-06-1992 UMUM UMBULAN
1-08-1989 UMUM SUKAWARIS
20-12-1983 UMUM SUMURBATU
03-04-1987 UMUM SUMURBATU
01-07-1985 UMUM SUMURBATU
13-06-2001 UMUM SUMURBATU
26-05-1986 UMUM UMBULAN
10-01-1965 UMUM SUKAWARIS
09-09-1986 UMUM SUMURBATU
09-02-1993 UMUM SUMURBATU
20-05-1980 UMUM SUMURBATU
11-06-1995 UMUM TANJUNGAN
06-09-1982 UMUM UMBULAN
02-04-1989 UMUM UMBULAN
02-08-1971 UMUM SUMURBATU
01-07-1972 UMUM SUMURBATU
06-02-1955 UMUM SUMURBATU
05-01-1994 UMUM SUMURBATU
04-09-1983 UMUM SUMURBATU
20-08-1987 UMUM SUMURBATU
10-04-1995 UMUM SUMURBATU
29-09-1990 UMUM SUMURBATU
06-09-1978 UMUM SUMURBATU
01-07-1978 UMUM UMBULAN
19-03-1963 UMUM SUMURBATU
23-03-1981 UMUM SUMURBATU
08-02-1996 UMUM SUMURBATU
05-03-1980 UMUM UMBULAN
15-04-1985 UMUM SUKAWARIS
10-09-2003 REMAJA SUMURBATU
15-04-1993 UMUM SUMURBATU
20-04-1984 UMUM SUMURBATU
03-10-1984 UMUM SUMURBATU
02-11-1972 UMUM SUMURBATU
27-02-1981 UMUM SUMURBATU
01-07-1968 UMUM SUMURBATU
30-12-1970- UMUM CIWET
11-01-1978 UMUM CIWET
10-08-1982 UMUM CIWET
04-10-1989 UMUM CIWET
09-11-2001 UMUM CIWET
07-02-1975 UMUM CIWET
01-07-1943 LANSIA RANCASENENG
19-09-1978 UMUM CIWET
05-08-1977 UMUM CIWET
12-05-1968 UMUM CIWET
24-04-1964 UMUM CIWET
02-10-1992 UMUM CIWET
07-01-1984 UMUM CIWET
19-09-1983 UMUM CIWET
20-06-1970 UMUM CIWET
10-06-1983 UMUM SUMURBATU
11-06-2009 REMAJA SUMURBATU
01-07-1959 UMUM CITEUREUP
24-01-1980 UMUM CIWET
06-04-1969 UMUM SUMURBATU
28-03-1969 UMUM UMBULAN
01-07-1973 UMUM CITEUREUP
16-03-1978 UMUM UMBULAN
01-07-1957 UMUM SUMURBATU
16-06-1998 UMUM SUMURBATU
01-07-1981 UMUM SUMURBATU
10-12-1974 UMUM SUMURBATU
01-11-1975 UMUM UMBULAN
02-01-1982 UMUM TANJUNGAN
15-05-1965 UMUM SUMURBATU
17-01-1981 UMUM SUMURBATU
05-04-1975 UMUM UMBULAN
06-02-1981 UMUM SUMURBATU
27-01-1973 UMUM SUMURBATU
15-05-1969 UMUM SUMURBATU
01-0701977 UMUM SUMURBATU
01-07-1965 UMUM SUMURBATU
07-05-1980 UMUM SUMURBATU
01-01-1965 UMUM SUMURBATU
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03-11-1987 UMUM SUMURBATU
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01-01-1958 UMUM SUKAWARIS
07-08-1993 UMUM SUKAWARIS
01-07-1976 UMUM SUKAWARIS
09-05-1965 UMUM SUKAWARIS
01-07-1961 UMUM SUMURBATU
25-06-1971 UMUM SUKAWARIS
29-08-1973 UMUM SUMURBATU
19-08-1982 UMUM SUMURBATU
11-12-1989 UMUM SUMURBATU
16-12-1969 UMUM UMBULAN
18-06-1978 UMUM SUMURBATU
10-03-1976 UMUM UMBULAN
04-03-1981 UMUM UMBULAN
01-07-1989 UMUM UMBULAN
02-05-2000 UMUM SUMURBATU
09-02-1983 UMUM UMBULAN
01-07-1979 UMUM SUMURBATU
23-03-1963 UMUM UMBULAN
04-11-1978 UMUM SUMURBATU
15-04-2002 UMUM SUMURBATU
01-12-1979 UMUM SUMURBATU
16-09-1978 UMUM SUMURBATU
24-07-1983 UMUM SUMURBATU
16-10-1958 LANSIA SUMURBATU
13-09-1970 UMUM SUMURBATU
02-03-1970 UMUM SUMURBATU
12-06-1997 UMUM SUMURBATU
07-03-1978 UMUM SUMURBATU
20-04-1986 UMUM SUKAWARIS
09-10-1977 UMUM TANJUNGAN
01-07-1958 LANSIA SUMURBATU
21-02-1971 UMUM UMBULAN
01-07-1956 LANSIA SUMURBATU
10-06-1976 UMUM SUMURBATU
24-06-2000 UMUM PEJATEN
02-08-1997 UMUM SUMURBATU
01-07-1975 UMUM SUMURBATU
11-07-1988 UMUM SUMURBATU
02-07-1979 UMUM TANJUNGAN
01-07-1978 UMUM UMBULAN
02-04-1991 UMUM SUMURBATU
14-09-1964 UMUM SUMURBATU
31-01-1958 LANSIA TANJUNGAN
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10-11-1972 UMUM SUMURBATU
23-04-1086 UMUM SUMURBATU
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10-06-1974 UMUM SUMURBATU
01-07-1964 UMUM SUMURBATU
01-07-1960 UMUM SUMURBATU
01-07-1951 LANSIA SUMURBATU
04-06-1967 UMUM SUMURBATU
23-09-1990 UMUM SUMURBATU
22-02-1988 UMUM SUMURBATU
30-11-1995 UMUM SUMURBATU
01-07-1977 UMUM SUKAWARIS
25-04-1983 UMUM SUMURBATU
01-07-1978 UMUM SUMURBATU
02-01-1988 UMUM SUMURBATU
03-03-1985 UMUM SUMURBATU
22-08-1969 UMUM SUKAWARIS
01-07-1961 UMUM SUMURBATU
01-07-1969 UMUM SUMURBATU
15-11-1970 UMUM SUMURBATU
01-01-1986 UMUM SUMURBATU
10-09-1963 UMUM UMBULAN
15-07-1974 UMUM SUMURBATU
12-05-1995 UMUM SUMURBATU
09-08-1989 UMUM SUMURBATU
01-03-1967 UMUM SUMURBATU
30-04-2005 REMAJA SUKAWARIS
01-07-1975 UMUM SUMURBATU
09-02-2001 UMUM SUMURBATU
24-03-1984 UMUM UMBULAN
10-12-1975 UMUM SUMURBATU
30-08-1980 UMUM SUMURBATU
01-07-1978 UMUM SUMURBATU
01-07-1991 UMUM SUMURBATU
07-05-1990 UMUM SUMURBATU
14-08-1978 UMUM SUMURBATU
15-08-1979 UMUM SUMURBATU
24-06-1993 UMUM SUKAWARIS
01-07-1980 UMUM SUMURBATU
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09-01-1985 UMUM SUKAWARIS
10-06-1986 UMUM SUMURBATU
11-02-1985 UMUM SUMURBATU
29-04-2002 UMUM SUMURBATU
02-05-1960 UMUM SUMURBATU
01-07-1958 LANSIA SUMURBATU
10-04-1982 UMUM UMBULAN
27-03-1987 UMUM SUKAWARIS
01-07-1968 UMUM SUMURBATU
05-10-1998 UMUM UMBULAN
25-06-1979 UMUM SUMURBATU
11-12-1990 UMUM SUMURBATU
02-08-1974 UMUM SUMURBATU
06-10-1977 UMUM SUMURBATU
05-06-1976 UMUM SUMURBATU
12-05-1975 UMUM SUMURBATU
12-09-1980 UMUM SUMURBATU
10-01-1975 UMUM SUMURBATU
01-07-1965 UMUM UMBULAN
19-06-1977 UMUM UMBULAN
06-08-1983 UMUM UMBULAN
11-01-1972 UMUM SUMURBATU
20-01-1962 UMUM SUMURBATU
19-04-2007 UMUM UMBULAN
01-07-1981 UMUM SUMURBATU
01-07-1963 UMUM SUMURBATU
18-10-1968 UMUM SUMURBATU
03-04-1974 UMUM SUMURBATU
01-07-1968 UMUM SUMURBATU
15-09-1972 UMUM SUMURBATU
13-09-1982 UMUM SUMURBATU
01-06-1975 UMUM SUMURBATU
01-02-1963 UMUM SUMURBATU
08-09-1965 UMUM SUMURBATU
17-02-1989 UMUM SUMURBATU
01-07-1942 UMUM SUMURBATU
01-07-1966 UMUM SUMURBATU
10-07-1977 UMUM SUMURBATU
02-07-1939 UMUM SUMURBATU
01-12-1980 UMUM SUMURBATU
22-06-1991 UMUM SUMURBATU
01-07-1855 UMUM SUMURBATU
01-07-1975 UMUM SUMURBATU
01-07-1958 UMUM SUMURBATU
22-04-1978 UMUM UMBULAN
16-10-1980 UMUM LEUWIGEDE
12-08-1974 UMUM SUMURBATU
05-04-1975 UMUM PEMATANG BUAH
01-07-1993 UMUM UMBULAN
16-06-1950 UMUM SUMURBATU
04-08-1960 UMUM SUKAWARIS
04-05-1990 UMUM SUMURBATU
18-09-1986 UMUM LEUWIGEDE
01-07-1975 UMUM SUMURBATU
07-07-1987 UMUM SUMURBATU
01-07-1958 UMUM UMBULAN
17-01-1985 UMUM CIWET
01-07-1976 UMUM SUMURBATU
17-12-1992 UMUM SUMURBATU
28-11-1992 UMUM SUMURBATU
11-04-1973 UMUM SUMURBATU
11-02-1987 UMUM SUMURBATU
01-07-1965 UMUM BABAKAN SABEULAH
05-01-1972 UMUM SUMURBATU
03-07-1979 UMUM BIDUR
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17-09-1983 UMUM SUMURBATU
11-04-1980 UMUM SUMURBATU
06-03-1985 UMUM LEUWIGEDE
01-07-1965 UMUM SUMURBATU
02-11-1988 UMUM LEUWIGEDE
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 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Tanggal
NO HP BPJS BPJS Non Merek Vaksin***
Screening
PBI Non PBI Anggota

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 Dosis I Dosis 2
Tanggal Tanggal
Pemberian No. Batch No seri Pemberian No. Batch
Vaksinasi Vaksinasi
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BUMIL

LANSIA
16259029662097
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 360104010730090 SARWA P
2 3601045011810002 JUAH P
3 36010450005750002 SARITEM P
4 3601044107660159 UNAH P
5 3601040107740058 JUHRA L
6 3601044808740001 SANAH P
7 360104410290008 NIAWATI P
8 ATIKAH P
9 ODAH P
10 3601044107890098 KENAM
11 3601045601000003 AYU LESTARI P
12 360104122650001 JAMHARI L
13 3601040303020001 NADI L
14 EROH P
15 360104107500092 SANDI L
16 3601040509760001 SACA L
17 AHMAD L
18 RAPI P
19 SARI P
20 3601040706500002 MARHAPI L
21 HASANAH P
22 3601040107780209 SANTA L
23 ADAH P
24 RUMSANAH P
25 3601041711760001 MEDI L
26 360104490950002 YANTI P
27 3601044107600044 RATI P
28 WASTA P
29 3601045002030006 ARNI P
30 MIMIN P
31 RITA P
32 MILA CARMELIA P
33 AKMID L
34 3601044107910132 MILAWATI P
35 360104514990004 OMAH P
36 3172042719660002 YAN MAMESSY L
37 3601045204780006 ARSIAL L
38 3601045402950004 YENI P
39 3601045105800005 WATI P
40 ROHAYATI P
41 360104703910001 NANI P
42 BANI L
43 ASTI P
44 3601040509010002 NURUL AZIZAH P
45 3601044107950106 JUHERI L
46 3601044903920002 ROSTIANI P
47 SUHENAH P
48 RUNAH P
49 3601045202050002 MILA FEBRIANTI P
50 SUTIHAT P
51 AMAH P
52 RESEM P
53 BAWON L
54 36010408050001 RIKI RAHMAN L
55 SUTARNA L
56 360104410763050 RUMINAH P
57 360104410750134 ASNAMAH P
58 SITI NURBAETI P
59 ENONG P
60 MARNAH P
61 ELAH P
62 RATNA P
63 SAKAM L
64 H. JAHAR L
65 JUMINAH P
66 3601040310750004 SAKUR L
67 YANA L
68 360104508000016 IMAS P
69 360104210290002 JONI L
70 YENI WIDAYATI P
71 3601040601000005 SAMSUL L
72 HERI L
73 3601040905070001 SARTANA L
74 JUMAN L
75 3601040107880168 DARSA L
76 3601040107880127 HAERUDIN L
77 3601044107750115 JUHA P
78 3601044102780003 SUKAESIH P
79 3601040107710077 SUKATMA L
80 3601044107480024 KASMAH P
81 PERI L
82 3601044107760129 SAMINAH P
83 3601045706890001 MARNAH P
84 3601044107950116 WARSINIH P
85 3601046107860001 WATI P
86 3601044390003 MISNAH P
87 3601044411900006 UNI P
88 RESNAWATI P
89 3601041212020001 TEDY L
90 3601045100000004 OMAH P
91 360104252460001 JUMEDI L
92 36010460110001 RUMSINAH P
93 360104611070001 RINDI P
94 3601040709030004 ANGGUN GUMILANG L
95 3601044107770049 KOKOM P
96 36010443476500003 DASMINAH P
97 3601085302950001 EMAH P
98 3601040107650071 SARMU L
99 3601044804000008 RITA P
100 360104420680009 RUMSANAH P
101 36010441090810005 KRISTININGSIH P
102 3601040107820070 SUKIRMAH P
103 DARNI L
104 360104470750005 JUHANAH P
105 3601040107750269 ARMAH P
106 3601040211830003 ENDANG L
107 JUHAYA P
108 TARSA L
109 3601041104880002 ROHMAN L
110 3601041300080002 BOHIN L
111 3601040309780001 AMAN L
112 3601044800050001 SUMINAH P
113 ERI L
114 3601040107500095 WARSA L
115 360104170770001 JULI L
116 JUJU L
117 IDA ROYANI P
118 3601041503790001 SARTU L
119 36010450117900012 ETI P
120 3601046705040003 RISKA P
121 EVA P
122 3601041906650001 JUHARIA L
123 3601045409800004 CICIH P
124 SALI L
125 ENAY P
126 CASTI P
127 SUMADI L
128 3601044610620002 MARNI P
129 3601044107670120 AMAH P
130 3602210112900004 ASNAP L
131 3601046501950001 SANAWI P
132 3601041309830004 ABSO'I L
133 3601044203830001 IJAH P
134 KAMID L
135 36010451030006 NIDIA P
136 36010423030001 MAYANG SARI P
137 3601040102770001 ATANG L
138 3601040102740002 TARINDA L
139 3601044706880001 DARWATI P
140 3601041204850001 ABDUL MUNIF L
141 3601042007260003 AHDI L
142 NENG RUSNAENI P
143 3601040107530153 IKUN L
144 3601044604800002 JUARSIH P
145 360227911290002 RAHMA ALYA P
146 JUMENAH P
147 3601045604020001 KARSIH P
148 3601044107650126 RASINAH P
149 MIRDAN L
150 SALIMAH P
151 3601044107700018 CASNITI P
152 360104041180003 SAMSA L
153 36022147050400004 MAE HELMI P
154 3601044107830437 AAN MARYANI P
155 3601044410930002 ASMINAH P
156 3601044407750006 BAYI P
157 3601041703830002 AGUS L
158 3601045806010002 GISNA NURHAYATI P
159 3601040401800003 AHMAD L
160 3601046707000004 YULIANI P
161 3601040107730402 SUKRI L
162 SANIAH P
163 360104410710011 WARTINI P
164 AISAH P
165 3601045403810003 WASIH P
166 360104311920001 MARYAM P
167 60104410760060 UMIDAH P
168 36010408820004 SAMAN L
169 3601040201920001 UKI L
170 360104590520001 ARSATI P
171 3601044104900007 MASRUBIAH P
172 IYON L
173 NURLI P
174 3601041008860001 SUHAYA L
175 3601041410720001 KODON L
176 SUHENDI P
177 SANUSI L
178 NANI. R P
179 3601041210750002 WAWAN SAEPUDIN L
180 3601045111710001 LILIS P
181 JUNTI P
182 3601040403000003 ROBI L
183 ADHAR L
184 TONI L
185 SAKI L
186 3601044112800006 SACI P
187 3601040105970006 HENDRI L
188 IDAH P
189 3601040107860083 DARYOM L
190 AGUS L
191 SARMINAH P
192 3601044204940001 IIN PADILLAH P
193 SAODAH P
194 3601040303520002 SANTA L
195 SAENAH P
196 3601045209850007 ENTIN P
197 MIMIN P
198 3601044208070001 YULIANI P
199 3601044911750001 NURYATI P
200 3601041510690001 ATMA L
201 IIS P
202 360104410800001 WARMI P
203 RUHE P
204 SADIRA L
205 3601040107750243 SOLIKIN L
206 ARUM P
207 3601046603680001 JANESIH P
208 JUHERI L
209 ROHMAN L
210 3601041011860003 TARSANI L
211 RASMAH P
212 3601044107600008 BAI P
213 UMAR L
214 KAISAH P
215 FATMAWATI P
216 TARSIH P
217 360104020560001 JAYA L
218 36010458075030007 JUMIYATI P
219 3601040110600003 SANTA L
220 36010442070001 CASMINAH P
221 KURIANI P
222 3601040107680267 DARSIYAH L
223 36010407050004 GIGIN L
224 3601046802060001 LUSI FEBRIANI P
225 360104200780002 KARMAN L
226 360104503980009 ROPIAH P
227 36010407860218 MARJANI P
228 IRI P
229 360104030500002 RASJANA L
230 3601044406800003 RUMSANAH P
231 3602269105990001 ANI SETIANA P
232 AAP TAPRIZIYAH P
233 KOMARIYAH P
234 RUMSIAH P
235 360104530700001 KARTI P
236 KENAH P
237 3601041307970001 LUKMAN L
238 3601045804660002 RUKMI P
239 TASLIAH P
240 HENDRIK L
241 3601042802860003 ALI L
242 3671015011790001 DANING SRI P
243 ADITIA P
244 3602210402910002 ASEP SUJAI L
245 360104580300002 MASNAH P
246 SITI RUKIYAH P
247 3601041510890004 RUDI IRAWAN L
248 3601044707900010 IIS DAHLIA P
249 3601041507030005 TAUFIK HIDAYAT L
250 360104490881000 ASIH P
251 SANIAH P
252 ARDIN L
253 JUBAEDAH P
254 360104410793461 LISA APYANTI P
255 3601044903800001 SUTINAH P
256 3601044304970003 EVA APRIYANTI P
257 3601046006790002 SALINAH P
258 3601040504820010 TARSANI L
259 TEGUH L
260 3601044107660001 MURHE P
261 MARKIM L
262 3601044107850046 IDA UMAMI P
263 3601040706760002 TARUM L
264 360104406700002 WARYAH P
265 360104417760074 HALIMAH P
266 3601045401900002 WASTEM P
267 360104010810143 ALI L
268 36010441076800003 IJAH P
269 3601044711930003 KRISNAWATI P
270 3601044107880202 WARNITI P
271 3601042501940001 JAMALUDIN L
272 UMAR LUBIS L
273 3601040107680301 ROSAD L
274 360104406050003 SI AYUNI P
275 360104230203060003 YOGI SAPUTRA L
276 360201460100002 FITRI MEILANI P
277 3601040107650001 WARDI L
278 36010445010001 TARMI L
279 IDEM P
280 JUHRO P
281 KASEM P
282 3601044109510001 RASLEM P
283 RASWINIH P
284 36010324006340001 ROHIM L
285 3601046004050001 SARNI P
286 3601044108100003 MASNI P
287 36010451000006 AETI P
288 360104410790109 ASTI P
289 3601044406610002 SARNITI P
290 MELAWATI P
291 CARSINEM P
292 36010468050010001 FATMAWATI P
293 3601041810870005 NURKAT L
294 M. WASEN L
295 KADMINIH P
296 KARSA L
297 360104437750002 SITI ASIYAH P
298 3601040107430081 KARNADI L
299 1603204305850001 SITI MAEMUNAH P
300 WARLAN L
301 SARINIH P
302 CARSIAH P
303 NAYA L
304 SARDAN L
305 PIPIH PITRIANI P
306 TASINIH P
307 TASKEM P
308 RIAH P
309 SITI HODIJAH P
310 KHODIJAH P
311 SAMSUDIN L
312 SAMA'IN L
313 SUNARTO L
314 WARIAH P
315 3601042508000002 PARNO L
316 NILAM P
317 KONIAH P
318 3601045710020006 RETNO PARIDA P
319 AJID L
320 ROHIM L
321 360104410730324 YENI P
322 SARINIH P
323 JUNAENI P
324 IIS MELANTIKA P
325 LESTINA P
326 SUKENAH P
327 3601044910750002 MUNASIH P
328 3601040508080005 MAULANA HOSYIM L
329 DULWAHID L
330 SITI JULAEHA P
331 3601044510850001 UMI P
332 360104231170001 USMAN L
333 3601044308630001 ITI P
334 360104410750059 WARINIH P
335 ENENG SANAH P
336 SARMILA P
337 JUNARIAH P
338 KADA L
339 ROMLAH P
340 3601040107580071 SARNI P
341 RATINIH P
342 NELA P
343 DAENAH P
344 3601040107650082 WAHIDIN L
345 3601041807530003 SUHENDI L
346 DIMAS L
347 CARTI P
348 TARIH P
349 TARMAH P
350 SADAH P
351 360104141270001 ADAR L
352 NURYATI P
353 3601044407290002 ROPIAH P
354 IIS DAHLIA P
355 RABANI L
356 SARTI P
357 360104480160001 ASNAH P
358 360104010770099 RASMAN L
359 3601040200530001 KADI L
360 ACIM L
361 RENA MAULIDA P
362 ROJI L
363 3601044602420002 AISAROH P
364 3601040003750001 ENEN R P
365 NURDIN L
366 3601041506080001 KODIRIN L
367 AKMASIH P
368 RUSNITI P
369 MASRIAH P
370 SALINAH L
371 AGUS L
372 KASIH P
373 JAMRUT L
374 SITI ALIAH P
375 360104410300004 CARINI P
376 TATI PURWATI P
377 JARTI P
378 ETIB SADAMA P
379 RUMINIH P
380 NURJAYA L
381 360104031920006 RUSDI L
382 JUARSIH P
383 OOM P
384 AMSIN L
385 AMIR L
386 360104911940002 KURNENGSIH P
387 TAFSIR L
388 360104410880002 NURHAETI P
389 SARDI L
390 3601044700200001 UMYATI P
391 YAHYA L
392 SUMINAH P
393 3601040102930008 ROHIK L
394 AMAN L
395 SUNARYA L
396 3601044709640001 CUCUM P
397 LAELA SARI P
398 PENDI L
399 KARYANTO L
400 WASAM P
401 SHELY MELODIANA P
402 M. DETRIS L
403 3601045204770002 KATMAH P
404 HJ.JASI P
405 JASMA L
406 ARSAMAN L
407 3601044107860009 ROSAH P
408 RISMAWATI P
409 360104510280001 SARMINAH P
410 SUTI P
411 RINI P
412 IIS P
413 3601045808900003 IKA P
414 SARNIAH P
415 3601040603700001 SARDI L
416 SAROH P
417 ATIAH P
418 ROHMAH P
419 3601044108810002 ARNI P
420 3601040707860003 DARTI P
421 WARJEM L
422 360104510410004 USIAWATI P
423 ROHMAH ROHAYATI P
424 MASTEM P
425 RUMI P
426 RIA HASTUTI P
427 TOYIB L
428 MAMAD L
429 IIS SUPRIYATI P
430 3601044107580114 CARTINIH P
431 WASTI P
432 SURATMOKO P
433 36010441778035 KARSINIH P
434 IDA PAUJIAH P
435 RASEM L
436 SUMANAH P
437 RATINI P
438 WARNI P
439 YATI P
440 IDAH P
441 NISTA L
442 3601041005420001 NIMAN L
443 TARTIB L
444 M. AYAT L
445 RAMSARI P
446 NURHAYATI P
447 NENENG SUGIHARTI P
448 EMAY P
449 H. SARHANI L
450 3601044107600005 TARNI P
451 SAMAH P
452 SIMAN L
453 SATIAH P
454 JAMSAH L
455 SUANDA L
456 WARTI P
457 SARUNAH P
458 HJ. BAYI P
459 3601044408950003 ARMAH P
460 ARNASIH P
461 SITI P
462 DAUD L
463 3601046599810001 ASYAROH P
464 360104410750062 SANYAH P
465 IPAH P
466 ARSAH P
467 SITI NURARIAH P
468 YOGA HERDIAN L
469 SARKI L
470 EMAH P
471 NURHAYATI P
472 FITRIA P
473 ANAH P
474 360104480810005 SUHERAH P
475 3601044107680299 ANIH P
476 PIAH P
477 JAENUDIN L
478 ASJA L
479 SARHANI L
480 HADIANA L
481 DARUL GUNAWAN L
482 360104600020001 EMI P
483 3601040909950001 ISKANDAR L
484 SARTI P
485 SUMINAR P
486 ENENG EMAH P
487 ALIS P
488 ROHMAT FAUZI L
489 YATI P
490 RINTA P
491 JARMIN L
492 ASTI P
493 SUPRIA L
494 360104454020004 ANISA P
495 RUDI L
496 360104554800005 ANIS P
497 SITI ROHMAH P
498 MISNAH P
499 3601041703780005 SATRIA L
500 SARIAH P
501 WARYO L
502 SUNENTI P
503 KUSNA L
504 ERIN P
505 ARMAH L
506 3601044107000299 IMAS P
507 SURNIAH P
508 DARSIWEN P
509 AWI P
510 KUSYUNINGSIH P
511 TARYUMI P
512 3601044107780213 ENENG SUHARTINI P
513 KASTINI P
514 SUGYANTI P
515 MAMAN L
516 SITI ROHMAH P
517 SUNAH P
518 36010450088200004 NURHAYATI P
519 DARTIM L
520 ESIH P
521 YAYAT L
522 360104550870003 MARYAMAH P
523 SUKARDI L
524 3601046507770001 SITI AISAH P
525 SARSIH P
526 ASIH P
527 KARTINAH P
528 URNI P
529 3601046000200003 LINA P
530 SARTIMIN P
531 SATINI P
532 HJ. SARMAH P
533 OOM P
534 3601080107950035 TAJUDIN L
535 RIANTI P
536 ISEM P
537 ALIMAH P
538 DEDE SITI P
539 SAMANI L
540 SUTI'AH P
541 SITI YULIANA P
542 BAYINAH P
543 3601044107800168 MASIAH P
544 MASNI P
545 MULYANTI P
546 3601045706990005 ATIN. A P
547 MARSIAH P
548 CUCUN P
549 RATIH P
550 ANHAR L
551 CAHYADI P
552 ADI PERMANA L
553 ANTON PALESTA L
554 ADE MURJASIAH L
555 DENI L
556 360104470370002 SUTIAH P
557 DASKEM P
558 MADKARIM P
559 SARIAH P
560 MARTI P
561 360104417830261 IPIT KURNIATI P
562 NURSAFITRI P
563 ROSIDAH P
564 SAMID L
565 3601046601800001 SUNTI P
566 ANITA P
567 TARUDI L
568 FAHRI L
569 NENG SITI P
570 WAHYUDI L
571 DARKA L
572 36010402090400001 FERDI L
573 RAPLI L
574 ANTON L
575 RIDWAN L
576 INES P
577 SUSI SUSANTI P
578 NANA L
579 KUSNADI L
580 360104554950002 AISAH P
581 M. ROTAM L
582 ATISAH P
583 NURYATI P
584 SITIANAH P
585 SARWI P
586 ASTI P
587 YULYANTI P
588 YATI P
589 FATMAWATI P
590 LAMRAH P
591 UCU SUHAETI P
592 YATI HARYATI P
593 SITI P
594 SANUSI L
595 MELINDA P
596 3601044107800169 KADMINIH P
597 ENTIN P
598 ROSIDANI P
599 TOSURI L
600 RASINAH P
601 SAJA L
602 CARLINI P
603 3601040107600061 SARDI L
604 NURHANI L
605 WARTIN P
606 UMAROH P
607 360104660880001 SITI PATIMAH P
608 REFI YULIYANA P
609 DEDIH P
610 360104150130002 OYOK L
611 TARYUMI P
612 ADON P
613 DANTO L
614 ROHETI P
615 WASMIN L
616 360104581720001 CASMINAH P
617 NIA KUSNIAWATI P
618 3601044203880006 ANAH MARYANAH P
619 ENNEG SITI P
620 ANDI SAPUTRA L
621 DEDI L
622 SODIKIN L
623 360104261760001 ABIDIN L
624 AKYAS NURSADINA L
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RICKO ROCHMAT
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1380 WINAH P
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1423 1603200404820001 YANTO L
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1466 3601046011950003 YUNITA RAHAYU P
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1500 3601044107810061 ROMINAH P
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1507 PANDI SUTISNA L
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1509 JOYO L
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1511 3604220708840009 MULYANA L
1512 DASIM L
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1551 3601040104790001 NASORI L
1552 WASTIM L
1553 3601040907840002 SURYADI L
1554 ENDI L
1555 UJANG L
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1558 TANISAH P
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1595 3601044606890001 SITI HASANAH P
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1637 3601044204810006 Shanah P
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1640 Arsidah P
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1678 Amsinah P
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1719 3601044107700106 Rustina bt Rawia P
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1760 Emin Sarminah P
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1801 3601042102700001 WASJUDI L
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1842 360104510380002 SANIMAH P
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1924 SUTINAH P
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1976 SODIKIN L
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1979 3601040107700102 SUHANDI L
1980 3601044703800001 ANASIH P
1981 TINAH P
1982 ATI ARYANI P
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1984 3601040102790002 SAHUDI L
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2036 3601045006780008 YETI SUMYETI P
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2047 ATI P
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2088 KAMHAR L
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2093 SUNARTO L
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2095 WARJI L
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2104
2105 3601044107830449 SUTIAWAN L
2106 ANI P
 Kepesertaan BPJS
'Ya' pada kolom y
Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

01-07-1953 LANSIA NANGGALA 081527073103

10-11-1981 UMUM NANGGALA 08577362498
10-05-1975 UMUM NANGGALA 08577362498
01-07-1966 UMUM NANGGALA 085217011506
01-07-1974 UMUM NANGGALA 085217011506
08-08-1974 UMUM NANGGALA 085880005318
10-02-1992 UMUM NANGGALA 085880005318
29-09-1986 UMUM NANGGALA 085880005318
17-03-1978 UMUM NANGGALA 085880005318
01-07-1989 UMUM NANGGALA 081298003009
16-01-2000 UMUM NANGGALA 081298003009
12-09-1965 UMUM NANGGALA 081517285721
03-03-2002 UMUM NANGGALA 081517285721
01-05-1983 UMUM NANGGALA 081517285721
14-10-1960 LANSIA NANGGALA 081517285721
05-09-1976 UMUM NANGGALA 081517285721
17-05-1985 UMUM NANGGALA 08577402916
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17-11-1977 UMUM CIWET 085711491727
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01-07-1962 UMUM NANGGALA 085711491727
01-07-1968 UMUM NANGGALA 085711491727
10-02-2003 REMAJA NANGGALA 085711491727
01-09-1993 UMUM NANGGALA 085711491727
13-05-1999 UMUM NANGGALA 085711491727
18-01-2000 UMUM NANGGALA 085711491727
05-02-1986 UMUM NANGGALA 085711491727
28-10-1990 UMUM NANGGALA 085711491727
11-04-1979 UMUM NANGGALA 081511408025
27-09-1966 UMUM NANGGALA 081511408025
12-04-19754 UMUM NANGGALA 081511408025
06-12-1993 UMUM NANGGALA 081511408025
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25-05-2001 UMUM NANGGALA 085215864115
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08-09-1993 UMUM NANGGALA 085215864115
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10-05-2000 UMUM NANGGALA 081511868384
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28-05-1983 UMUM NANGGALA 081511868384
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01-07-1973 UMUM NANGGALA 085715496882
08-09-1960 LANSIA NANGGALA 082374627574
03-10-1975 UMUM NANGGALA 082374627574
14-03-1992 UMUM NANGGALA 082374627574
05-08-2000 UMUM NANGGALA 082374627574
21-02-1999 UMUM NANGGALA 082374627574
10-05-1996 UMUM NANGGALA 082374627574
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14-03-1994 UMUM NANGGALA 082374627574
09-01-1987 UMUM NANGGALA 085718800293
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01-07-1968 UMUM NANGGALA 085718800293
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04-11-1990 UMUM NANGGALA 081380313787
07-08-1996 UMUM NANGGALA 082374627534
12-12-2002 UMUM NANGGALA 082374627534
14-08-1980 UMUM NANGGALA 082374627534
25-02-1976 UMUM NANGGALA 082374627534
20-11-1977 UMUM NANGGALA 082374627534
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07-09-2003 REMAJA NANGGALA 082374627534
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NANGGALA 085882452029
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CIWET 085212527770
01-07-1950 LANSIA NANGGALA 085212527770
17-01-1977 UMUM CIKDONG 085780477397
05-06-1981 UMUM CIKDONG 085780477397
14-06-1989 UMUM SUKAWARIS 085780477397
15-03-1976 UMUM SUKAWARIS 085780477397
10-11-1979 UMUM SUKAWARIS 085780477397
27-05-2004 REMAJA NANGGALA 085882502064
08-01-2005 REMAJA NANGGALA 085281808787
19-06-1965 UMUM SUKAWARIS 085281808787
14-09-1980 UMUM SUKAWARIS 085281808787
12-06-1965 UMUM SUKAWARIS 082312399090
15-11-1982 UMUM SUKAWARIS 082312399090
01-07-1970 UMUM SUMURBATU 082312399090
07-01-1981 UMUM CIKDONG 082312399090
06-10-1962 UMUM SUKAWARIS 082312399090
02-04-1976 UMUM SUKAWARIS 082312399090
25-01-1992 UMUM CIKDONG 082312399090
25-01-1955 LANSIA SUKAWARIS 082312399090
13-09-1983 UMUM SUKAWARIS 082312399090
02-03-1983 UMUM SUKAWARIS 08566761684
02-07-1981 UMUM SUKAWARIS 085773525765
11-07-1990 UMUM SUKAWARIS 085773525765
23-03-2003 BUMIL SUKAMULYA 085773525765
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28-04-1976 UMUM CIKDONG 085894541210
12-01-1979 UMUM SUKAWARIS 085894541210
01-07-1953 LANSIA CIKDONG 085894541210
06-04-1980 UMUM SUKAWARIS 085894541210
28-02-2008 REMAJA CIKEUSIK 081282437679
01-01-1966 UMUM CIWET 081282437679
16-04-2002 UMUM SUKAWARIS 085718763272
01-07-1977 UMUM CIKDONG 085817951846
09-02-1963 UMUM CIKDONG 085817951846
06-04-1970 UMUM SUKAWARIS 085817951846
01-07-1970 UMUM SUKAWARIS 085817951846
04-11-1989 UMUM CIKDONG 085817951846
07-05-2004 REMAJA PARUNGPANJNAG 085817951846
05-04-1981 UMUM CURCI 085817951846
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 15-08-1989 UMUM TANJUNGAN 087773101368
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26-03-1968 UMUM SUKASENENG 085810903798
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29-09-1999 UMUM TANJUNGAN 085775202827
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25-01-1994 UMUM SUKASENENG 082311540329
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;09-03-1978 UMUM RANCASENENG 082120609501
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18-06-2008 REMAJA UMBULAN 085718763867
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 4/2/1981 Sukawaris 081287776658
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 11/6/1981 Sumurbatu 085210225433
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3/5/2004 Sumurbatu 081386079989
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6/4/1975 Umbulan 085887771336
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 7/1/1970 Cikeusik 085714775332
7/1/1979 Sumurbatu 085773220370
5/15/1960 Umbulan 085718265166
7/1/1963 Sukaseneng 081211485848
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Sukamulya 081224191498
Sukamulya 0813835418893
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10/26/2003 Cikeusik 0822568090106
10/10/2003 Cikeusik 085691312673
7/1/1976 Cikeusik 08569100904
10/9/2004 Cikeusik 085668785233
2/27/1984 Cikeusik 085819577404
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4/17/2004 Cikeusik 085814303414
8/17/1981 Rancaseneng 083875405824
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9/11/1976 Cikeusik 085210780415
3/6/1988 Cikeusik 085779054278
7/1/1973 Cikeusik 085714215218
9/6/1983 Cikeusik 087720843450
11/20/1956 Cikeusik 085779054278
8/1/1987 Cikeusik 085718246848
8/17/1967 Cikeusik 085261464143
5/8/1969 Cikeusik 081511868594
8/17/1984 Cikeusik 085892746930
Cikeusik 081511406474
12/2/1979 Cikeusik 085891255722
1/25/1968 Sukaseneng 085810133827
11/27/1983 Cikeusik 085313117508
7/1/1950 Cikeusik 085776131200
8/10/1974 Cikeusik 083893090548
 6/5/1964 Cikeusik 083871333722
8/7/2001 Cikeusik 085771613861
7/2/1954 Cikeusik 081513882162
2/8/1994 Nanggala 0857782199168
1/7/1979 UMUM NANGGALA 85695409565
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UMUM NANGGALA 85691159062
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UMUM NANGGALA 85774964969
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6/8/1997 REMAJA NANGGALA 85691437147
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20-01-1977 UMUM NANGGALA 85691159062
1/2/1970 UMUM NANGGALA 8212615469
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15-04-1973 UMUM NANGGALA 85715268434
17-04-1995 UMUM NANGGALA 85717563965
1/7/1963 UMUM NANGGALA 87754421677
10/1/1999 REMAJA NANGGALA 0852189820983
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3/1/1988 UMUM CIKEUSIK 81314142256
5/3/1989 UMUM NANGGALA 85718800293
 5/10/1972 UMUM NANGGALA 82378456558
15-04-1985 UMUM NANGGALA 8576217721
26-03-2000 REMAJA NANGGALA 85773624427
1/7/1995 UMUM NANGGALA 81574876572
17-12-2003 REMAJA NANGGALA 85717565226
1/7/1985 UMUM NANGGALA 81311182983
1/7/1982 UMUM NANGGALA 85283753515
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1/7/1975 UMUM NANGGALA 85762188225
10/5/1988 UMUM NANGGALA 85219538917
25-01-1975 UMUM NANGGALA 8314250426
6/10/1996 UMUM NANGGALA 8576217721
12/5/1978 UMUM SUKAWARIS 95779621322
26-01-2005 REMAJA CIHANJUANG 85281808787
26-04-2006 REMAJA CIKEUSIK 82113371749
12/2/1973 UMUM NANGGALA 83817877156
21-10-1970 UMUM NANGGALA 85771308802
9/7/1990 UMUM SUKAWARIS 82310864049
6/3/1982 UMUM NANGGALA 85810133797
18-08-1998 REMAJA TANJUNGAN 8561006554
9/5/1992 UMUM SUKAWARIS 83151495925
4/3/1950 LANSIA CIKEUSIK 81284647029
8/8/1998 REMAJA SUKAWARIS 8592643294
11/12/1982 UMUM CIKDONG 81318024397
27-11-1984 UMUM CIKEUSIK 81284647029
3/12/2003 REMAJA CIKDONG 85282387727
3/6/1982 UMUM SUKAWARIS 81398285492
5/6/1994 UMUM SUKAWARIS 85866761684
1/11/1969 UMUM NANGGALA 85268820947
7/1/1958 LANSIA CIKDONG 85817951846
1/7/1973 UMUM CIKDONG 85717656573
15-09-2000 REMAJA CIKDONG 85778187864
2/7/1980 UMUM CIKDONG 85719437065
17-03-1947 LANSIA JAKARTA UTARA 85216557427
5/5/1966 UMUM SUKAWARIS 81315543448
1/2/1963 UMUM SUKAWARIS 82149935278
10/12/2004 REMAJA PARKOS 85880138168
4/7/2001 REMAJA SUKAWARIS 85882444875
3/3/1976 UMUM SUKAWARIS 82149935278
TANJUNGAN 85714197683
10/8/1985 UMUM SUKAWARIS 85770277705
15-10-1991 UMUM CIKDONG 8579715972
15-04-1982 UMUM CIKDONG 85697417180
26-10-1937 LANSIA CIKDONG 85283234637
1/7/1976 UMUM NANGGALA 83136086959
3/4/1977 UMUM SUKAWARIS 81318396161
7/7/1990 UMUM CURUGCIUNG 85771002609
20-07-1989 UMUM CIKDONG 8580440366
22-11-1973 UMUM NANGGALA 85771613899
12/4/1988 UMUM SUKAWARIS 0821119935278
1/3/2002 REMAJA SUKAWARIS 81587934782
30-12-1991 UMUM CURUGCIUNG 81586143523
14-11-1999 UMUM SUKASENENG 85782269291
25-03-1981 UMUM CIWET 8577278864
6/6/1999 UMUM SUKASENENG 85891485080
2/4/1968 UMUM PARKOS 83893885845
17-01-2004 REMAJA SUKAWARIS 81794918077
10/9/1945 LANSIA TANJUNGAN 85776862529
18-08-1980 UMUM TANJUNGAN 85888377509
2/12/2002 REMAJA SUMURBATU 82122100739
4/12/1984 UMUM CIKEUSIK 85773210130
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9/11/1988 UMUM CIWET 85894005649
13-02-2001 REMAJA CIKDONG 85774393904
8/5/1985 UMUM SUKASENENG 85319045740
1/7/1983 UMUM SUKASENENG 85213864485
4/1/1988 UMUM SUKASENENG 85213864485
30-07-2004 REMAJA CIKDONG 85716206151
1/11/1996 UMUM SUKASENENG 83171442080
18-08-1976 UMUM SUKASENENG 85213005797
2/5/1988 UMUM SUKASENENG 85882802979
8/9/1978 UMUM SUKASENENG 89218247726
3/6/1982 UMUM CURUGCIUNG 857797768
11/4/1975 UMUM JAHA 81545829901
1/7/1981 UMUM SUKASENENG 81519281518
17-06-1979 UMUM TANJUNGAN 85695285685
6/7/1975 UMUM SUKASENENG 85782980835
16-03-1986 UUMUM SUKASENENG 85779170561
14-06-1997 UMUM SUKASENENG 085819879310
04-03-1974 UMUM SUKASENENG 85216583013
5/4/1952 LANSIA SUKASENENG 085778212835
15-03-1972 UMUM SUKASENENG 85212609501
10/10/1990 UMUM SUKASENENG 83890793550
23-12-1982 UMUM SUKASENENG 85820431947
10--07-1965 UMUM NANGGALA 81289662791
11/9/1979 UMUM SUKASENENG 81311481848
6/2/1994 UMUM MARGASANI 82110768982
10/10/1975 UMUM UMBULAN 8558926529
11/7/1990 UMUM UMBULAN 85695264402
5/2/1991 UMUM SUKASENENG 85215739630
12/1/2000 REMAJA SUKASENENG 82127361062
18-09-2005 REMAJA CIHANJUANG 85892615461
15-06-1989 UMUM CIKEUSIK 85892625431
1/7/1975 UMUM SUKAWARIS 82149935278
22-12-1962 UMUM SUKASENENG 85693645905
1/7/1968 UMUM SUKASENENG 85283046746
22-11-1990 UMUM SUKASENENG 85718271216
1/7/1977 UMUM CIKEUSIK 85862775850
14-3-1977 UMUM SUKASENENG 85773237471
4/9/1987 UMUM SUKASENENG 0859102630897
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1/9/1973 UMUM SUKAWARIS 82149935278
5/4/1980 UMUM SUKASENENG 85776467277
7/1/1987 UMUM CIKEUSIK 85864154877
1/1/1970 UMUM SUKASENENG 8570776924
10/2/2002 REMAJA SUKAMULYA 85694723404
17-08-1999 UMUM SUKAMULYA 85694723404
20-07-2005 REMAJA SUKASENENG 85694136520
1/7/1955 LANSIA UMBULAN 85718265266
25-10-1996 UMUM SUKASENENG 81284850131
31-03-2003 REMAJA SUKASENENG 85212570754
1/7/1968 UMUM SUKASENENG 81311481848
1/7/1974 UMUM UMBULAN 82113158443
13-11-1965 UMUM SERANG 85939531807
29-08-1974 UMUM SERANG 085939531807
10/9/1952 LANSIA RANCASENNENG 81288007836
6/12/1992 UMUM SUKASENENG 85718722206
27-08-1987 UMUM UMBULAN 83115443589
12/7/1980 UMUM SUKASENENG 85695267356
7/1/1995 UMUM SUKAMULYA 82310670877
20-02-1970 UMUM NANGGALA 85711493780
 5/1/1977 UMUM RANCASENENG 85695393577
27-02-1982 UMUM SUKAMULYA 82310670877
12/11/1975 UMUM RANCASENENG 85695393577
3/2/1971 UMUM UMBULAN 87802090608
5/9/1970 UMUM RANCASENENG 85216097533
1/7/1973 UMUM UMBULAN 85891154151
21-04-1974 UMUM RANCASENENG 85810913671
21-12-2001 REMAJA SUKASENENG 81382846728
16-07-1970 UMUM RANCASENENG 85782266359
9/3/1993 UMUM TANJUNGAN 81574093693
2/5/1981 UMUM RANCASENENG 85280311568
27-8-1994 UMUM RANCASENENG 85273379912
2/6/1991 UMUM SUKAMULYA 87720573262
10/12/1967 UMUM UMBULAN 85776127313
5/2/1982 UMUM RANCASENENG 85797175817
1/7/1961 UMUM RANCASENENG 85771972844
10/7/1988 UMUM CIKDONG 85892995705
1/7/1948 LANSIA UMBULAN 85692653988
13-11-1994 UMUM RANCASENENG 85773892845
10/5/1995 UMUM UMBULAN 85782267207
9/9/1999 UMUM UMBULAN 85315197900
5/7/1978 UMUM UMBULAN 0819941118132
1/7/1963 UMUM UMBULAN 85692653986
27-9-1995 UMUM CIKEUSIK 81398827237
1/7/1961 UMUM UMBULAN 85886821886
23-04-1978 UMUM RANCASENENG 85213478240
6/5/1982 UMUM SUKASENENG 85213864485
1/5/1970 UMUM RANCASENENG 85781080969
15-06-1999 UMUM TANJUNGAN 85691788579
2/5/1977 UMUM SUKASENENG 85715854492
7/7/1973 UMUM UMBULAN 85219331306
9/4/1974 UMUM UMBULAN 81994118132
1/8/1975 UMUM RANCASENENG 83135106323
1/7/1965 UMUM RANCASENENG 85210572127
1/7/1982 UMUM RANCASENENG 8575262091
1/7/1961 LANSIA CIKEUSIK 81385771672
1-7- RANCASENENG 81617677889
22-8-1992 UMUM RANCASENENG 83895409403
5/5/1986 UMUM TANGERANG 857790613
16-11-1972 UMUM RANCASENENG 85319359626
23-01-1993 UMUM RANCASENENG 85891485051
25-10-2004 REMAJA SUMURBATU 85774957841
1/7/1962 LANSIA SUMURBATU 85718270136
5/7/1977 UMUM UMBULAN 85885276749
12/1/1990 UMUM SUKASENENG 85210053965
1/6/1975 UMUM PARKOS 85773632819
1/6/1984 UMUM SUKASENENG 85896429389
10/12/1975 UMUM UMBULAN 085694239468
7/6/1972 UMUM SUKAWARIS 85895877860
CIKEUSIK 85710525776
23-02-2000 REMAJA RANCASENENG 85773224570
16-3-1995 UMUM SUKAMULYA 85862775830
17-01-19991 UMUM RANCASENENG 82312010915
11/1/1972 UMUM SUKASENENG 82184434120
17-06-1981 UMUM RANCASENENG 85219665747
15-4-1972 UMUM CIKEUSIK 81298968581
7/3/1980 UMUM CIKEUSIK 085212817706
27-6-1985 UMUM UMBULAN 85692729274
2/3/1994 UMUM PASIR ANGIN 85871278791
6/6/2003 REMAJA UMBULAN 85280006401
1/2/1979 UMUM PARKOS 085719636874
17-2-1994 UMUM PARKOS 85759541739
1/6/1997 UMUM SUKASENENG 82312946766
10/2/1995 UMUM PARKOS 85319358129
11/11/2005 REMAJA CIKEUSIK 85693476866
12/9/1966 LANSIA UMBULAN 85894828863
9/10/1966 LANSIA CIKEUSIK 83139334987
25-11-2006 REMAJA UMBULAN 85772256916
7/8/1975 UMUM LEWI BALANG 85718779797
1/1/1991 UMUM UMBULAN 81646061904
10/2/1997 UMUM CIKEUSIK 81511412524
6/5/1994 UMUM PARKOS 87889894165
29-4-2006 REMAJA UMBULAN 85718265160
5/5/2006 REMAJA CIKDONG 81517286084
7/12/1992 UMUM CIKEUSIK 85771002061
10/11/2006 REMAJA CIKEUSIK 81514572561
12/11/1996 UMUM UMBULAN 85216070519
1/7/1977 UMUM CIKEUSIK 85770972292
7/6/1981 UMUM CIKEUSIK 85861145364
5/9/1995 UMUM CIKEUSIK 85282258865
13-11-1972 UMUM RANCASENENG 82311699377
12/2/1962 UMUM CIKEUSIK 85881197244
 23-6-1995 UMUM CIKEUSIK 85881197244
17-05-1994 UMUM RANCASENENG 85750189019
21-09-1989 UMUM UMBULAN 8778226610
30-10-1986 UMUM SUKASENENG 85219422163
13-11-2006 REMAJA CIKEUSIK 85285593438
19-10-1986 UMUM RANCASENENG 85891154317
5/6/1978 UMUM CIKEUSIK 82312569165
10/5/1987 UMUM CIKEUSIK 85283862114
18-8-1995 UMUM CIKEUSIK 85216085817
8/12/1973 UMUM CIKEUSIK 85770149981
1/7/1956 LANSIA RANCASENENG 85892626574
2/7/1971 UMUM CIKEUSIK 85770149920
2/7/1970 UMUM CIKEUSIK 85770149920
1/7/1971 UMUM UMBULAN 83871094458
29-10-2005 REMAJA CIKEUSIK 85773237562
6/11/1979 UMUM PARKOS 0852111871987
6/1/1988 UMUM SUMURBATU 85216219428
7/1/1976 UMUM UMBULAN 83172382994
5/7/1978 UMUM PARKOS 85886129884
25-03-1998 UMUM CIKEUSIK 0856981489820
1/7/1975 UMUM PARKOS 85710119963
26-5-2000 REMAJA PARKOS 85886129884
19-04-2004 REMAJA CURUGCIUNG 85213477221
15-07-1960 LANSIA RANCASENENG 8783730200
10/10/2002 REMAJA CIKEUSIK 85692349473
1/7/1990 UMUM UMBULAN 8561932033
19-9-1999 UMUM CIKEUSIK 85810132853
8/5/1973 UMUM SUKASABA 85894829601
1/7/1978 UMUM UMBULAN 8561932033
3/3/1980 UMUM LEWIBALANG 85709426492
10/6/1978 UMUM UMBULAN 81223682264
1/7/1975 UMUM SUKAMULYA 83113371756
11/9/1988 UMUM CIKEUSIK 85779054219
22-08-1983 UMUM CIKEUSIK 85779568762
11/5/1964 UMUM UMBULAN 85311380056
2/4/1976 UMUM CIKEUSIK 85210705213
23-12-1966 LANSIA CIKEUSIK 8521705213
15-10-1971 UMUM CIKEUSIK 85216919893
12/2/1968 UMUM CIKEUSIK 85210705213
1/7/1965 UMUM CIKEUSIK 81318524893
1/7/1968 UMUM LEWIBALANG 85779569028
 1/7/1967 UMUM UMBULAN 85779670680
1/1/1986 UMUM CIKEUSIK 85864161446
28-10-1994 UMUM CIKEUSIK 85890124823
5/7/1972 UMUM CIKEUSIK 85282387720
20-9-1985 UMUM CIKEUSIK 85672187295
4/12/1963 LANSIA 85871278992
16-12-1998 UMUM CIKEUSIK 85772258024
1/7/1997 UMUM 85881369548
27-09-1994 UMUM CIKEUSIK 87899877997
1/7/1967 UMUM CIKEUSIK 85214887644
15-03-1991 UMUM CIKEUSIK 85899932656
1/8/1980 UMUM CIKEUSIK 8577756695
14-5-1977 UMUM LEWIBALANG 85772743208
15-10-1982 UMUM LEWIBALANG 81511757132
1/7/1980 UMUM UMBULAN 81213382995
18-5-1979 UMUM SUKAMULYA 81553998495
22-12-1997 UMUM SUMUR BATU 85891581142
30-3-1995 UMUM UMBULAN 85692729270
20-1-1983 UMUM CIKEUSIK 85212405362
10/10/1985 UMUM SUMURBATU 85219605782
1/7/1983 UMUM CIKEUSIK 8531090752
9/9/1992 UMUM CIKEUSIK 81318024412
8/8/1960 LANSIA CIKEUSIK 85780744430
16-11-1976 UMUM UMBULAN 83874996637
22-1-1971 UMUM RANCASENENG 085732997921
6/7/1992 UMUM JAKARTA UTARA 85691133313
24-11-1989 UMUM RANCASENENG 85707776771
14-7-1950 LANSIA CIKEUSIK 85779054278
10/12/1978 UMUM SUKASENENG 8588276973
19-5-1991 UMUM CURUGCIUNG 85691921223
16-11-2001 REMAJA CIKEUSIK 85782261628
12/9/1995 UMUM CIKEUSIK 85775261628
17-10-1980 UMUM CIKEUSIK 82310789823
8/2/1972 UMUM CIKEUSIK 81282809153
4/1/1955 LANSIA SUKASENENG 85772345289
15-06-1972 UMUM CIKEUSIK 85211722423
15-07-1982 UMUM CIKEUSIK 87719203681
10/12/1962 LANSIA CIKEUSIK 85715094330
10/8/1988 UMUM CIKEUSIK 85882452047
17-11-1960 LANSIA CIKEUSIK 85891083180
25-10-1993 UMUM CIKEUSIK 81932296045
 1/7/1980 UMUM UMBULAN 85891154475
1/7/1959 UMUM UMBULAN 85218566558
8/6/1989 UMUM UMBULAN 85717359484
1/7/1974 UMUM RANCASENENG 85894432921
20-9-1999 UMUM SUKALAKSANA 85882204998
2/7/1980 UMUM CIKEUSIK 85719066114
10/8/1996 UMUM CIKEUSIK 85694946140
5/1/1973 UMUM CIKEUSIK 8382190098
1/7/1966 LANSIA CIKEUSIK 81517284140
13-01-2001 REMAJA CIKEUSIK 81646091735
6/8/1985 UMUM SUKASENENG 85773632420
27-4-1990 UMUM CIKEUSIK 81930838330
20-03-1986 UMUM SUKASENENG 8570972250
17-01-2006 REMAJA SUMURBATU 85770144035
30-8-1982 UMUM CIKEUSIK 85213499771
10/2/2002 REMAJA CIKEUSIK 81511899991

24-03-2004 REMAJA CIKEUSIK

05-06-1976 UMUM NANGGALA 085714953431
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi
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CoronaVac 1/7/2021 1/7/2021
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CoronaVac 03-09-2021
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

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NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045902700003 MASRINAH P
2 3601045507820004 CASNITI P
3 3601044107630316 RAMEN P
4 3601085107950001 TRI DESTRIANI P
5 3601042064430001 CARKENI P
6 3601045010880003 TARSIH P
7 3601044106340001 WARINAH P
8 3601044107840116 RUMSINAH P
9 360104530180002 CASTINI P
10 3601040712570001 SUMARTA L
11 3601044201750003 SUNAETI P
12 3601044205770001 ARTI P
13 36010446099900001 SULIS HANI P
14 TARPAN L
15 3601041002500001 IBRAHIM L
16 36010428060900002 IKBAL L
17 3601046002030002 MAYA LESPIANA P
18 3601041201020001 ADI WASESA L
19 3601042707870002 JAMANI L
20 3601042507040003 ANDIE SOPIADI L
21 3601042407860003 KODIR L
22 3601045203720003 ANI MARTINI P
23 3601045010880007 TARSIH P
24 3601045705040002 TITIN SURYANI P
25 360104030700009 PURWANI P
26 3601041012770004 ODIH L
27 3601044104070004 RISKA P
28 3601041507930001 DIRMAN L
29 3601040810550001 KISAN L
30 6206111007890001 DARPIN L
31 3601045604750001 ICAH P
32 36010401016900002 KASIR L
33 3601044107730427 ASMANAH P
34 3601044302910001 DASPAN P
35 36010416027800001 DARSIM L
36 3601044203980008 YAYAH INAYAH P
37 3601044408000002 LIA SETIAN P
38 3601041110710001 NANO L
39 3601045202040001 SISKA ROHMAH P
40 3601040507930003 TARYONO L
41 3601040107791113 ENUR P
42 3601040207720002 M. APIP L
43 3601045403040001 IKA MAESAROH P
44 3601040107800267 JUJU L
45 3601045204830004 RAWITI P
46 3601045402040002 RIRIN AMELIA P
47 3601040107690107 ISMAIL L
48 360104050720001 MUHAMMAD L
49 3601044107790017 CARSITI P
50 3601044107680283 HJ. WARNI P
51 360104010690001 RAHIM SUNARTO L
52 3601043108020003 DEDE JEKI L
53 3601040206090002 JAHIR L
54 3601045901030003 MASNAN P
55 3601046403710002 SITI MARIAM P
56 3601030401950001 PEPN L
57 3601046012040001 RASINAH P
58 3601041802690001 CARSILAH P
59 3601042805010001 DULYADI L
60 RAINA DWY P
61 360104410781017 DASINAH P
62 3601045708040006 MELI AGUSTIN P
63 3601045705980003 YUYUN P
64 3671055704940005 DANTI P
65 36010401027200094 DARNA L
66 3601082511830002 ASAP L
67 3173065309860001 MURDIYANAH P
68 3601044106830003 RUMI P
69 3601040103060002 M. TOLIB L
70 3601045803700001 JUHENAH P
71 360104010794003 SUNENDRA L
72 36010451045750001 WARSIH P
73 3601040207880007 CARLIM L
74 3601040301880002 SARTA L
75 3601040207050001 HAMDALAH P
76 3601045805890003 SARIPAH P
77 3601042010590001 MARDI L
78 3601044509720003 RASMI P
79 3601046010800005 TINI P
80 3601040702770003 SUKANTA L
81 3601045411250003 TASIRI P
82 3601041506420003 K. JARIPUDIN L
83 3601122708790001 HERIYANA L
84 3601041808760001 WARGA L
85 3601044311920003 RUMINI P
86 3601040508700002 KARNA L
87 3601040107780317 WAHYU L
88 3601044304590002 PARWATI P
89 3601044105910006 CARSINAH P
90 3601040204860081 ENDIN L
91 3601045004660002 WASNIPAH P
 92 3601045912020001 SARNI P
93 360104410777044 CARINI P
94 3601042003000003 DEDE JUNAEDI L
95 3601044207040009 ERNAWATI P
96 3601041803580002 ODIH L
97 3601040107790070 DIRJA L
98 3601041101000007 AYA L
99 3601044105870002 RASWATI P
100 3601040708880001 ADE MULYADI L
101 3601041510070005 SATORI L
102 3601040207490001 KASTA L
103 3601046005740001 WARKEM P
104 3601041076700044 RUMI P
105 3601046307010001 ROHATI P
106 3601046307010001 SUSANTIKA P
107 3600140607090001 YANI P
108 3601040612810004 ASMAR L
109 3601044510650001 AMISAH P
110 3601045110730002 CASEM P
111 36010301075000070 HASAN L
112 3601030109850002 SUARNA L
113 3601095507730004 HENDRA L
114 3601042011720001 BUSERI L
115 3601045212000006 IYOT P
116 3601045404560001 RUMSAH P
117 360104410730136 JARMAH P
118 3601044107650091 RASNI P
119 3601040605570001 H. KAMIDI L
120 360104581260001 YATI P
121 3601046008700002 KANAH P
122 3601040202730003 DASKIM L
123 36010442068600042 HAPIDOH P
124 3601046709780001 HAMDAH P
125 3601040406930001 SODIKIN L
126 36010445210030001 PITRI NURAENI P
127 3601041004000007 SANUDIN L
128 3601045007760001 SAKIAH P
129 3601043007990001 M. JUJUN L
130 3601044505920004 EEM P
131 3601045305780003 NURHAETI P
132 3601044108750003 ISAH P
133 360104580910002 MARHAMAH P
134 3601041105780007 DASUKI L
135 360104411080003 SITI JAHRONAH P
136 3601276006980002 ASNIAH P
137 3601031010970001 SUKANDI L
138 3601045802030001 WINDA LESTARI P
139 3601030209710001 SUMARNA L
140 3601045210760002 KARISEM P
141 3601044104850003 TUTI P
142 3601040707660003 JUANDA L
143 360104450300004 YENI NURAENI P
144 3601045209120002 PATIMAH P
145 3601034204720004 AMINAH P
146 3601045302680002 SARTIAH P
147 3601041705880001 DEDE MAULANA L
148 3601040203850005 YANI. S L
149 3601040501730003 RAAM L
150 3601042103890001 YADI L
151 3601040108720003 RAPUDIN L
152 3601041607030001 DEDE NURMAN L
153 360104410500002 DANIEM P
154 3601045507000002 AMELIA P
155 3601040107740065 SARDAN L
156 360104100160007 SARDIMIN L
157 3601040103630001 WASLA L
158 3601040506720001 SAMID L
159 3601040401920002 MUHANI L
160 '3601040107630196 DULHANAN L
161 3601045111050006 MELDA P
162 3601040702770004 JUANDA L
163 3601040107870181 AMSARI L
164 3601046811020002 SAMINAH P
165 '360104410791011 HALIMAH P
166 3601044304910003 SARKAH P
167 360104302070001 IDRUS L
168 3575022710930001 NADIM L
169 3601042307520001 SURYADI L
170 360104410783025 CASWATI P
171 360104450505880012 NITA NOVIANA P
172 3601041805920001 LUMRI L
173 3601044107920072 TARIDAH P
174 3601041409950001 HERDIYANA L
175 3601041006030001 HARNO L
176 3601042012740002 TARNADI L
177 3601044701850006 TAWINAH P
178 360104070810002 KARNO L
179 3601041910950001 ASRUDIN L
180 3601045207820003 ENTIN P
181 360104110720003 JOHAN L
182 3601040904870002 PENDI L
183 3672026309030002 INAYA P
184 3601041509780001 IPEN L
185 33290264099100002 ANDIN P
186 36010415079900005 MAMAN SUPARMAN L
187 3601044609040003 EVALINA P
188 3601040702510001 MUNAJI L
189 3601046212030003 DESI FITRIYANI P
190 3601040107630171 SARONI L
191 3601041111560001 HUMAEDI L
192 3602211307920002 JULI L
193 3601041010930001 RIKI HARIADI L
194 36010402076000003 M. DIDING L
195 3601046812040003 MUTIA AUYU P
196 3601040107030070 WAHYUDIN L
197 360104502800004 RAFI L
198 3601046609030001 FITRIYANI P
199 3601040501050001 RENDI L
200 3601045109040001 SITI NURAISAH P
201 3602206005800002 ROHAENAH P
202 3601044100780003 NUNUNG P
203 36010405030400003 FERI IRAWAN L
204 3601044606730002 SAROH P
205 3601034107920310 ERNAWATI P
206 3601041711770002 ROHADI L
207 EBAH P
208 3601044801910003 HENI P
209 360104050280001 JUARNA L
210 36010442049500001 TINI P
211 3602010102040006 MAMAN P
212 3601046903830001 LILIS P
213 3601045804860002 IDA FARIDA P
214 3601043103160004 NURHERINA P
215 3601040107920234 BIDIN L
216 3601042807660001 ADE MULYADI L
217 3601042607040002 NOVAL ADNAN TADIRAN L
218 1607025004700004 JANI P
219 3601047005660001 DARSINAH P
220 3601041603900001 ENJANG SUJANA L
221 3601040205830005 HANI P
222 3601042006960002 AJIS MUSTOPA L
223 3601045507810006 ASMI P
224 3601046101680003 SUKAESIH P
225 3601042810020003 NIKY OKTA ROSADI L
226 2601045008540001 MASKUNAH P
227 3601045108890006 RITMA NOVITA P
228 3601044706960008 NOPIAH P
229 3601044103700005 WASIRAH P
230 3601044611950003 SITI NURMALA SARI P
231 3601046304730003 TITIN P
232 3601040107680295 SAKI L
233 3601045306000006 IIN P
234 3601044107610099 RAWEN P
235 3601044107610094 MURDA P
236 3601044512830001 LINA P
237 3601045804990002 RAMAH P
238 3601044107790137 SARTIAH P
239 3601044107580205 MARNASIH P
240 3601044107600097 SUNI P
241 3601044768730001 SACEM P
242 3601044107270016 MUMUN P
243 3601044107950254 KOKOM P
244 3601044107650192 JUHEMI L
245 3601044506800003 EWAT P
246 3601044107830419 ENI P
247 3601044107900233 ROHAETI P
248 3601044803930003 NURHAYATI P
249 3601040107820127 RASIMAN L
250 3601044102630011 JARNIAH P
251 3601045211870001 NENG YULI P
252 3601045304480001 SARAH P
253 3601044810920002 IIN P
254 3601044107990232 ROHILAH P
255 3601045167570003 DARIH P
256 3601044107500086 HASANAH P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

19-02-1970 UMUM SUKASENNEG

15-07-1982 UMUM CIKEUSIK
01-07-1963 UMUM SUKASENNEG
04-07-1995 UMUM CIKEUSIK
02-06-1943 LANSIA CIKEUSIK
10-10-1988 UMUM SUKASENNEG
04-06-1976 UMUM CIKEUSIK
01-07-1984 UMUM CIKEUSIK
13-01-1980 UMUM CIKEUSIK
07-12-1957 LANSIA SUMURBATU
02-01-1975 UMUM CIKEUSIK
02-05-1977 UMUM CIKEUSIK
09-09-1997 UMUM CIKEUSIK
12-10-1984 UMUM SUKASENNEG
10-12-1950 LANSIA CIKEUSIK
20-06-2009 REMAJA CIKEUSIK
20-02-2003 REMAJA NANGGALA
12-01-2002 UMUM CIKDONG
27-07-1987 UMUM SUKASENNEG
25-07-2004 REMAJA RANCASENENG
24-07-1986 UMUM CIKEUSIK
02-04-1979 UMUM CIWET
10-10-1980 UMUM CIKEUSIK
07-05-2004 REMAJA CIKEUSIK
03-05-1970 UMUM CIKEUSIK
29-02-1980 UMUM CIKEUSIK
01-04-2007 REMAJA CIKEUSIK
15-07-1993 UMUM NANGGALA
01-07-1952 LANSIA CIKEUSIK
10-07-1989 UMUM CIKEUSIK
16-04-1975 UMUM SUKAWARIS
01-07-1965 UMUM CIKEUSIK
01-07-1973 UMUM NANGGALA
03-02-1991 UMUM SUKASENNEG
16-02-1978 UMUM SUKASENNEG
07-03-1998 UMUM CIKEUSIK
04-09-1999 UMUM CIKEUSIK
11-10-1972 UMUM SUKASENNEG
12-02-2004 REMAJA CIKEUSIK
02-04-1994 UMUM SUKASENNEG
01-02-1977 UMUM CIKEUSIK
06-02-1971 UMUM CIKEUSIK
14-03-2004 REMAJA SUMURBATU
06-06-1984 UMUM SUKASENNEG
12-04-1983 UMUM CIKEUSIK
26-06-2004 REMAJA CIKEUSIK
01-07-1969 UMUM TANJUNGAN
05-07-2002 UMUM CIKEUSIK
01-07-1979 UMUM SUMURBATU
01-07-1968 UMUM CIKEUSIK
01-08-1989 UMUM CIKEUSIK
21-08-2002 UMUM CIKEUSIK
02-06-1989 UMUM CIKEUSIK
09-01-1983 UMUM CIKEUSIK
24-03-1972 UMUM CIKEUSIK
04-01-1995 UMUM CIHANJUANG
20-12-2004 REMAJA CIKEUSIK
18-02-1969 UMUM SUKAMULYA
28-05-2001 UMUM NANGGALA
05-04-2004 REMAJA RANCASENENG
02-06-1982 UMUM CIKEUSIK
17-08-2004 REMAJA SUKASENNEG
17-05-1998 UMUM CIKDONG
12-04-1994 UMUM SUKASENNEG
01-07-1972 UMUM CIKEUSIK
25-11-1985 UMUM CIKEUSIK
13-09-1986 UMUM KALIDERES
01-06-1983 UMUM NANGGALA
01-03-2006 REMAJA CIKEUSIK
18-03-1970 UMUM TANJUNGAN
01-07-1994 UMUM SUMURBATU
11-04-1975 UMUM TANJUNGAN
02-07-1988 UMUM CIKEUSIK
03-01-1980 UMUM CICADAS
02-07-2005 REMAJA CIKEUSIK
18-05-1989 UMUM SUMURBATU
20-10-1959 LANSIA CIKEUSIK
05-09-1972 UMUM TANJUNGAN
20-10-1980 UMUM LEUWIBAALANG
04-09-1975 UMUM PARKOS
14-11-1975 UMUM SUMURBATU
15-06-1972 UMUM CIKEUSIK
27-08-1977 UMUM UMBULAN
18-08-1976 UMUM CIKEUSIK
03-11-1992 UMUM CIKEUSIK
05-08-1970 UMUM CIKEUSIK
15-07-1980 UMUM CIKEUSIK
03-04-1959 LANSIA CIKDONG
01-05-1991 UMUM LEUWIBAALANG
02-04-1986 UMUM CIKEUSIK
10-04-1966 UMUM CIKEUSIK
19-12-2002 UMUM CIKEUSIK
01-07-1977 UMUM CIKEUSIK
20-03-2000 UMUM SUKAWARIS
05-06-2004 REMAJA CIKEUSIK
04-12-1980 UMUM SUKASENNEG
25-07-1987 UMUM NANGGALA
11-09-1999 UMUM SUKASENNEG
01-05-1987 UMUM NANGGALA
07-08-1988 UMUM PARKOS
15-10-1967 UMUM CIKEUSIK
02-07-1949 LANSIA CIKEUSIK
20-05=1974 UMUM CIKEUSIK
25-02-1967 UMUM CIHANJUANG
01-07-1975 UMUM CIKEUSIK
23-07-2001 UMUM CIKEUSIK
06-02-1989 UMUM NANGGALA
06-12-1981 UMUM NANGGALA
25-04-1966 UMUM CIKEUSIK
11-01-1973 UMUM CIKEUSIK
01-07-1950 LANSIA CIHANJUANG
01-09-1985 UMUM CIHANJUANG
29--09-1991 UMUM PAGELARAN
20-11-1972 UMUM CIKEUSIK
12-12-2000 UMUM PARKOS
14-04-1956 LANSIA SUKAMULYA
01-07-1943 LANSIA SUKASENNEG
01-07-1965 UMUM CIKEUSIK
06-05-1957 LANSIA CIKEUSIK
03-03-1991 UMUM TANJUNGAN
20-08-1970 UMUM SUKAMULYA
02-02-1973 UMUM SUKASENNEG
02-08-1986 UMUM CIKEUSIK
27-09-1978 UMUM CIKEUSIK
04-06-1993 UMUM SUKAMULYA
12-10-2003 REMAJA CIKEUSIK
10-04-2000 UMUM CIKEUSIK
10-07-1976 UMUM CIKEUSIK
30-07-1999 UMUM CIKEUSIK
05-05-1992 UMUM CIKDONG
13-05-1978 UMUM CIKEUSIK
01-08-1975 UMUM SUKAMULYA
18-09-1981 UMUM CIKEUSIK
11-05-1978 UMUM CIKEUSIK
01-10-1980 UMUM RANCASENENG
20-06-1998 UMUM CIKDONG
10-10-1993 UMUM CIHANJUANG
18-02-2003 REMAJA CIKDONG
08-02-1971 UMUM CIHANJUANG
12-10-1975 UMUM CIKEUSIK
01-04-1985 UMUM SUKASENNEG
07-07-1966 UMUM CIKDONG
05-03-2000 UMUM TANJUNGAN
12-09-1952 LANSIA SUKASENNEG
02-04-1972 UMUM CIHANJUANG
13-02-1968 UMUM SUKAMULYA
05-04-1990 UMUM CIKDONG
02-03-1985 UMUM SUKASENNEG
05-01-1973 UMUM CIKDONG
21-03-1989 UMUM TANJUNGAN
01-08-1972 UMUM SUKAMULYA
16-07-2003 REMAJA PARKOS
01-01-1950 LANSIA SUKAMULYA
06-01-2004 REMAJA CIKEUSIK
15-05-1974 UMUM NANGGALA
10-01-1960 LANSIA CIKEUSIK
01-03-1963 UMUM CIKEUSIK
05-06-1972 UMUM SUKASENNEG
24-02-1993 UMUM SUKASENNEG
01-07-1963 UMUM CIKEUSIK
11-11-2005 REMAJA RANCASENENG
07-02-977 UMUM SUKASENNEG
01-07-1987 UMUM CIKEUSIK
28-11-2002 UMUM
0-01-1989 UMUM RANCASENENG
22-03-1991 UMUM CIKDONG
13-02-2007 REMAJA CIKEUSIK
27-10-1993 UMUM JAWA TIMUR
23-07-1982 UMUM SUKASENNEG
01-07-1982 UMUM SUKASENNEG
26-11-1996 UMUM RANCASENENG
18-05-1992 UMUM SUKAMULYA
01-07-1992 UMUM RANCASENENG
14-09-1995 UMUM CIKEUSIK
10-06-2003 REMAJA CIKDONG
20-12-1974 UMUM RANCASENENG
07-01-1985 UMUM RANCASENENG
 07-01-01981 UMUM RANCASENENG
09-09-1989 UMUM SUKASENNEG
16-07-1982 UMUM CIKEUSIK
11-07-1972 UMUM CIKEUSIK
09-04-1987 UMUM RANCASENENG
3-09-2003 REMAJA BINUANGEUN
15-09-1978 UMUM RANCASENENG
24-09-1991 UMUM TANJUNGAN
05-09-1997 UMUM SUKASENNEG
06-09-2004 REMAJA MALANGSARI
27-02-1951 LANSIA RANCASENENG
22-12-2003 REMAJA TANJUNGAN
01-07-1963 UMUM CIKEUSIK
11-11-1956 LANSIA CIKDONG
13-07-1992 UMUM SUKASENNEG
10-10-1993 UMUM CIKEUSIK
29-12-1968 UMUM CIKEUSIK
28-12-2004 REMAJA TANJUNGAN
25-02-2002 UMUM NANGGALA
05-02-1980 UMUM NANGGALA
26-09-2003 REMAJA CIWET
07-06-2006 REMAJA SUKAMULYA
14-02-2005 REMAJA SUMURBATU
20-05-1980 UMUM CILOGRANG
01-06-1978 UMUM CIKDONG
05-03-2004 REMAJA SUKAMULYA
06-06-1973 UMUM CIKEUSIK
12-06-1995 UMUM CIBINGBIN
17-11-1977 UMUM CIKEUSIK
01-01-1960 UMUM TANJUNGAN
08-01-1991 UMUM CIKDONG
16-05-1978 UMUM CIKEUSIK
02-04-1996 UMUM CIKEUSIK
IRT 24-06-2002 UMUM CIKIRUHWETAN
IRT 29-03-1983 UMUM CIKIRUHWETAN
IRT 01-08-1990 UMUM CIKIRUHWETAN
IRT 17-09-2005 UMUM CIKIRUHWETAN
WIRASWASTA 01-01-1993 UMUM CIKIRUHWETAN
WIRASWASTA 09-06-1970 UMUM CIKIRUHWETAN
WIRASWASTA 26-07-2004 UMUM CIKIRUHWETAN
IRT 10-09-1970 UMUM CIKIRUHWETAN
IRT 04-03-1973 UMUM CIKIRUHWETAN
WIRASWASTA 16-03-1992 UMUM CIKIRUHWETAN
IRT 02-05-1983 UMUM CIKIRUHWETAN
20-06-1998 UMUM UMBULAN
15-07-1981 UMUM UMBULAN
07-09-1966 UMUM UMBULAN
28-10-2002 UMUM UMBULAN
10-08-1954 UMUM UMBULAN
11-08-1989 UMUM RAHONG
02-02-2006 UMUM UMBULAN
01-03-1970 UMUM UMBULAN
06-11-1995 UMUM UMBULAN
03-03-1970 UMUM PEUNDEUY
01-07-1968 UMUM PEUNDEUY
13-06-2006 UMUM UMBULAN
01-07-1961 UMUM UMBULAN
30-06-1950 UMUM UMBULAN
22-05-1985 UMUM UMBULAN
18-04-1999 UMUM UMBULAN
07-07-1982 UMUM UMBULAN
01-07-1958 UMUM UMBULAN
01-07-1960 UMUM UMBULAN
07-08-1973 UMUM UMBULAN
01-07-1950 UMUM UMBULAN
14-04-1992 UMUM UMBULAN
01-07-1965 UMUM UMBULAN
05-03-1980 UMUM UMBULAN
01-07-1975 UMUM UMBULAN
05-08-1989 UMUM UMBULAN
07-05-1994 UMUM SUKAWARIS
01-07-1982 UMUM UMBULAN
01-02-1993 UMUM UMBULAN
12-11-1987 UMUM UMBULAN
13-09-1998 UMUM UMBULAN
08-10-1992 UMUM UMBULAN
01-07-1999 UMUM UMBULAN
11-07-1957 UMUM UMBULAN
01-07-1950 UMUM UMBULAN
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Tanggal
NO HP BPJS BPJS Non Merek Vaksin*** Screening
PBI Non PBI Anggota
081311188468 CORONAVAC 15-11-2021
085719069733 CORONAVAC 15-11-2021
085719069733 CORONAVAC 15-11-2021
085813892404 CORONAVAC 15-11-2021
085813892404 CORONAVAC 15-11-2021
085893307009 CORONAVAC 14-10-2021
085211891513 CORONAVAC 15-11-2021
085211891513 CORONAVAC 15-11-2021
085211891513 CORONAVAC 14-09-2021
08221348021 CORONAVAC 15-11-2021
08221348021 CORONAVAC 15-11-2021
08221348021 CORONAVAC 15-11-2021
08221348021 CORONAVAC 15-11-2021
085776130290 CORONAVAC 27-09-2021
CORONAVAC 15-11-2021
081219721904 CORONAVAC 15-11-2021
081219721904 CORONAVAC 15-11-2021
081219721904 CORONAVAC 15-11-2021
081219721904 CORONAVAC 26-08-2021
08138552641 CORONAVAC 15-11-2021
08138552641 CORONAVAC 15-11-2021
08138552641 CORONAVAC 15-11-2021
085893307009 CORONAVAC 15-11-2021
085893307009 CORONAVAC 11-10-2021
08121971904 CORONAVAC 15-11-2021
08121971904 CORONAVAC 15-11-2021
08121971904 CORONAVAC 14-10-2021
083875337107 CORONAVAC 15-11-2021
083875337107 CORONAVAC 15-11-2021
083875337107 CORONAVAC 15-11-2021
081236286624 CORONAVAC 13-10-2021
085235725579 CORONAVAC 15-11-2021
085235725579 CORONAVAC 15-11-2021
085235725579 CORONAVAC 15-11-2021
085235725579 CORONAVAC 15-11-2021
085235725579 CORONAVAC 15-11-2021
081296529704 CORONAVAC 15-11-2021
085212511481 CORONAVAC 15-11-2021
085212511481 CORONAVAC 11-10-2021
081314667857 CORONAVAC 15-11-2021
081314667857 CORONAVAC 15-11-2021
081314667857 CORONAVAC 15-11-2021
085212667586 CORONAVAC 11-10-2021
085219331233 CORONAVAC 15-11-2021
085219331233 CORONAVAC 15-11-2021
085219331233 CORONAVAC 11-10-2021
085691863492 CORONAVAC 15-11-2021
085691863492 CORONAVAC 15-11-2021
085691863492 CORONAVAC 15-11-2021
085219454801 CORONAVAC 15-11-2021
085219454801 CORONAVAC 15-11-2021
085219454801 CORONAVAC 15-11-2021
085219454801 CORONAVAC 15-11-2021
085810708156 CORONAVAC 15-11-2021
085810708156 CORONAVAC 15-11-2021
085210726770 CORONAVAC 15-11-2021
085210726770 CORONAVAC 11-10-2021
085216167868 CORONAVAC 15-11-2021
085216167868 CORONAVAC 15-11-2021
085216167868 CORONAVAC 11-09-2021
085886425249 CORONAVAC 15-11-2021
085886425249 CORONAVAC 15-11-2021
085886425249 CORONAVAC 15-11-2021
082319853600 CORONAVAC 15-11-2021
082319853600 CORONAVAC 15-11-2021
085216049151 CORONAVAC 15-11-2021
085216049151 CORONAVAC 15-11-2021
085216049151 CORONAVAC 15-11-2021
085216049151 CORONAVAC 24-10-2021
085216049151 CORONAVAC 15-11-2021
085216049151 CORONAVAC 27-09-2021
085773490908 CORONAVAC 15-11-2021
085773490908 CORONAVAC 15-11-2021
081513957376 CORONAVAC 15-11-2021
081513957376 CORONAVAC 11-10-2021
081211312864 CORONAVAC 15-11-2021
081211312864 CORONAVAC 15-11-2021
081211312864 CORONAVAC 15-11-2021
081211312864 CORONAVAC 15-11-2021
081211312864 CORONAVAC 15-11-2021
081211312864 CORONAVAC 15-11-2021
085771846357 CORONAVAC 15-11-2021
085771846357 CORONAVAC 15-11-2021
085718733605 CORONAVAC 15-11-2021
085718733605 CORONAVAC 15-11-2021
085718733605 CORONAVAC 14-10-2021
085092022391 CORONAVAC 15-11-2021
085092022391 CORONAVAC 15-11-2021
085092022391 CORONAVAC 15-11-2021
085092022391 CORONAVAC 15-11-2021
081316753034 CORONAVAC 15-11-2021
081316753034 CORONAVAC 14-10-2021
085692463132 CORONAVAC 14-10-2021
081220848858 CORONAVAC 15-11-2021
081220848858 CORONAVAC 15-11-2021
081220848858 CORONAVAC 15-11-2021
081220848858 CORONAVAC 15-11-2021
081220848858 CORONAVAC 30-09-2021
081220848858 CORONAVAC 15-11-2021
081220848858 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08137816036 CORONAVAC 15-11-2021
08211549366 CoronaVac 15-11-2021
08211549366 CoronaVac 15-11-2021
08211549366 CoronaVac 14-10-2021
085960533826 CoronaVac 15-11-2021
085960533826 CoronaVac 15-11-2021
085960533826 CoronaVac 15-11-2021
085960533826 CoronaVac 15-11-2021
085960533826 CoronaVac 14-10-2021
085693645877 CoronaVac 15-11-2021
085693645877 CoronaVac 15-11-2021
085693645877 CoronaVac 14-10-2021
085693645877 CoronaVac 30-09-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
083877430365 CoronaVac 15-11-2021
085311558162 CoronaVac 14-10-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085311558162 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085710457231 CoronaVac 15-11-2021
085219423411 CoronaVac 15-11-2021
085219423411 CoronaVac 15-11-2021
085219423411 CoronaVac 15-11-2021
085219423411 CoronaVac 15-11-2022
085773782563 CoronaVac 15-11-2021
085773782563 CoronaVac 15-11-2021
085773782563 CoronaVac
085782266645 CoronaVac 15-11-2021
085782266645 CoronaVac 15-11-2021
085782266645 CoronaVac 15-11-2021
085782266645 CoronaVac 15-11-2021
085782266645 CoronaVac 15-11-2021
085782266645 CoronaVac 15-11-2021
085782266645 CoronaVac 27-09-2021
085893185302 CoronaVac 15-11-2021
085893185302 CoronaVac 15-11-2021
085893185302 CoronaVac 15-11-2021
085893185302 CoronaVac 15-11-2021
085773226537 CoronaVac 15-11-2021
085773226537 CoronaVac 20-09-2021
085778212395 CoronaVac 15-11-2021
085778212395 CoronaVac 15-11-2021
085778212395 CoronaVac 30-09-2021
0852862746 CoronaVac 15-11-2021
085782263112 CoronaVac 14-10-2021
085890125872 CoronaVac 14-10-2021
085217821409 CoronaVac 15-11-2021
085217821409 CoronaVac 15-11-2021
085217821409 CoronaVac 14-10-2021
085217821409 CoronaVac 14-10-2021
085217821409 CoronaVac 14-10-2021
085805737199 CoronaVac 15-11-2021
085805737199 CoronaVac 15-11-2021
085805737199 CoronaVac 15-11-2021
085805737199 CoronaVac 15-11-2021
085805737199 CoronaVac
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 15-11-2021
085813892478 CoronaVac 14-10-2021
085770984362 CoronaVac 15-11-2021
085770984362 CoronaVac 15-11-2021
085770984362 CoronaVac 15-11-2021
085770984362 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 16-09-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 14-10-2022
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
085715458191 CoronaVac 15-11-2021
8780089756 CORONOVAC 15-11-2021
085216588080 CORONOVAC 15-11-2021
081219714859 CORONOVAC 15-11-2021
085216588080 CORONOVAC 15-11-2021
085894691330 CORONOVAC 15-11-2021
081910822244 CORONOVAC 15-11-2021
085813586916 CORONOVAC 15-11-2021
082350591119 CORONOVAC 15-11-2021
085649018072 CORONOVAC 15-11-2021
082112047076 CORONOVAC 15-11-2021
081296011496 CORONOVAC 15-11-2021
085773750301 SINOVAC 15-11-2021
085212805184 SINOVAC 15-11-2021
081808201484 SINOVAC 15-11-2021
083815428561 SINOVAC 15-11-2021
082324122166 SINOVAC 15-11-2021
082324122166 SINOVAC 15-11-2021
085852498805 SINOVAC 15-11-2021
082310247116 SINOVAC 15-11-2021
085215871422 SINOVAC 15-11-2021
085311379311 SINOVAC 15-11-2021
087882553944 SINOVAC 15-11-2021
085716578421 SINOVAC 15-11-2021
081213953905 SINOVAC 15-11-2021
085778986942 SINOVAC 15-11-2021
085219869455 SINOVAC 15-11-2021
085813894347 SINOVAC 15-11-2021
085782266237 SINOVAC 15-11-2021
085718729810 SINOVAC 15-11-2021
085717062153 SINOVAC 15-11-2021
085882165313 SINOVAC 15-11-2021
085891152932 SINOVAC 15-11-2021
087899245600 SINOVAC 15-11-2021
081317471872 SINOVAC 15-11-2021
085770149409 SINOVAC 15-11-2021
083891474668 SINOVAC 15-11-2021
082241858144 SINOVAC 15-11-2021
085715270208 SINOVAC 15-11-2021
085880112217 SINOVAC 15-11-2021
085695267391 SINOVAC 15-11-2021
085218320629 SINOVAC 15-11-2021
085779061583 SINOVAC 15-11-2021
081381319177 SINOVAC 15-11-2021
085697592197 SINOVAC 15-11-2021
081284923573 SINOVAC 15-11-2021
0857822655834 SINOVAC 15-11-2021
 Dosis I Dosis 2
Tanggal Tanggal KET
Pemberian No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi Vaksinasi
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NO No. Ticke NIK Nama Penerima Vaksin JK

1 3601040107450052 KAJARI L
2 3601044107650178 SANITI P
3 3601046011670001 KAYAH P
4 3601044108760004 KASMITI P
5 3601044703810003 SARAH P
6 3601040107610127 TARYANA L
7 3601042001000002 RUDINI L
8 3601045505800006 KARSINI P
9 3601041805850002 ASEP DEDI L
10 3601045205800001 BAYI P
11 36010471080010001 NURLELI P
12 3601040107800259 CARILAH L
13 3601041210690002 TINGGAL L
14 3601040105820006 MUHDIN L
15 3601040107080010 JASMAN L
16 3601041201650001 SAMAYA L
17 3601042306870000 RATNO L
18 '3601040310830006 ANDI L
19 3601045307730003 SUTINAH P
20 3601044107710154 EMOT P
21 3601044107730357 SURNI P
22 3601044107780397 AMI P
23 3601042001000004 SAMAR L
24 3601045807720001 KASTEM P
25 3601040906730002 ROJI L
26 3601041007980001 RASMIN L
27 3601040102780006 HADIRO L
28 3601045207940001 KURNAESIH P
29 3601044107880163 IIN NOPIYANTI P
30 3601040107750001 SAMIN L
31 3603194610880004 ENENG IMAS P
32 3601045702740001 SUAMAH L
33 3601045106900004 ANI SUSILAWATI P
34 3601040107910265 CASTANA L
35 3601041504920003 LUKMAN L
36 3601041704720001 MUHAD L
37 3601041012920001 JUMANTA L
38 3601044908780002 UNTAH P
39 3601044503060001 YOLA P
40 3601046606900003 YULIANSARI P
41 360104512680001 ATITI P
42 3601044107860197 EMBAY P
43 3601044107800283 AMINAH P
44 3601040106750006 MISJA L
45 3601040107630366 KARDI L
46 3601041406600001 SAMSURI L
47 3601042203800001 WASPAN L
48 3601044603830002 SRININGSIH P
49 3601041203910001 DEDI L
50 3601040606770001 SAID L
51 3601040107560089 SANTIM L
52 3601041501630001 MA'IN L
53 3601044102640002 ROPIAH P
54 3601040303920005 ERYANTO L
55 3601042703690001 RASJA L
56 3601040604000003 AGIS RIYAN HIDAYAT L
57 36010411047440002 TUHNI L
58 3601044106710002 TARSIH P
59 3601041706870001 CASTIM L
60 3601044102870004 SITI ROHMAH P
61 3601044107470024 WASKINAH P
62 3601044107000302 SITI MARDIAH P
63 3603030202780001 ROHMAT L
64 3601040609700002 HAMBALI L
65 3601044107780388 LINDA P
66 3601041202950002 EPI TRIANA P
67 3601041502900002 YAHYA L
68 3601042406890002 SAEP L
69 3601040107920034 KOSIRIN L
70 3601044107930305 ERUM P
71 3601045006840005 MARWIYAH P
72 3601040107910268 BILY SURLELI L
73 3601044107030138 SITI AMINAH P
74 3601044704470002 HJ. RASTI P
75 3601046707000006 ERAH P
76 3601041805010002 UU AGIS L
77 3601040107940210 RAMAN L
78 3601044108660002 YUNI P
79 3601040505040003 SAYIDIN L
80 3601041002000002 SOLEHUDIN L
81 3601040804470002 JUMARI L
82 3601040302820001 WAHYU WARNOTO L
83 3601044602710001 MAESIH P
84 3601041408050002 DIMAS L
85 3601044107420064 KALIMAH P
86 3601044107520070 MUINAH P
87 3601045107500002 SARMI P
88 360104410779068 TASIMPEN P
89 360104010790238 JULI L
90 3601044107740113 RUKAYAH P
91 3601041305900001 SARIP L
92 3601044107720012 TIAH P
93 3601041007730003 SAMAN L
94 3601040107780402 MASAN L
95 3601040107680311 SAPID L
96 3601044606770003 UMIYATI P
97 3601044103750006 DARSIH P
98 3601044805010002 MIRNAWATI P
99 3602010101650009 CASTIM L
100 3601040406630004 MADSARI L
101 3601044412030293 MISNAH P
102 3601046302000002 WASTINAH P
103 3601040603680001 UDIN L
104 3601040308080001 RESTA FAUZI L
105 3602014812700002 HALIMAH P
106 3602214404910001 MINAH P
107 3601040701070001 BAGAS L
108 3601046505010006 OYAH P
109 3601040107890170 TOIP L
110 3601041007800009 YASIN L
111 3601041810070001 ANGGA L
112 3601046402690001 IYUM P
113 3601044107730354 WASNI P
114 3601041004900003 RUDINI L
115 3601040102050004 TASIAH P
116 3601044107820153 ASRI P
117 3601045201710001 IAH P
118 3601041706840002 JAMHADI L
119 3601041903010005 SEPTIANAH P
120 3601044808670002 RUKMANAH P
121 3601040107750208 SUTARYO L
122 3601044706800003 AMAH P
123 3601044701930005 ANI HANDAYANI P
124 3601044107500077 RUKMINAH P
125 360104580960006 LENI APRIANI P
126 3601044107570065 AMSI P
127 3601047008880002 ELA HAYATI P
128 3601040107730376 SARNEN L
129 3601041202700003 CASTAM L
130 3601045310810001 KAMSAH P
131 3601046711020001 ALFIAH P
132 3601040608730002 KADIMAN L
133 3601040107600102 ARJAWI L
134 3601040107500079 SUMAD L
135 3601040107600122 SAMSURI L
136 3601040107000307 ROSID L
137 3601040209680001 AHMID L
138 3601042702880001 TONO L
139 3209271405770038 JUMENAH L
140 3601045007860005 SUMARNI P
141 3601041712750001 HERMAN L
142 3601040903870002 WASKIM L
143 3601040401960004 MARHANI L
144 3601040107870162 SUKARTA L
145 3601041012900002 BUSTOMI L
146 3601044107780436 JUHE P
147 3601041502810002 JUMADI L
148 3601040111840002 AEP SAEPUDIN L
149 3601040107640076 SUKMA L
150 3601044106760002 AMINAH P
151 3601044107730360 RATNENGSIH P
152 3601040903780002 JURTA L
153 3601040101730003 WAKIR L
154 3601041007810002 EMEN L
155 3601044811770001 RASIH P
156 3601045203880003 INIH P
157 3601045412680003 IIN P
158 3601040107610122 MARTA WIJAYA L
159 3601040107780381 DAYA L
160 3601044107770138 MARSANAH P
161 3601041702020001 ALIMAN L
162 3601040107730405 SANUSI L
163 3601044107800240 SUKATI P
164 3601040107970221 NURHANI L
165 3601040701720002 WARDI L
166 3601044203970003 ENI SUHENI P
167 3602210909810001 ANTO HARYANTO L
168 3601044107710176 TITIN P
169 3601044107520064 WARSENI P
170 3602214910770002 SRI RAHAYU P
171 3601041107430001 TARSIM L
172 3601040509900001 ASMIR HIDAYAT PUTRA L
173 3601041208770002 UPI KELLAR L
174 3601045906690001 WASNI P
175 3601044107540067 RASWEN P
176 3601040107750235 MUKRI L
177 3601040107760225 JAENUDIN L
178 3601044107580203 EUYEUM P
179 3601046209830001 ERNI YULIA P
180 3601040107840176 NADI L
181 3601350505770002 TONI L
182 3601044202820003 NENGSIH P
183 3601044107620068 ARSIAN P
184 3601046803770001 IDA ROSIDA P
185 3601045006930003 ANDIKA KUSUMA L
186 3601044806850001 ROHAMAH P
187 3601040107830277 PUULUNG ANDI L
188 3601040804690004 CASIM L
189 3601045609620001 SANI P
190 3601044107880152 WARNI P
191 3601045107570002 UMINIH P
192 3601045807010001 NENI NURHAYATI P
193 3601045808990004 JUHEMI P
194 3601040307960004 SURIMAN L
195 3275115103970006 ULFAH SILFIAH P
196 3601045810810001 ALISAH P
197 3601041203750001 SUYANDI L
198 3601044404060002 NOVITASARI P
199 3601040601000003 TONI L
200 3601044306960003 SITI HALIMA P
201 3601044405810002 TASIAH P
202 3601041705870003 SAID L
203 3601045206750005 ODAH P
204 3601040107880256 NANA SUPRIYATNA L
205 3601044708830010 SRI YULIATI P
206 36010040607850005 NURYANI L
207 3601040107800217 SUHNI L
208 3601040701730002 WACA L
209 3601045603790001 SUKAESIH P
210 3601040107650174 EMED L
211 3601040110910001 SUHAR L
212 360104470480008 EDAH P
213 3601040603860002 MAMAT AKEH L
214 3601044107940200 TASINAH P
215 3602215309720001 TATI P
216 3601040804050001 M. HARIS L
217 3601040706770001 ASYADI L
218 3601041202820004 IIP SAEPUDIN L
 Umur
Kelompok
Pekerjaan* (18-59 INSTANSI Alamat NO HP
Umur
tahun)

01-07-1945 UMUM UMBULAN 081266785419

01-07-1965 UMUM UMBULAN 081283449576
20-11-1967 UMUM UMBULAN 082125756743
01-08-1976 UMUM UMBULAN 081585994043
07-03-1981 UMUM UMBULAN 0812848043
01-07-1962 UMUM UMBULAN 085770120032
12-02-1998 UMUM UMBULAN 081266785419
15-05-1980 UMUM UMBULAN 085770304125
18-05-1985 UMUM UMBULAN 085219423919
12-05-1980 UMUM UMBULAN 085813892487
31-08-2001 UMUM UMBULAN 085770120032
15-02-1981 UMUM UMBULAN 083871179326
12-10-1969 UMUM UMBULAN 08219423895
01-06-1982 UMUM UMBULAN
11-03-1965 UMUM UMBULAN 087772770100
12-01-1965 UMUM UMBULAN 081311980471
23-06-1987 UMUM UMBULAN 081266785419
03-10-1983 UMUM UMBULAN 081283449576
13-07-1973 UMUM UMBULAN 082125756743
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01-07-1973 UMUM UMBULAN 0812848043
12-04-1976 UMUM UMBULAN 085770120032
20-04-1999 UMUM UMBULAN 081266785419
18-07-1972 UMUM UMBULAN 085770304125
09-06-1973 UMUM UMBULAN 085219423919
18-07-2000 UMUM UMBULAN 085813892487
17-04-1973 UMUM UMBULAN 085770120032
12-07-1994 UMUM UMBULAN 083871179326
18-12-1986 UMUM UMBULAN 08219423895
01-06-1975 UMUM UMBULAN 081266785419
06-10-1988 UMUM UMBULAN 081283449576
02-08-1992 UMUM UMBULAN 082125756743
12-02-1990 UMUM UMBULAN 081585994043
27-09-1991 UMUM UMBULAN 0812848043
10-05-1987 UMUM UMBULAN 085770120032
06-10-1975 UMUM UMBULAN 081266785419
10-12-1992 UMUM UMBULAN 085770304125
12-11-1980 UMUM UMBULAN 085219423919
05-03-2006 UMUM UMBULAN 085813892487
26-06-1990 UMUM UMBULAN 085770120032
10-12-1968 UMUM UMBULAN 083871179326
01-07-1987 UMUM UMBULAN 08219423895
UMUM UMBULAN 081266785419
UMUM UMBULAN 081283449576
UMUM UMBULAN 082125756743
UMUM UMBULAN 081585994043
UMUM UMBULAN 0812848043
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 081266785419
UMUM UMBULAN 081283449576
UMUM UMBULAN 082125756743
UMUM UMBULAN 081585994043
UMUM UMBULAN 0812848043
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
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UMUM UMBULAN 081266785419
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UMUM UMBULAN 085813892487
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UMUM UMBULAN 08219423895
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
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UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 085770120032
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 085813892487
UMUM UMBULAN 085770120032
UMUM UMBULAN 083871179326
UMUM UMBULAN 08219423895
UMUM UMBULAN 081266785419
UMUM UMBULAN 085770304125
UMUM UMBULAN 085219423919
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

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 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601041902970002 DEDE WAHYUDIN L

2 3601045804830004 SURYANI P
3 3601045807840005 TINI P
4 3601045602810002 TIRAH P
5 3601045504870001 MAEMUNAH P
6 3601040107770138 WAKIR L
7 3601044809810003 ETI P
8 3601044107760055 SUMINAH P
9 3601043430400003 KALSUM P
10 3601044107670025 SUPIHAT P
11 3601045506830003 KEMI P
12 3601044105910007 NENG DINA P
13 3173016307800010 NURHAENI P
14 3601045109750001 RASIH P
15 3601044107700176 BAYI P
16 3601041201930002 FAS FAHIS SOFKHAL L
17 3601042301740001 H.KUSNADI L
18 3601044104640002 EROH P
19 3602880501680002 JUMALI L
20 3601044104640002 EROH P
21 3601044107750049 SARHENAH P
22 3601045708900003 NURLELA P
23 3601045203710001 BAYI P
24 3601040303780001 MULYADI L
25 3601045401890001 MELA P
26 3601046309850003 MARSINAH P
27 3601044107760251 LILIS P
28 3601044107040010 NOVI TIARASARI P
29 3601044607690002 SUARSIH P
30 3601044309940003 RANTI P
31 3601064909780001 DARIAH P
32 3601046804740001 SARPI P
33 3601044411810002 TANIA P
34 3601046606890001 TINI P
35 3601042302860000 LUKI NURHOLIS L
36 3601045403580002 KOYAH P
37 3601041506670002 RAMAN L
38 3601040112790001 ETI SUSILAWATI P
39 3601045204790001 SUMINAR P
40 3601041301630001 OBAY L
41 3601044102660002 ROHMAN L
42 3601041705870001 IBRA L
43 3601045104770002 ELI L
44 3601045210890002 NURHAENI P
45 3601044104640002 EROH P
46 3601040503780003 SAPRUDIN L
47 3601046202960003 ELIS P
48 3601044708800004 INAR P
49 3601045912830002 ERAH P
50 3601040805690001 AYUT L
51 3601044506770005 SARMINAH P
52 3601044107560008 ENI BT USMAN P
53 360104160740001 RASMAN L
54 3601044711960001 WARSIH P
55 3601044609010001 SRI HESTINA P
56 3601044310020004 SITI KHODIJAH P
57 3214034101800005 YUYUN L
58 3601040107700009 RAJI L
59 3601046502970002 ERNASARI P
60 3601040107670023 ARSIM L
61 3601041203660002 KADAR L
62 3601040605880002 JAJANG L
63 3601045810500002 MARHENI P
64 3601046109980001 SAENAH P
65 3602211307920004 UDI L
66 3601042302630001 ASJA L
67 3601040512780001 SARMANI L
68 3601044101850013 RUMI P
69 3601044406940001 CUCU CAHAYATI P
70 3601044905060003 SARMAH P
71 3601046001030002 YANTI SUSANTI P
72 3601040211630001 ALEH L
73 3601045404850002 ABSAH P
74 360104407590001 UPI P
75 3601044607990005 NENTI YULIYANTI P
76 3601045206860002 SUHETI P
77 360211203870005 ZANI PAHROJI P
78 3601044804960002 LINDA YANTI P
79 3601045903980002 SANARIAH P
80 3601044309860003 ROHMAN L
81 3601042802890001 RASMIN L
82 3601042605810002 ARIMAN L
83 360104260880001 SUNAYA P
84 3601040305800001 SARKIAN L
85 3601040703950004 PUDIN L
86 3601044107870165 AMI P
87 3601042203530001 SUHELI L
88 3601047008780001 ADIAH P
89 3601040401680001 SADISA L
 90 3601044501800007 ADIL L
91 3601041908890004 ASMANUDIN L
92 3601045010750008 RUKIAH P
93 3601045306870001 NENI P
94 3601041802740001 RUMINTA P
95 3601044107680331 SANIMAH P
96 3601045806780001 NURHAENI P
97 3601040303750002 IBRAHIM AZIS L
98 3601046202930003 ANIS RAHMAH WATI P
99 3601044601980005 SUHENI P
100 3602210205850008 AHMAD YANI L
101 3601040107660001 HJ ISAH P
102 3601046811930003 AI NURAENI P
103 3329065507770007 WADHIKA P
104 3601040309830003 ABDUL ROHMAN L
105 3601045405040001 VINA MEYLANI P
106 3601044806080005 BUNGA NUR HALIZAH P
107 3601046412020002 NUR HOLIDAH P
108 3601047004810001 ENO P
109 3601044306810001 WARSIH P
110 3601045404580002 SARNITI P
111 3601041209950004 SUHARNA L
112 3601044607790002 ADE L
113 3601041507940004 ANDI L
114 3601040205900001 DENI HIDAYAT L
115 3601040102030011 IPAL L
116 3601046206630001 ONAH P
117 3601044102610001 MARIAM P
118 3601040107890114 AMONG HIDAYAT L
119 3601044203850010 UNAYAH P
120 3602211209980003 PARTA WIJAYA L
121 3505062909720001 AGUS KUSWANTO L
122 3601040303990007 M.ABDUH MUHAJIR L
123 3601045109920001 RESTI P
124 3601045103800005 ETI SUSILAWATI P
125 3601041707820004 UDIN SUPANDI L
126 3601044404000005 EMAH P
127 9111024805900000 EMAH NURHALIMAH P
128 3601044810800081 SITI HOLIDAH P
129 3601041605910005 HADA L
130 3601044508720003 SAMI P
131 3601045208990002 KIKI NURHASANAH P
132 3601045105910001 NENI MEGALANI P
133 3601045902790001 CUCUM P
134 360104506860002 ASIAH SAPTI P
135 3601044701690002 NURPIAH P
136 3601014660578003 TATI P
137 3601045509880001 TINAH P
138 3601044901010007 ACIH SULAESIH P
139 360104610400003 NANADA RIA PUSPITA P
140 3601045109600001 HENI IDA LESTARI P
141 3601041306020002 SUNARTO L
142 3601042804050001 ARYA WIGUNA L
143 3601046802730001 ENONG P
144 3601040306750005 HUDRI L
145 3601045102550003 UAS P
146 3601041307100004 AGUN GUNAWAN L
147 3601040503100002 ERWIN MAULANA L
148 3601045903840001 EVA P
149 3601046709950002 RASINAH P
150 3601041707930003 YANA SUTIANA L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

WIRASWASTA 27-08-1997 UMUM SUKAWARIS

IRT 16-04-1983 UMUM SUKAWARIS
IRT 18-07-1984 UMUM SUKAWARIS
IRT 16-02-1981 UMUM SUKAWARIS
IRT 15-04-1987 UMUM CILUKUT
WIRASWASTA 01-07-1977 UMUM SUKAWARIS
IRT 08-09-1981 UMUM SUKARENDAH
IRT 01-07-1976 UMUM CILUKUT
WIRASWASTA 03-04-2000 UMUM CILUKUT
IRT 01-07-1957 UMUM SUKAWARIS
IRT 15-06-1983 UMUM TANJUNGAN
WIRASWASTA 01-05-1991 UMUM SUKAWARIS
IRT 23-07-1980 UMUM CIKIRUHWETAN
IRT 11-09-1975 UMUM SUKAWARIS
IRT 01-07-1970 UMUM SUKAWARIS
WIRASWASTA 31-10-1993 UMUM CIKIRUHWETAN
WIRASWASTA 23-01-1974 UMUM CIKIRUHWETAN
IRT 23-11-11973 UMUM SUKARENDAH
WIRASWASTA 09-03-1970 UMUM SUKARENDAH
IRT 23-11-1973 UMUM SUKARENDAH
IRT 01-07-1975 UMUM SUKARENDAH
IRT 17-08-1990 UMUM SUKAWARIS
IRT 12-03-1971 UMUM SUKAWARIS
WIRASWASTA 03-03-1978 UMUM SUKAWARIS
IRT 27-12-1988 UMUM CIKIRUHWETAN
IRT 23-09-1985 UMUM SUKARENDAH
IRT 01-07-1976 UMUM CIKIRUHWETAN
IRT 20-08-2003 UMUM CIKIRUHWETAN
IRT 06-07-1969 UMUM CIKIRUHWETAN
IRT 03-09-1994 UMUM SUKAWARIS
IRT 09-09-1978 UMUM CIKIRUHWETAN
IRT 28-12-1979 UMUM CIKIRUHWETAN
IRT 04-11-1981 UMUM CIKIRUHWETAN
IRT 26-06-1989 UMUM CIKIRUHWETAN
WIRASWASTA 23-07-1986 UMUM CIKIRUHWETAN
IRT 14-03-1958 UMUM CIKIRUHWETAN
WIRASWASTA 13-06-1967 UMUM CIKIRUHWETAN
IRT 1/2/1985 UMUM SUKAWARIS
IRT 12/4/1979 UMUM CIKIRUHWETAN
PETANI 13-01-1963 UMUM CIKIRUHWETAN
WIRASWASTA 11-02-1966 UMUM CIKIRUHWETAN
WIRASWASTA 02-05-1987 UMUM SUKAWARIS
WIRASWASTA 11-04-1977 UMUM SUKAWARIS
IRT 12-10-1989 UMUM SUKAWARIS
IRT 01-04-1964 UMUM SUKAWARIS
WIRASWASTA 06-03-1978 UMUM CIKIRUHWETAN
IRT 02-02-1997 UMUM CIKIRUHWETAN
IRT 07-08-1980 UMUM CIKIRUHWETAN
IRT 12-10-1974 UMUM CIKIRUHWETAN
WIRASWASTA 08-05-1969 UMUM CIKIRUHWETAN
IRT 05-06-1977 UMUM CIKIRUHWETAN
IRT 05-10-1976 UMUM CIKIRUHWETAN
PETANI 16-07-1994 UMUM CIKIRUHWETAN
IRT 09-07-1997 UMUM CIKIRUHWETAN
IRT 09-09-2001 UMUM CIKIRUHWETAN
IRT 03-10-2002 UMUM CIKIRUHWETAN
IRT 01-01-1980 UMUM CIKIRUHWETAN
NELAYAN 13-04-1973 UMUM CIKIRUHWETAN
IRT 25-02-1997 UMUM CIKIRUHWETAN
PETANI 01-07-1967 UMUM SUKAWARIS
PETANI 12-03-1966 UMUM CIKIRUHWETAN
WIRASWASTA 07-05-1985 UMUM CIKIRUHWETAN
IRT 18-10-1950 UMUM PARUNGKOKOSAN
IRT 01-03-1995 UMUM SUKAWARIS
WIRASWASTA 13-07-1992 UMUM PARUNGPANJANG
WIRASWASTA 23-02-1963 UMUM CIKIRUHWETAN
PETANI 05-12-1978 UMUM CIKIRUHWETAN
IRT 01-01-1985 UMUM CIKIRUHWETAN
IRT 04-06-1994 UMUM CIKIRUHWETAN
PELAJAR 09-05-2006 REMAJA CIKIRUHWETAN
PELAJAR 20-07-2004 REMAJA CIKIRUHWETAN
WIRASWASTA 10-05-1963 UMUM CIKIRUHWETAN
IRT 14-04-1985 UMUM CIKIRUHWETAN
IRT 02-10-1962 UMUM CIKIRUHWETAN
IRT 6/7/1999 UMUM CIKIRUHWETAN
IRT 12-06-1976 UMUM CIKIRUHWETAN
IRT 12-03-1987 UMUM CIKIRUHWETAN
IRT 17-08-1996 UMUM CIKIRUHWETAN
IRT 19-03-1998 UMUM SUKAWARIS
WIRASWASTA 03-09-1986 UMUM SUKAWARIS
PETANI 28-02-1989 UMUM CIKIRUHWETAN
PETANI 26-05-1981 UMUM CIKIRUHWETAN
IRT 26-08-1981 UMUM CIKIRUHWETAN
PETANI 03-05-1980 UMUM TANJUNGAN
PETANI 07-03-1994 UMUM CIKIRUHWETAN
IRT 01-07-1987 UMUM CIKIRUHWETAN
PETANI 22-03-1953 UMUM CIKIRUHWETAN
IRT 30-08-1978 UMUM CIKIRUHWETAN
WIRASWASTA 04-01-1968 UMUM CIKIRUHWETAN
WIRASWASTA 15-01-1980 UMUM CIKIRUHWETAN
WIRASWASTA 19-08-1989 UMUM CIKIRUHWETAN
IRT 10-10-1979 UMUM CIKIRUHWETAN
IRT 24-04-1986 UMUM TANJUNGAN
IRT 18-02-1974 UMUM CIKIRUHWETAN
IRT 01-07-1977 UMUM CIKIRUHWETAN
IRT 18-06-1978 UMUM CIKIRUHWETAN
IRT 03-03-1975 UMUM CIKIRUHWETAN
IRT 22-02-1993 UMUM CIKIRUHWETAN
IRT 06-01-1998 UMUM CIKIRUHWETAN
WIRASWASTA 02-05-1985 UMUM CIKIRUHWETAN
IRT 28-04-1969 UMUM CIKIRUHWETAN
IRT 28-11-1993 UMUM CIKIRUHWETAN
IRT 15-07-1977 UMUM CIKIRUHWETAN
WIRASWASTA 03-09-1983 UMUM CIKIRUHWETAN
IRT 14-05-2004 UMUM CIKIRUHWETAN
IRT 08-06-2007 UMUM CIKIRUHWETAN
IRT 24-12-2002 UMUM CIKIRUHWETAN
IRT 30-04-1981 UMUM CIKIRUHWETAN
IRT 03-06-1981 UMUM CIKIRUHWETAN
IRT 14-04-1958 UMUM CIKIRUHWETAN
WIRASWASTA 12-09-1995 UMUM CIKIRUHWETAN
WIRASWASTA 06-07-1979 UMUM CIKIRUHWETAN
WIRASWASTA 11-04-1996 UMUM CIKIRUHWETAN
WIRASWASTA 02-05-1990 UMUM CIKIRUHWETAN
PELAJAR 28-10-2002 UMUM CIKIRUHWETAN
IRT 22-06-1963 UMUM CIKIRUHWETAN
IRT 01-02-1961 UMUM CIKIRUHWETAN
WIRASWASTA 18-04-1987 UMUM CIKIRUHWETAN
IRT 02-03-1985 UMUM CIKIRUHWETAN
WIRASWASTA 01-07-1998 UMUM CIKIRUHWETAN
WIRASWASTA 29-09-1972 UMUM CIKIRUHWETAN
WIRASWASTA 03-03-1999 UMUM CIKIRUHWETAN
IRT 11-09-1992 UMUM CIKIRUHWETAN
IRT 01-01-1975 UMUM CIKIRUHWETAN
NELAYAN 17-07-1982 UMUM CIKIRUHWETAN
IRT 04-04-2000 UMUM CIKIRUHWETAN
IRT 08-05-1990 UMUM CIKIRUHWETAN
IRT 08-10-1981 UMUM CIKIRUHWETAN
WIRASWASTA 16-05-1991 UMUM CIKIRUHWETAN
IRT 05-08-1972 UMUM CIKIRUHWETAN
IRT 12-08-1999 UMUM CIKIRUHWETAN
IRT 11-05-1999 UMUM CIKIRUHWETAN
IRT 19-02-1979 UMUM CIKIRUHWETAN
IRT 14-06-1986 UMUM CIKIRUHWETAN
IRT 05-02-2002 UMUM CIKIRUHWETAN
IRT 26-05-1978 UMUM CIKIRUHWETAN
IRT 15-09-1988 UMUM CIKIRUHWETAN
IRT 09-01-2001 UMUM CIKIRUHWETAN
IRT 21-04-2000 UMUM CIKIRUHWETAN
IRT 11-09-1981 UMUM CIKIRUHWETAN
PELAJAR 13-06-2002 UMUM CIKIRUHWETAN
WIRASWASTA 19-12-1999 UMUM CIKIRUHWETAN
IRT 05-10-1976 UMUM CIKIRUHWETAN
WIRASWASTA 03-06-1975 UMUM CIKIRUHWETAN
IRT 11-02-1955 UMUM CIKIRUHWETAN
WIRASWASTA 18-07-2004 UMUM REMAJA
WIRASWASTA 16-09-2004 UMUM CIKIRUHWETAN
IRT 19-03-1977 UMUM CIKIRUHWETAN
IRT 27-09-1992 UMUM CIKIRUHWETAN
WIRASWASTA 04-09-1993 UMUM CIKIRUHWETAN
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal
Tanggal Pemberi
NO HP BPJS BPJS Non Vaksin** Screening No.
* an
PBI Non PBI Anggota Batch
Vaksina
si
082149935278 15-11-2021
085866761684 15-11-2021
085814314321 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
083819339053 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
085866761684 15-11-2021
085773674637 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
087773360666 15-11-2021
085212667580 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082149935278 15-11-2021
082312006593 15-11-2021
082149935278 15-11-2021
083873620275 15-11-2021
085811970277 15-11-2021
085814339752 15-11-2021
082124723019 15-11-2021
08782090576 15-11-2021
085212667580 15-11-2021
085881645824 15-11-2021
085779439844 15-11-2021
087820116556 CORONOV15-11-2021 15-11-202 2.02E+09
087773084523 CORONOV15-11-2021 15-11-202 2.02E+09
085881149376 CORONOV15-11-2021 15-11-202 2.02E+09
081249935278 CORONOV15-11-2021 15-11-202 2.02E+09
085893722465 CORONOV15-11-2021 15-11-202 2.02E+09
082130201476 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
085714949821 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
085211706742 CORONOV15-11-2021 15-11-202 2.02E+09
085283712370 CORONOV15-11-2021 15-11-202 2.02E+09
085211706742 CORONOV15-11-2021 15-11-202 2.02E+09
081317238322 CORONOV15-11-2021 15-11-202 2.02E+09
085780510334 CORONOV15-11-2021 15-11-202 2.02E+09
081910822244 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
085247992131 CORONOV15-11-2021 15-11-202 2.02E+09
083811510829 CORONOV15-11-2021 15-11-202 2.02E+09
084710492066 CORONOV15-11-2021 15-11-202 2.02E+09
082310863979 CORONOV15-11-2021 15-11-202 2.02E+09
082258022157 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
081317238322 CORONOV15-11-2021 15-11-202 2.02E+09
085214993527 CORONOV15-11-2021 15-11-202 2.02E+09
085614397852 CORONOV15-11-2021 15-11-202 2.02E+09
085283712370 CORONOV15-11-2021 15-11-202 2.02E+09
0852149935278 CORONOV15-11-2021 15-11-202 2.02E+09
085718132018 CORONOV15-11-2021 15-11-202 2.02E+09
0856718132018 CORONOV15-11-2021 15-11-202 2.02E+09
085773647850 CORONOV15-11-2021 15-11-202 2.02E+09
08568459931 CORONOV15-11-2021 15-11-202 2.02E+09
085813104054 CORONOV15-11-2021 15-11-202 2.02E+09
0857737751885 CORONOV15-11-2021 15-11-202 2.02E+09
08581093941 CORONOV15-11-2021 15-11-202 2.02E+09
085773487037 CORONOV15-11-2021 15-11-202 2.02E+09
085776861046 CORONOV15-11-2021 15-11-202 2.02E+09
085813104054 CORONOV15-11-2021 15-11-202 2.02E+09
083874666450 CORONOV15-11-2021 15-11-202 2.02E+09
085773669705 CORONOV15-11-2021 15-11-202 2.02E+09
085781194733 CORONOV15-11-2021 15-11-202 2.02E+09
085214153097 CORONOV15-11-2021 15-11-202 2.02E+09
085860454812 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
082149935278 CORONOV15-11-2021 15-11-202 2.02E+09
085217038458 CORONOV15-11-2021 15-11-202 2.02E+09
085774297745 CORONOV15-11-2021 15-11-202 2.02E+09
083808863788 CORONOV15-11-2021 15-11-202 2.02E+09
083808863788 CORONOV15-11-2021 15-11-202 2.02E+09
083812674404 CORONOV15-11-2021 15-11-202 2.02E+09
085778218814 CORONOV15-11-2021 15-11-202 2.02E+09
085882204718 CORONOV15-11-2021 15-11-202 2.02E+09
085866176274 CORONOV15-11-2021 15-11-202 2.02E+09
085216910189 CORONOV15-11-2021 15-11-202 2.02E+09
083856598724 CORONOV15-11-2021 15-11-202 2.02E+09
085694275880 CORONOV15-11-2021 15-11-202 2.02E+09
083873171035 CORONOV15-11-2021 15-11-202 2.02E+09
083 CORONOV15-11-2021 15-11-202 2.02E+09
081511690140 CORONOV15-11-2021 15-11-202 2.02E+09
085960106910 CORONOV15-11-2021 15-11-202 2.02E+09
087875525895 CORONOV15-11-2021 15-11-202 2.02E+09
085773883624 CORONOV15-11-2021 15-11-202 2.02E+09
085772729308 CORONOV15-11-2021 15-11-202 2.02E+09
085719805299 CORONOV15-11-2021 15-11-202 2.02E+09
085215864039 CORONOV15-11-2021 15-11-202 2.02E+09
085894695428 CORONOV15-11-2021 15-11-202 2.02E+09
085691728320 CORONOV15-11-2021 15-11-202 2.02E+09
087885154463 CORONOV15-11-2021 15-11-202 2.02E+09
087772581616 CORONOV15-11-2021 15-11-202 2.02E+09
085861153774 CORONOV15-11-2021 15-11-202 2.02E+09
085781545481 CORONOV15-11-2021 15-11-202 2.02E+09
085211701139 CORONOV15-11-2021 15-11-202 2.02E+09
085819915796 CORONOV15-11-2021 15-11-202 2.02E+09
085695000981 CORONOV15-11-2021 15-11-202 2.02E+09
085695000981 CORONOV15-11-2021 15-11-202 2.02E+09
085894544979 CORONOV15-11-2021 15-11-202 2.02E+09
085693150236 CORONOV15-11-2021 15-11-202 2.02E+09
085813108708 CORONOV15-11-2021 15-11-202 2.02E+09
0857722033649 CORONOV15-11-2021 15-11-202 2.02E+09
085794156814 CORONOV15-11-2021 15-11-202 2.02E+09
0856500090 CORONOV15-11-2021 15-11-202 2.02E+09
08565000981 CORONOV15-11-2021 15-11-202 2.02E+09
085776135178 CORONOV15-11-2021 15-11-202 2.02E+09
081296011496 CORONOV15-11-2021 15-11-202 2.02E+09
081908179766 CORONOV15-11-2021 15-11-202 2.02E+09
085691080993 CORONOV15-11-2021 15-11-202 2.02E+09
085714287120 CORONOV15-11-2021 15-11-202 2.02E+09
081511690897 CORONOV15-11-2021 15-11-202 2.02E+09
08585670671 CORONOV15-11-2021 15-11-202 2.02E+09
08589424872 CORONOV15-11-2021 15-11-202 2.02E+09
085782267346 CORONOV15-11-2021 15-11-202 2.02E+09
081223682320 CORONOV15-11-2021 15-11-202 2.02E+09
08210827668 CORONOV15-11-2021 15-11-202 2.02E+09
81223682320 CORONOV15-11-2021 15-11-202 2.02E+09
81223682320 CORONOV15-11-2021 15-11-202 2.02E+09
83891887888 CORONOV15-11-2021 15-11-202 2.02E+09
83891887888 CORONOV15-11-2021 15-11-202 2.02E+09
8528159784 CORONOV15-11-2021 15-11-202 2.02E+09
83891887888 CORONOV15-11-2021 15-11-202 2.02E+09
085312959896 CORONOV15-11-2021 15-11-202 2.02E+09
085773762964 CORONOV15-11-2021 15-11-202 2.02E+09
085650000981 CORONOV15-11-2021 15-11-202 2.02E+09
085312959896 CORONOV15-11-2021 15-11-202 2.02E+09
081383677441 CORONOV15-11-2021 15-11-202 2.02E+09
08565000981 CORONOV15-11-2021 15-11-202 2.02E+09
08138108993 CORONOV15-11-2021 15-11-202 2.02E+09
085721569296 CORONOV15-11-2021 15-11-202 2.02E+09
085773669705 CORONOV15-11-2021 15-11-202 2.02E+09
082113212490 CORONOV15-11-2021 15-11-202 2.02E+09
083147314933 CORONOV15-11-2021 15-11-202 2.02E+09
08577366705 CORONOV15-11-2021 15-11-202 2.02E+09
085814397852 CORONOV15-11-2021 15-11-202 2.02E+09
085794449110 CORONOV15-11-2021 15-11-202 2.02E+09
085692735179 CORONOV15-11-2021 15-11-202 2.02E+09
085779347845 CORONOV15-11-2021 15-11-202 2.02E+09
 Dosis 2

Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi

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15-11-2021 2021081641
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NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601041102840001 WITA L
2 3601040205000006 ANDA L
3 3601042612960001 M. IKHSAN L
4 3601041812600001 MADSUHI L
5 3601046705920001 NURSIH P
6 3601045802730001 SITI P
7 3601042610930001 SUANDI L
8 3601040207430003 SARMANDI L
9 3601040909670001 KURDI L
10 3601041202680003 SAEPUDIN L
11 3601042812020001 DIKI L
12 3601042411610001 MARJANI L
13 3601042301840001 ABIDIN L
14 3601045902720003 SARIAH P
15 3602211402580003 MUHAMAD DAYAT SETIANA L
16 3601041110720002 TURNA L
17 3601043003770001 ASIK L
18 3601041103920005 KALIM L
19 3601040706720002 SELMAT B KADIAH L
20 3601045402970004 AI KOMARIAH P
21 3601041503920003 SAMAN L
22 3601042205970001 SUKENDA L
23 3601040910010005 INDRA MUJAKI L
24 3601044107760164 SURENI P
25 3601042109890002 JARIPUDIN L
26 3601042005970001 MUDIN L
27 3601040106010003 MUHAMAD SOLEH L
28 3601041705980001 TARYADI L
29 3601040207790006 EBIT L
30 3601044506980003 BIAH SUSANTI P
31 3601040212600001 WASBUN L
32 3601040504550003 WASDU L
33 3601040305990003 RASMADI L
34 3601040906970002 SUAWANDI L
35 3601040304890003 USNADI L
36 3601040511000001 KADMAN L
37 3601046109860001 EEN P
38 3601045005680002 RUMSIH P
39 3601041905620001 KAPIYUDIN L
40 3601045308720003 ICEU P
41 3601040504970002 IRFAN KHAERUDIN L
42 3602274811920001 UNIAH P
43 3601041104850003 ENDRI L
44 3601040107730136 DALI L
45 3601044712870002 LIA SUPERI P
46 3601040812850002 AHMAD L
47 3601045305820001 CARMI P
48 3601044910850001 KARMIN L
49 3601049902740002 JENAH P
50 3601040704420001 WARPAN L
51 3601046211750001 TASINGKEM P
52 3602215110990001 NURHASAN P
53 3601045507800026 MIMIN P
54 3601040506740001 RUSLAN L
55 3601044305820003 JURIAH P
56 3601041512820001 TARDI L
57 3601041101870002 DAMIN L
58 3601047006960001 RINI ASTUTI P
59 3601044506760002 SANAH IAH P
60 3601042201870001 KUSTANI L
61 3601044610720003 Tiah P
62 3601045011820003 Rokayah P
63 3601040107520069 carya L
64 36010445304720001 KARMINIH P
65 3602211402580003 M. DAYAT SETIANA L
66 3601040106010003 M. SOLEH L
67 3601044107100001 KONOL P
68 3601046004920001 TIAH P
69 3601040606820004 DEDI L
70 3601045705820004 ENJUN P
71 3601046906770001 ETI P
72 3601040107900042 HENDRA L
73 3601045011890003 ENOK HASANAH P
74 3602216603940001 NENTI P
75 3601044107910056 ERI RISANTI P
76 3601044107830075 MURSINAH P
77 3601041403720001 KARSIM L
78 3601044107760028 SAMIAH P
79 3601040707950003 JAYANA L
 80 3601040803530002 MUKTAR L
81 3601040104540001 TARLIM L
82 3601044107860037 KARIDAH P
83 3601046407790001 ESIH P
84 3601046308820001 JUJU P
85 3601041910690001 ROHIM L
86 3601040503020005 SAEPUL ADHA L
87 3601045106980002 MAESAROH P
88 3601040104600001 SUNGAWA L
89 3601044102670001 YAYAH P
90 3601040706050003 IPAN BAYU L
91 3601044606890003 NUNUNG NURASIAH P
92 3601041910020002 M.YUSRIL ZM L
93 3601044203780003 HANAH P
94 3601044107680053 SAEBAH P
95 3601041807820002 SUMARIH L
96 3601041801750002 SARNA L
97 3601041102960001 UKI YUSUP L
98 3601040304030006 ANDI CHAN L
99 3601042909840002 AHMAD RUSDI L
100 3601040207580003 H.MUDI L
 Kepesertaan BPJS
'Ya' pada kolom
Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP BPJS
ok Umur
tahun) PBI

11-03-1966 KP. CIKONCANG 087827730099

02-05-2000 KP. CIRIRIGI 081511865919
26-12-1996 KP. CIRIRIGI 083127238383
18-12-1960 KP. CIRIRIGI 085695269926
03-04-1993 KP. JAHA 08158249160
10-11-1975 KP. JAHA 085881657374
26-10-1993 KP. SUKAMANDI 081318829671
02-07-1943 KP. SUKAMANDI 085692653825
05-15-1961 KP. JAHA 085281456494
12-02-1968 KP. CIRIRIGI 083813032597
28-12-2002 KP. CIRIRIGI 083877715737
24-11-1961 KP. CIRIRIGI 083877715737
23-01-1984 KP. CIRIRIGI 083877715737
19-01-1972 KP. SUKAMANDI 081646059262
14-02-1958 KP. BUDIMULYA BARAT 083173541349
11-10-1972 KP. PEMATANGSEMPUR 085218566583
30-03-1977 KP. CIRIRIGI 085795271102
11-03-1992 KP. RANCASENENG 085624601956
07-06-1972 KP. PEMATANGSEMPUR 085779568773
14-01-1995 KP. RANCASENENG 085624601956
15-03-1993 KP. CIRIRIGI 085721883231
22-05-1997 KP. PEMATANGSEMPUR 085771000699
10-09-2001 KP. SUKASENENG 081574720976
01-07-1976 KP. PEMATANGSEMPUR 085778279631
18-06-1989 KP. SUKAMANDI 085691133336
20-05-1997 KP. SUKAMANDI 083878400101
01-06-2001 KP. PEMATANGSEMPUR 085714399929
04-06-1999 KP. PEMATANGSEMPUR 085819518692
02-07-1979 KP. SINAPEUL 085817090148
05-06-1998 KP. JAHA 087761678921
02-12-1960 KP. PEMATANGSEMPUR 085697744621
05-041955 KP. TAMELAK 085212606364
2-08-1999 KP. PEMATANGSEMPUR 085810876909
10-10-1986 KP. JAHA 085770582550
12-05-1989 KP. JAHA 081316967684
05-09-1999 KP. PEMATANGSEMPUR 085778279631
 08-10-1989 KP. SUKAMANDI 081295007074
10-05-1968 KP. CIRIRIGI 085776879363
19-05-1962 KP. SUKAMANDI 085211575290
13-08-1972 KP. SUKAMANDI 085212609501
28-01-1998 KP. SUKAMANDI 081280547828
08-11-1992 KP. CIRIRIGI 085695269926
11-04-1985 KP. CIKONCANG 085321519977
01-07-1973 KP. BABAKAN CIBALIUNG085699723797
06-01-1988 KP. CIKONCANG 085782261636
08-12-1985 KP. CIRIRIGI 085798840129
13-05-1982 KP. TAMELAK 085321519977
02-03-1975 KP. PEMATANGSEMPUR 085694723747
09-02-1974 KP. SUKAMANDI 082195007074
07-04-1942 KP. KIARAJANGKUNG 085281449160
22-11-1975 KP. CIKONCANG 0858101324828
11-10-1999 KP. JAHA 085781806062
15-07-1980 KP. JAHA 085283233958
05-06-1974 KP. JAHA 085283233958
03-05-1982 KP. CIRIRIGI 085893165302
15-12-1982 KP. CANGKORE WETAN 085882322996
11-01-1987 DESA SUKASENENG 082312162899
30-06-1996 KP. CIRIRIGI 083892164915
15-06-1976 KP. CIRIRIGI 083892164915
03-07-1987 KP. KIARAJANGKUNG 082315367001
04-08-1974 Kp.Kiarajangkung 081242216990
'10-11-1982 Sukaseneng '085282338930
01-07-1952 Sukaseneng 081218302622
13-04-1972 Sukaseneng 087827730099
14-02-1958 Sukaseneng 0813173541349
-01-06-2001 Sukaseneng 0857143999929
IRT 01-07-1935 LANSIA SUKAWARIS 081511586211
IRT 20-04-1992 UMUM SUKAWARIS 085697807993
WIRASWA06-06-1982 UMUM SUKAWARIS 081585671473
IRT 17-05-1982 UMUM SUKAWARIS 085774384414
IRT 28-08-1977 UMUM SUKAWARIS 085773105835
WIRASWA27-01-1990 UMUM SUKAWARIS 085773105809
IRT 10-11-1989 UMUM SUKAWARIS 085773648353
IRT 26-03-1994 UMUM SUKAWARIS 085863461560
IRT 06-07-1990 UMUM SUKAWARIS 081511586211
IRT 01-07-1983 UMUM SUKAWARIS 085774324414
WIRASWA10-12-1972 UMUM SUMURBATU 085892618577
IRT 17-11-1975 UMUM SUMURBATU 085892618571
WIRASWA07-07-1995 UMUM SUKAWARIS 083874406508
WIRASWA08-03-1953 LANSIA CIKIRUHWETAN 081511791521
WIRASWA01-04-1954 UMUM CIKIRUHWETAN 085695388439
IRT 01-07-1986 UMUM SUKAWARIS 083804547731
IRT 24-07-1979 UMUM SUKAWARIS 085280519393
IRT 23-08-1982 UMUM SUKAWARIS 085780879505
WIRASWA19-10-1969 UMUM SUKAWARIS 082125371987
TDK BEKE05-03-2002 REMAJA SUKAWARIS 085691857627
IRT 06-11-1998 UMUM SUKAWARIS 085693151749
WIRASWA05-10-1969 UMUM SUKAWARIS 083890673302
IRT 02-07-1965 UMUM SUKAWARIS 085286880579
PELAJAR 07-06-2005 REMAJA SUKAWARIS 085719025006
IRT 06-06-1989 UMUM SUKAWARIS 087882158812
TDK BEKE19-10-2002 REMAJA SUKAWARIS 085695062375
IRT 02-03-1978 UMUM CIKIRUHWETAN 085881149375
IRT 01-07-1970 UMUM SUKAWARIS 083841531742
WIRASWA18-07-1982 UMUM SUKAWARIS 085960049891
WIRASWA18-01-1975 UMUM SUKAWARIS 085693480823
WIRASWA13/03/1996 UMUM SUKAWARIS 083871334609
WIRASWA03-04-2003 REMAJA SUKAWARIS 083896743416
WIRASWA29-09-1984 UMUM SUKAWARIS 082317676215
WIRASWA02-07-1958 LANSIA SUKAWARIS 085866761684
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Merek Tanggal Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri Pemberian
Non PBI Anggota
Vaksinasi Vaksinasi

CORONAVAC 16-11-2021 16-11-2021 24005021

CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC '16-11-2021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 24005021
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
CORONAVAC 16-11-2021 16-11-2021 202108145H
Dosis 2

KET
No. Batch No Seri

24005021
24005021

'24005021
NO No. Ticket NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601046703950001 YANI SURYANI P

2 3601041610680001 SARIP L
3 3601040107630292 AMI P
4 3601041107820002 TURNO L
5 3601041504880004 JUMRI L
6 3601044107750239 RATI P
7 3604042501670001 ATEP L
8 3601040204840002 ULUNG SUPENDI L
9 3601045809750002 WARNIAH P
10 3601045303950002 PITRIANI P
11 3601044107930278 DEWI NOFIANA P
12 3601045907780002 YANTI P
13 3601044107800190 ACIH P
14 3601040107960268 ISROUNDIN L
15 3601040707030003 EKI L
16 3601046506840001 SUHETI P
17 3601040102860009 ARMAN L
18 3601044301750002 ASRIAH P
19 3601040805860003 SARWIN L
20 3601044111010004 PITRI P
21 3601040708850007 HARDI L
22 3601041202930001 ASEP L
23 3601044611960001 NOVIYANTI P
24 3601040508000004 MEGA SUDIRMAN L
25 3601040406950009 SADARI L
26 3601040207800013 ERI PRIATNA L
27 3601040804770002 ASAN L
28 3601046208000003 SARINI P
29 360104010480007 UDIN SETIAWAN L
30 3601041209510001 DARMAN L
31 3601044105980006 MIA MELIANI P
32 3601071501970001 LAMRI L
33 3601040407790008 SATHIA L
34 3601040105890002 INANG L
35 3601044102910005 SAENAH P
36 3601040107910213 ADI FIRDAUS L
37 3601044310000001 LINA LESTARI P
 Umur Kelomp
INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

11-01-1995 UMUM CURUGCIUNG 08557882947

16-10-1986 UMUM CURUGCIUNG 085693789076
02-10-1970 UMUM CURUGCIUNG 085693789076
11-07-1982 UMUM RANCASENENG 085281459534
15-04-1988 UMUM CURUGCIUNG 085779422035
01-07-1975 UMUM CURUGCIUNG 085759541690
11-10-1960 UMUM CURUGCIUNG 085770122037
02-04-1984 UMUM CURUGCIUNG 085770122037
18-09-1975 UMUM CURUGCIUNG 085894310560
22-02-1996 UMUM CURUGCIUNG 081210776430
25-11-1996 UMUM CURUGCIUNG 081287291109
19-07-1978 UMUM CURUGCIUNG 085883409690
01-07-1980 UMUM CURUGCIUNG 085772746950
27-09-1995 UMUM CURUGCIUNG 085774393863
07-02-2003 UMUM CURUGCIUNG 085759541690
25-06-1984 UMUM CURUGCIUNG 085770122037
01-02-1982 UMUM CURUGCIUNG 085770122037
03-01-1975 UMUM CURUGCIUNG 085894310560
08-05-1986 UMUM CURUGCIUNG 081210776430
01-11-2001 UMUM CURUGCIUNG 081287291109
07-08-1985 UMUM CURUGCIUNG 085883409690
12-02-1990 UMUM CURUGCIUNG 085772746950
06-11-1996 UMUM CURUGCIUNG 085774393863
05-08-2000 UMUM CURUGCIUNG 085759541690
04-06-1995 UMUM CURUGCIUNG 085770122037
17-07-1978 UMUM CURUGCIUNG 085770122037
08-04-1977 UMUM CURUGCIUNG 085894310560
22-08-2000 UMUM CURUGCIUNG 081210776430
01-04-1983 UMUM CURUGCIUNG 081287291109
12-09-1951 UMUM CURUGCIUNG 085883409690
01-05-1998 UMUM CURUGCIUNG 085772746950
02-05-1996 UMUM CURUGCIUNG 085774393863
UMUM CURUGCIUNG 085883409690
01-05-1989 UMUM LEUWIBALANG 085691312840
01-02-1991 UMUM CURUGCIUNG 085782624300
UMUM CURUGCIUNG
05-05-2000 UMUM CIKEUSIK 082311450334
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
PBI Non PBI Anggota
Vaksinasi

SINOVAC 16-11-2021 16-11-2021 202108171F

SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
SINOVAC 16-11-2021 16-11-2021 202108171F
 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

HAMIL
16-11-2021

16-11-2021
NO No. Ticke NIK Nama Penerima Vaksin JK

1 3601041906850002 TESSA RAMDHANI L

2 3601040612010002 SANA ARIS SUSANTO L
3 3601046406890001 NANI P
4 3601041408850005 DARSUN L
5 3601040107950063 ROHMANI L
6 3601044101920002 SITI MASRIAH P
7 3601044602990001 RITA RISMAYANTI P
8 3601041301850002 IHAD SUHADA L
9 3601044103660001 DASIH P
10 3601045707020007 RUSITA L
11 3601045301000001 SILPIA P
12 3601040707780002 SUPRIADI L
13 3601040311900003 ABDUL GONI L
14 3601041305990002 KASIM AGUSTIAN L
15 3601040807800003 JUMALI L
16 3602010811840004 BAIHAKI L
17 3601045407840002 NIA P
18 3601045202960007 SUMINAR P
19 3601044603750001 SABI'AH P
20 3601040105840006 ROPI L
21 3601046701900003 SIRI AISYAH P
22 3601046702820001 AHDI L
23 3601040711910001 M.SAEFUL ANWAR L
24 3601044807890005 JUMANAH P
25 3601040107800001 SAYUTI L
26 3601045901850002 TARISEM P
27 3601040910900001 JOHANA L
28 3601044105660003 ARNAYAH P
29 3601040512670001 UBUH L
30 3601044203940009 IDA P
31 3601046206070003 SUCILAWATI P
32 3601064406920002 SITI SAPUROH P
33 3601044106820002 SUHA P
34 3601040903000001 MOCH.ERIKA ABI UBAIDILL
35 3601041309700001 ABIDIN L
36 3601042107750001 H.TOBARI L
37 3601044710650001 MUNI P
38 3601041306830001 SUMIN L
39 3601045601850001 INAH P
40 3601044102870005 AMELIA P
41 3601040104990007 JUJUN JUNAEDI L
42 3601043011970001 SARHATA L
43 3601041904860001 DEDE ROMLI B MUKTAR L
44 3601045005080001 RINI P
45 1602116802930004 LIA ERNA WATI P
46 3601046006840004 RIRIN P
47 3601040101980002 ARDIN L
48 3601044108570003 SUTINAH P
49 3601044910990005 ITA ROSITA P
50 3601044107720024 JUMANAH P
51 3601062008850002 TISNO L
52 3601044107080001 SAWA L
53 3602185208670003 KOKOM KOMALASARI P
54 3601044101900011 EMUN` P
55 3601040911690001 MAHPUDIN L
56 3604046104850003 MUNAROH P
57 3601040107760024 ACENG ALEK CHASMITA L
58 3601045810850005 TONAH P
59 3601044107790016 ARNI RAHMAWATI P
60 3601044308040001 SITI NURAISAH P
61 3601045610790001 SITI KOMARIAH P
62 3601042002650001 MANSUR L`
63 3601040304050002 SENDI WINATA L
64 3601040107800051 JEJEN L
65 3601274511920001 YANI MULYANTI P
66 3601040707890002 BADRI L
67 3601044503770005 HJ.SOHIPPAH P
68 3601044103930002 FIAN ADIYANTI P
69 3601044406620001 HJ.SARMI P
70 3601044511630002 HATI P
71 3601040102560004 UDI L
72 3601044804680001 JUBAEDAH P
73 3601045504870004 NUNUNG KHAERIYAH P
74 3601044607820007 KESIH P
75 3601044403890002 ENUR P
76 3601044104530001 ANTIKAH P
77 3601046007710003 ERAH P
78 3601040708590001 KUSNADI L
79 3601044602900002 SITI AISAH P
80 3601044501850008 HENAH P
81 3601040509820002 AAN L
82 3601044103600002 EEN P
83 3601040102730004 SUKARDI B CARMADI L
84 3602262103550001 SANIMAH P
85 3601045207840008 ANAH HAYATI P
86 3601041705920001 WIGUNA L
87 3601041307890002 HERI L
88 3601045910970002 PATIMAH AZZAHRA P
89 3601040611810001 KARDI L
 90 3601044204750005 ODAH P
91 3601042303760001 TONI L
92 3601046704810001 ENENG TATI NURHAYATI P
93 3601046111080001 SINTA P
94 3601046404870002 SATINAH P
95 3601040103850003 ANIH SUPRIYANIH L
96 3601045603780002 ATIKAH P
97 3601044807800001 SATI BT EMUH P
98 3601040601860002 AJOT SUNARYA L
99 3601047012710003 ECIH P
100 3601040107050021 ANDI L
101 3601040107020043 EKA BIMA L
102 3601045207050005 ELSA YULIA PUTRI P
103 3601044107730078 JARSITI P
104 3601044405570002 SARNI P
105 3601045504870005 NENG UTAMI P
106 3601044103750001 TIHAT P
107 3601045002850003 JUNI P
108 3601045010720002 MASKAMAH P
109 3601044104880002 MOMOH P
110 3601040102670002 MAHDI L
111 3601045207050002 AMELIA P
112 3601046710820003 JUARSIH P
113 3602214305880001 ENI ANDRAENI P
114 3601044107800230 YAYAH P
115 3601044407720001 HJ.ENENG YUNENGSIH P
116 3601044603750002 IYAH P
117 3601040107690007 ALISAM L
118 3601045403010007 RATIH PURWASIH P
119 3601045010770003 AMI P
120 3601040607950001 HERDI YANSAH L
121 3601044909780001 ROSIAH P
122 3601045306960004 SUSANTI P
123 3601040401670002 RASIDI L
124 3601116009920001 SISKA DIANA P
125 3601041203630005 SUHARTO P
126 3601044801900005 ANI P
127 3601044401890006 NURHAYATI P
128 3601045010800007 IMAS MAESAROH P
129 3601046107850002 TATI P
130 3601044103780003 KEBOT P
131 3601045603910001 KURNAESIH P
132 3601046202960001 MARNI P
133 3601045912000002 MARIA ULFAH P
134 3601040109980001 DIDIN WAHYUDIN L
135 3602211704930003 DEDE L
136 3601034107650031 RUKIYAH P
137 3601046307840002 SITI MAEMUNAH P
138 3601040702490003 EMOD L
139 3601044608790001 ASTI P
140 3601041708730002 SUKEMI L
141 3601040511860001 WARSAM L
142 3601040104540003 BUHORI L
143 3601045207840009 TATAN P
144 3601041012770001 TASMAN L
145 3601040903930002 EPUL BILAL RAMDHAN L
146 3602165611830003 HERLIS P
147 3601045201000006 DEDE RIKA P
148 3601042005800004 SADI L
149 3601041007680003 CEMONG L
150 3601046507010002 ANISA NARDIN P
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

WIRASWATA 19-06-1985 UMUM CIKIRUHWETAN 081382364449

WIRASWATA 06-12-2001 UMUM SUKAWARIS 085693152692
IRT 24-06-1989 UMUM SUKAWARIS 085866761984
WIRASWATA 14-08-1985 UMUM SUKAWARIS 083890673302
WIRASWATA 17-09-1995 UMUM SUKAWARIS 083896745794
IRT 01-01-1992 UMUM SUKAWARIS 085771007297
IRT 28-11-1998 UMUM SUKAWARIS 085866761684
WIRASWATA 17-08-1984 UMUM SUKAWARIS 087773035661
IRT 17-11-1967 UMUM SUKAWARIS 081315543448
WIRASWATA 17-07-2002 REMAJA SUKAWARIS -
IRT 13-01-2000 UMUM CIKIRUHWETAN 089676538102
WIRASWATA 07-07-1978 UMUM SUKAWARIS 085773498467
WIRASWATA 28-03-1992 UMUM SUKAWARIS 085894272056
WIRASWATA 22-08-2001 UMUM SUKAWARIS 085693152692
WIRASWATA 08-07-1980 UMUM CIKIRUHWETAN 085888233720
WIRASWATA 08-11-1984 UMUM SUKAWARIS 085216818042
IRT 14-07-1984 UMUM SUKAWARIS 085774602134
IRT 12-02-1996 UMUM SUKAWARIS 081386351641
IRT 09-03-1975 UMUM SUKAWARIS 085716582021
WIRASWATA 01-05-1984 UMUM SUKAWARIS 082310358330
IRT 11-05-1990 UMUM SUKAWARIS 081382364949
WIRASWATA 14-04-1997 UMUM SUKAWARIS 085893380690
WIRASWATA 07/11/1991 UMUM SUKAWARIS 081511791466
IRT 08-07-1989 UMUM SUKAWARIS 085795689072
WIRASWATA 01-04-1980 UMUM SUKAWARIS 081617198225
IRT 19-01-1985 UMUM SUKAWARIS 085714949397
WIRASWATA 09-10-1980 UMUM SUKAWARIS 082310314466
IRT 01-05-1966 UMUM SUKAWARIS 085715817622
WIRASWATA 05-12-1967 UMUM SUKAWARIS 082216794389
IRT 02-03-1994 UMUM SUKAWARIS 085692285799
PELAJAR 22-06-2007 REMAJA SUKAWARIS 085810157101
IRT 04-06-1992 UMUM SUKAWARIS 085771007297
IRT 01-09-1982 UMUM SUKAWARIS 085778188658
WIRASWATA 09-03-2000 UMUM SUKAWARIS 085217371018
WIRASWATA 13-09-1970 UMUM SUKAWARIS 085283234518
WIRASWATA 12-08-1975 UMUM SUKAWARIS 085213304948
IRT 07-10-1965 UMUM SUKAWARIS 083890673302
WIRASWATA 13-06-1983 UMUM SUKAWARIS 085794110993
IRT 16-01-1985 UMUM SUKAWARIS 085794110993
IRT 01-02-1987 UMUM SUKAWARIS 085776826943
WIRASWATA 13-07-1999 UMUM SUKAWARIS 085774848618
WIRASWATA 30-11-1997 UMUM SUKAWARIS 085695760831
WIRASWATA 02-010-1984 UMUM SUKAWARIS 085782794024
PELAJAR 10-05-2008 REMAJA UMBULAN 085693636926
IRT 28-02-1993 UMUM TULUNG SELAPAN 085693636926
IRT 20-06-1984 UMUM SUKAWARIS 085774324414
WIRASWATA 09-01-1998 UMUM SUKAWARIS 085719784640
IRT 01-08-1957 UMUM SUKAWARIS 085693584925
IRT 09-01-1999 UMUM SUKAWARIS 085695760831
IRT 01-07-1972 UMUM SUKAWARIS 085774840618
WIRASWATA 04-06-1986 UMUM SUKAWARIS 085771007297
IRT 18-01-1958 UMUM SUKAWARIS 083109806131
IRT 12-08-1967 UMUM CIBADAK 081384839889
IRT 01-01-1990 UMUM SUKAWARIS 085693584925
WIRASWATA 09-11-1969 UMUM SUKAWARIS 085715817622
IRT 21-04-1985 UMUM CIKIRUHWETAN 085311841907
WIRASWATA 09-08-1970 UMUM SUKAWARIS 083841531742
IRT 18-10-1985 UMUM SUKAWARIS 085781674124
IRT 07-08-1980 UMUM SUKAWARIS 085310666007
IRT 03-08-2004 UMUM SUKAWARIS 083819981504
IRT 16-10-1979 UMUM SUKAWARIS 085694957330
WIRASWATA 20-02-1965 UMUM CIKIRUHWETAN 083165784887
PELAJAR 03-04-2005 UMUM SUKAWARIS 085694276599
WIRASWATA 01-07-1980 UMUM SUKAWARIS 085866761684
IRT 05-10-1992 UMUM SUKAWARIS 085866761684
WIRASWATA 07-07-1988 UMUM CIKIRUHWETAN 085890653563
IRT 05-03-1977 UMUM SUKAWARIS 081386078807
IRT 05-07-1993 UMUM SUKAWARIS 085892826916
IRT 04-06-1962 UMUM SUKAWARIS 085866761684
IRT 05-11-1963 UMUM SUKAWARIS 08554181116
WIRASWATA 01-02-1956 LANSIA SUKAWARIS 081315543448
IRT 08-04-1968 UMUM SUKAWARIS 081384839889
IRT 01-01-1990 UMUM SUKAWARIS 085782739974
IRT 06-07-1982 UMUM CIKIRUHWETAN 085219819390
IRT 04-03-1989 UMUM CIKIRUHWETAN 083812674792
IRT 01-04-1953 UMUM SUKAWARIS 085814863140
IRT 20-07-1971 UMUM SUKAWARIS 085778188658
WIRASWATA 07-08-1959 LANSIA SUKAWARIS 085866761684
IRT 06-03-1989 UMUM SUKAWARIS 085778188658
IRT 05-01-1985 UMUM SUKAWARIS 085778188658
WIRASWATA 05-09-1982 UMUM SUKAWARIS 085217040010
IRT 01-03-1960 UMUM SUKAWARIS 082123554454
WIRASWATA 12-12-1972 UMUM SUKAWARIS 085283848014
IRT 21-03-1955 UMUM SUKAWARIS 085866761684
IRT 12-07-1984 UMUM SUKAWARIS 085711304620
WIRASWATA 17-05-1992 UMUM SUKAWARIS 085892826916
WIRASWATA 13-07-1989 UMUM SUKAMULYA 083892646761
IRT 02/06/1996 UMUM CIKIRUHWETAN 085311841907
WIRASWATA 06-11-1981 UMUM SUKAWARIS 081219344781
IRT 02-04-1975 UMUM SUKAWARIS 085817536282
WIRASWATA 23-03-1975 UMUM SUKAWARIS 085693826583
IRT 08-11-1985 UMUM CIKIRUHWETAN 085219673094
PELAJAR 21-11-2008 REMAJA SUKAWARIS 087875565609
IRT 24-04-1987 UMUM SUKAWARIS 081575859126
WIRASWATA 01-11-1983 UMUM SUKAWARIS 085311828987
IRT 16-03-1978 UMUM SUKAWARIS 083890673302
IRT 08-07-1980 UMUM SUKAWARIS 085778188658
WIRASWATA 09-10-1986 UMUM SUKAWARIS 085693450414
IRT 30-12-1971 UMUM SUKAWARIS 082130201465
WIRASWATA 30-12-2005 UMUM SUKAWARIS 087880577574
PELAJAR 14-08-2002 REMAJA SUKAWARIS 085811462150
PELAJAR 12-07-2005 REMAJA CIKIRUHWETAN 085282258968
IRT 01-07-1960 UMUM SUKAWARIS 085717330713
IRT 04-05-1957 UMUM SUKAWARIS 085866761684
IRT 15-04-1987 UMUM SUKAWARIS 087773346100
IRT 01-03-1975 UMUM SUKAWARIS 085866761684
IRT 10-02-1985 UMUM SUKAWARIS 085811462150
IRT 10-10-1972 UMUM TANJUNGAN 082125371987
IRT 01-05-1979 UMUM SUKAWARIS 082333111067
WIRASWATA 04-06-1965 UMUM SUKAWARIS 085866761684
PELAJAR 12-07-2005 REMAJA SUKAWARIS 085714214967
IRT 27-10-1982 UMUM CIKIRUHWETAN 085219819390
IRT 20-03-1988 UMUM SERANG 0857595529590
IRT 01-01-1980 UMUM SUKAWARIS 085866761684
IRT 04-07-1974 UMUM SUKAWARIS 081519588365
IRT 06-03-1976 UMUM SUKAWARIS 085697428965
WIRASWATA 01-07-1969 UMUM SUKAWARIS 085694952218
IRT 14-03-2001 UMUM LEMAHABANG 081289250631
IRT 10-10-1977 UMUM SUKAWARIS 083109806131
WIRASWATA 06-07-1995 UMUM SUKAWARIS 08528323385
IRT 09-09-1978 UMUM SUKAWARIS 081218307390
IRT 19-06-1996 UMUM SUKAWARIS 083890673302
WIRASWATA 03-07-1979 UMUM SUKAWARIS -
IRT 20-09-1992 UMUM SUKAWARIS 085788528470
WIRASWATA 05-07-1971 UMUM CIKIRUHWETAN 085717330713
IRT 08-01-1990 UMUM SUKAWARIS 085714565188
IRT 03-07-1992 UMUM CIKIRUHWETAN 085719805740
IRT 10-10-1980 UMUM SUKAWARIS 087888385466
IRT 21-07-1985 UMUM SUKAWARIS 085217323568
IRT 01-03-1978 UMUM SUKAWARIS 085714234967
IRT 16-03-1991 UMUM SUKAWARIS 085811084172
IRT 18-08-1996 UMUM SAMBOJA 085215692896
WIRASWATA 19/12/2000 REMAJA CIKIRUHWETAN 085813679417
TDK BEKERJA 07-09-2000 REMAJA SUKAWARIS 081514585903
WIRASWATA 17-04-1990 UMUM SUKAWARIS 085714565188
IRT 31-10-1965 UMUM SUKAWARIS 085714565188
IRT 09-06-1984 UMUM SUKAWARIS 081585819203
WIRASWATA 07-02-1949 LANSIA SUKAWARIS 083890673302
IRT 06-08-1979 UMUM SUKAWARIS 085773648353
WIRASWATA 19-08-1973 UMUM SUKAWARIS 085695416838
WIRASWATA 05-11-1986 UMUM RANCASENENG 085891485051
WIRASWATA 17-10-1980 UMUM SUKAWARIS 083879981504
IRT 12-07-1984 UMUM SUKAWARIS 085866761684
WIRASWATA 10-12-1977 UMUM SUKAWARIS 085695147609
WIRASWATA 09-03-1993 UMUM SUKAWARIS 081276945238
IRT 16-11-1983 UMUM CIJAKU 085694308835
IRT 12-01-2000 UMUM SUKAWARIS 081276945238
WIRASWATA 20-05-1980 UMUM SUKAWARIS 085797418330
WIRASWATA 10-07-1968 UMUM SUKAWARIS 085866761884
TDK BEKERJA 25-07-2001 REMAJA SUKAWARIS 085885456585
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal Tanggal
Pemberi
BPJS BPJS Non Merek Vaksin*** Screeni No.
ng an No seri
PBI Non PBI Anggota Batch
Vaksina
si

CORONAVAC 16-11-202 16-11-202 202108145H

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CORONAVAC 16-11-202 16-11-202 202108145H
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 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
16-11-2021 202108145H
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601041707600001 RAMIN LANSIA

2 3601044107630127 SARTI LANSIA
3 3601044408800004 SUNARTI
4 ;3601046003930002 SUHAEMAH
5 3601030107920025 HERNI
6 3601044107020090 SUPIANTO
7 3601031011740001 RASTAM
8 3601042406810003 ROHIM
9 3601042810650002 MUHARI LANSIA
10 3601044107740039 WARSIH
11 3601044904700001 ODAH
12 3601044107630124 AYINAH LANSIA
13 3601040104810005 HAMDANI
14 3601044107710087 SUKMANAH
15 3601042009680002 SANUSI
16 3601044107830197 ERUM RUMHAYATI
17 3601040711680007 SARIPUDIN
18 3601044107790063 SUMARNI
19 3601042107750003 UDIN
20 3601045805830002 HETI
21 3601044107710084 NACI
22 3601044908870003 MURNI
23 3601041012520004 ONAH LANSIA
24 3601044306840001 ENI
25 3601044107940104 AMAH
26 3601046903900001 NURHASANAH
27 3601046002000003 RAMAH
28 3601044107880081 RUSNI
29 3601045511760002 SANIMAH
30 3601041307590001 ARJAI LANSIA
31 3329064405890001 IIS APRIANTI
32 3601034403960001 JUMROH
33 3601046807950002 ARMINAH
34 3601045005840002 ELIYAH
35 3601044107820065 ASWI
36 3601045112700002 DEDEH
37 3601036607930002 STI MAESAROH
38 3601041705960001 SUPARDI
39 3601044107540077 BAYI LANSIA
40 3601045205870005 MISRI
41 3601040702700007 RANTA SUPIANTO
42 3601046003840002 ISAH
43 3601045311740001 DARSIH
44 3601040107680122 MARSIDIN
45 3601044107520043 SARINAH LANSIA
46 3601045501880002 ERAH
47 3601046011910002 HENI
48 3601044201850001 SUKARIAH
49 3601045207680001 ENAH
50 3601045111590001 JANAH LANSIA
51 3601046304770002 BAYI
52 3601044606490001 ROHENAH LANSIA
53 3601044107710069 RUMIDAH
54 3601044610910002 SUKATI
55 3601044107750104 SAFIAH
56 3601040310830007 NANA
57 360104448950004 ROHMAH
58 3601044101820007 SUKANAH
59 3601042305840002 ASEP
60 3601044106850004 UNI
61 3601040703940004 KOMARUDIN
62 3601042103820002 UKAR
63 3601040501000006 IJEN
64 3601042510650002 JUNAEDI
65 3601041007650002 UJANG
66 3601044107790054 EJAH
67 3601044101000018 IKA MUSPIKA DEWI
68 3601045201960002 RINA DAMAYANTI
69 3601045902060001 SRI NILAWATI
70 3601040601050002 M. RISNA
71 3601040706040003 M. TAUFIK HIDAYAT
72 3601041206530001 SUBANDI LANSIA
73 3601040804810002 SAMSUDIN
74 3601041808700001 WARLAN
75 3601045702740002 SARNAH
76 3601041104940003 HENRI
77 3601044311800008 EROH
78 3601042611910002 DEDE JUBAEDI
79 3601041705830004 YANTO
80 3601040408770001 RAHMAT
81 3601041507900004 SAPRI
82 3601040107730185 SURNA
83 3601041703910002 JUMAN
84 3601045002860010 KARTISEM
85 3601041607800002 HAMDAN
86 3601044107890084 SUENAH
87 3601045306870002 CICICH
88 3601041709660001 HAERUDIN B H MADSIRA
89 3601041305800002 DIKMANSYAH
90 3601040801050002 YANA
91 3601041509040002 MUHAMAD ZAINI
92 3601040704800008 MARDANI
93 3601042210000001 UDI
94 3601045405960005 MARNI
95 3601044204970008 SARINAH
96 3601042608930001 IPAN
97 3601040107650079 KIDONG
98 3601041206970001 ROBI
99 3601040107730182 AJO
100 3601040602790004 ASRI
101 3601041011710003 DEDI
102 3601045203680001 JUHARIAH BT SAIJA
103 3601040111710003 ABDUL ROHMAN
104 360104530468002 YAYAH
105 3601046005780003 RUMSANAH
106 3601045606040001 ANITA
107 3601041710960001 NEDI
108 3601044101020010 ATIKAH
109 3601045802810002 MURNAETI
110 3601041206970001 ROBI
111 3601041607800002 HAMDAN
112 3601040801050002 YANA
113 3601041701990002 MARHADI
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

17-07-1960 KP. SUKAJAYA 085810142812

01-07-1963 KP. SUKAJAYA 085719064011
04-08-1980 KP. SUKAJAYA 085880001950
20-03-1993 KP. SUKAJAYA 085782676963
01-07-1992 KP. SUKAJAYA 085810133794
19-05-2002 KP. SUKAJAYA 081584685254
10-11-1974 KP. SUKARATU
24-06-1981 KP. SUKAJAYA 085781536694
28-10-1965 KP. SUKAJAYA 081311414881
01-07-1974 KP. SUKAJAYA 085882817515
09-04-1970 KP. SUKAJAYA 085882817515
01-07-1963 KP. SUKAJAYA 085882817515
07-101984 KP. SUKAJAYA
01-07-1971 KP. SUKAJAYA 081511414881
11-04-1970 KP. SUKAJAYA
01-07-1983 KP. SUKAJAYA 085771289796
07-11-1968 KP. SUKAJAYA 085695153368
0604-1981 KP. SUKAJAYA 085880001950
21-07-1975 KP. SUKAJAYA 0857782773758
18-05-1983 KP. SUKAJAYA 081584956398
01-07-1971 KP. SUKAJAYA 085773624164
09-081987 KP. SUKAJAYA 085714231032
10-12-1952 KP. SUKAJAYA 0857719064011
03-06-1984 KP. SUKAJAYA 0857142310232
02-08-1997 KP. SUKAJAYA 085778279515
29-03-1990 KP. SUKAJAYA 085694240938
20-02-2000 KP. SUKAJAYA 081528727060
01-07-1988 KP. SUKAJAYA
15-11-1976 KP. SUKAJAYA
13-07-1959 KP. SUKAJAYA 085710515638
04-05-1989 KP. SUKAJAYA 085773210243
10-06-1996 KP. SUKAJAYA 085715282254
28-07-1995 KP. SUKAJAYA 085771292961
10-05-1984 KP. SUKAJAYA 08577292987
01-07-1982 KP. SUKAJAYA 085773624302
11-12-1970 KP. SUKAJAYA 085769115435
26-07-1993 KP. SUKAJAYA 085694490843
17-05-1996 KP. SUKAJAYA
01-07-1954 KP. SUKAJAYA 085691154335
12-05-1987 KP. SUKAJAYA 085883201400
07-02-1970 KP. SUKAJAYA 085691096408
20-03-1984 KP. SUKAJAYA 085710515607
13-111974 KP. SUKAJAYA 085778282566
01-07-1968 KP. SUKAJAYA 085773486366
01-07-1952 KP. SUKAJAYA 085776181495
15-01-1988 KP. SUKAJAYA 081517285728
20-11-1991 KP. SUKAJAYA 085811336299
02-01-1985 KP. SUKAJAYA 085893695660
12-07-1968 KP. SUKAJAYA 085691307268
11-11-1959 KP. SUKAJAYA 085773624191
23-04-1977 KP. SUKAJAYA 085710903245
06-06-1949 KP. SUKAJAYA 085773027956
01-07-1971 KP. SUKAJAYA 085693593858
06-10-1991 KP. SUKAJAYA 085691312406
01-07-1975 KP. SUKAJAYA 085773486412
03-10-1983 KP. SUKAJAYA 085695601343
04-08-1995 KP. SUKAJAYA 085711493790
01-01-1982 KP. SUKAJAYA 085714407912
23-05-1984 KP. SUKAJAYA 085778279515
01-06-1985 KP. SUKAJAYA 085773227764
07-03-1994 KP. SUKAJAYA 085771292961
21-03-1982 KP. SUKAJAYA 085695409491
05-01-2000 KP. SUKAJAYA 085773624191
25-10-1965 KP. SUKAJAYA 85691154335
10-07-1965 KP. SUKAJAYA 08568192290
12-06-1977 KP. SUKAJAYA 08581014289
01-01-2000 KP. SUKAJAYA 085817263791
12-01-1996 KP. SUKAJAYA 085714407912
KP. SUKAJAYA
06-01-2006 KP. SUKAJAYA 085691785957
07-06-2004 KP. SUKAJAYA 085695409697
12-06-1953 KP. SUKAJAYA 085719064011
08-04-1981 KP. SUKAJAYA 085771289833
18-08-1970 KP. SUKAJAYA 085773624164
17-02-1974 KP. SUKAJAYA 08581922290
09-04-2005 KP. SUKAJAYA 83171877128
03-11-1980 KP. SUKAJAYA 085710515638
28-11-1991 KP. SUKAJAYA 085782676963
17-05-1983 KP. RANCA NAGA081517844579
04-08-1977 KP. SUKAJAYA 081511414881
14-07-1990 KP. SUKAJAYA 085779161330
18-09-1972 KP. SUKAJAYA 082210078822
17-03-1985 KP. SUKAJAYA 081511414881
10-02-1986 KP. SUKAJAYA 081212317174
16-07-1980 KP. SUKAJAYA 085773624368
01-07-1989 KP. SUKAJAYA 085810903862
13-06-1987 KP. SUKAJAYA 085810133791
17-09-1966 KP. SUKAJAYA 081574609470
13-05--1998 KP. SUKAJAYA 085881232262
08-01-2005 KP. SUKAJAYA 081392354304
15-09-2004 KP. SUKAJAYA 085894816049
07-04-1980 KP. SUKAJAYA 085776128347
22-10-2000 KP. SUKAJAYA 081649501829
14-05-1996 KP. SUKAJAYA 085715282236
02-04-1997 KP. SUKAJAYA 085810903862
26-08-1993 KP. SUKAJAYA 085715612813
01-07-1965 KP. SUKAJAYA 085695601343
12-06-1997 KP. SUKAJAYA 085719064011
01-07-1973 KP. SUKAJAYA 085715282135
06-02-1979 KP. SUKAJAYA 085861171539
10-11-1971 KP. SUKAJAYA 085691785973
12-03-1968 KP. SUKAJAYA 081574609470
01-11-1971 KP. SUKAJAYA 085773413009
13-04-1969 KP. SUKAJAYA 085738470029
20-05-1978 KP. SUKAJAYA 085691785973
26-06-2004 KP. SUKAJAYA 085882817515
17-11-1996 KP. SUKAJAYA 085776181495
03-04-1980 KP. SUKAJAYA 085773413009
8-02-1981 KP. SUKAJAYA 081511408294
12-06-1997 KP. SUKAJAYA 085719064011
16-07-1980 KP.SUKAJAYA 08577773624368
08-01-2005 KP. SUKAJAYA 083192354304
17-01-1999 KP.SUKAJYA 085882817515
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21 17/11/21 202108196H
CORONAVAC 17/11/21
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
CORONAVAC 17/11/21 17/11/21 202108164I
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
17/11/21 202108196H 1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
163246729 17/11/21 202108196H 1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
163246729 17/11/21 202108196H 1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
17/11/21 202108164I 1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
17/11/21 202108164I 1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
1632467292252
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044107460004 NERSIH P
2 3601035511930001 ROKAYAH P
3 3601044807010003 YATI AMINAH P
4 3601044204530002 AMSAH P
5 3601046508880003 AMNAH P
6 3601040107740114 ROHMAN L
7 3601044203920002 ASMI P
8 3601042006910003 RONI SAHRONI L
9 3601041012840004 SAMSUL BAHRI L
10 3601045505640003 AMAH P
11 3601042106820003 SARNAN L
12 3601040107420032 KASUHI L
13 3601044107780035 SAIYAH P
14 3601044107780039 AMINAH P
15 3601040311570001 TARJO L
16 3601045806870001 IROH P
17 3207111504760007 TATANG HARUN L
18 3601040107850317 AHMAD L
19 3601040107680033 KIMONG L
20 360104606770002 SUPANDI L
21 3601040107760011 ADE L
22 3601041412750001 WAWAN L
23 3601040107850030 OJIM L
24 36010441077800238 NARSAH P
25 3601040107840012 RIDWAN L
26 3601040107760012 ENDANG. S L
27 3601046605920002 TARIH P
28 3601041005030007 SUKRIA L
29 3601043105000002 TAYUDIN L
30 3601040307820006 JOHAR L
31 360104111800007 USUP L
32 3601040107580007 MADRAIS L
33 3601040107830050 SAIDI L
34 3601044107830054 RUMSIH P
35 3601041010040001 SENDI SAPUTRA L
36 3207020101700001 WAWAN HERNAWANL
37 3601042210630001 SUKRA L
38 3601044107850052 SURINAH P
39 3601040107830046 DARSO L
40 3601044107760027 CUCUM P
41 3215090511740002 AHMAD MUBAROK L
42 36010401079300015 ASEP SAEPUDIN L
43 3601044401140003 PARWATI P
44 3601045209010001 ELIS SOPIANTI P
45 3601040107960035 JUHRA L
46 3601046204750001 TASIH P
47 3601044710820001 CARTI P
48 3601044107630040 SITI AISAH P
49 3601045406800001 ATI P
50 3601041308630001 AHAD L
51 3601044107710020 CARTI P
52 3601044107780223 SACEM P
53 3601040107910042 KARIM L
54 3601044504810002 SARWIYAH P
55 3601040107720011 TARMA L
56 360104410790028 PITRI P
57 3601044502880005 ENI P
58 3601040107650020 CARIM L
59 3601044107730054 SARIH P
60 3601046910770001 SAPUTRI P
61 3601045510780003 SUNARJAH P
62 3601040107610014 RUNITA P
63 3601045512990001 INDAH LEVIANA P
64 3601044107410006 TOLIB L
65 3601044107750035 SUMI P
66 3601044107430014 SATINIH P
67 3601044107700013 RASEM P
68 3601040107580033 SARDI L
69 360104010738002 SAKUM L
70 3601041707470001 YUDI L
71 3601044107580048 RASIM L
72 3601044107780064 WATINI P
73 3601040107630033 NARYO L
74 3601044401970003 ERIKA LISMAWATI P
75 3601040107830035 WAHID L
76 3601046107070002 DEFI. P P
77 3601044211850002 LELA P
78 3601044411880004 SITI ASIYAH P
79 3601040107510016 SARDAN L
80 3601046501960003 INDRIYANI P
81 3601045008040004 TARSEM P
82 3601045007830002 ELY SUCI P
83 3601044411790001 IPAH P
84 3601046701950003 EKA IDAYATI P
85 3601040107800032 JAKA L
86 3601041507820001 WASAM. S L
87 36010467050004 RATIMAH P
88 3601046802010002 PENI. P P
89 3602140105030003 YUDHI P L
90 3601041203030010 ODIH L
 91 3601044107960034 DARSAH P
92 3601040901830004 ARMIN L
93 360104410750005 SARNAN L
94 3601040602960001 IRWAN L
95 3601044209720001 WATI P
96 3601041308950002 YUNUS L
97 3601041701530001 WASIAL L
98 3601044107620011 CARIDEM P
99 3601040806700004 TOSIN L
100 3601041409960001 JUMHADI L
101 3601045109880002 ELIS N P
102 3601046404030001 NITA. S P
103 3601045603790003 RASCI P
104 3601041206780003 SUPENDI L
105 3601040706860001 MUSRI L
106 3601044107600006 DAYEM P
107 3601045005730005 RIKA FATIMAH P
108 3601045608740001 NARTI P
109 3601042403850006 INDRA L
110 3601041605760001 INEN P
111 3601045506970001 KARLINA P
112 3601041507020015 PITO PERMANA L
113 3601044505700001 HJ. SARAH P
114 3601041003930003 SIDIK L
115 3601044107820031 ARMI L
116 36010401077800074 NADI L
117 3601044404060001 DEVI P
118 3601044404940004 RUSTIANAH P
 Kepesertaan BPJS (tuli
'Ya' pada kolom yang

Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

01-07-1946 LANSIA SUMURBATU 085882754295

15-11-1992 BUMIL SUMURBATU 081511922148
08-07-1998 UMUM SUMURBATU 08211017995
02-04-1953 LANSIA SUKAWARIS 083815336135
25-08-1988 UMUM SUMURBATU 085211377344
01-07-1974 UMUM SUMURBATU 082110179950
02-03-1992 UMUM SUMURBATU 081381318873
20-06-1981 UMUM CURUGCIUNG 085283768107
10-12-1984 UMUM SUMURBATU 085894002133
15-05-1964 UMUM SUMURBATU 08558169675
21-06-1982 UMUM SUMURBATU 085692044704
12-01-1991 UMUM SUMURBATU 085213059534
01-07-1978 UMUM SUMURBATU 085218572660
01-07-1978 UMUM SUMURBATU 082159640516
03-11-1957 LANSIA SUMURBATU 085213059534
18-06-1987 UMUM SUMURBATU 085780712698
15-04-1976 UMUM DUSUN MUNJUL 085320720716
01-07-1985 UMUM SUMURBATU 085710515862
01-07-1980 UMUM SUMURBATU 085710515862
06-06-1977 UMUM SUMURBATU 085710515862
28-04-1977 UMUM SUMURBATU 085319075955
14-12-1975 UMUM SUMURBATU 082119771427
25-04-1985 UMUM SUMURBATU 085892441528
17-07-1982 UMUM SUMURBATU 085892441528
01-07-1984 UMUM SUMURBATU 085714565112
01-07-1981 UMUM SUMURBATU 085714565112
26-05-1992 UMUM SUMURBATU 085798840015
10-05-2003 REMAJA SUMURBATU 085862775903
31-05-2000 UMUM SUMURBATU 082258976245
03-07-1982 UMUM SUMURBATU 082258976245
11-11-1980 UMUM SUMURBATU 082258976245
01-07-1958 LANSIA SUMURBATU 082258976245
01-07-1983 UMUM SUMURBATU 085798840015
01-07-1963 UMUM SUMURBATU 085814314458
10-10-2004 REMAJA SUMURBATU 085383717156
01-10-1970 UMUM SINDANG SARI 081294917905
22-10-1963 UMUM SUKAWARIS 081294911905
26-08-1984 UMUM SUMURBATU 085882443083
01-07-1982 UMUM SUMURBATU 085882443083
01-07-1976 UMUM SUMURBATU 085882443083
05-11-1971 UMUM DUSUN DESA 081318839262
01-07-1993 UMUM SUMURBATU 085711036440
22-07-2004 REMAJA SUMURBATU 085711036440
12-09-2001 UMUM SUMURBATU 085711036440
13-08-1996 UMUM SUMURBATU 081211622401
22-04-1975 UMUM SUMURBATU 083856598689
07-10-1982 UMUM SUMURBATU 083856598689
10-02-1963 UMUM SUMURBATU 083856598689
14-06-1980 UMUM SUMURBATU 085771917912
18-08-1963 UMUM SUMURBATU 085771917912
01-07-1971 UMUM SUMURBATU 085771917912
16-06-1977 UMUM SUKASENENG 085283050973
18-02-1979 UMUM SUMURBATU 085283050973
05-04-1981 UMUM SUMURBATU 085283050973
24-07-1972 UMUM SUMURBATU 085282258775
27-11-1997 UMUM SUMURBATU 085693222532
05-02-1988 UMUM SUMURBATU 085693222532
24-11-1968 UMUM SUMURBATU 085694673191
01-07-1973 UMUM SUMURBATU 085694673191
29-10-1977 UMUM SUMURBATU 085694673191
15-10-1978 UMUM SUMURBATU 085694673191
01-07-1961 UMUM SUMURBATU 085211296914
15-12-1999 UMUM SUMURBATU 085211296914
13-05-1975 UMUM SUMURBATU 08211479324
01-07-1975 UMUM SUMURBATU 085215419223
08-12-1976 UMUM SUMURBATU 085882443083
01-07-1970 UMUM SUMURBATU 085882443083
23-05-1957 LANSIA SUMURBATU 085715270636
03-07-1945 LANSIA SUMURBATU 085772964818
17-07-1947 LANSIA SUMURBATU 082114797324
01-07-1958 LANSIA SUMURBATU 082114797324
03-05-1974 UMUM SUMURBATU 085213478186
24-11-1975 UMUM SUMURBATU 085213478186
04-01-1997 UMUM SUMURBATU 085711036440
01-07-1983 UMUM SUMURBATU 082311644855
21-07-2007 REMAJA SUMURBATU 085811430452
02-11-1985 UMUM SUMURBATU 085811430452
04-11-1988 UMUM SUMURBATU 085217105451
01-07-1977 UMUM SUMURBATU 085217105451
25-01-1996 UMUM SUMURBATU 082312056977
10-08-2004 REMAJA SUMURBATU 083856598689
12-07-1983 UMUM SUMURBATU 083856598689
04-11-1979 UMUM SUMURBATU 085888389568
27-01-1995 UMUM SUMURBATU 085283236120
20-10-1979 UMUM SUMURBATU 085894698983
12-05-1982 UMUM SUMURBATU 085882754295
27-05-1985 UMUM SUMURBATU 085718719605
28-02-2001 UMUM SUMURBATU 085774957896
01-05-2003 REMAJA WANASALAM 081311283356
12-03-2007 REMAJA SUMURBATU 081311283356
 SUMURBATU 081311283356
09-01-1983 UMUM UMBULAN 0857735073643
01-07-1954 LANSIA SUMURBATU 0857735073643
14-03-1996 UMUM SUKAWARIS 0857735073643
02-09-1972 UMUM SUMURBATU 082114797324
13-08-1995 UMUM SUMURBATU 085282259140
17-01-1953 LANSIA SUKAWARIS 085282259140
SUMURBATU 085282259140
08-06-1970 UMUM SUMURBATU 085711102579
SUMURBATU 085711102579
01-04-1999 UMUM SUMURBATU 081546891282
24-04-2003 REMAJA SUMURBATU 081546891282
16-03-1979 UMUM SUMURBATU 081546891282
12-06-1976 UMUM SUMURBATU 081546891282
07-06-1986 UMUM SUMURBATU 081546891282
SUMURBATU 085771417912
10-05-1973 UMUM SUMURBATU 085771417912
16-08-1974 UMUM SUMURBATU 085771417912
SUMURBATU 085771417912
16-05-1976 UMUM SUMURBATU 085283234163
15-06-1997 UMUM SUMURBATU 085283234163
16-07-2002 UMUM CIKEUSIK 085694138203
05-05-1970 UMUM SUMURBATU 085694673191
01-12-1996 UMUM SUMURBATU 085694673191
06-01-1983 UMUM SUMURBATU 085776427855
01-09-1980 UMUM SUMURBATU 085776427855
04-04-2006 REMAJA SUMURBATU 085776427855
04-04-1994 UMUM SUMURBATU 085776427855
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi

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 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

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17-11-2021 202108145H

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 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044109520001 ARSINAH P
2 3601046301680002 SAIKAH P
3 3601040107680327 MISTA L
4 3601042703850001 YADI L
5 3601044301600002 APIAH P
6 3601040612920001 AYUT L
7 3601044104790007 EEN P
8 3601044108930003 MISNAH P
9 3601046507870003 NENI P
10 3601046502870001 INAH P
11 3601044801910001 IYOH P
12 3601045605870003 SUTINI P
13 3601041501830002 UJA TONIK L
14 3601045102630002 JANATI P
15 3601044107680201 JARMAH P
16 3601040612640002 NARIP L
17 3601044107930215 ARNAENI P
18 3601044811800004 ATI P
19 3601044107640047 KOYOT P
20 3601042406810002 SUMAR L
21 3601044701800007 YATI P
22 3601044701600003 SANEAH P
23 3601044701800009 UMYANAH P
24 3601044107780242 OLIAH P
25 3601044911830002 WAHYUN EKOWATI P
26 3601044107590033 RASMI P
27 3601044704970003 NURMAH P
28 3601045002630002 SUTI P
29 3601045212840004 JAMSIAH P
30 3601045508830004 ENJUN P
31 3601045509820003 UMRAH P
32 360104570800002 YEYEN P
33 3601045002900010 ITA YULIANTI P
34 3601045102900003 ONAH P
35 360104291186004 AGUS JUMHANA L
36 3601044107760179 SARNAH P
37 3601044408750001 SARINAH P
38 3601044107790094 ISNAH P
39 3601044103780007 SAPIAH P
40 3601044703830001 SUHERNI P
41 3601044406620003 ICIH P
42 3601044501760002 ROHMAN P
43 3601044804070000 RISMAH P
44 3601041507000003 SAHRA L
45 3601040103030010 MOH AJAT L
46 3601040503960001 ASNAM L
47 3601046405600001 TUI L
48 3601041105940002 AHMAD EFENDI L
49 3601040210840001 JAENAL MUTAKIN L
50 3601044307940001 LAMIN L
51 3601044107780250 SAMPENAH P
52 1812024902860001 DWI SUSWARI P
53 3601045702800007 SARMACIH P
54 3601041105810001 IYUSWANDI L
55 3601040611860001 AGUS JUMHANA L
56 3601045302820001 BEBEN P
57 3601041306740001 IBNU ROSID L
58 3601040109690001 EMAN L
59 3601045911980001 ETI P
60 3601045208870002 NENI P
61 3601040107580169 JONYANTO L
62 3601040107630213 SANARI L
63 360045604040001 RENI P
64 3600140410950006 ROHIM SAPUTRA L
65 3601041708050005 SOPIANI L
66 3601040210980002 SANIMAN L
67 3601040103760001 JUANDA P
68 3601040203880005 SUHDI L
69 3601044107730253 DIAN L
70 3601041708030005 M. PURKON NURPALL
71 3601040210840001 JAENAL MUTAKIN L
72 3601044607750002 YATI ISAH P
73 3601045506950008 NIA P
74 3601045110840001 ELIS P
75 3601040207810004 SADAR L
76 3601044701700006 TITIN P
77 3601044704940006 DEWI YUNTIKA P
78 3601044701870009 PULUNG P
79 3601044107900145 SARMINAH P
80 3601044602930003 KARMI NOFIYANTI P
81 3602012001000004 RONI SOPIAN L
82 3601040701750003 BAI P
83 3601045001620001 DARMEN P
84 3601042301910002 ABAS L
85 3601046110980002 NETI HAYATI P
86 3601044408830002 DURIAH P
87 3601040701890002 SUDIRJA L
88 3601044407800011 DAENAH P
89 3601046412960001 ROSINAH P
90 3601042406810002 SUMAR L
91 3601040107530154 SARWAN L
92 3601044212840001 SITI MUTIAH P
93 3601044107880110 EEN P
94 3601044408830002 DURIAH P
95 3601044204740001 OOM P
96 3601041002020002 IRWANSYAH L
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

IRT 01-09-1984 UMUM CIKADONGDONG 081310976418

IRT 23-01-1968 UMUM CIKADONGDONG 085880004727
WIRASWASTA 01-07-1968 UMUM CIKADONGDONG 085287258528
WIRASWASTA 09-07-1995 UMUM CIKADONGDONG 085216056482
IRT 01-01-1985 UMUM CIKADONGDONG 085782266732
WIRASWASTA 10-09-1992 UMUM CIKADONGDONG 085691159086
IRT 01-04-1979 UMUM CIKADONGDONG 085216056482
IRT 19-09-1993 UMUM CIKADONGDONG 085216056482
IRT 25-07-1987 UMUM CIKADONGDONG 085774393878
IRT 25-02-1987 UMUM CIKADONGDONG 081283541681
IRT 08-01-1991 UMUM CIKADONGDONG 085882158271
IRT 16-05-1987 UMUM CIKADONGDONG 085882158271
WIRASWASTA 15-01-1993 UMUM CIKADONGDONG 085882158271
IRT 11-02-1963 UMUM CIKDONG 085692741295
IRT 01-07-1963 UMUM CIKDONG 085692741293
PETANI 06-12-1964 UMUM CIKDONG 085774962122
IRT 17-08-1994 UMUM CIKDONG 085772394360
IRT 08-11-1980 UMUM CIKDONG 085889418198
IRT 15-02-1954 UMUM CIKDONG 081311836540
WIRASWASTA 01-07-1975 UMUM CIKDONG 081584772533
IRT 07-01-1980 UMUM CIKDONG 085774393854
IRT 07-01-1960 UMUM CIKDONG 085693222400
IRT 07-01-1980 UMUM CIKDONG 0857711070824
IRT 01-07-1978 UMUM CIKDONG 085776129565
IRT 21-05-1986 UMUM CIKDONG 085778755946
IRT 01-07-1959 UMUM CIKDONG 081517690084
IRT 01-01-1974 UMUM CIKDONG 085813295243
IRT 10-02-1990 UMUM CIKDONG 081584772533
IRT 04-04-1980 UMUM CIKDONG 082184397822
IRT 17-08-1982 UMUM CIKDONG 085645413700
IRT 15-09-1982 UMUM CIKDONG 085774771630
IRT 17-08-2000 UMUM CIKDONG 085721886560
IRT 10-01-1990 UMUM CIKDONG 085719313725
IRT 11-02-1985 UMUM CIKDONG 085779455069
WIRASWASTA 29-11-1986 UMUM CIKDONG 085718725045
IRT 01-07-1976 UMUM CIKDONG 08571554508
IRT 01-05-1984 UMUM CIKDONG 085782266732
IRT 10-05-1979 UMUM CIKDONG 081511776773
IRT 01-03-1978 UMUM CIKDONG 085213872615
IRT 07-03-1986 UMUM CIKDONG 085776131104
IRT 17-02-1959 UMUM CIKDONG 085817951846
05-01-1976 UMUM CIKDONG 085817103688
PELAJAR 09-04-2005 UMUM CIKDONG 085776129560
PELAJAR 15-07-2000 UMUM CIKDONG 085697102708
PELAJAR 01-02-2004 UMUM CIKDONG 085772730563
WIRASWASTA 05-03-1996 UMUM CIKDONG 085380371172
PETANI 24-05-1960 UMUM CIKDONG 085782266732
WIRASWASTA 11-06-1994 UMUM CIKDONG 085776129474
WIRASWASTA 25-07-1986 UMUM CIKDONG
PETANI 07-02-1983 UMUM CIKDONG 085817501368
IRT 01-07-1978 UMUM CIKDONG 085782266732
PETANI 09-02-1986 UMUM CIKDONG 081291682727
IRT 17-02-1980 UMUM CIKDONG 085213885600
WIRASWASTA 11-05-1981 UMUM CIKDONG 085780043199
WIRASWASTA 19-08-1989 UMUM CIKDONG 085217347358
IRT 18-04-1987 UMUM CIKDONG 085774393854
WIRASWASTA 01-07-1979 UMUM CIKDONG 085694641165
WIRASWASTA 01-09-1969 UMUM CIKDONG 08589299501
IRT 20-10-1995 UMUM CIKDONG 085817963393
IRT 12-08-1987 UMUM CIKDONG 085776131189
PETANI 01-07-1958 UMUM CIKDONG 085881378544
PETANI 01-06-1952 UMUM CIKDONG 085776131189
27-09-2004 UMUM CIKDONG 085881531141
WIRASWASTA 04-10-1995 UMUM CIKDONG 085782266732
PELAJAR 17-08-2005 UMUM CIKDONG 081511407964
PELAJAR 02-10-1998 UMUM CIKDONG 085775167200
WIRASWASTA 05-06-1980 UMUM CIKDONG
WIRASWASTA 02-03-1988 UMUM CIKDONG 085691912401
WIRASWASTA 01-07-1973 UMUM CIKDONG 085819877005
PELAJAR 17-08-2003 UMUM CIKDONG 085810907260
WIRASWASTA 25-07-1986 UMUM CIKDONG 085782266732
IRT 01-04-1975 UMUM CIKDONG 085691437267
IRT 15-06-1995 UMUM CIKDONG 085776129445
IRT 11-10-1995 UMUM CIKDONG 085715497592
PETANI 02-07-1981 UMUM CIKDONG 085773078945
IRT 07-01-1970 UMUM CIKDONG 085892792521
IRT 07-04-1994 UMUM CIKDONG 085778218908
IRT 07-01-1987 UMUM CIKDONG 085781795910
IRT 05-08-1988 UMUM CIKDONG 082324158398
IRT 18-11-1993 UMUM CIKDONG 085813104930
WIRASWASTA 04-05-1997 UMUM CIKDONG 085776131076
IRT 07-01-1975 UMUM CIKDONG 085810913611
IRT 10-11-1962 UMUM CIKDONG 085774393912
WIRASWASTA 23-01-1991 UMUM CIKDONG 085778418414
IRT 21-101998 UMUM CIKDONG 085776129565
IRT 04-08-1983 UMUM CIKDONG
WIRASWASTA 07-01-1989 UMUM CIKDONG 081584773230
IRT 04-07-1980 UMUM CIKDONG 085771613833
IRT 24-12-1996 UMUM CIKDONG 085781667075
WIRASWASTA 01-07-1975 UMUM CIKDONG 081584772533
PETANI 01-07-1953 UMUM CIKDONG 081584773248
IRT 12-12-1984 UMUM CIKDONG 085691947858
IRT 01-07-1988 UMUM CIKDONG 085715251675
IRT 04-08-1983 UMUM CIKDONG 085774393854
IRT 02-04-1974 UMUM CIKDONG 08159824614
PELAJAR 05-07-2002 UMUM CIKDONG 085890550075
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
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 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi

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 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601041708680002 SARMIN L
2 3601055209970001 IDA PURWATI P
3 3601045011900001 RATNA P
4 3601045002980002 LINA P
5 3601044703900003 IMAS PERMASI P
6 3601044310850002 RATNASARI P
7 3601044804800007 SAMI P
8 3602164806960001 SITI LOMRAH P
9 3601045803620001 TARSIH P
10 3601044608940005 SARNI P
11 3601041006670001 MADHAYA L
12 360104120389002 SADUN L
13 3601042712730001 USUP L
14 3601042002850005 KARIS L
15 3601042701580003 JAWARI L
16 3602016712000002 SINTA P
17 3601045510770001 ELAH P
18 3601044501700002 NINING P
19 3601041812850001 JUMHADI L
20 3601044409740003 EROH ROHAYATI P
21 3601040107870003 ANORI L
22 3601045407990005 SUSI SUSANA P
23 3601041206730001 SUKATMA L
24 3601041504820001 KOSIM L
25 3601041005640001 TAIM L
26 3601042506900004 HENDRA L
27 3212226102900001 ARNAH NURHASANAHP
28 3601044805940008 HERAWATI P
29 3601045504920006 TARMI P
30 3601045002960006 NINA EKA WIDIAWATI P
31 3601046005810001 METI P
32 3601045112910001 IKMAH P
33 3601045608950004 MAWI P
34 3601044104990008 SULASTRI P
35 3601040906680001 ABAD P
36 3601041212720002 UMIN L
37 3601040605840002 SANTIKA L
38 3601045705760003 ISAH P
39 3601044607950005 MEGA RAHMA P
40 3601041612670001 ARTAM L
41 3601045002780001 YATI P
42 3601044412800002 TIAH P
43 3601046203020002 IIN MARLINA P
44 36010445008940002 TRIA HANDASARI P
45 3601044301990005 ETI NURHAYATI P
46 3601274607570042 SANAH P
47 3601044303760003 EMIN ARMINAH P
48 3601034104000002 ERNA P
49 3601040611820001 SAMIN L
50 3601044704980007 SUMHAYATI P
51 3601044304580003 MINAH P
52 3601046702070002 ALIS PUJIANTI P
53 3601044706720001 SANAWI P
54 3601045607930001 BOHANA L
55 3601044701850002 JUMSI P
56 3601040104850002 ANEN L
57 3601046811770001 JUHENI P
58 3601270101920001 ANTON L
59 3601040203910001 ASTI P
60 3601046104730001 ENAH P
61 3601041605670001 SURYANTO L
62 3602016909990001 ULPAH P
63 3601045706800002 ATI B ATMA P
64 3601044112800006 SUNARTI P
65 3601044405720001 PATIMAH P
66 3601044108930001 RATNASIH P
67 3601046609930001 TETI P
68 3601040205910003 ADSARI L
69 3601044103780016 SAPTI P
70 3601046106800001 YENI OKTAVIA P
71 3601044101790001 SAENAH P
72 3601041502500001 KARDI L
73 3601046807840002 IJAH P
74 3601047003950001 LENI P
75 3601041807900004 JUHEDI L
76 3601044403680002 HAEN P
77 3601040107930002 ASEP HENDRAWA L
78 3601040107730002 WAWAN IRAWAN L
79 3601042306820004 SONIP L
80 3601041607820001 SUMARLIN L
81 3601045405960008 NURSAH P
82 3601045102970007 JUMINAH P
83 3601045411940001 CICIH P
84 3601040510890001 SUDIN L
85 3601044305820012 MURNI P
86 3601044112030003 RISE DAMAYANTI P
87 3601042212950001 USED L
88 360104006810001 DASA L
89 3601044107750004 ISAH P
 90 3601040211780003 EDI L
91 3601041110970007 SATIP L
92 3601046203800001 KARSIH P
93 3601044407720002 JANI P
94 3601044102700007 HARTI P
95 360104410690009 SURNAH P
96 3601041912720001 TUDIN L
97 3601046803980002 EMAH P
98 3601044402780007 SARTINI P
99 '3601040207920004 ADE L
100 3601042111730001 ADANG L
101 3601045006750001 YATI P
102 3601041005810004 NURHADI L
103 3601045509770002 ASIAH P
104 3601041511740001 SALIKIN L
105 3601045702940004 CICIH P P
106 3601046602920001 RISNA P
107 3601041208950002 MISNAH P
108 36010459059300002 NITI P
109 3601040607880005 RASID L
110 3601044104920001 AMI P
111 3601041807720001 KOMARUDIN L
112 3601045402860001 NURMALASARI P
113 3601045106700001 YATI P
114 3601044202760001 NENGSIH P
115 3601044701830001 ARNI P
116 36010468079500003 LIA P
117 3601042006830002 RONI L
118 3601044507960006 MARWATI P
119 3601045702760001 TITIN P
120 3601042804900001 SOHIB L
121 3601041404940001 SARKIAN L
122 3601041007780001 JAHRA P
123 3601040205620001 HASANUDIH L
124 3601041107850001 SARDI L
125 360104520690006 NANIE P
126 3601044106790001 ARTIAH P
127 3601041606950004 BENDI. S L
128 3601045108840003 SINAH P
129 3601041110670001 SUKANDAR L
130 3601044101840001 ELAH P
131 3601041406900001 ANDI L
132 3601041011650002 SARNATA L
133 36010462088800002 KOMARIAH P
134 360014418600001 AI P
135 3601046107890005 SANEMI P
136 3601045406660007 IRAH P
137 3601045206960002 DEDE P
138 3601040809750002 MUSLIJ. H L
139 3601045403800003 ITA L
140 3601044910930003 AAS P
141 3601045005690008 CICIH P
142 3601044512090005 ELA P
143 3601045111920002 OCIH P
144 3601045306860002 JUNETI P
145 3601040305890001 TITA L
146 3601046807850003 TITIN N P
147 3602016801970003 ECIH P
148 3601045107780002 SACI P
149 3601042101900002 DEDEN L
150 3601041506820001 DONI L
151 3601044107950256 ANI P
 Umur
Kelompok
Pekerjaan* (18-59 INSTANSI Alamat
Umur
tahun)

WIRASWASTA 05-07-1972 KP.MANTIUNG

IRT 12/9/1997 KP.MANTIUNG
IRT 13-08-1989 KP.CIKUJANG BARAT
IRT 10/2/1998 KP.CIAPU
IRT 6/6/1993 KP.PASIR KALIKI
IRT 12/10/1991 KP.CIKUJANG BARAT
IRT 8/4/1980 KP.CIKUJANG TIMUR
IRT 8/7/1996 KP.CIKUJANG
IRT 18-03-1962 KP.CIDAIMAH
IRT 6/8/1994 KP.CIGADOG
PETANI 10/6/1967 KP.CIKUJANG DUA
WIRASWASTA 12/3/1989 KP.MANTIUNG
PETANI 27-12-1945 KP.MANTIUNG
WIRASWASTA 20-02-1985 KP.MANTIUNG
PETANI 27-01-1958 KP.TANJUNGAN
IRT 8/12/1999 KP.CIKUJANG BARAT
IRT 15-10-1977 KP.CIKUJANG BARAT
IRT 5/1/1970 KP.CITENGAH
WIRASWASTA 10/12/1985 KP.SUKAMANDI
IRT 4/9/1979 KP.CIKUJANG
WIRASWASTA 1/8/1988 KP.CIKUJANG TIMUR
IRT 14-07-1999 KP.MANTIUNG
PETANI 12/6/1973 KP.CIKUJANG BARAT
PETANI 15-04-1982 KP.CIKEUSIK GEBLUG
PETANI 12/11/1965 KP.CIKUJANG BARAT
PETANI 25-07-1991 DS.TANJUNGAN
IRT 21-02-1990 KP.CIKUJANG
IRT 8/5/1994 KP.TANJUNGAN
IRT 15-04-1992 KP.CIKUJANG TIMUR
IRT 10/2/1996 KP.PASIR KALIKI
IRT 20-05-1981 KP.MANTIUNG
IRT 11/12/1991 KP.SINAR BAKTI
IRT 16-08-1995 KP.MANTIUNG
IRT 1/4/1999 KP.MANTIUNG
IRT 9/6/1968 KP.CIKUJANG BARAT
PETANI 12/12/1972 KP.MANTIUNG
PETANI 21-09-1985 KP.CIBAKARANG
IRT 17-05-1976 KP.CIKEUSIK GEBLUG
IRT 06-071995 KP.MANTIUNG
PETANI 16-12-1967 KP.CIBAKARANG
IRT 10/2/1978 KP.MANTIUNG
IRT 4/12/1980 KP.CIBAKARANG
PELAJAR 22-03-2002 KP.TALANCA
WIRASWASTA 10/8/1994 KP.CILUKUT
IRT 3/1/1999 KP.MANTIUNG
IRT 1/7/1980 KP.TANJUNGAN
IRT 3/3/1976 KP.MANTIUNG
IRT 1/8/2000 KP.MANTIUNG
WIRASWASTA 16-02-1975 KP.TAMJUNGAN
IRT 7/4/1998 KP.CIBAKARANG
IRT 3/4/1958 KP.CIKEUSIK GEBLUG
IRT 27-02-2007 KP.CIKUJANG TIMUR
PETANI 7/6/1972 KP.CIKEUSIK GEBLUG
WIRASWASTA 6/9/1993 KP.MANTIUNG
IRT 6/1/1988 KP.MANTIUNG
IRT 01-04-01985 KP.MANTIUNG
IRT 28-11-1977 KP.CIKEUSIK GEBLUG
PETANI 1/1/1992 KP.MANTIUNG
PETANI 1/3/1963 DS.TANJUNGAN
IRT 21-04-1973 KP.CISEUREUH
PETANI 2/9/1972 DS.TANJUNGAN
PELJAR 29-09-1999 DS.TANJUNGAN
IRT 12/9/1982 DS.TANJUNGAN
IRT 1/12/1989 DS.TANJUNGAN
IRT 8/5/1972 DS.TANJUNGAN
IRT 1/8/1993 DS.TANJUNGAN
IRT 26-09-1993 DS.TANJUNGAN
IRT 19-09-1999 DS.TANJUNGAN
IRT 1/3/1978 DS.TANJUNGAN
IRT 21-06-1980 DS.TANJUNGAN
PETANI 24-04-1979 DS.TANJUNGAN
WIRASWASTA 15-02-1950 DS.TANJUNGAN
IRT 28-07 - 1984 DS.TANJUNGAN
IRT 26-03-1995 DS.TANJUNGAN
WIRASWASTA 18-07-1990 DS.TANJUNGAN
IRT 2/5/1965 DS.TANJUNGAN
WIRASWSTA 22-05-1998 DS.TANJUNGAN
WIRASWASTA 17-07-1978 DS.TANJUNGAN
PETANI 23-06-1982 DS.TANJUNGAN
WIRAUWASTA 17-09-1988 DS.TANJUNGAN
IRT 14-05-1996 DS.TANJUNGAN
IRT 11/2/1997 DS.TANJUNGAN
TIDAK BEKERJA14-04-1994 DS.TANJUNGAN
PETANI 13-07-1989 DS.TANJUNGAN
IRT 03/5/1982 DS.TANJUNGAN
PELAJAR 1/12/2003 DS.TANJUNGAN
WIRASWSTA 22-12-1995 DS.TANJUNGAN
PETANI 03/6/1971 DS.TANJUNGAN
IRT 01-07-1975 DS.TANJUNGAN
PETANI 02-11-1978 DS.TANJUNGAN
WIRASWASTA 11/10/1997 DS.TANJUNGAN
IRT 22-03-1980 DS.TANJUNGAN
IRT 04-07-1972 DS.TANJUNGAN
IRT 01-02-1979 DS.TANJUNGAN
IRT 1/6/1990 DS.TANJUNGAN
PETANI 19-12-1972 DS.TANJUNGAN
WIRAWASTA 16-06-1996 DS.TANJUNGAN
PETANI 04-02-1978 DS.TANJUNGAN
02-07-1992 DS.TANJUNGAN
21-11-1973 DS.TANJUNGAN
10-06-1975 DS.TANJUNGAN
10-05-1991 DS.TANJUNGAN
21-01-1978 DS.TANJUNGAN
04-08-1975 DS.TANJUNGAN
14-01-1996 DS.TANJUNGAN
25-02-1992 DS.TANJUNGAN
12-08-1995 DS.TANJUNGAN
07-03-1984 DS.TANJUNGAN
06-07-1988 DS.TANJUNGAN
01-04-1992 DS.TANJUNGAN
18-07-1972 DS.TANJUNGAN
14-02-1986 DS.TANJUNGAN
11-06-1970 DS.TANJUNGAN
02-02-1976 DS.TANJUNGAN
07-01-1983 DS.TANJUNGAN
14-07-1995 DS.TANJUNGAN
20-06-1983 DS.TANJUNGAN
05-07-1996 DS.TANJUNGAN
17-02-1976 DS.TANJUNGAN
28-04-1990 DS.TANJUNGAN
14-04-1994 UMUM DS.TANJUNGAN
20-01-1979 UMUM DS.TANJUNGAN
02-05-1962 UMUM DS.TANJUNGAN
11-07-1985 UMUM DS.TANJUNGAN
12-06-1992 UMUM DS.TANJUNGAN
01-06-1979 UMUM DS.TANJUNGAN
16-04-1996 UMUM DS.TANJUNGAN
11-06-1994 UMUM DS.TANJUNGAN
15-06-1963 UMUM DS.TANJUNGAN
01-01-1984 UMUM DS.TANJUNGAN
05-01-1990 UMUM DS.TANJUNGAN
10-11-1965 UMUM DS.TANJUNGAN
02-08-1989 UMUM DS.TANJUNGAN
01-0601996 UMUM DS.TANJUNGAN
21-07-1989 UMUM DS.TANJUNGAN
14-06-1966 UMUM DS.TANJUNGAN
12-06-1998 UMUM DS.TANJUNGAN
20-08-1974 UMUM DS.TANJUNGAN
14-03-1980 UMUM DS.TANJUNGAN
09-10-1993 UMUM DS.TANJUNGAN
02-06-1986 UMUM DS.TANJUNGAN
05-12-2000 UMUM DS.TANJUNGAN
11-11-1992 UMUM DS.TANJUNGAN
13-06-1986 UMUM DS.TANJUNGAN
03-06-1969 UMUM DS.TANJUNGAN
28-07-1985 UMUM DS.TANJUNGAN
28-01-1997 UMUM DS.TANJUNGAN
01-04-1987 UMUM DS.TANJUNGAN
21-01-1990 UMUM DS.TANJUNGAN
15-06-1982 UMUM DS.TANJUNGAN
01-07-1995 UMUM DS.TANJUNGAN
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Merek Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening
PBI Non PBI Anggota

081282774782 CORONAVAC 18-11-2021

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081511690531 CORONAVAC 18-11-2021
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081511690531 CORONAVAC 18-11-2021
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085287259120 CORONAVAC 18-11-2021
085287259120 CORONAVAC 18-11-2021
085287259120 CORONAVAC 18-11-2021
085773810926 CORONAVAC 18-11-2021
085773810926 CORONAVAC 18-11-2021
085773810926 CORONAVAC 18-11-2021
085773810926 CORONAVAC 18-11-2021
085771427457 CORONAVAC 18-11-2021
085771427457 CORONAVAC 18-11-2021
085771427457 CORONAVAC 18-11-2021
085771427457 CORONAVAC 18-11-2021
085771427457 CORONAVAC 18-11-2021
085771427457 CORONAVAC 18-11-2021
085815759150 CORONAVAC 18-11-2021
085815759150 CORONAVAC 18-11-2021
085815759150 CORONAVAC 18-11-2021
 Dosis I Dosis 2
Tanggal
Tanggal Pemberi KET
No.
Pemberian No. Batch No seri an No Seri
Batch
Vaksinasi Vaksina
si
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
18-11-2021 202109180M
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 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601046204760002 SARNAH P
2 360104060900001 IYAS L
3 3601045907440002 NANI P
4 3601044103820001 MURSITI P
5 3601042607940003 MULYANA L
6 3601045504940001 ROSIKAH P
7 3601046906940001 AMAH P
8 3601041108940002 DONI L
9 3601041203820001 SIDIK L
10 3601046708740001 ISAH P
11 3601045610870001 ILIS P
12 3601040502930001 JAJA L
13 3601044211890003 KASMAWATI P
14 3601041006800011 ATMA L
15 3601046004930003 TATI P
16 3601040106750002 ADE SUMANTRI L
17 3601042008820001 SARTA L
18 3601041103750006 MMIN L
19 3601044106840005 UMU P
20 3601040407700004 SAMANI L
21 3601045307810001 SUMYATI P
22 3601045103650001 IKAH P
23 3601045407930002 IMAS P
24 3601045503640001 JUE P
25 3601045308720002 MARTI P
26 3601045709840001 IDAH PUKANAH P
27 3601041907830002 UENG L
28 3601044301960002 ARMAH P
29 3601041312660001 ACIH P
30 3601046009880001 NENIH P
31 3601044403730001 LILIS P
32 3601045703820001 YATI P
33 3601045707820001 SARMINAH P
34 3601045901880001 HENI P
35 360104203780001 MIMI P
36 360104442900002 SATINAH P
37 36010401-5800007 HERMAN L
38 3601045912860001 JUJU P
39 3601040102800020 RUKMAN L
40 3601045107660001 ATI P
41 3601274107920107 YANTI P IRT
42 3601042604970001 SARMAYA L WIRASWA
43 3601044208950007 SARAH P IRT
44 3601044111800003 ANI P IRT
45 3601040608790001 MUSA L PETANI
46 3601045011850003 ASLIAH P IRT
47 3601045005620001 SAYATI P IRT
48 3601045409750001 INAH P IRT
49 3601045807700003 JUNI P IRT
50 3601046404750001 SATIAH P IRT
51 3601044808670001 SUDARSIH P IRT
52 3601045911870004 IDS ROSITA P IRT
53 3601042011620001 SARONI L PETANI
54 3601045507880020 NARWATI P IRT
55 3601041909610001 RASMAN L PETANI
56 3601044102600001 ARMASIH P IRT
57 3601041808970003 ARIP L WIRASWA
58 3601044603960005 OOM MAYASARI P IRT
59 3601045710980003 AAS P IRT
60 3601045510750001 ANAH P IRT
61 3601045003770003 ENAY P IRT
62 3601041303780004 KARYA PERMANA L WIRASWA
63 3601046201010001 ASMINI P IRT
64 3601046301040001 RATIH P REMAJA
65 3601044605950004 TETI JUMHETI P IRT
66 3601046003850001 BAI MAENAH P IRT
67 3602214112900005 LIAH P IRT
68 3601042111720001 SADIK L PETANI
69 3601040502870002 M.ALDI L WIRASWA
70 3601045512850002 EMIN P IRT
71 3601046102750001 MURNI P IRT
72 3601041512920003 SANAKIR L PETANI
73 3601041204620001 KEMAN L PETANI
74 3601046004790002 MAELANI P IRT
75 3601044807280001 TETI ROHAYATI P IRT
76 3601045508850001 ROHENAH P IRT
77 3601046103670002 ANIH P IRT
78 3601044901030001 NINA INDRIANI P IRT
79 3601045506650006 ESIH P IRT
80 3601040403580000 H. SUKARDI L PNS
81 3601046610960006 KHOTIMAH P IRT
82 3601040107830051 KARNA L WIRASWA
83 3601042503730001 BAI L PETANI
84 3601041504610002 SUGAN L PETANI
85 3601045507880006 CARMINAH P IRT
86 3602215401880001 YENI P IRT
87 3601040705840006 RATMANTO L PETANI
88 3601041807660001 SAKIM L WIRASWA
89 3601041104800002 NURJAYA L PETANI
 90 3601046703000001 RITA AMINDI P IRT
91 3601040904830001 SURJAYA L WIRASWA
92 3601040107630111 KAPIK L PETANI
93 3601040107730177 WARNA B ARDAN L WIRASWA
94 3601046006680001 ACIH P IRT
95 3601044107700023 WASTI P IRT
96 3601040107740112 EDI L PETANI
97 3601044207040012 SRI KARTIKA P PELAJAR
98 3601043001910003 SUTARNO B SUPARDIL WIRASWA
99 3601192908990003 AHMAD DIDI TURMUDI
L WIRASWA
100 3601040701010007 RUDI L PELAJAR
101 3601040107770068 DAYAT FIRDAUS L PETANI
102 3601044804810002 LAMRAH P IRT
103 3601046001580001 CARTI P IRT
104 3601043010960003 YOGI SAPUTRA L WIRASWA
105 3601041512670001 PUDIN L WIRASWA
106 3601046007890004 ARMAH P IRT
107 3601040103820005 MUHAMAD TARYANAL WIRASWA
108 3601042703930004 DANURI L WIRASWA
109 3601045002030005 NENGSIH P BELUM KE
110 3601040107430094 KARWIYAH L PETANI
111 3601044107670068 KATINAH P IRT
112 3601040107680191 AKROBI L WIRASWA
113 3601041706890003 ACUN L WIRASWA
114 3601044107780069 DARSIH P IRT
115 3601034602720003 ENAH P IRT
116 3601041907720001 SABA L PETANI
117 3601040104410001 ADE SUNARDI L WIRASWA
118 3601042502870001 SANARA L WIRASWA
119 3601044705720002 UUN UNARIAH P IRT
120 3601040307770002 ABDUL KOHAR L WIRASWA
121 3601045210930002 DENTIKA P BELUM KE
122 3601046505070005 TIANA SARI P PELAJAR
123 3601046007050004 SITI FATIMAH P PELAJAR
124 3601044311030001 SITI MAEMUNAH P PELAJAR
125 3601034411030002 SELA SUSILAWATI P PELAJAR
126 3601040107630044 JABIDI L PETANI
127 3601034601040002 SONIA FITRIANI P PELAJAR
128 3602210110970004 SUNA L WIRASWA
129 3601041108740002 TASKA L WIRASWA
130 3601034505040003 RUMAY P PELAJAR
131 3601042109570002 DARYAM L PETANI
132 3601040107780219 SUKARMAN L WIRASWA
133 3304146503780001 KAMI L WIRASWA
134 3601042009870003 ASMIN HIDAYAT L HONORER
135 '3601040107700171 RATIM B KANDEG L PETANI
136 3601046503850002 NURAENI P IRT
137 3601040107680053 CASWITA L PETANI
138 3601011710670001 SALIMAH P IRT
139 3601045002070003 RIA SULISTIA FEBRIAP PELAJAR
140 3601041810980001 TB. AGUS MUHIDIN L WIRASWA
141 3601040107030082 WIRANTO L PELAJAR
142 3601041707810001 ODIH L WIRASWA
143 3601044310540001 RUMI P IRT
144 3601045709820002 CARINIH P IRT
145 3601045209780001 AAM P IRT
146 3601045703680003 BADRIAH P IRT
147 3601045107740003 SUHETI P IRT
148 3601040109040004 DELON ARIFKA L PELAJAR
149 3601274307870001 SUHENAH P IRT
150 317410130805006 FANDI L PELAJAR
151 3601041712870001 SULTONI L WIRASWA
152 3601040107750238 SANUSI L PETANI
153 3601041002900004 IMAN L PETANI
154 3601040702830003 SUHAEMIN L WIRASWA
155 3601046907050001 EKA AYU ZENITHIA P PELAJAR
156 3601044501990003 ROSIKA P PELAJAR
157 3601041805870001 JUANDA L WIRASWA
158 3601040105970008 SUPRATNA L WIRASWA
159 3601044107970194 NINDI WIJAYA L WIRASWA
160 3601040706030001 MUHAMAD IIK IKLA L PELAJAR
161 3601040107610082 RASWIN L PETANI
162 3601046502750001 BEDAH P IRT
163 3112244103970004 WARKENI P IRT
164 3323081010710004 SUTARA B MUSTOFA L WIRASWA
165 3601044107530259 CARWEN P IRT
166 3601045002900008 ISEM P IRT
167 3601041001880006 IBING L WIRASWA
168 3601045010040001 WINDI OKTAVIA P PELAJAR
169 3601044107540043 RASIEM P IRT
170 3601040606520002 WASLAM L PETANI
171 3601042310810001 HAERUDIN L WIRASWA
172 3601041005810001 JUNENIH P PETANI
173 3601040404860001 KARSID L PETANI
174 3601046505900002 TATI YUNINGSIH P IRT
175 3601044405780001 KARSI'AH P IRT
176 3601270107890006 ARSUDIN L WIRASWA
177 3601040205980003 NURUL HUSAENI L WIRASWA
178 3601041211880002 OTONG L WIRASWA
179 3601046211920001 RATNA SUMINAR P IRT
180 3601044102510002 HADIJAH P IRT
181 3601044103970004 NITA NURSYAFITRI P IRT
182 3601042201030001 ARI CHANDRA IRAWAL PELAJAR
183 3601041006960002 AHYUDIN NURWAHIDL BELUM KE
184 3601046207000003 UNASIH P IRT
 Kepesertaan BPJS
'Ya' pada kolom y

Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

22-04-1976 UMUM TANJUNGAN 08569456851

17-03-1990 UMUM TANJUNGAN 083897121257
01-12-1991 UMUM TANJUNGAN 083897121257
01-03-1982 UMUM TANJUNGAN 085694723474
26-07-1994 UMUM TANJUNGAN 085694723474
15-04-1992 UMUM TANJUNGAN 085894695438
10-05-1994 UMUM TANJUNGAN 085894695438
03-02-1992 UMUM TANJUNGAN 085780688376
12-03-1982 UMUM TANJUNGAN 08158574659
27-08-1972 UMUM TANJUNGAN 083171594632
16-10-1987 UMUM TANJUNGAN 083171594632
06-02-1993 UMUM TANJUNGAN 083171594632
02-11-1989 UMUM TANJUNGAN 081318342591
10-06-1980 UMUM TANJUNGAN 081318342591
20-04-1983 UMUM TANJUNGAN 082164164941
25-10-1975 UMUM TANJUNGAN 08583722803
20-08-1982 UMUM TANJUNGAN 08583722803
11-03-1975 UMUM TANJUNGAN 08583722803
01-06-1984 UMUM TANJUNGAN 08583722803
04-07-1978 UMUM TANJUNGAN 08583722803
13-07-1981 UMUM TANJUNGAN 08583722803
10-08-1972 UMUM TANJUNGAN 085217827775
14-07-1983 BUMIL TANJUNGAN 085217827775
05-03-1963 UMUM TANJUNGAN 085810157163
13-08-1972 UMUM TANJUNGAN 085810157163
17-09-1984 UMUM TANJUNGAN 085810157163
15-07-1983 UMUM T TANJUNGAN 081511690531
22-12-1996 UMUM TANJUNGAN 081511690531
13-12-1980 UMUM TANJUNGAN 081511690531
20-09-1988 UMUM TANJUNGAN 081511690531
04-03-1973 UMUM TANJUNGAN 085211283482
17-03-1972 UMUM TANJUNGAN 085211283482
17-07-1972 UMUM TANJUNGAN 085810910212
19-01-1988 UMUM TANJUNGAN 085810910212
02-03-1978 UMUM TANJUNGAN 085694609226
01-04-1990 UMUM TANJUNGAN 085694609226
01-05-1980 UMUM TANJUNGAN 085694232260
19-12-1988 UMUM TANJUNGAN 08521643782
01-02-1980 UMUM TANJUNGAN 08521643782
11-07-1966 UMUM TANJUNGAN 08521643782
01-07-1992 UMUM TANJUNGAN 082311276489
26/04/1997 UMUM TANJUNGAN 082311276489
02-08-1995 UMUM TANJUNGAN 085770621079
01-01-1980 UMUM TANJUNGAN 085694473692
15-02-1979 UMUM TANJUNGAN 089628293147
10-11-1985 UMUM TANJUNGAN 085774595474
10-05-1962 UMUM TANJUNGAN 085813590658
14-09-1986 UMUM TANJUNGAN 081511690531
18-0701970 UMUM TANJUNGAN 085254244827
24-04-1975 UMUM TANJUNGAN 085860513916
08-08-1967 UMUM TANJUNGAN 085694496878
19-11-1987 UMUM TANJUNGAN 081511406468
20-11-1962 UMUM TANJUNGAN 081586127450
15-07-1988 UMUM TANJUNGAN 085216453782
01-03-1961 UMUM TANJUNGAN 085893722725
10-04-1967 UMUM TANJUNGAN 085891152156
18-08-1997 UMUM TANJUNGAN 085282258957
06-03-1996 UMUM TANJUNGAN 085779055213
17-10-1998 UMUM TANJUNGAN 085810586087
15-10-1975 UMUM TANJUNGAN 085893722716
10-03-1977 UMUM TANJUNGAN 085813590593
13-03-1978 UMUM TANJUNGAN 085212810708
22-01-2001 UMUM TANJUNGAN 085891025077
23-01-2004 UMUM TANJUNGAN 082320720903
06-05-1995 UMUM TANJUNGAN 081296603801
01-09-1990 UMUM TANJUNGAN 085694609244
20-10-1989 UMUM TANJUNGAN 081514753684
21-01-1972 UMUM TANJUNGAN 085778224992
08-08-1989 UMUM TANJUNGAN 085733077981
15-12-1985 UMUM TANJUNGAN 085215869856
21-02-1975 UMUM TANJUNGAN 085714214479
15-12-1992 UMUM TANJUNGAN 088219431437
06-11-1871 UMUM TANJUNGAN 085217827775
20-04-1979 UMUM TANJUNGAN 085693719950
10-07-1978 UMUM TANJUNGAN 08582906450
15-08-1982 UMUM TANJUNGAN
21-0301967 UMUM TANJUNGAN
09-01-2003 UMUM TANJUNGAN
15-06-1965 UMUM TANJUNGAN 081511196526
04-03-1958 UMUM PKM CIKEUSIK 085966203222
26-10-1996 UMUM PKM CIKEUSIK 081280313711
01-07-1983 UMUM PKM CIKEUSIK 087721902770
25-03-1973 UMUM PKM CIKEUSIK 081284559992
15-04-1961 UMUM PKM CIKEUSIK 085886944915
17-08-1982 UMUM PKM CIKEUSIK 083891391401
14-01-1988 UMUM PKM CIKEUSIK 085219655761
07-05-1984 UMUM PKM CIKEUSIK 085795308305
18-07-1966 UMUM PKM CIKEUSIK 085213872127
11-04-1970 UMUM PKM CIKEUSIK 085319359483
27-03-2000 UMUM PKM CIKEUSIK 083871139882
09-04-1985 UMUM PKM CIKEUSIK 085819341347
01-07-1963 UMUM PKM CIKEUSIK 085773624417
03-08-1973 UMUM PKM CIKEUSIK 085210919426
20-06-1963 UMUM PKM CIKEUSIK 085886944915
23-02-1970 UMUM PKM CIKEUSIK 081382285668
01-07-1974 UMUM PKM CIKEUSIK 081248280759
20-06-2004 UMUM PKM CIKEUSIK
07-07-1992 UMUM PKM CIKEUSIK 085778219176
29-08-1999 UMUM PKM CIKEUSIK
07-02-2001 UMUM PKM CIKEUSIK 081511757220
28-10-1977 UMUM PKM CIKEUSIK 085710316117
08-04-1981 UMUM PKM CIKEUSIK 085213478166
20-01-1958 UMUM PKM CIKEUSIK 081511406398
07-05-1999 UMUM PKM CIKEUSIK 085775164119
15-12-1967 UMUM PKM CIKEUSIK 085219822570
20-07-1989 UMUM PKM CIKEUSIK 085813586372
01-03-1982 UMUM PKM CIKEUSIK 085813586372
27-03-1993 UMUM PKM CIKEUSIK 081511869538
10-02-2003 UMUM PKM CIKEUSIK 081511407945
01-07-1943 UMUM PKM CIKEUSIK 085211640991
01-08-1965 UMUM PKM CIKEUSIK 085810910019
01-07-1968 UMUM PKM CIKEUSIK 085691308359
17-06-1989 UMUM PKM CIKEUSIK 082111544491
24-06-1982 UMUM PKM CIKEUSIK 082320540005
06-02-1972 UMUM PKM CIKEUSIK 085883394240
19-07-1971 UMUM PKM CIKEUSIK 082312013182
01-04-1991 UMUM PKM CIKEUSIK 085811677867
25-02-1987 UMUM PKM CIKEUSIK 085770331347
07-05-1972 UMUM PKM CIKEUSIK 081380116812
02-07-1977 UMUM PKM CIKEUSIK 085218265625
04-07-1994 UMUM PKM CIKEUSIK 085778219176
25-05-2007 UMUM PKM CIKEUSIK 085811264499
12-10-2004 UMUM PKM CIKEUSIK 085283233986
01-11-2003 UMUM PKM CIKEUSIK 085773746244
04-11-2003 UMUM PKM CIKEUSIK
01-07-1963 UMUM PKM CIKEUSIK 082320540005
06-01-2004 UMUM PKM CIKEUSIK 083139334986
16-02-1996 UMUM PKM CIKEUSIK 081511406477
11-08-1974 UMUM PKM CIKEUSIK 085779570481
05-05-2004 UMUM PKM CIKEUSIK 083136748624
21-09-1957 UMUM PKM CIKEUSIK 081287150864
10-04-1978 UMUM PKM CIKEUSIK 08568930801
25-03-1978 UMUM PKM CIKEUSIK 085219602231
20-09-1987 UMUM PKM CIKEUSIK 085717544965
03-05-1958 UMUM PKM CIKEUSIK 085714775992
25-03-1985 UMUM PKM CIKEUSIK 085774965010
10-07-1963 UMUM PKM CIKEUSIK
10-10-1967 UMUM PKM CIKEUSIK 085871278984
10-02-2007 UMUM PKM CIKEUSIK 085770149893
12-08-1999 UMUM PKM CIKEUSIK 085811464515
24-08-2003 UMUM PKM CIKEUSIK
12-02-1985 UMUM PKM CIKEUSIK 087772800300
03-10-1967 UMUM PKM CIKEUSIK 081398129568
17-09-1982 UMUM PKM CIKEUSIK 085218263625
12-09-1978 UMUM PKM CIKEUSIK 085718256149
17-03-1963 UMUM PKM CIKEUSIK 087772320241
11-07-1974 UMUM PKM CIKEUSIK 081398286028
01-08-2004 UMUM PKM CIKEUSIK 081280313736
04-01-1993 UMUM PKM CIKEUSIK 081511862715
13-08-2005 UMUM PKM CIKEUSIK 085814564248
17-12-1987 UMUM PKM CIKEUSIK 081244123210
01-07-1975 UMUM PKM CIKEUSIK
10-02-1990 UMUM PKM CIKEUSIK 085894828757
07-02-1983 UMUM PKM CIKEUSIK 085779054237
01-01-2007 UMUM PKM CIKEUSIK 081316929807
11-07-2003 UMUM PKM CIKEUSIK 085161433546
18-05-1987 UMUM PKM CIKEUSIK 085886416145
01-05-1997 UMUM PKM CIKEUSIK 085774607068
05-09-1997 UMUM PKM CIKEUSIK 085695388255
07-06-2003 UMUM PKM CIKEUSIK 085714772501
01-07-1951 UMUM PKM CIKEUSIK 082312236954
25-02-1950 UMUM PKM CIKEUSIK 085692386046
10-03-1997 UMUM PKM CIKEUSIK 085694570421
10-10-1971 UMUM PKM CIKEUSIK 081212088882
01-07-1953 UMUM PKM CIKEUSIK
10-02-1990 UMUM PKM CIKEUSIK 081398286028
10-01-1988 UMUM PKM CIKEUSIK 081398286028
01-10-2004 UMUM PKM CIKEUSIK 081295091285
01-07-1954 UMUM PKM CIKEUSIK 081311481848
06-06-1952 UMUM PKM CIKEUSIK 085773491015
23-10-1981 UMUM PKM CIKEUSIK 085694946160
10-05-1980 UMUM PKM CIKEUSIK 085778185452
11-01-1985 UMUM PKM CIKEUSIK 083841260350
25-05-1990 UMUM PKM CIKEUSIK 085886793334
14-05-1976 UMUM PKM CIKEUSIK 085894828229
01-03-1987 UMUM PKM CIKEUSIK 08158263004
02-05-1998 UMUM PKM CIKEUSIK 085709090095
12-11-1988 UMUM PKM CIKEUSIK 085719972783
10-10-1994 UMUM PKM CIKEUSIK 085719972783
05-04-1960 UMUM PKM CIKEUSIK 087709925341
30-05-1997 UMUM PKM CIKEUSIK 085892746902
22-07-2002 UMUM PKM CIKEUSIK 081280858962
07-06-1997 UMUM PKM CIKEUSIK 085624970438
22-07-2000 UMUM PKM CIKEUSIK 085892749548
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
Non PBI Anggota
Vaksinasi

CORONAVAC 18-11-2021 18-11-2021 202109180M

CORONAVAC 18-11-2021 18-11-2021 202109180M
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 Dosis 2
Tanggal
Pemberi KET
No.
an No Seri
Batch
Vaksina
si

18-11-202 202109180M
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 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601044107930114 ARSIDA P
2 3601044107580078 SUKMA P
3 3601044107610030 RASMI P
4 3601044107830155 SUSILAWATI P
5 3601042004760002 ROHMAN RAPEI L
6 3601044107730135 SARKONAH P
7 3601040107570026 SAHADI L
8 3601044107650058 ENONG ATIAH P
9 3601044107990122 LENI P
10 3601044212880003 NURMI P
11 3601040107910124 ROSID L
12 3601044107930105 SUMARNI P
13 3601044107750090 KUNAH P
14 3601044107810070 NANI YUNENGSIH P
15 3601034204970001 ELIM HALIMAH P
16 3601040107710041 ASRIK L
17 3601044107940081 BEDAH P
18 3601041207780003 M JASIDIN L
19 3601044705780004 IYOH P
20 3601044402740001 JUHA P
21 3601044811800002 SANI P
22 3601040107860271 ASRA L
23 3601040107780144 ACIP L
24 3601044802610001 NASIH P
25 3601040402720001 TISNA P
26 3601044107840064 CUCUN P
27 3601040102860006 DUSIN L
28 3601044101010016 SAENAH P
29 3601044604750001 ARMI P
30 3601044107610029 SAMUNAH P
31 3601044110650001 SANIMAH P
32 3601044209700002 TIAH P
33 3601044110750001 SADIAH P
34 3601044102860007 RODIAH P
35 3601040107550033 DULJAYA L
36 3601044204650006 SARWITI P
37 3601044402900015 YAYAH P
38 3601040601010004 DEDE EKO PATRIO L
39 3601045704770003 WANTI P
40 3601040309870003 KURDI SUPANDI L
41 3601044107650061 KAMSAH P
42 3601044607980006 DEWI ERNIKA P
43 3601042505760001 ASJA P
44 3601044507650002 ERAH P
45 3601040406730002 SUANDA L
46 3601047108910001 TURIAH P
47 3601045009660001 UWEN P
48 3601044807660001 ARIS P
49 3601044107700179 SANAAH P
50 3601044304900002 IIS P
51 3601041605780001 ASEP SAEPUL ANWAR L
52 3601044201680001 ESIH P
53 3601044007630004 KENAH P
54 3601044704770001 YATI P
55 3601040107720033 SUMINTA L
56 3601044301580001 DURIAH P
57 3601045011880003 SAENAH P
58 3601044108880001 AAM P
59 3601040107930110 IIP APANDI L
60 3601041803760001 ASEP L
61 3601040803970002 AHYANI L
62 3601044112650002 SUSILAWATI P
63 3601045103780002 RUMNAH P
64 3601044102770005 ARSAH P
65 3601044104680002 SUHETI P
66 3601031109860001 SARDI L
67 3601044905060002 RESTI P
68 3601044101050007 RISKA REGINA PUT[RI P
69 3601040203600001 SARMAN L
70 3601040503820001 HENDI L
71 3601044503780003 SUHA P
72 3601040406880002 AGUS L
73 3601044709910001 SUKMA L
74 3601040107880123 AWIK RIPAI L
75 3601040407680001 ENGKUS P
76 3601040507910008 SUBAD L
77 3610403087700001 SAMBA L
78 3601044502820001 SURHETI P
79 3601044702850003 ATIKAH P
80 3601040403750001 AWALUDIN L
81 3601041103590001 SURDI L
82 3601041111850003 TONI L
83 3601044702880002 SUNARYA P
84 3601040305020001 UBAY L
85 3601040407010008 ROUP L
86 3601040207800002 ENTUS L
87 3601044107800129 NENI BT SADIRA P
88 3601040106980004 AKIM L
89 3601040705530001 YAYAT P
90 3601044107510071 SATIAH P
91 3601041303880002 KAMSAN L
92 3601044704680002 SARTINAH P
93 3601041602900005 SOBUR L
94 3601045008030001 ASNAH MELITA P
95 3601044107050005 IKEU KUSUMA DEWI P
96 1405012005400001 SURAT[NA P
97 3601044109880001 CUCUM P
98 3601042004780001 ROHMAN L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI

25/02/1986 PARUNGKOKOSAN 081585115668

01/07/1968 PARUNGKOKOSAN 081585115668
01/07/1961 PARUNGKOKOSAN 081646085417
01/07/1983 PARUNGKOKOSAN 085694522652
20/04/1976 PARUNGKOKOSAN 085782264551
09/08/1971 PARUNGKOKOSAN 081585115211
01/07/1957 PARUNGKOKOSAN 081510447641
01/07/1965 PARUNGKOKOSAN 081646085417
05/08/1999 PARUNGKOKOSAN 085694590497
02/12/1988 PARUNGKOKOSAN 081296557716
01/07/1991 PARUNGKOKOSAN 085810132502
27/11/1993 PARUNGKOKOSAN 085718724740
01/07/1975 PARUNGKOKOSAN 085710121735
09/06/1978 PARUNGKOKOSAN 085773227534
02/04/1997 PARUNGKOKOSAN 083831176612
01/07/1971 PARUNGKOKOSAN 085777331996
01/07/1994 PARUNGKOKOSAN 085813586141
16/06/1983 PARUNGKOKOSAN 085710506544
07/05/1978 PARUNGKOKOSAN 081296557716
02/05/1979 PARUNGKOKOSAN 085282669442
08/11/1980 PARUNGKOKOSAN 085710121735
05/10/1988 PARUNGKOKOSAN 081646085417
07/03/1978 PARUNGKOKOSAN 085777789488
06/05/1950 PARUNGKOKOSAN 085216914135
07/06/1977 PARUNGKOKOSAN 085282669442
06/12/1984 PARUNGKOKOSAN 081585115668
18/02/1986 PARUNGKOKOSAN 085772832780
01/01/2001 PARUNGKOKOSAN 0815117863849
06/04/1975 PARUNGKOKOSAN 082312461122
01/07/1961 PARUNGKOKOSAN 082312461122
01/10/1965 PARUNGKOKOSAN 082312461122
02/09/1970 PARUNGKOKOSAN 085710515542
01/10/1975 PARUNGKOKOSAN 085216914135
01/02/1966 PARUNGKOKOSAN 085718259114
01/07/1955 PARUNGKOKOSAN 082312461122
02/04/1965 PARUNGKOKOSAN 085282669442
04/02/1990 PARUNGKOKOSAN 085216423419
08/01/2001 PARUNGKOKOSAN 081574748587
17/04/1977 PARUNGKOKOSAN 085714231164
03/09/1987 PARUNGKOKOSAN 081282806716
21/11/1959 PARUNGKOKOSAN 081585260172
06/07/1998 PARUNGKOKOSAN 085829102069
25/05/1976 PARUNGKOKOSAN 08568558156
05/07/1965 PARUNGKOKOSAN 081296557716
17/06/1973 PARUNGKOKOSAN 085216423419
31/08/1991 PARUNGKOKOSAN 085694145351
25/07/1975 PARUNGKOKOSAN 081517741756
08/07/1966 PARUNGKOKOSAN 085714231164
01/07/1970 PARUNGKOKOSAN 085282669442
03/04/1990 PARUNGKOKOSAN 081514466856
16/05/1978 PARUNGKOKOSAN 082139630205
02/01/1968 PARUNGKOKOSAN 085780867971
01/07/1963 PARUNGKOKOSAN 085839198183
07/04/1977 PARUNGKOKOSAN 085771919344
09/07/1975 PARUNGKOKOSAN 085810876839
05/10/1958 PARUNGKOKOSAN 082312461122
10/11/1988 PARUNGKOKOSAN 082312461122
01/08/1988 IBU HAMIL PARUNGKOKOSAN 08558660309
13/02/1992 PARUNGKOKOSAN 081646085417
18/03/1976 PARUNGKOKOSAN 085219421574
05/09/1996 PARUNGKOKOSAN 085880004573
02/02/1992 PARUNGKOKOSAN 082312461122
11/03/1978 PARUNGKOKOSAN 08577930395
14/03/1980 PARUNGKOKOSAN 085782673903
01/04/1969 PARUNGKOKOSAN 082312461122
02/06/1991 PARUNGKOKOSAN 087804048008
09/05/2006 PARUNGKOKOSAN 085695271691
01/01/2005 PARUNGKOKOSAN 085773486968
02/03/1960 PARUNGKOKOSAN 082312461122
06/10/1980 PARUNGKOKOSAN 085210948235
05/03/1958 PARUNGKOKOSAN 082312461122
04/06/1988 PARUNGKOKOSAN 081318024726
07/09/1991 PARUNGKOKOSAN 085810876781
13/05/1992 PARUNGKOKOSAN 081513223303
04/07/1969 PARUNGKOKOSAN 085774033503
05/07/1991 PARUNGKOKOSAN 085280200580
03/06/1977 PARUNGKOKOSAN 08779303951
05/02/1982 PARUNGKOKOSAN 085777823015
01/01/1984 PARUNGKOKOSAN 085695052812
15/06/1973 PARUNGKOKOSAN 085777823015
15/05/1959 PARUNGKOKOSAN 0838723606853
11/11/1985 PARUNGKOKOSAN 085216452538
04/09/1985 PARUNGKOKOSAN 085280200580
03/05/2002 PARUNGKOKOSAN 081382712748
07/08/2001 PARUNGKOKOSAN 081398233099
03/08/1979 PARUNGKOKOSAN 085891580722
01/07/1980 PARUNGKOKOSAN 0857194476938
01/06/1998 PARUNGKOKOSAN 081281037664
07/05/1951 PARUNGKOKOSAN 082312461122
01/07/1951 PARUNGKOKOSAN 082312461122
08/01/1988 PARUNGKOKOSAN 082312461122
07/04/1968 PARUNGKOKOSAN 081282769920
16/02/1990 PARUNGKOKOSAN 085773348068
25/05/2005 PARUNGKOKOSAN 085884397288
03/07/2005 PARUNGKOKOSAN 085714775794
20/05/1940 PARUNGKOKOSAN 081280313686
01/09/1988 PARUNGKOKOSAN 085773348068
20/04/1976 PARUNGKOKOSAN 08586943576
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal Tanggal
Merek
Non Screeni Pemberi Pemberi
Vaksin*** an No. Batch No seri an
Anggota ng
Vaksina Vaksina
si si
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CORONAVAC 18/11/21 08/09/21 202108151 18/11/21
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CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 18/11/21 202108171F EUA22057300143AI
CORONAVAC 18/11/21 11/10/21 202108171F 18/11/21
CORONAVAC 18/11/21 11/10/21 18/11/21
CORONAVAC 18/11/21 18/11/21 EUA22057300143AI
CORONAVAC 18/11/21 18/11/21
CORONAVAC 18/11/21 18/11/21
Dosis 2

No. KET
No Seri
Batch

202108171EUA220573
DOSIS 2
202108171EUA220573
DOSIS 2

202108171EUA220573
DOSIS 2
202108171EUA220573
DOSIS 2

202108171EUA220573
DOSIS 2
202108171EUA220573
DOSIS 2
202108171EUA220573
DOSIIS 2
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045508830006 RASMINAH P
2 3601040705820002 SETIAWAN L
3 3601044402900002 KOSIDAH P
4 360104423370001 WARSIH P
5 3601044503860006 TASINIH P
6 3601041002820001 KURDI L
7 3601044107660034 SANI P
8 3601044505600002 CARIWEN P
9 3601044107600039 SATI P
10 3601040107760005 TALFIAH P
11 3601040102260003 ACAM L
12 3601044305710002 SAMINAH P
13 3601040107630091 WASIM B CAPLIYAH L
14 3601040107700025 MISNA L
15 360104180380001 DARWIN L
16 3601040107890071 AHIM L
17 3601040107760005 TALIM L
18 3601041046003710001 RATINI P
19 3601041810900002 SUDARYO L
20 3601045204890005 SITI NURBAETI P
21 3601044802920007 SARI P
22 3601042107010005 RAHMAT L
23 36010477500076 DULGANI L
24 360104171170001 SANAIAH P
25 36010441010770007 SARTI DIANA P
26 3601040707740032 DARWAN L
27 3601046306550001 WASTEM P
28 3601047007760001 YANAH P
29 3601046711760002 ETI ROHAYATI P
30 3602214301850002 LILI P
31 360104010766068 SUDARSONO L
32 3601044807880001 KARINIH P
33 3601044203840001 SAWI P
34 3601044103690101 KASINAH P
35 3216076707740001 EMAH P
36 3602212311780001 SOLEMAN L
37 3601045503990004 TANIAH P
38 3601044105850006 WATI P
39 3601046003880002 IYUNG P
40 3601046504810007 CASIH P
41 3601040507780001 SANIM L
42 3601045808840005 SANIMAH P
43 360104407700070 SUNIROH P
44 3601044107760108 ARWITI P
45 3601040208030002 NURHOLIS P
46 3601044107890064 LISYANA P
47 3601040501900001 FAHRUROZI L
48 3601042711790003 INDRA L
49 3601041203820004 RALIS L
50 3601040606810001 EDI HERMAWAN L
51 3601040107880089 WARSO L
52 3601041408700003 SUKANDI L
53 3601046105030004 IDA LESTARI P
54 3601045711810001 SARTINI P
55 360104670870002 TARCI P
56 3601044705040003 KASITI P
57 3601044706950009 WARSINAH P
58 3601040107450016 CARMAN L
59 36010464097400001 CASMEN P
60 3601040107870056 SRI ASIH P
61 3172041109910003 HARIFFUDIN L
62 3601040904050001 RANI MULYANI P
63 3601046101040001 MELLY JULIANI P
64 360104112670001 DARNI P
65 3601042104930001 ENTIS SUTISNA P
66 3601045607030002 UNASIH P
67 3601046302960001 EVI FITRIANI P
68 360104107250090 SAMSUDIN L
69 3601040711810005 TARDI L
70 3601044107970064 TANISAH P
71 360104107730106 WARKIM L
72 3601044107700137 HJ. ASMANAH P
73 3673016504840006 THINI P
74 3601044107880057 SARTI P
75 363010307720001 RASPAN L
76 3601046710010001 KRISDAYANTI P
77 3602211004910003 H. NUHAMAD SAPRIYUDIN L
78 360104140570001 BAKRI ADI L
79 3601040406950004 AGUS L
80 3601044107800108 UTING L
81 3601040104520046 DULJALIL L
82 3601046205050001 RESTI R P
83 3601045405000003 SALINAH P
84 360104010760071 SUKENDI L
85 360104070180005 MUDA L
86 3601042705950003 SUPANDI L
87 3601044107990002 HERTI P
88 3601044806870002 UTARI P
89 3601044107510006 RAWI P
90 3601044608040001 HODIJAH P
91 3601044506710003 DASMI P
 92 3601041502710003 SAHRANA L
93 3601040107700069 WASMIN L
94 3601045012780003 SANAH P
95 3601044107420001 MURSAH P
96 360305480580001 ROSYANTI P
97 3601046910040003 SITI ROHMAH P
98 3601045109600001 SITI ROSIDAH P
99 3602016204800001 RUNASIH P
100 3601040107650047 KASDINAH P
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

15-08-1983 UMUM RANCASENENG

15-05-1984 UMUM RANCASENENG
04-02-1990 UMUM RANCASENENG
02-03-1937 UMUM RANCASENENG
05-03-1986 UMUM RANCASENENG
16-05-1984 UMUM RANCASENENG
01-08-1966 UMUM RANCASENENG
05-05-1960 LANSIA RANCASENENG
28-07-1970 UMUM RANCASENENG
11-11-1978 UMUM RANCASENENG
06-05-1978 UMUM RANCASENENG
03-05-1971 UMUM RANCASENENG
15-06-1968 UMUM RANCASENENG
03-05-1973 UMUM RANCASENENG
18-03-1980 UMUM RANCASENENG
08-07-1988 UMUM RANCASENENG
10-10-1980 UMUM RANCASENENG
20-03-1971 UMUM RANCASENENG
18-10-1990 UMUM RANCASENENG
12-04-1989 UMUM RANCASENENG
08-02-1992 UMUM RANCASENENG
21-07-2001 UMUM RANCASENENG
25-10-1972 UMUM RANCASENENG
07-05-1978 UMUM RANCASENENG
01-01-2007 REMAJA RANCASENENG
11-03-1968 UMUM RANCASENENG
23-06-1955 LANSIA RANCASENENG
30-07-1976 UMUM RANCASENENG
27-11-1976 UMUM RANCASENENG
03-01-1985 UMUM RANCASENENG
08-06-1966 UMUM RANCASENENG
08-07-1988 UMUM RANCASENENG
05-12-1983 UMUM RANCASENENG
01-07-1969 UMUM RANCASENENG
27-07-1978 UMUM RANCASENENG
23-11-1978 UMUM RANCASENENG
15-03-1999 UMUM RANCASENENG
01-05-1985 UMUM RANCASENENG
20-03-1988 UMUM RANCASENENG
07-09-1981 UMUM RANCASENENG
06-09-1979 UMUM RANCASENENG
18-08-1984 UMUM RANCASENENG
17-04-1973 UMUM RANCASENENG
01-07-1976 UMUM RANCASENENG
02-08-2003 REMAJA RANCASENENG
17-07-1989 UMUM RANCASENENG
05-01-1989 UMUM RANCASENENG
27-11-1979 UMUM RANCASENENG
12-03-1982 UMUM RANCASENENG
06-06-1981 UMUM RANCASENENG
24-01-1986 UMUM RANCASENENG
14-08-1970 UMUM RANCASENENG
20-09-2003 UMUM RANCASENENG
17-11-1981 UMUM RANCASENENG
277-06-1978 UMUM RANCASENENG
27-05-2002 UMUM RANCASENENG
07-06-1995 UMUM RANCASENENG
01-07-1945 LANSIA RANCASENENG
24-09-1974 UMUM RANCASENENG
14-05-1987 UMUM RANCASENENG
11-09-1991 UMUM RANCASENENG
01-05-2004 REMAJA RANCASENENG
21-01-2004 REMAJA RANCASENENG
23-04-1960 LANSIA RANCASENENG
21-04-1993 UMUM RANCASENENG
16-07-2003 REMAJA RANCASENENG
23-02-1996 UMUM RANCASENENG
01-07-1975 UMUM RANCASENENG
07-11-1981 UMUM RANCASENENG
11-02-1996 UMUM RANCASENENG
01-07-1965 UMUM RANCASENENG
20-11-1969 UMUM RANCASENENG
25-04-1984 UMUM RANCASENENG
28-04-1984 UMUM RANCASENENG
03-07-1982 UMUM RANCASENENG
30-09-2001 UMUM RANCASENENG
10-04-1991 UMUM RANCASENENG
19-03-1974 UMUM RANCASENENG
18-08-1995 UMUM RANCASENENG
01-07-1980 UMUM RANCASENENG
01-07-1952 UMUM RANCASENENG
22-02-2005 REMAJA RANCASENENG
14-05-2000 UMUM RANCASENENG
06-09-1972 UMUM RANCASENENG
07-01-1980 UMUM RANCASENENG
27-05-1995 UMUM RANCASENENG
26-04-1997 UMUM RANCASENENG
08-06-1987 UMUM RANCASENENG
12-12-1954 LANSIA RANCASENENG
06-08-2004 REMAJA RANCASENENG
05-06-1971 UMUM RANCASENENG
15-02-1971 UMUM RANCASENENG
01-07-1970 UMUM RANCASENENG
10-12-1978 UMUM RANCASENENG
01-07-1942 LANSIA RANCASENENG
08-05-1981 UMUM RANCASENENG
29-10-2004 REMAJA RANCASENENG
11-09-1960 LANSIA RANCASENENG
22-04-19980 UMUM RANCASENENG
05-09-1966 UMUM RANCASENENG
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Tanggal
NO HP BPJS BPJS Non Merek Vaksin***
Screening
PBI Non PBI Anggota
085219655886 CORONAVAC 19-11-2021
085880846155 CORONAVAC 19-11-2021
085880846155 CORONAVAC 19-11-2021
085782266230 CORONAVAC 19-11-2021
085773756231 CORONAVAC 19-11-2021
085773756231 CORONAVAC 19-11-2021
085774802590 CORONAVAC 30-09-2021
08121329519 CORONAVAC 19-11-2021
085778520221 CORONAVAC 19-11-2021
085693994322 CORONAVAC 19-11-2021
085693994322 CORONAVAC 19-11-2021
085782265984 CORONAVAC 19-11-2021
085219655886 CORONAVAC 19-11-2021
085283862115 CORONAVAC 19-11-2021
085283862115 CORONAVAC 19-11-2021
085311380104 CORONAVAC 19-11-2021
085311380104 CORONAVAC 19-11-2021
085710515902 CORONAVAC 19-11-2021
085710515902 CORONAVAC 19-11-2021
085894826665 CORONAVAC 19-11-2021
085894826665 CORONAVAC 19-11-2021
085894826665 CORONAVAC 20-09-2021
085718886678 CORONAVAC 19-11-2021
085718886678 CORONAVAC 19-11-2021
081398803972 CORONAVAC 19-11-2021
081398803972 CORONAVAC 19-11-2021
08588411031 CORONAVAC 05-07-2021
085889411031 CORONAVAC 05-07-2021
085889411031 CORONAVAC 23-09-2021
085624601909 CORONAVAC 19-11-2021
085624601909 CORONAVAC 19-11-2021
085624601909 CORONAVAC 19-11-2021
085624601909 CORONAVAC 19-11-2021
085624601909 CORONAVAC 19-11-2021
085211499941 CORONAVAC 19-11-2021
085624601909 CORONAVAC 19-11-2021
085891152267 CORONAVAC 19-11-2021
085891152267 CORONAVAC 19-11-2021
085891152267 CORONAVAC 19-11-2021
085891152267 CORONAVAC 19-11-2021
085715264480 CORONAVAC 11-10-2021
081296010260 CORONAVAC 19-11-2021
085774802590 CORONAVAC 30-09-2021
085773757862 CORONAVAC 14-10-2021
0895703192008 CORONAVAC 19-11-2021
0895703192008 CORONAVAC 02-09-2021
0895703192008 CORONAVAC 30-09-2021
0895703192008 CORONAVAC 30-09-2021
087887539000 CORONAVAC 19-11-2021
087887539000 CORONAVAC 19-11-2021
085282338975 CORONAVAC 02-09-2021
083812324104 CORONAVAC 19-11-2021
083812324104 CORONAVAC 19-11-2021
087887539000 CORONAVAC 19-11-2021
087887539000 CORONAVAC 19-11-2021
085694946170 CORONAVAC 19-11-2021
085715268486 CORONAVAC 19-11-2021
085715268486 CORONAVAC 19-11-2021
085715268486 CORONAVAC 15-07-2021
085210703736 CORONAVAC 19-11-2021
085210703736 CORONAVAC 19-11-2021
085210703736 CORONAVAC 19-11-2021
0858861413965 CORONAVAC 30-09-2021
081511407886 CORONAVAC 19-11-2021
081511407886 CORONAVAC 19-11-2021
085714772496 CORONAVAC 20-09-2021
081283773291 CORONAVAC 19-11-2021
081283773291 CORONAVAC 19-11-2021
081283773291 CORONAVAC 19-11-2021
085210132764 CORONAVAC 19-11-2021
085210132764 CORONAVAC 19-11-2021
085210132764 CORONAVAC 19-11-2021
085210132764 CORONAVAC 19-11-2021
085210132764 CORONAVAC 19-11-2021
085215439674 CORONAVAC 19-11-2021
085215439674 CORONAVAC 19-11-2021
085215439674 CORONAVAC 19-11-2021
085215439674 CORONAVAC 29-06-2021
085219673042 CORONAVAC 19-11-2021
085219673042 CORONAVAC 19-11-2021
085695274238 CORONAVAC 19-11-2021
085695274238 CORONAVAC 19-11-2021
085695274238 CORONAVAC 19-11-2021
085213478251 CORONAVAC 19-11-2021
085213478251 CORONAVAC 19-11-2021
085779985914 CORONAVAC 30-09-2021
085810876764 CORONAVAC 14-10-2021
085810876764 CORONAVAC 19-11-2021
085810876764 CORONAVAC 19-11-2021
085810876764 CORONAVAC 19-11-2021
085810876764 CORONAVAC 19-11-2021
087772900071 CORONAVAC 19-11-2021
087772900071 CORONAVAC 19-11-2021
087772900071 CORONAVAC 19-11-2021
087772900071 CORONAVAC 19-11-2021
087772900071 CORONAVAC 19-11-2021
085695601229 CORONAVAC 19-11-2021
085695337642 CORONAVAC 19-11-2021
085695337642 CORONAVAC 19-11-2021
085695337642 CORONAVAC 19-11-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
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CORONAVAC
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CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
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CORONAVAC
CORONAVAC
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 Dosis I Dosis 2
Tanggal Tanggal KET
No.
Pemberian No. Batch No seri Pemberian No Seri
Batch
Vaksinasi Vaksinasi
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
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19-11-2021 24005021
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19-11-2021 24005021
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19-11-2021 24005021
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19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
 19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
19-11-2021 24005021
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601041107770001 SARTU L
2 3601044804750002 TARISEM P
3 3601041401680002 EMED L
4 3601042103710001 APAN L
5 3601044801820002 AMINAH P
6 3601040107680177 TARMAN L
7 360104107870138 IKA RAHMATIKA P
8 3601045211730001 NARSANAH P
9 3601046510550001 SARTI P
10 3601041007750001 NARTA L
11 3601040603880002 KASRA L
12 3601044107870172 SANIAH P
13 3601040107880151 SAKUR L
14 3601041208700002 ABUN L
15 3601041712650001 CARTIWAN P
16 3601040904700001 TARDI L
17 3601040607950005 SUIDIT L
18 3601041504910002 ASDI L
19 3601046209930003 ASIH P
20 3601044102880001 DETI P
21 3601046006830002 SOPIAH P
22 3601044212070002 NITA ABABIL P
23 3601046307960006 NUNUNG NURHAYATI P
24 3601041505830005 RENDI L
25 3601045902010001 SITI DAMINIH P
26 3601041206720003 SARNEN L
27 36010451509630004 ABDUL HAMID L
28 360104680390002 KOKOM KOMARIAH P
29 3601044808970001 DEDE JULFAH P
30 3601044701030006 MARYAM P
31 3601040205990002 DIAN H P
32 3601040107660189 SAMID L
33 3601041710940007 NURHASAN L
34 3601040107450040 ENI P
35 3601046510830002 ROIDAH P
36 3601042211940003 RISMAN L
37 3601044204820006 EMI UMINI P
38 3601040107550112 JAMIR L
39 360104216502040001 SUHETI P
40 3202391704700002 YADI SUNARYA L
41 3602214507075001 NIA P
42 3602210102840005 SUNTANA L
43 3601040502930005 AMSIR L
44 3601040205740001 CARYA L
45 3601046507870002 SITI HERIAH P
46 36010441010015 AMI LARAS AYU P
47 3601046306020001 ROSPITA P
48 3601044107000275 ROSINAH P
49 3601044402010004 EPAH P
50 3601045112790001 RASIH P
51 3601044107602000 SUHENAH P
52 3601044912790001 SITI URIAN P
53 3601041001820004 WARTAKA L
54 360104410780043 SAMAAH P
55 3601040611540001 ANISAN P
56 3601046807770001 RASIH P
57 3601044107940128 SITI JUHARIAH P
58 3601040408990007 MUSTOPA L
59 36010441079001399 ENENG P
60 3601044107730206 WASREM P
61 3602210798800001 RAHMAT L
62 3601040108770003 SUPARMAN L
63 3601040608860001 YOPI YUDIN L
64 3601044403980006 KASTI P
65 3601041711610001 SANIAH P
66 3601040107760014 WARSAD L
67 3601046807800003 HATI P
68 3213151610970007 DEDE SUHENDRA L
69 3601040107890176 SUPANDI L
70 3601041205670008 MADHARI L
71 3601040201730003 M. HANDANI L
72 3601040107990208 ENDANG L
73 3601046006030007 IKA DIALESTARI P
74 3601040107760119 TARMIN L
75 3601044107850321 TRIYATI P
76 3601045507740002 NURHAYATI P
77 3601044408910001 ARPAH P
78 3601045008990008 SANAH P
79 3601040410040001 SUHENDI L
80 3601044912960001 IRA ROHMAWATI P
81 3601040612640001 SUPRIYANTO L
82 3601045309000006 RANTI P
83 3601040102930009 ROSIM L
84 360104606950001 MELANI P
85 3603125707840009 JULINAH P
86 3601041107700005 DASA L
87 3601041009840002 RIYANDI L
88 3603121107800012 HIDAYAT L
89 3601040710810003 CASYA L
90 3601046106790002 IING P
 91 3601044104950017 MIARSIH P
92 360103050590001 JANA L
93 3601043008800001 ELY L
94 3601042403020006 NURJA L
95 3601040903010002 NURYADI L
96 3601041412010001 EKA L
97 3601046409020002 SUYANTO L
98 360104270880009 JUANDA L
99 3601041003610001 RASID L
100 3601041810690001 CATU L
101 3601045507750006 SAMIAH P
102 3601044106860006 ATIYAH P
103 3601046002930002 UNASIH P
104 3601042311990001 SUMARNA L
105 3601041207590001 DIDI W L
106 3601040207550001 DLAMER L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur sesuai)
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI

11-07-1979 UMUM CIKEUSIK 085282259060

08-04-1975 UMUM CIKEUSIK 085717563867
01-04-1968 UMUM SUKASENENG 085810133811
21-03-1971 UMUM CIKEUSIK 083841438904
08-01-1982 UMUM CIKEUSIK 083871333716
01-07-1968 UMUM CIKEUSIK 083871333716
10-12-1989 UMUM SUKASENENG 083871333716
12-11-1973 UMUM CIKEUSIK 081906158207
25-10-1955 LANSIA CIKEUSIK 083872512080
10-07-1975 UMUM SUKASENENG 083872512080
05-07-1986 UMUM CIKEUSIK 085714379677
01-07-1987 UMUM CIKEUSIK 08569267400
01-07-1988 UMUM NANGGALA 085694608948
12-08-1970 UMUM SUKASENENG 085694608948
17-12-1970 UMUM CIKEUSIK 085694608948
09-04-1970 UMUM CIKEUSIK 085694608948
06-07-1995 UMUM SUKASENENG 085692654753
16-04-1991 UMUM CIKEUSIK 081296010203
22-09-1993 UMUM CIKEUSIK 081296010203
01-02-1988 UMUM CIKEUSIK 085782266734
20-06-1983 UMUM CIKEUSIK 085782266734
02-12-2007 REMAJA CIKEUSIK 085282259060
23-07-1996 UMUM SUKASENENG 085894004157
15-05-1963 UMUM CIKEUSIK 085894004157
20-12-2001 UMUM CIKEUSIK 085894004157
11-05-1973 UMUM CIKEUSIK 085770621174
15-09-1963 UMUM CIKEUSIK 085770621174
28-03-1996 UMUM CIKEUSIK 085219602263
09-08-1997 UMUM CIWET 085219602263
07-01-2003 REMAJA CIKEUSIK 085717563867
20-07-2000 UMUM CIKEUSIK 085591308916
01-07-1977 UMUM CIKEUSIK 085214056061
17-10-1994 UMUM RANCASENNEG 085214056061
01-07-1945 LANSIA CIKEUSIK 087808227728
25-10-1983 UMUM CIKEUSIK 087808227728
22-11-1994 UMUM CIKEUSIK 082324150289
02-04-1982 UMUM RANCASENNEG 081818246041
01-07-1955 LANSIA CIKEUSIK 0826710306973
25-02-2004 REMAJA PARUNGSARI 0826710306973
17-04-1970 UMUM SUKABUMI 082130051699
08-07-2005 REMAJA PARUNGSARI 082130051699
03-04-2003 REMAJA WANASALAM 082130051699
05-02-1993 UMUM CIKEUSIK 085813586058
02-05-1974 UMUM CIKEUSIK 085813586058
25-07-1987 UMUM CIKEUSIK 085813586058
01-01-2001 UMUM CIKEUSIK 085810057945
03-06-2002 UMUM CIKEUSIK 085810057945
16-04-2000 UMUM CIKEUSIK 085216922138
04-02-2001 UMUM CILEGON 085216922138
11-12-1987 UMUM CIKEUSIK 085214931828
01-07-1963 UMUM CIKEUSIK 085214931828
09-12-1979 UMUM CIKEUSIK 085214931828
01-10-1982 UMUM CIKEUSIK 085214931828
01-07-1980 UMUM RANCASENNEG 085214931828
06-11-1954 LANSIA CIKEUSIK 085214931828
28-07-1977 UMUM CIKEUSIK 081413316393
04-12-1995 UMUM CIKEUSIK 081413316393
04-08-1999 UMUM SUKASENENG 085215814184
07-07-1990 UMUM CIKEUSIK 085215814184
01-07-1973 UMUM CIKEUSIK 085215814184
07-09-1988 UMUM SUKASENENG 085215814184
09-08-1977 UMUM RANCASENNEG 085215814184
06-08-1986 UMUM CIKEUSIK 085215814184
04-03-1996 UMUM CIKEUSIK 085215814184
17-11-1961 UMUM CIKEUSIK 085215814184
01-07-1976 UMUM SUMURBATU 085714215370
28-07-1980 UMUM CIKEUSIK 085714215370
01-11-1999 UMUM KIARASARI 085714215370
01-07-1989 UMUM UMBULAN 085714215370
12-05-1967 UMUM SUMURBATU 085714215370
08-08-1974 UMUM CIKEUSIK 085714215370
05-06-1998 UMUM UMBULAN 085779061598
20-06-2003 UMUM SUKASENENG 085779061598
01-07-1976 UMUM CIKEUSIK 085779061598
01-07-1985 UMUM SUKASENENG 085779061598
15-07-1974 UMUM CIKEUSIK 085779061598
04-08-1991 UMUM CIKEUSIK 085695409667
10-08-1999 UMUM CIKEUSIK 085695409667
11-04-2003 REMAJA CIKEUSIK 085695409667
09-12-1996 UMUM NANGGALA 085695409667
16-12-1963 UMUM CIKEUSIK 085695409667
13-09-2000 UMUM NANGGALA 085695409667
19-09-1996 UMUM CIKDONG 085695409667
14-05-1996 UMUM CIKDONG 085695409667
17-07-1984 UMUM CIKEUSIK 085695409667
11-07-1970 UMUM CIKEUSIK 085695409667
26-05-1987 UMUM CIKEUSIK 085695409667
11-07-1980 UMUM CIKEUSIK 085695409667
07-10-1981 UMUM CIKEUSIK 085771731816
21-06-1979 UMUM TANJUNGAN 085771731816
01-04-1995 UMUM TANJUNGAN 085771731816
23-04-1990 UMUM CIKEUSIK 085771731816
30-08-1988 UMUM CIKEUSIK 085771731816
24-03-2002 UMUM CIKEUSIK 085773219001
01-01-2001 UMUM UMBULAN 085773219001
04-02-2002 UMUM UMBULAN 085773219001
24-09-2002 UMUM UMBULAN 085773219001
27-08-1980 UMUM RANCASENNEG 085773219001
10-03-1961 UMUM CIKEUSIK 085773219001
03-11-1959 LANSIA CIKEUSIK 085773219001
15-07-1975 UMUM CIKEUSIK 085773219001
01-06-1986 UMUM CIKEUSIK 082311533966
20-02-1993 UMUM CIKEUSIK 082311533966
23-06-1999 UMUM SUKASENENG 082311533966
25-12-1959 LANSIA CIKEUSIK 082311533966
01-08-1961 UMUM CIKEUSIK 082311533966
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai) Tanggal
Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian Pemberia
No. Batch No seri
Anggota n
Vaksinasi
Vaksinasi
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 18-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 23-09-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 23-09-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021 22-11-202 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 13-09-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 28-10-2021 22-11-2021
CORONAVAC 11-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-10-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 21-12-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 25-03-2021 22-11-2021
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC 22-11-2021 22-11-2021 202108146H
CORONAVAC
CORONAVAC 13-10-2021 22-11-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 24-10-2021 22-11-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
Dosis 2

KET
No. Batch No Seri

20210814614

20210814614

20210814614
20210814614

202108146H

202108146H

202108146H

202108146H
202108146H
202108146H

202108146H

202108146H
202108146H
202108146H

202108146H

202108146H
202108146H
202108146H

202108146H

202108146H
202108146H

202108146H
NO No. Ticket NIK Nama Penerima Vaksin

1 3601044107930296 YANTI
2 3601042202870001 ASEP
3 3601042406500001 TARMEDI
4 3601041102900005 CASNO
5 3601040107550103 PULUNG
6 3601044107950207 CUCU SULASTRI
7 3601044107800238 SARMI
8 3601040602770002 DAHURI
9 3601045403890007 JAMAH
10 3601044408780003 UMAENAH
11 3601040409820002 UDIN
12 3601044107740110 INAH
13 3601044108950006 ASNAH NARISAH
14 3601046903960001 URPAH
15 3601041306000003 HERI HERYANTO
16 3601041707010004 RASTA
17 3601045109830004 SUSI
18 3601041006760001 HADIM
19 3601055110480001 NURTIAH
20 3601040611990005 RUMAN
21 3601041103060001 M PERDIANSYAH
22 3601044804970007 SITI ANDEWI
23 3601044301570001 WASTI BT KUSEN
24 3601040107500074 CARBA
25 3601045204000006 JAAH
26 3601041901800001 ENUNG
27 3601044611820002 SUTINI SETIAWATI
28 3601044107570062 SATURI
29 3601045607860003 UUM UMYATI
30 3601045610540001 SARWI
31 3601040107620082 KAMSARI
32 3601046503970002 JUMANAH
33 3601046411840003 ELA BUDIYANTI
34 3601040403720002 RASMINI
35 3601045002600002 ADE
36 3601040107740110 SUDIN
37 3601045103790001 YATI
38 3601041102780005 TAMAL
39 3601042404040002 APIT PIRMANSYAH
40 3601040808850001 DARPAN
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

P 01/07/1994 UMBULAN 081514562763

L 22/02/1987 UMBULAN 085317136603
L 24/06/1950 UMBULAN 085281722283
L 11/07/1992 UMBULAN 085214152619
L 01/07/1955 UMBULAN 085216331713
P 05/06/1995 UMBULAN 085694726404
P 01/07/1980 UMBULAN 085216331713
L 06/02/1987 UMBULAN 085216331713
P 14/03/1989 UMBULAN 085216331713
P 01/11/1976 UMBULAN 083892744231
L 12/02/1979 UMBULAN 085375574313
P 01/07/1974 UMBULAN 085779570718
P 28/08/4139 UMBULAN 085886414139
P 14/12/1997 UMBULAN 082311646240
L 14/10/2000 UMBULAN 085710525668
L 17/07/2001 UMBULAN 085778520248
P 11/09/1983 UMBULAN 083893641432
L 10/04/1979 UMBULAN 087772712872
P 15/04/1991 UMBULAN 081311188439
P 02/03/1996 UMBULAN 085691437579
L 25/02/2005 UMBULAN 085813892317
P 08/04/1997 UMBULAN 085894698950
P 03/01/1957 UMBULAN 085894698950
L 01/01/1950 UMBULAN 085282258721
P 12/04/2000 UMBULAN 085280546102
P 19/01/1958 UMBULAN 081280219143
P 06/11/1982 UMBULAN 085882443277
P 11/07/1957 UMBULAN 085882443277
P 16/07/1986 UMBULAN 081574901779
P 16/10/1954 UMBULAN 085882443277
L 12/04/1963 UMBULAN 085214054861
P 18/04/1997 UMBULAN 085214887601
P 24/11/1984 UMBULAN 085782989641
P 04/03/1972 UMBULAN 081286951876
P 10/02/1960 UMBULAN 085887771330
L 01/07/1974 UMBULAN 085211667757
P 21/03/1979 UMBULAN 081994118157
L 11/02/1978 UMBULAN 081994118157
L 24/04/2003 UMBULAN 085319298908
L 8/8/1986 UMBULAN 085718763868
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
PBI Non PBI Anggota
Vaksinasi

CORONAVAC 22/11/21 22/11/21 2021081641

CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 05/07/21 24003921
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 30/08/21 24200121
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 22/11/21 22/11/21 2021081641
CORONAVAC 11/21/2022 11/21/2022 2021081641
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601045605790000 NENENG BADRIAH P

2 3601044607860001 MARFU'AH P
3 3601040709800008 SAEPUDIN L
4 3601046807760004 DARWINAH P
5 3601045504990003 ANA APRIYANA P
6 3601046008060003 SALMI P
7 3601044101000003 AWALIA DINDA M P
8 3671024811080002 AMELLIA AGUSTIN P
9 3601040209060001 FIDHEL AVICHIENA H L
10 3601046602090003 VIKA MAULIDA P
11 3601044607530000 SUKMI P
12 3601046111900002 MARLINA P
13 3601041108580001 RODIN L
14 3601044311060001 ANDI KHAIRAL AFRIGH L
15 3601046005680001 SACI P
16 3601045203990004 YOPA SOPIYANTI P
17 3601041207780001 EDI SUPRIYADI L
18 3601044407880006 SUHALIAH P
19 3601046712100005 ITAH P
20 3601040107830337 ARDI L
21 3601041604050001 ANGGA PIRMANSYAH L
22 3601042512950001 NANANG MULYADI L
23 3601044701080004 RISMA NURHAYATI P
24 3601041908660002 MARCEL L
25 3601046207720001 JARSINAH P
26 3601042507070001 RANGGA SAPUTRA L
27 3601040807820003 H.MASYHURI L
28 3601044909090002 NURMALA SARI P
29 3601044411090004 NURHAYATI P
30 3601044511080003 PUSPITA PUSPASARI P
31 3601045012090003 NILAM P
32 3601046404630001 IPUR P
33 3601042602080006 IRNA AZ-ZAHRA P
34 3601045309090002 INDAH PUSPITASARI P
35 3601041912060001 HASBI YALLOH L
36 3601044107850375 SUHENI P
37 3601044312040001 RINI YULIANI P
38 3601040401060004 YOGI PEBRIAN L
39 3601046504620002 SARIAH P
40 3602215003040001 NENTI HARYATI P
41 3601045505780002 AMINAH P
42 3601045710150001 DIYAH P
43 3602016805950002 ERIS SRI MERITA P
44 3601041506080003 AWANG L
45 3601041010090001 DAFA RIFAI AWALUDIN L
46 3601045410940004 ANIS SULASTRI P
47 3601046110980001 FITRI PIDYA YANTI P
48 3601045504050001 APRILIA P
49 3601045608060004 LINDA AGUSTIN P
50 3601042610130001 SITI ALMINAH SARI P
51 3601046198070001 IIN SULASTRI P
52 3601047107050002 ALIA CAHYANI P
53 3601045606050002 JUNITA P
54 3601044310860005 SRI NURHAYATI P
55 3602215205060009 PUTRI AYU NURFATWA P
56 3601040810040002 JASRIP L
57 3601044101060006 NAIMA DWI SUZANA P
58 3602214901050007 HENTI FAUZIAH P
59 3601041908820006 ROHAYATI P
60 3601044505060002 DIANA MEI SAFITRI P
61 3601046108080003 FILA SASMITHA P
62 3602216803050001 SUANAH P
63 3601044406650001 ECIH P
64 3601046601950001 KAROMAH P
65 3602215306110001 SITI MAESAROH P
66 3601044609070001 CINTA P
67 3601044110970010 SUMINAR P
68 3601042503050001 OPIK GINANJAR L
69 3602217003060003 SITI DIJAH P
70 3601044511030005 NANDA SAFITRI P
71 3601041811070003 REJA PRATAMA MAUDI L
72 360104201283002 HERI P
73 3601045205050002 AMAH P
74 3601047007090002 SUHE SUSANTI P
75 3601042703090004 CINTA QALLIZA SUHENDRIP
76 3601045809820004 TINI SUHETI P
77 3601045912090001 HILAH NURWAHIDAH P
78 3601045006070001 IIN INAYAH P
79 3601046910060002 CHELSEA P
80 3601044302090002 DINATUL HANIFAH P
81 3601041303160001 MELDA AMELIA P
82 3601046308090001 RUSYDA HANIFA RAMADH P
83 3601045109070003 ULAN RAMAHDANI P
84 3601046611080003 SITI SOPIAH P
85 3601041002030003 RONI L
86 3601045806080004 IRYANI RATNA P
87 3601046807080005 PUSPA AYU A P
88 3601045011970001 IIN INAYAH P
89 3601045904970002 SUSI P
90 3601045402070006 DITA GIPANI P
91 3601040510780001 SARTANA L
 92 3601044912060001 PUTRI YANI P
93 3601040911010002 SUPYADI L
94 3601041604830001 ASEP SAEPUDIN L
95 3601041704040001 TIRTA WIGUNA L
96 3601043007050001 REKSO BUONO L
97 36010402070030010 YANDI L
98 3601042208100001 M HIDAYATUL R L
99 1804171112080002 AHMAD SHOLEH L
100 3601045312080001 WINDIYAWULAN P
101 3601041808800002 ABDUL KARIM L
102 3601045008090001 TITIN MARYATI P
103 3601046406070005 MAYA AGUSTINA P
104 3601045009070001 RESTI P
105 3601046604090002 ELSA APRILIA S P
106 3601041002030003 RONI L
107 3601041608080001 HANDIKA RAYA L
108 3601044707070010 INTAN P
109 3601040307080001 M AGIL DAEROBI L
110 3601044107590049 ETI P
111 3601041002050001 RADI L
112 3601020402080001 NADI SAPUTRA L
113 3602014506880005 JAHROTUL UBAIDAH P
114 LISAH SILVIA P
115 3601042509080003 BILAL HILLABI L
116 3601045712090001 SERA KUSNIAWAN P P
117 3601044606070004 SITI KOMARIAH P
118 3601041308090001 HERU CHAERU P L
119 3601040503550001 DULHALIM L
120 3601042003060001 PAUD HAKIKI L
121 3601042603070001 RONI SAHRONI L
122 3601042702040002 ROMI FADILAH L
123 3601042701060001 ANWAR L
124 3674062806080014 DIMAS TUBAUS L
125 3601045004860006 IPAH MASTUPAH P
126 3601040107960038 DAUD FIRDAUS L
127 3601046301900001 NISA SORAYA P
128 3602211905080001 ANDRI SAPUTRA L
129 3601040810060002 MUHAMAD RAMDAN L
130 3601041603790001 MASTONO L
131 3601041006080003 MUHAMAD FAHRUIL L
132 3601042703070003 AGUNG RAHMAT L
133 3601040107910031 BAHTIAR RIFA'I L
134 3601040603810003 UJANG SAEPULLAH L
135 3601040107890031 RAPI L
136 3601042504770003 ARIF HAKIM L
137 3601040201060006 M.ACEP SUTIANA L
138 3602010812070001 RAYHAN RADITIA NUGRAHL
139 3601042712820001 IWANA BIN AJAT L
140 3601040212080002 MOH.WIGUNA DIMYATI L
141 3601040812830002 SATRIA L
142 3601041412080003 SANDI SUHENDAR L
143 3601042703070001 IVAN ANDI FADILAH L
144 3601042406070002 M.PERDI PIRMANSYAH L
145 3601042305080001 DEDE ARIF RIFAI L
146 3601042705070003 MUHAMAD LOMRI L
147 3601041811030002 AGO L
148 3601040106070003 EKI GUNAWAN L
149 3601040406050005 M.YUSUF AWALUDIN L
 Umur Kelomp
Pekerjaan* INSTANSI
(18-59 tahun) ok Umur

GURU 5/16/1979 MTS HUNIBERA

GURU 2/9/1979 MTS HUNIBERA
MASY UMUM 10/2/1980
MASY UMUM 7/28/1976
MASY UMUM 4/15/1999
REMAJA 8/20/2006 MTS HUNIBERA
REMAJA 1/1/2009 MTS HUNIBERA
REMAJA 11/8/2008 MTS HUNIBERA
REMAJA 9/2/2006 MTS HUNIBERA
REMAJA 2/26/2009 MTS HUNIBERA
LANSIA 7/6/1953
MASY UMUM 11/21/1990
LANSIA 8/11/1958
REMAJA 11/3/2006 MTS HUNIBERA
MASY UMUM 5/20/1968 MTS HUNIBERA
MASY UMUM 3/12/1999 MTS HUNIBERA
MASY UMUM 11/15/1978 MTS HUNIBERA
MASY UMUM 7/4/1988 MTS HUNIBERA
REMAJA 12/27/2010 MTS HUNIBERA
MASY UMUM 7/1/1983 MTS HUNIBERA
REMAJA 4/16/2005 MTS HUNIBERA
MASY UMUM 12/25/1995 MTS HUNIBERA
REMAJA 007-01-2006 MTS HUNIBERA
REMAJA 8/19/2006 MTS HUNIBERA
MASY UMUM 8/17/1971 MTS HUNIBERA
REMAJA 7/25/2007 MTS HUNIBERA
MASY UMUM 7/8/1982 MTS HUNIBERA
REMAJA 9/9/2009 MTS HUNIBERA
REMAJA 11/4/2009 MTS HUNIBERA
REMAJA 11/5/2008 MTS HUNIBERA
REMAJA 12/10/2009 MTS HUNIBERA
MASY UMUM 4/24/1963 MTS HUNIBERA
REMAJA 2/16/2008 MTS HUNIBERA
REMAJA 9/13/2009 MTS HUNIBERA
REMAJA 12/9/2006 MTS HUNIBERA
MASY UMUM 7/1/1985 MTS HUNIBERA
REMAJA 12/3/2004 MTS HUNIBERA
REMAJA 1/4/2006 MTS HUNIBERA
MASY UMUM 4/25/1962 MTS HUNIBERA
REMAJA 3/10/2004 MTS HUNIBERA
MASY UMUM 5/15/1978 MTS HUNIBERA
MASY UMUM 7/20/1995 MTS HUNIBERA
MASY UMUM 5/28/1995 MTS HUNIBERA
REMAJA 6/15/2008 MTS HUNIBERA
REMAJA 10/10/2009 MTS HUNIBERA
MASY UMUM 10/14/1994 MTS HUNIBERA
MASY UMUM 9/11/1998 MTS HUNIBERA
REMAJA 4/15/2005 MTS HUNIBERA
REMAJA 8/16/2006 MTS HUNIBERA
REMAJA 5/6/2006 MTS HUNIBERA
REMAJA 12/12/2007 MTS HUNIBERA
REMAJA 7/31/2005 MTS HUNIBERA
REMAJA 6/16/2005 MTS HUNIBERA
MASY UMUM 1/3/1983 MTS HUNIBERA
REMAJA 2/12/2006 MTS HUNIBERA
REMAJA 10/8/2004 MTS HUNIBERA
REMAJA 1/1/2006 MTS HUNIBERA
REMAJA 1/9/2005 MTS HUNIBERA
MASY UMUM 5/8/1985 MTS HUNIBERA
REMAJA 5/5/2006 MTS HUNIBERA
REMAJA 8/21/2008 MTS HUNIBERA
REMAJA 3/28/2005 MTS HUNIBERA
MASY UMUM 6/4/1965 MTS HUNIBERA
MASY UMUM 5/3/1995 MTS HUNIBERA
REMAJA 3/16/2005 MTS HUNIBERA
REMAJA 9/6/2007 MTS HUNIBERA
MASY UMUM 10/1/1997 MTS HUNIBERA
REMAJA 3/25/2005 MTS HUNIBERA
REMAJA 3/30/2006 MTS HUNIBERA
MASY UMUM 11/5/2003 MTS HUNIBERA
REMAJA 11/18/2007 MTS HUNIBERA
MASY UMUM 12/20/1983 MTS HUNIBERA
REMAJA 5/12/2005 MTS HUNIBERA
REMAJA 7/30/2009 MTS HUNIBERA
REMAJA 3/27/2009 MTS HUNIBERA
MASY UMUM 9/18/1982 MTS HUNIBERA
REMAJA 12/8/2008 MTS HUNIBERA
REMAJA 8/10/2007 MTS HUNIBERA
REMAJA 10/29/2006 MTS HUNIBERA
REMAJA 2/3/2009 MTS HUNIBERA
REMAJA 2/21/2009 MTS HUNIBERA
REMAJA 8/23/2009 MTS HUNIBERA
REMAJA 9/11/2007 MTS HUNIBERA
REMAJA 11/26/2003 MTS HUNIBERA
REMAJA 9/8/2005 MTS HUNIBERA
REMAJA 6/18/2008 MTS HUNIBERA
REMAJA 7/28/2008 MTS HUNIBERA
MASY UMUM 11/10/1997
MASY UMUM 8/14/1997
REMAJA 2/14/2007 MTS HUNIBERA
MASY UMUM 10/5/1982
REMAJA 12/9/2006
MASY UMUM 4/27/2000
MASY UMUM 12/11/1983
REMAJA 4/17/2004
REMAJA 7/30/2005
REMAJA 7/2/2003
REMAJA 8/22/2010
REMAJA 12/11/2008
REMAJA 12/13/2008
MASY UMUM 6/12/1978
REMAJA 8/10/2009
REMAJA 6/24/2007
REMAJA 9/10/2007
REMAJA 4/26/2009
REMAJA 9/8/2005
REMAJA 8/18/2008
REMAJA 7/7/2010
REMAJA 7/3/2008
LANSIA 7/1/1959
REMAJA 4/21/2004
REMAJA 2/4/2008
MASY UMUM 6/5/1988
REMAJA 12/10/2005
REMAJA 10/25/2008
REMAJA 12/17/2009
REMAJA 6/6/2007
REMAJA 8/13/2009
MASY UMUM 3/10/1965
REMAJA 3/20/2003
REMAJA 3/26/2007
REMAJA 2/27/2004
REMAJA 1/27/2006
REMAJA 6/26/2006
MASY UMUM 4/10/1986
GURU 10/2/1996
MASY UMUM 1/23/1990
REMAJA 5/19/2008
REMAJA 10/8/2006
MASY UMUM 3/16/1979
REMAJA 6/10/2008
REMAJA 3/27/2007
MASY UMUM 4/21/1992
MASY UMUM 3/6/1981
MASY UMUM 11/22/1987
WIRASWASTA 25/04/1977
REMAJA 2/1/2006
REMAJA 28-01-2007
MASY UMUM 27-12-1982
REMAJA 2/12/2008
MASY UMUM 8/12/1983
REMAJA 14-12-2008
REMAJA 27-03-2007
REMAJA 24-06-2007
REMAJA 23-05-2008
REMAJA 8/3/2014
REMAJA 18-11-2013
REMAJA 1/6/2002
REMAJA 4/6/2005
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Alamat NO HP BPJS BPJS
PBI Non PBI
KP. BABAKAN BANDUNG DS CIKIRUHWETAN 085890162085
KP. BABAKAN CIBALIUNG DS RANCASENENG 081211557158
KP MALANGSARI DS CIKIRUHWETAN 085777889544
KP HUNIBERA DS CIKIRUHWETAN 085794156388
KP TANEUH BEUREUM DS CIRNGKONG 085893566410
KP SINAR JATI DS CIKIRUHWETAN 082113372099
KP TANUNG JAYA DS SUMURBATU 081210633837
KP HUNIBERA DS CIKIRUHWETAN 085862716228
DS CIKIRUHWETAN 081287120453
DS CIKIRUHWETAN 083841520717
DS CIKIRUHWETAN 083147314933
DS CIKIRUHWETAN
DS CIKIRUHWETAN 081905620901
DS CIKIRUHWETAN 085890162085
DS CIKIRUHWETAN 081314607830
DS CIKIRUHWETAN 085773667312
DS CIKIRUHWETAN 081511761570
DS CIKIRUHWETAN
DS CIKIRUHWETAN 081381089887
DS CIKIRUHWETAN 082312774675
DS CIKIRUHWETAN 081398264084
DS CIKIRUHWETAN 085892614375
DS CIKIRUHWETAN
DS CIKIRUHWETAN 085212700564
DS CIKIRUHWETAN 087721900542
DS CIKIRUHWETAN 085692188119
DS CIKIRUHWETAN 085813330859
DS CIKIRUHWETAN 085694572902
DS CIKIRUHWETAN 085773762964
DS CIKIRUHWETAN 085718763357
DS CIKIRUHWETAN 085691131076
DS CIKIRUHWETAN 085283145527
DS CIKIRUHWETAN 083152272141
DS CIKIRUHWETAN 085716244014
DS CIKIRUHWETAN 085773765979
DS CIKIRUHWETAN 08577062656
DS CIKIRUHWETAN 085695147783
DS CIKIRUHWETAN 085871072134
DS CIKIRUHWETAN 085211550153
DS CIKIRUHWETAN 081311978750
DS CIKIRUHWETAN 085893400157
DS CIKIRUHWETAN
DS CIKIRUHWETAN 082148663986
DS CIKIRUHWETAN 085715504099
DS CIKIRUHWETAN 085714261784
DS CIKIRUHWETAN
DS CIKIRUHWETAN 085779428872
DS CIKIRUHWETAN 085781008583
DS CIKIRUHWETAN 085893722475
DS CIKIRUHWETAN 081511791531
DS CIKIRUHWETAN 085759552921
DS CIKIRUHWETAN 085715543696
DS CIKIRUHWETAN 085759541668
DS CIKIRUHWETAN 085697655820
DS CIKIRUHWETAN 083819902937
DS CIKIRUHWETAN 081283905900
DS CIKIRUHWETAN 085886124670
DS CIKIRUHWETAN 081287325071
DS CIKIRUHWETAN 085773238411
DS CIKIRUHWETAN 081280549110
DS CIKIRUHWETAN 083802190068
DS CIKIRUHWETAN 083148980518
DS CIKIRUHWETAN 082213486621
DS CIKIRUHWETAN 085716763992
DS CIKIRUHWETAN 085773749278
DS CIKIRUHWETAN 085778239959
DS CIKIRUHWETAN 081299259574
DS CIKIRUHWETAN 085213872695
DS CIKIRUHWETAN 082123935721
DS CIKIRUHWETAN 085773210393
DS CIKIRUHWETAN 081511869915
DS CIKIRUHWETAN 085693152695
DS CIKIRUHWETAN 085714640083
DS CIKIRUHWETAN 085960084631
DS CIKIRUHWETAN 085852427797
DS CIKIRUHWETAN 085281761252
DS CIKIRUHWETAN
DS CIKIRUHWETAN 085782396481
DS CIKIRUHWETAN 081282745520
DS CIKIRUHWETAN 081585553890
DS CIKIRUHWETAN
DS CIKIRUHWETAN 085795308418
DS CIKIRUHWETAN 083815227262
DS SUKAWARIS 081585819203
DS CIKIRUHWETAN 081310368720
DS SUKAWARIS 085717544478
DS SUMURBATU 085880153354
DS CIKIRUHWETAN 085710730998
DS BEJOD 085212604813
DS SUKAWARIS 081218168393
DS CIKIRUHWETAN 085714640083
DS CIKIRUHWETAN 085319354388
DS CIKIRUHWETAN 085891165223
DS CIKIRUHWETAN 085723723129
DS TANJUNGAN 081318935413
DS SUKAWARIS 083815814790
DS SUMURBATU 085283444134
DS CIKIRUHWETAN 085319411230
DS PAGAR BUKIT 085894195061
DS SUKAWARIS 085892624472
DS CIKIRUHWETAN 085886172684
DS SUKAWARIS
DS TANJUNGAN 085213812242
DS SUMURBATU 085860730617
DS SUKAWARIS 081584048413
DS CIKIRUHWETAN 081310368720
DS CIKIRUHWETAN
DS SUMURBATU 081295096113
DS CIKIRUHWETAN
DS CIKIRUHWETAN 081398897114
DS SUMURBATU 085759552962
DS TUGU 085359541719
DS MALINGPING 085711045893
DS CIKIRUHWETAN 081282437822
DS SUMURBATU 085359541719
DS SUMURBATU 085773755902
DS SUMURBATU 085359541719
DS SUMURBATU 085212687065
DS CIKIRUHWETAN 085891165223
DS CIKIRUHWETAN 085714379775
DS CIKIRUHWETAN 085810328526
DS CIKIRUHWETAN 085714379775
DS SUMURBATU 081323793901
DS PONDOK CABE UDIK 085710519565
DS CIKIRUHWETAN 085810328526
DS SUMURBATU 085319411230
DS CIKIRUHWETAN 083898635781
DS UNYUR 085280670797
DS CIKIRUHWETAN 085714379775
DS CIKIRUHWETAN 083898955680
DS CIKIRUHWETAN 085810328526
DS CIKIRUHWETAN 085714379775
DS SUMURBATU 085691096434
DS CIKIRUHWETAN 085283145527
DS SUKAWARIS 085890662346
CIKIRUHWETAN SS
CIKIRUHWETAN 085813639916
MALINGPING UTARA 083812741343
CIKIRUHWETAN 087874376006
SUMURBATU 085773897016
CIKIRUHWETAN 085972802472
SUMURBATU
SUKAWARIS 085695088221
SUMURBATU 085282389866
SUMURBATU 085817101063
CIKIRUHWETAN 085717726348
SUKAWARIS 085710730975
CIKIRUHWETAN 081382378461
CIKIRUHWETAN 081282437814
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch
Anggota
Vaksinasi
CORONAVAC 22/11/21 22/11/21 202108171F
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CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21
CORONAVAC 22/11/21 22/11/21
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
CORONAVAC 22/11/21 22/11/21 202108171F
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
EUA2057300143AI
EUA2057300143AI 22/11/21 202108171F EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI 22/11/21 202108171F EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI 22/11/21 20210817F EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI
EUA2057300143AI 22/11/21 202108171F EUA2057300143AI
EUA2057300143AI
EUA2057300143AI 22/11/21 202108171F EUA2057300143AI
EUA22057300143AI
18/11/21 202108171F EUA22057300143AI DOSIS 2
18/11/21 202108171F EUA22057300143AI DOSIIS 2
EUA22057300143AI
 Nama Umur
Kelomp
NO No. Ticket NIK Penerim JK Pekerjaan* (18-59 INSTANSI
ok Umur
a Vaksin tahun)

38 360104161SANUDI RL 16/12/20001
39 360104100HENDI L 10/07/1987
40 360108070NURHIDAYL 07/06/1999
41 360121270RUSMIYADL 27/07/1987
42 360104120RIKI L 12/02/2003
 Kepesertaan BPJS (tulis 'Ya' pada kolom yang
sesuai)
Merek
Alamat NO HP Non Vaksin**
BPJS PBI BPJS Non PBI *
Anggota

CURUGCI 085890550057 CORONAV

CURUGCI 081574609739 CORONAV
CURUGCI 0857105048959 CORONAV
SAKETI CORONAV
CURUGCI 085777374324 CORONAV
 Dosis I
Tanggal
Tanggal Pemberi
Screening No.
an No seri
Batch
Vaksina
si
23/11/21 23/22/22 202108145H
23/11/21 23/11/22 202108145H
23/11/21 23/22/23 202108145H
23/11/21 23/11/23 202108145H
23/11/21 23/22/24 202108145H
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601040907750001 MAHPUDIN L
2 3601046503800001 MAMAY MAEH P
3 3601042410990001 DIDI L
4 3601044701810010 RISKA P
5 3601040510830006 UUS L
6 3601045308030002 SITI RAHAYU P
7 3601040107800264 SUNARDI L
8 3601040107040048 NURJANI L
9 3601040705750003 DASIRIN L
10 3601045506820001 MARSAH P
11 3602995210764948 LINA P
12 3601044402650001 AMI P
13 3601040407670004 JAHALIM L
14 3601040405950002 SUDIN L
15 3601045805780002 NUNUNG P
16 3601045505920004 RISNAWATI P
17 3601041202640001 ARSAD L
18 3601042912720001 SOLIHIN L
19 3601041403870004 SUNAEDI L
20 3601045509790003 SAROH P
21 3601040904700002 AMAT L
22 3601041506660001 SODIKIN L
23 3601044101000013 BELA SAPIRAH P
24 3601044112780001 SUNARIAH P
25 3601041702970003 DEDE YUSUF L
26 3601040107680261 WARSA L
27 3601041103780004 TARKIM L
28 3601045206010001 LENI MARLINA P
29 3601040307730003 K SAIMAN L
30 3601040702050005 M RIPAI L
31 3601045507270002 CASMANAH P
32 3601045204630002 RUMSIH P
33 3601044405740001 TARINIH P
34 3601041906830001 HERMAN L
35 3601045502650003 ETI P
36 3601041802720001 MAIL L
37 3601045110980002 DEDE NADIYAH P
 Kepesertaan BPJS (
'Ya' pada kolom ya

Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

25/03/1976 SUKASENENG 085319358540

25/03/1980 SUKASENENG 085219690385
24/10/1999 CIKEUSIK 085782490912
07/10/1981 CIKEUSIK 083873629164
05/10/1983 KIARAJANGKUNG 085247976571
13/08/2000 SUKASENENG 082311533991
01/07/1980 PEMATANG SEMPUR 085819880812
01/07/2004 SUKASENENG 085781660370
07/05/1975 SUKASENENG 085210703452
15/06/1982 LEUWIMUJA 085281459914
12/10/1976 PASIR AWI BEAS 081295855795
04/02/1965 LEUWIMUJA 085210054371
04/07/1967 LEUWIMUJA 085770620338
04/05/1995 LEUWIMUJA 081296008696
18/05/1978 SUKASENENG 085210550403
15/05/1992 SUKASENENG 085892625431
01/07/1970 SUKAMANDI 085213477318
29/12/1972 LEUSIMUJA 085210550403
14/03/1987 SUKASENENG 085892625431
15/09/1979 CIRIRIGI 083834364953
12/05/1970 LEUSIMUJA 085213477318
15/06/1966 KIARAJANGKUNG 081380166442
01/01/2007 KIARAJANGKUNG 085283293895
01/12/1978 LEUWIMUJA 085319359540
18/02/1997 SUKASENENG 081213949090
01/07/1968 SUKASENENG 083848555476
08/08/1978 SUKASENENG 082155500460
12/06/2001 SUKASENENG 085281459533
08/10/1963 SUKASENENG 085697592232
07/02/2005 SUKASENENG 085897592232
04/07/1962 SUKASENENG 085693645905
12/04/1957 SUKASENENG 085213477318
04/05/1974 SUKASENENG 085219423928
19/06/1984 SUKASENENG 085280171177
15/02/1965 SUKASENENG 081222414919
17/03/1970 SUKASENENG 085697810766
11/10/1998 SUKASENENG
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal Tanggal
BPJS Non Merek Vaksin*** Screenin Pemberi No.
g an No seri
Non PBI Anggota Batch
Vaksina
si
CORONAVAC 23/11/21 07/09/21 2021081511
CORONAVAC 23/11/21 07/09/21 2021081511
CORONAVAC 23/11/21 21/10/21 202108145H
CORONAVAC 23/11/21 21/10/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108141
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 07/09/21 2021081511
CORONAVAC 23/11/21 21/10/21 202108145H
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 21/10/21 202108145H
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 23/11/21 2021081641
CORONAVAC 23/11/21 21/10/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
CORONAVAC 23/11/21 15/09/21 2021081511
CORONAVAC 23/11/21 23/22/21 202108145H
CORONAVAC 23/11/21 23/11/21 202108145H
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044412960005 NUNUNG NURAZIZAH P

2 3601046508050001 DELA AMELIA P
3 3601045204820005 EEN P
4 3601045603870003 SITI AMINAH P
5 3601044512020002 FITRI HANDAYANI P
6 3601041309850002 MUMUH L
7 3601041005850009 WAWAN L
8 3202015105770008 SUNARIH P
9 3601040107790012 RAKIM FIRMANSYAH L
10 3601040807890004 MARDIANTO L
11 3601040705780006 SIRWAN L
12 3601040107730060 TARNA L
13 3601040107860059 CASONO L
14 3602281204560002 USIN L
15 3601040810600003 MASNAH P
16 3601041706990003 ANJONI L
17 3601040806680002 UDI L
18 3601040704810001 UJID HIDAYAT L
19 3601044107670002 JUMI P
20 3601044106030002 RINA HERLINA P
21 3601041110530001 SARMAYA L
22 3601040106880001 HENDRA IRAWAN L
23 3601040107810038 HAPID HAMDANI L
24 3601041207650006 TARMIN L
25 3601041209750002 AYIP L
26 3601040107920250 DERI SUPIAN L
27 3601046108870005 ROSNAH P
28 3601040409900003 RUYANI L
29 3601044805800007 EROH P
30 3601045409830001 ADAH P
31 3601044102590001 CASTI P
32 3601044309690001 RUMSINAH P
33 3601040107670024 NANANG WASLIMAN L
34 3601040107630071 WARSIM L
35 3601045405030004 ANIS P
36 3601044811740003 SATIAH P
37 3601045610990001 CECEP ROHIDIN L
38 3601040107630069 RAJAB L
39 3601040107760044 KARNATA L
40 3601041703640001 MUKTAR L
41 3601044105990005 AWALIAH P
42 3601045107860005 LEHA P
43 3601042404820003 SUKIRMAN MAULANA L
44 3601045012720003 KASTINI P
45 3601041402670001 USUP L
46 3601045302890003 SITI P
47 3601044811840001 SITI P
48 3601041011820005 SAMA PRAYOGA P
49 3601040107860066 AHYUDIN L
50 3601041603730003 ANI L
51 3601046604030003 RENI NURAENI P
52 3601042002950005 UJUM L
53 3601045205840004 ENENG LILIS P
54 3601041504970004 S ABDUL AJIJ L
55 3329141711790005 TARJONO L
56 3601042008750004 EDI SOFYANDI L
57 3601040901000002 AEP SAEPUDIN L
58 3601040102980001 UNAY L
59 3601040107020046 UTAR L
60 3601046112020002 DEDE NURMALA P
61 3601040107950064 ATIM L
62 3601044307020003 SAFITRI P
63 3601040104670001 USUP L
64 3601045703900001 NUNI P
65 3601040103740001 TARNO L
66 3601040604970001 JUMINAH P
67 3601046411040002 SINTA P
68 3601044512850002 SITI AISAH P
69 3601045303800001 OTIH P
70 3601045701800002 KHODIJAH P
71 3601044206830002 ENOK P
72 3601045410060006 ANITA OKTOFIANI P
73 3601040112970003 RIZAL L
74 3601044504940005 NESA P
75 3601044408810003 AISYAH BT IRJA P
76 3202012011690003 TASLIM L
77 3601041110800003 DARMAN L
78 360104230501070004 SUPANDI L
79 3601045502720003 MASRI P
80 3601044106900007 SUNTI P
81 3601040107860059 CASONO L
82 3601045104850005 LINDA P
83 3601042610940001 JEFRI FIRDAUS L
84 3601044107680046 RASITI P
85 3601040107640004 WASKAM L
86 3601041108620001 SUBAR L
87 3601045803740001 MUHIBAH L
88 3601044506860005 AMAH P
89 3601040706860002 SUHERI L
 90 3601046303040001 PANI OKTAPIANI P
91 3671041906050001 M. IFAN L
92 3329024205830006 WIWIN P
93 3601046004770003 SARVIA LOMBENG P
94 360104010780074 M HAMDANI L
95 3601041408850001 SARWIN L
96 3601042204880004 RASDI L
97 3601040808770006 DENI L
98 3601040803800004 ahmad L
99 3601041707710001 KAMONG L
100 3601044511060004 LENI SUSILAWATI P
101 3601045505830002 MARNAH P
102 3601044308600001 HJ. KARIAH P
103 3601046006900001 RUKMI P
104 3601045010820002 DARMI P
105 3601044401030001 SINDI M.A P
106 3601044185720000 ERI P
107 3601040107400006 KIMING L
108 3601040911840001 TORI L
109 3601041607840005 SARIP L
110 3601040107600029 BADRUN L
111 3601042603690001 ENDANG L
112 3601044609730003 ISAH P
113 3601040107640007 SABAN L
114 3601040108970004 M. IMAM PENDI L
115 3601042306040004 RENDI PEBRIANA L
116 3601045203920001 AMI P
117 3601041803030003 DODI WAHYUDIN L
118 3601040104790005 DARSONO L
119 3601046706850005 HOYANAH P
120 3601040107920066 ITA PURNAMASARI P
121 3601041212980003 M. RIFA'I L
122 3601041009020005 RIKI HAETAMI L
123 3601040402710001 YADI L
124 3601041210780004 SUANDI L
125 3601046507040001 HENI RATNASARI P
126 3601041402000001 ANANG L
127 3601044709600001 WARMI P
128 3601045709020001 DEVI SALSA BILAH P
129 3601035311030005 NURUL ANISA P
130 3601044703890001 MISNAH P
131 3601041709700001 AMIRUDIN L
132 NARTO L
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat
ok Umur
tahun)

IRT 12/4/1996 UMUM SUKAWARIS

PELAJAR 3/10/2004 UMUM SUKAWARIS
IRT 4/12/1982 UMUM SUKAWARIS
IRT 6/12/1990 UMUM SUKAWARIS
PELAJAR 12/5/2002 UMUM SUKAWARIS
BURUH 9/13/1985 UMUM SUKAWARIS
WIRASWASTA 5/10/1985 UMUM SUKAWARIS
IRT 5/11/1977 UMUM SUKAWARIS
WIRASWASTA 7/13/1980 UMUM SUKAWARIS
WIRASWASTA 7/8/1989 UMUM SUKAWARIS
WIRASWASTA 5/7/1978 UMUM SUKAWARIS
WIRASWASTA 7/10/1962 UMUM SUMURBATU
PETANI 11/27/1983 UMUM SUKAWARIS
PETANI 1/12/1956 UMUM SUKAWARIS
PETANI 10/8/1960 UMUM SUKAWARIS
PELAJAR 6/17/1999 UMUM SUMURBATU
PETANI 6/8/1968 UMUM SUKAWARIS
PETANI 4/7/1981 UMUM SUKAWARIS
IRT 6/1/1967 UMUM SUKAWARIS
PELAJAR 1/1/2003 UMUM SUKAWARIS
WIRASWASTA 10/11/1953 UMUM SUKAWARIS
WIRASWASTA 6/1/1988 UMUM SUKAWARIS
WIRASWASTA 7/1/1981 UMUM SUKAWARIS
PETANI 7/12/1965 UMUM SUKAWARIS
WIRASWASTA 9/12/1975 UMUM SUKAWARIS
6/6/2003 UMUM SUKAWARIS
IRT 12/5/1987 UMUM CIKIRUHWETAN
WIRASWASTA 9/4/1990 UMUM SUKAWARIS
IRT 5/8/1980 UMUM SUKAWARIS
IRT 9/14/1983 UMUM SUKAWARIS
PETANI 2/1/1959 UMUM SUKAWARIS
IRT 9/3/1969 UMUM SUKAWARIS
WIRASWASTA 9/17/1972 UMUM SUKAWARIS
PETANI 2/15/1977 UMUM SUKAWARIS
PELAJAR 5/14/2003 UMUM SUKAWARIS
IRT 11/8/1974 UMUM SUKAWARIS
PELAJAR 10/16/1999 UMUM SUKAWARIS
PETANI 7/1/1963 UMUM SUKAWARIS
PETANI 7/1/1976 UMUM SUKAWARIS
PETANI 3/17/1964 UMUM SUKAWARIS
IRT 5/1/1999 UMUM SUKAWARIS
IRT 7/11/1986 UMUM SUKAWARIS
WIRASWASTA 4/25/1982 UMUM SUKAWARIS
IRT 12/10/1972 UMUM SUKAWARIS
PETANI 2/14/1967 UMUM SUKAWARIS
IRT 2/13/1979 UMUM SUKAWARIS
IRT 11/8/1984 UMUM SUKAWARIS
WIRASWASTA 11/10/1982 UMUM SUKAWARIS
WIRASWASTA 6/12/1985 UMUM SUKAWARIS
PETANI 3/16/1973 UMUM SUKAWARIS
BELUM BEKERJA 4/25/2003 UMUM SUKAWARIS
PELAJAR 4/20/1995 UMUM SUKAWARIS
IRT 5/12/1984 UMUM SUKAWARIS
BELUM BEKERJA 4/15/1997 UMUM SUKAWARIS
WIRASWASTA 11/17/1979 UMUM SUKAWARIS
WIRASWASTA 8/20/1975 UMUM SUKAWARIS
PELAJAR 6/4/2000 UMUM SUKAWARIS
PELAJAR 8/8/1998 UMUM SUKAWARIS
BELUM BEKERJA 5/29/2002 UMUM SUKAWARIS
PELAJAR 12/12/2002 UMUM SUKAWARIS
PETANI 7/1/1995 UMUM SUKAWARIS
PELAJAR 7/3/2002 UMUM SUKAWARIS
PETANI 4/1/1967 UMUM SUKAWARIS
IRT 3/17/1990 UMUM SUKAWARIS
WIRASWASTA 3/1/1974 UMUM SUKAWARIS
IRT 14-04-1996 UMUM
PELAJAR 24-11-2004 REMAJA
WIRASWASTA 05-12-1985 UMUM
IRT 13-03-1980 BUMIL
IRT 17-01-1990 UMUM
IRT 02-06-1983 UMUM
PELAJAR 22-06-2015 UMUM
WIRASWASTA 01-12-1997 UMUM
WIRASWASTA 05-04-1994 UMUM
IRT 04-08-1981 UMUM
BURUH 20-11-1969 UMUM
WIRASWASTA 01-10-1960 UMUM
BELUM KERJA 23-05-2003 UMUM
IRT 14-02-1972 UMUM
IRT 01-06-1990 UMUM
PETANI 27-11-1983 UMUM
IRT 11-04-1985 UMUM
WIRASWASTA 15-12-1993 UMUM
IRT 23-07-1972 UMUM
PETANI 01-07-1964 UMUM
PETANI 12-07-1963 UMUM
PELAJAR 30-05-1998 UMUM
IRT 05-06-1986 UMUM
WIRASWASTA 07-06-1986 UMUM
PELAJAR 24-10-2004 UMUM
PELAJAR 19-06-2005 UMUM
WIRASWASTA 15-08-1991 UMUM
IRT 20-04-1977 UMUM
BELUM KERJA 07-07-2000 UMUM
WIRASWASTA 14-08-1985 UMUM
WIRASWASTA 22-04-1988 UMUM
BURUH 08-08-1977 UMUM
WIRASWASTA 08-03-1980 UMUM
PETANI 17-07-1971 UMUM
IRT 05-11-2006 UMUM
IRT 15-05-1983 UMUM
IRT 03-08-1960 UMUM
IRT 20-06-1990 UMUM
IRT 19-05-1985 UMUM
PELAJAR 04-01-2003 UMUM
IRT 07-05-1972 REMAJA
PETANI 01-07-1957 UMUM
PETANI 09-11-1984 UMUM
PETANI 16-07-1984 UMUM
PETANI 01-07-1960 UMUM
BURUH 12-07-1975 UMUM CIKIRUHWETAN
IRT 06-02-1980 UMUM
PETANI 11-09-1964 UMUM
PETANI 01-08-1997 UMUM
PELAJAR 23-06-2004 UMUM
IRT 12-03-1992 UMUM
BELUM KERJA 18-03-2003 UMUM
WIRASWASTA 01-04-1979 UMUM
IRT 27-06-1985 UMUM
WIRASWASTA 23-03-1994 UMUM
BELUM KERJA 12-12-1998 UMUM
PELAJAR 10-09-2002 UMUM
WIRASWASTA 04-02-1971 UMUM
WIRASWASTA 12-10-1978 BUMIL
BELUM KERJA 25-07-2004 UMUM
PELAJAR 13-05-2000 UMUM
IRT 27-06-1965 UMUM
PELAJAR 17-09-2002 UMUM
PELAJAR 13-11-2003 UMUM
IRT 07-03-1989 UMUM
WIRASWASTA 17-09-1970 UMUM
WIRASWASTA UMUM
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai) Merek Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening
PBI Non PBI Anggota
085891512416 CORONAVAC 11/23/2021
081212895110 CORONAVAC 11/23/2021
085777629036 CORONAVAC 11/23/2021
083834320703 CORONAVAC 11/23/2021
085711304504 CORONAVAC 11/23/2021
082362734744 CORONAVAC 11/23/2021
081280854837 CORONAVAC 11/23/2021
085939517117 CORONAVAC 11/23/2021
085778294445 CORONAVAC 11/23/2021
087871820465 CORONAVAC 11/23/2021
085694089782 CORONAVAC 11/23/2021
085891512416 CORONAVAC 11/23/2021
085891512416 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085779621164 CORONAVAC 11/23/2021
085697428965 CORONAVAC 11/23/2021
085773648354 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
083179507110 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085778188658 CORONAVAC 11/23/2021
081585819203 CORONAVAC 11/23/2021
087713226805 CORONAVAC 11/23/2021
085711304620 CORONAVAC 11/23/2021
085283952374 CORONAVAC
085866761684 CORONAVAC
081390233602 CORONAVAC 11/23/2021
085710494370 CORONAVAC 11/23/2021
085219421567 CORONAVAC 11/23/2021
085866761684 CORONAVAC
085866761684 CORONAVAC
085694504449 CORONAVAC
085866761684 CORONAVAC 11/23/2021
085861602043 CORONAVAC 11/23/2021
08219285944 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
083890673302 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085774324414 CORONAVAC 11/23/2021
083890673302 CORONAVAC 11/23/2021
082299424453 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085866761684 CORONAVAC 11/23/2021
085794453009 CORONAVAC 11/23/2021
085866761684 CORONAVAC
085774607032 CORONAVAC 11/23/2021
081574640480 CORONAVAC 11/23/2021
085862716229 CORONAVAC 11/23/2021
085893367031 CORONAVAC 11/23/2021
082125754520 CORONAVAC 11/23/2021
085794453009 CORONAVAC 11/23/2021
081511690569 CORONAVAC 11/23/2021
085894002098 CORONAVAC 11/23/2021
081332934157 CORONAVAC 11/23/2021
083879634293 CORONAVAC 11/23/2021
085887120168 CORONAVAC 11/23/2021
085773757805 CORONAVAC
082149935278 CORONAVAC 11/23/2021
08558168050 11/23/2021
085866761684 11/23/2021
085890744018 11/23/2021
085694957330 11/23/2021
085774960003 CORONAVAC 23-11-2021
085319358158 CORONAVAC 23-11-2021
085211885982 CORONAVAC 23-11-2021
CORONAVAC 23-11-2021
085219421567 CORONAVAC 23-11-2021
085219421567 CORONAVAC 23-11-2021
082310769521 CORONAVAC 23-11-2021
08577505886 CORONAVAC 23-11-2021
0812125841619 CORONAVAC 23-11-2021
083879981504 CORONAVAC 23-11-2021
085939517117 CORONAVAC 23-11-2021
085772743237 CORONAVAC 23-11-2021
083891957386 CORONAVAC 23-11-2021
085666761684 CORONAVAC 23-11-2021
087773920556 CORONAVAC 23-11-2021
085891512416 CORONAVAC 23-11-2021
083856591976 CORONAVAC 23-11-2021
085695139997 CORONAVAC 23-11-2021
081297410563 CORONAVAC 23-11-2021
082310995772 CORONAVAC 23-11-2021
083856591955 CORONAVAC 23-11-2021
085813647610 CORONAVAC 23-11-2021
085666761684 CORONAVAC 23-11-2021
085866761684 CORONAVAC 23-11-2021
085715817990 CORONAVAC 23-11-2021
083891136352 CORONAVAC 23-11-2021
081282341415 CORONAVAC 23-11-2021
081311826461 CORONAVAC 23-11-2021
085654439170 CORONAVAC 23-11-2021
081390233475 CORONAVAC 23-11-2021
085654439170 CORONAVAC 23-11-2021
085866761684 CORONAVAC 23-11-2021
085795689093 CORONAVAC 23-11-2021
085866761684 CORONAVAC 23-11-2021
085866761684 CORONAVAC 23-11-2021
085813107241 CORONAVAC 23-11-2021
085866761684 CORONAVAC 23-11-2021
085866761684 CORONAVAC 23-11-2021
085718763904 CORONAVAC 23-11-2021
085811024043 CORONAVAC
085866761684 CORONAVAC
083890673302 CORONAVAC
085717350223 CORONAVAC
085866761684 CORONAVAC
085866761684 CORONAVAC
081322419835 CORONAVAC
081322419835 CORONAVAC
085866761684 CORONAVAC
085885456585 CORONAVAC
081295006495 CORONAVAC
085778056980 CORONAVAC
081574640480 CORONAVAC
085894198215 CORONAVAC
085892624472 CORONAVAC
085755669950 CORONAVAC
085819915796 CORONAVAC
085892624370 CORONAVAC
085212424822 CORONAVAC
085216702665 CORONAVAC
085819602202 CORONAVAC
081323793925 CORONAVAC
085866761684 CORONAVAC
085718271872 CORONAVAC
085695115634 CORONAVAC
085773225554 CORONAVAC
085782605197 CORONAVAC
CORONAVAC
 Dosis I Dosis 2
Tanggal Tanggal KET
Pemberian No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi Vaksinasi
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
 11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
11/23/2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
18-10-2021 202108145H 23-11-2021 202109149H
18-10-2021 202108145H 23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
18-10-2021 202108145H 23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
18-10-2021 202108145H 23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
18-10-2021 202108145H 23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
25-10-2021 202108145H 23-11-2021 202109149H
23-11-2021 202109149H
13-10-2021 202108171H 23-11-2021 202109149H
23-11-2021 202109149H
13-10-2021 202108171F 23-11-2021 202109149H
21-10-2021 202108145H 23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 20210914H
23-11-2021 202109149H
23-11-2021 202109149H
23-11-2021 202109149H
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601040306540001 NASRIP L
2 3601046407880001 IKAH P
3 3203215502860009 RISKA P
4 3601044107740063 ENTIN P
5 3601044802830002 ESIH P
6 3601045105770001 SUHENAH P
7 3601044107870164 ROHIMAH P
8 3601045712970003 YOSI YULIANTI P
9 3601044107710090 RAKMAH P
10 3601045007720002 NANI ELISNAWATI P
11 APRIANO L
12 3601046908980003 SUKAENAH P
13 3601040500870006 ASMAN L
14 3601044201920003 HANAH P
15 3601044607750007 ETIN SUTINI P
16 3601044907900007 SAKNITI P
17 3601040604210002 SUPARDI L
18 3601044107580091 RASITEM P
19 3601044711950001 SARMINAH P
20 3601040606850001 ATA L
21 3601044102030153 OMI P
22 3601040809560001 ROIS HAMBALI L
23 JUNAEDI L
24 3601040906850004 DEDI L
25 3601046101890001 MILA SUMIATI P
26 3601042609850002 LIKI L
27 3601044702700003 WARSEM P
28 3601044107010293 ICIH P
29 3601040302920002 AHMAD YANI L
30 3601040107860142 HANI P
31 3601042305070003 M. RIO MAULANA L
32 3601041207650002 ARJALI L
33 3601040107730417 AMIR L
34 360104320108030003 JAMAK SARIAL L
35 3601045810850002 RAKMAH P
36 3601042703690001 SURNA P
37 360106010780158 UJANG L
38 360104701820005 SANTA L
39 LIS EUIS INDRIANI P
40 3601044201440006 MAYANG SARI P
41 36010427111030002 AMAR MA'RUF L
42 3601045701670001 ASTI P
43 3601040107760108 SUKARTA L
44 360104041040003 ATIAH P
45 3601184110970003 SANDI KURNIAWAN L
46 3601045407940002 ARIMAH P
47 3601044107940162 ATI NURHAYATI P
48 3601045706680001 RANIMAH P
49 3601044107860107 RATMINAH P
50 3601045702950002 KUSNIAWATI P
51 3601044107850170 YATI P
52 3601041107790004 TABANI L
53 3601041409810001 SALI L
54 3601044203690004 MIMIN P
55 3601044107870107 SURTIMAH P
56 3601044711980004 AMANDA DHEA P
57 3601046909910001 WASTEM P
58 3601041303020001 ALDI RIPALDI L
59 3601041301900002 KUSMAN EFENDI L
60 3601042811820003 TARNO L
61 3601041311970003 WARSO HIDAYAT L
62 360104407670054 RUMI P
63 3601044107960140 RAHAYU P
64 360104010278502099 SARI P
65 3601040107680143 SARKAM L
66 3601040107820050 RUHENDI L
67 3601046101790004 NANI P
68 3601040905040002 FAHMI AJI L
69 JUMHAR L
70 3601040107910154 WARNATA L
71 3601040107550044 SAKIM L
72 3601040107680129 SARDA L
73 3601044102830009 SUKMINAH P
74 3601045405070005 SITI NURHOLISOH P
75 3601035404930001 ROHAYATI P
76 3601045306750003 ESIH P
77 3601040107830142 ANTUSI L
78 3601044506070003 FEBY AYU P
79 3601040102000004 ROHIM L
80 3601040107770053 SUDIRMAN L
81 3601040811740001 RASA L
82 360104140660002 SUNINTA P
83 3601042311930002 MAMAT L
84 3601040107880169 JUHED L
85 3600140809650003 SUNIAH P
86 3601041609150001 ARKAMAN L
87 3601041204970003 SARMANI L
88 3601041101820002 ARMAN L
89 3601044107490037 SUKMANAH P
 90 3601041701950004 SANEN L
91 3601040107950159 TARSONO L
92 3601040107560056 ARSIDAN L
93 3601044307870006 ASIAH P
94 360104403610001 TITIN SUHARTINI P
95 3601040107610069 CARLAM L
96 3601044201950006 SANTI P
97 360104180580002 SUDIANA L
98 3601045705900009 ESIH SUKAESIH P
99 3601044108850024 CARINIH P
100 3601040705700002 DANI L
101 3601040107790066 TASKIM L
102 3601040107900129 WARJA L
103 3601045401890002 ARSIH P
104 3601044903920005 SURNIAH P
105 3601044509730002 SUMIYATI P
106 36010420084890009 NENDI L
107 360104050940001 AYU SUDRAJAT P
108 3601042803870003 SADI WIGUNA L
109 3601042209740001 JAYA L
110 3601045706900004 GINA P
111 3601045312950002 SANAH P
112 3601044107500088 JUHA P
113 3601045508750007 NENGSIH P
114 3601040107710069 SANIM L
115 36010410102770004 ASORI P L
116 3601041203880003 DANI L
117 3601040506600002 H. SARDI L
118 3601040906810002 HENDRA L
119 3601041104850001 JUNAEDI L
120 3601042509020003 ABDUL MUBAROK L
121 3601044107650078 UNI P
122 3601042108800001 SURYADI L
123 3601040107620051 ANI P
124 3601040206730001 RIPTO WIBOWO L
125 3601034207820004 ENENG P
126 3601350066000006 MESTI P
127 3601041408710002 WARDIPAH L
128 360104107730190 CARITEM P
129 3601047910150 UCU KUSWITA L
130 3601046203710002 ERNA HARIYANTI P
131 3601040107750125 DEDEN L
132 36010423028200002 SARMIN L
133 3601041703990001 AMAN SUTISNA L
134 3601044107730155 CARIMPEN L
135 3601041204000003 GUGUN GUNAWAN L
136 3601044809020002 BELA PERTIWI P
137 3601040107870176 YULI P
138 3601045111810001 EEN SUENI P
139 3601040107760253 EMAN L
140 3601045201010004 SUMARNI P
141 3601041504770002 KATU HERYANTO L
142 36010411102990010 IRFAN L
143 3601044712060002 DESI AULIA P
144 3601046703920001 PENTI P
145 3602090703800005 JASRIP L
146 3601041057500002 SUARYO L
147 3602094210750003 SUKMI P
148 3601045310970002 RATNAWATI L
149 3602094604870006 AAS P
150 3601043008060000 KOMARUDIN L
151 3601041505010000 LATIP L
152 3601040304940002 SUNINGRAT P
153 3601040107800125 ADRODI L
154 3601041208060005 M. AANG K L
155 3601042909990003 GUNAWAN L
156 3601047011740001 MISTI P
157 3601044212040002 JUJU REGINA P
158 3601044101600002 JARSIH P
159 3601040406000002 RIKI PIRMANSYAH L
160 3601044107700095 KACEM L
161 3601044105600006 WARSIH P
162 3601044107440015 INAH P
163 3601040207750008 ADRA L
164 3601042311930003 ADJI L
165 3601044604680002 MARIAH P
166 3601040808910001 IIM L
167 3601041012700002 ASTU L
168 3601041008050006 ROJALI L
169 3601040705780008 HAMID L
170 3601040708840007 ADE UJANG A L
171 3601041002480002 SAR'AN L
172 3601044107730166 JUHA P
173 3601041808900002 HERDI L
174 3601040107670042 SUKARDI L
175 3601040107880125 SARDA L
176 3601040310820002 ASMA L
177 3601040107720108 SARIM L
178 3601046207650002 MAESAROH P
179 3601040307020006 ASKANI L
180 3601043008920002 HUSEN L
181 3601040304000012 TOMI L
182 3601045502630002 SUKMI P
183 360104010760049 MISRAN L
184 3608200410880001 SODIK L
185 3601043112820001 RUSMAN L
186 3601040602100001 SUPANDI L
187 3601040409010002 FAHMI AL-IDRUS L
188 3601040202000008 M. IKBAL P L
189 3601042609880002 ROIS L
190 3601041411920001 ARMAT L
191 3601045010050001 DIANA RAMADAN P
192 3601045012930006 SOPIAH P
193 3601045002960003 NIA ZULKARNAIN P
194 3203091110930011 DEDE FIRMAN L
195 3601042609980002 ANDRIANSYAH L
196 3601042704890002 JUHER L
197 3601044107000309 LALA YULIANTI P
198 3601044809830001 YAYAH SUHARIYAH P
199 3601044203970001 SUNENGSIH P
200 3601040809110001 NASIR L
201 3601040107710051 SARDAM L
202 3601041212920007 RATINI L
203 3601042005860001 RASID L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

03-06-1970 UMUM NANGGALA 085718800394

24-06-1988 UMUM NANGGALA 085773218967
15-02-1986 UMUM NANGGALA 082111549366
01-07-1974 UMUM NANGGALA 085211822867
08-08-1983 UMUM NANGGALA 081511959178
27-03-1976 UMUM NANGGALA 082297768800
01-07-1987 UMUM NANGGALA 085776716320
17-12-1997 UMUM NANGGALA 085210600529
10-07-1971 UMUM NANGGALA 085771913634
10-08-1970 UMUM NANGGALA 085827119599
27-04-1991 UMUM NANGGALA 085213110549
29-08-1998 UMUM NANGGALA 082113261685
05-07-1987 UMUM NANGGALA 081413487364
02-01-1992 UMUM NANGGALA 081617456413
06-07-1975 UMUM NANGGALA 085772740177
09-02-1990 UMUM NANGGALA 085740018524
09-04-1981 UMUM NANGGALA 085740018524
01-07-1958 LANSIA NANGGALA 081332114950
07-11-1995 UMUM NANGGALA 083179798507
06-06-1989 UMUM NANGGALA 085778282417
02-07-1963 UMUM NANGGALA 083890588266
08-09-1986 UMUM NANGGALA 085720607204
10-02-1980 UMUM NANGGALA 085740018524
09-06-1965 UMUM NANGGALA 08231250087
05-05-1989 UMUM NANGGALA 085714776053
28-04-1985 UMUM NANGGALA 081572743336
07-02-1970 UMUM NANGGALA 085814303350
01-07-2001 UMUM NANGGALA 085717563965
10-07-1992 UMUM NANGGALA 08154592451
01-07-1986 UMUM NANGGALA 08574038584
23-05-2007 REMAJA NANGGALA 083871877156
12-07-1965 UMUM NANGGALA 083871877156
01-07-1973 UMUM NANGGALA 085691316270
01-08-2003 REMAJA NANGGALA 085716576997
18-10-1985 UMUM NANGGALA 081511928283
22-03-1968 UMUM NANGGALA 085880005324
01-07-1984 UMUM NANGGALA 08347979850741
07-01-1982 UMUM NANGGALA 08121781718
30-01-1982 UMUM NANGGALA 085218170106
08-10-1999 UMUM NANGGALA 082312765395
27-11-2003 REMAJA NANGGALA 0857173502959
7-01-1969 UMUM NANGGALA 082113371749
01-07-1976 UMUM NANGGALA 085693603585
15-11-2005 REMAJA NANGGALA 085217563908
11-10-1997 UMUM NANGGALA 08528237643
14-07-1994 UMUM NANGGALA 085295409489
05-07-1994 UMUM NANGGALA 08521177437
01-07-1962 UMUM NANGGALA 085212849590
01-07-1951 LANSIA NANGGALA 085693603640
17-02-1995 UMUM NANGGALA 085280171243
01-07-1985 UMUM NANGGALA 083819339411
12-04-1975 UMUM NANGGALA 085772739883
14-09-1981 UMUM NANGGALA 085710770222
02-03-1969 UMUM NANGGALA 085211426941
14-05-1989 UMUM NANGGALA 085719069448
07-11-1998 UMUM NANGGALA 081219466923
29-09-1991 UMUM NANGGALA 081219466923
13-03-2005 REMAJA NANGGALA 085773624173
13-03-1990 UMUM NANGGALA 081517844550
28-11-1982 UMUM NANGGALA 08231810813
15-11-1997 UMUM NANGGALA 085886792080
14-01-1967 UMUM NANGGALA 085311554241
21-02-1996 UMUM NANGGALA 085773624346
01-07-1985 UMUM NANGGALA 08569182516
03-08-1972 UMUM NANGGALA 085691307212
16-09-1981 UMUM NANGGALA 085719648327
21-05-1979 UMUM NANGGALA 085882817515
05-09-2004 REMAJA NANGGALA 085772730610
17-08-1988 UMUM NANGGALA 081517285728
01-07-1989 UMUM NANGGALA 085691307212
21-07-1955 LANSIA NANGGALA 081280229985
01-07-1968 UMUM NANGGALA 085691307212
01-02-1983 UMUM NANGGALA 08191086223
14-05-2007 REMAJA NANGGALA 085280545982
16-03-1995 UMUM NANGGALA 083107982891
13-06-1975 UMUM NANGGALA 081511407982
01-07-1983 UMUM NANGGALA 085810133791
06-08-2007 REMAJA NANGGALA 085691307177
06-04-1996 UMUM NANGGALA 082123723668
06-08-1974 UMUM NANGGALA 082123723668
08-11-1974 UMUM NANGGALA 085692915743
14-06-1960 UMUM NANGGALA 082125223668
23-11-1968 UMUM NANGGALA 082125223668
01-07-1988 UMUM NANGGALA 082125223668
08-09-1965 UMUM NANGGALA 082125223668
16-09-1975 UMUM NANGGALA 082125223668
12-04-1997 UMUM NANGGALA 085771289818
11-01-1982 UMUM NANGGALA 085279280149
01-07-1949 UMUM NANGGALA 081511862749
17-01-1996 UMUM NANGGALA 085863416223
01-07-1995 UMUM NANGGALA 085782131287
17-05-1948 UMUM NANGGALA 081511899703
03-07-1987 UMUM NANGGALA 081511862749
02-04-1999 UMUM NANGGALA 085691096500
01-07-1961 UMUM NANGGALA 085694436764
02-01-1995 UMUM NANGGALA 085703083400
08-05-1987 UMUM NANGGALA 085718877044
17-05-1994 UMUM NANGGALA 085718877044
01-08-1985 UMUM NANGGALA 085718877044
07-05-1970 UMUM NANGGALA 085883202203
12-10-1979 UMUM NANGGALA 085751470725
01-07-1990 UMUM NANGGALA 085751470725
15-02-1989 UMUM NANGGALA 085751470725
09-03-1992 UMUM NANGGALA 085810132880
05-09-1973 UMUM NANGGALA 085288963938
20-08-1969 UMUM NANGGALA 085778279554
05-05-1994 UMUM NANGGALA 085778279554
28-03-1987 UMUM NANGGALA 085778279554
22-08-1974 UMUM NANGGALA 085776869612
17-06-1990 UMUM NANGGALA 085880901747
13-12-1995 UMUM NANGGALA 085772856250
01-07-1950 LANSIA NANGGALA 085772856250
15-05-1975 UMUM NANGGALA 083870877397
06-11-1971 UMUM NANGGALA 083870877397
10-10-1987 UMUM NANGGALA 085283533389
12-03-1988 UMUM NANGGALA 085283533389
05-06-1960 LANSIA NANGGALA 085283533389
09-06-1981 UMUM NANGGALA 085283533389
11-04-1985 UMUM NANGGALA 085283533389
25-09-2002 UMUM NANGGALA 085283533389
01-07-1965 UMUM NANGGALA 081522874232
21-08-1980 UMUM NANGGALA 081522874232
01-07-1962 UMUM NANGGALA 081522874232
09-09-1960 LANSIA NANGGALA 085773624106
02-07-1982 UMUM NANGGALA 085773624106
10-06-2000 UMUM NANGGALA 085773624106
14-08-1971 UMUM NANGGALA 081617456663
01-07-1993 UMUM NANGGALA 081617456663
25-05-1991 UMUM NANGGALA 081617456663
27-03-1971 UMUM NANGGALA 081617456663
06-05-1977 UMUM NANGGALA 081617456663
23-02-1982 UMUM NANGGALA 085774964791
17-03-1999 UMUM NANGGALA 085774964791
17-05-1973 UMUM NANGGALA 085810132980
 28-06-1999 UMUM NANGGALA 085810132980
24-07-2001 UMUM NANGGALA 085810132980
27-06-1992 UMUM NANGGALA 081584955552
11-11-1981 UMUM NANGGALA 081584955552
01-07-1976 UMUM NANGGALA 081584955552
12-01-2001 UMUM NANGGALA 081584955552
15-04-1977 UMUM NANGGALA 081584955552
11-02-1999 UMUM NANGGALA 081584955552
07-12-2006 REMAJA NANGGALA 081584955552
27-03-1992 UMUM NANGGALA 087870094386
5/5/1981 DESA NANGGALA 085691134258
5/1/1975 NANGGALA 085772740177
10/2/1975 NANGGALA 085691154228
10/13/1997 NANGGALA 083890588266
8/8/1987 NANGGALA 085691134258
8/30/2006 REMAJA NANGGALA 085695409565
5/15/2001 NANGGALA 085691805358
11/23/1996 NANGGALA 085776869612
7/1/1980 NANGGALA 085773624071
8/12/2006 REMAJA NANGGALA 083870874397
5/29/1999 NANGGALA 083804126934
11/30/1974 CIKEUSIK 085693293617
12/2/2004 REMAJA NANGGALA 085695409639
1/1/1960 LANSIA NANGGALA 083179798507
8/4/2000 NANGGALA 085774305323
7/1/1970 NANGGALA 085892747460
5/1/1960 NANGGALA 081517894161
7/1/1914 NANGGALA 085715496808
2/2/1975 NANGGALA 085888551639
11/23/1993 NANGGALA 085817959800
4/6/1968 NANGGALA 085778281050
8/7/1988 NANGGALA 085779170391
12/10/1970 NANGGALA 085718778667
8/10/2005 REMAJA NANGGALA 081617456265
3/7/1978 NANGGALA 082298536866
8/7/1984 NANGGALA 083815154322
2/10/1948 REMAJA NANGGALA 083815154322
6/3/1950 REMAJA NANGGALA 085715496808
8/18/1990 NANGGALA 085779170255
7/1/1967 NANGGALA 085717563941
9/12/1984 NANGGALA 085839070211
10/3/1982 NANGGALA 085175496734
7/1/1972 NANGGALA 085216583063
7/22/1965 NANGGALA 085219518264
7/3/2002 NANGGALA 085719437051
03/06/1992 NANGGALA 085771289164
4/3/2000 NANGGALA 085779054294
 2/15/1963 NANGGALA 081511899703
6/1/1956 NANGGALA 085883567318
10/4/1988 NANGGALA 082282322029
4/8/1981 NANGGALA 085771308715
6/27/2008 NANGGALA 081584376583
9/4/2001 NANGGALA 085773668164
2/2/2000 NANGGALA 08158475887
4/25/1988 NANGGALA 085880329481
11/14/1992 NANGGALA 085893508537
10-10-2005 REMAJA NANGGALA 085893508537
10-12-1993 UMUM NANGGALA 0859302940003
10-02-1996 UMUM NANGGALA 0859302940003
11-10-1993 UMUM NANGGALA 0859302940003
26-09-1998 UMUM NANGGALA 08588000465
27-04-1989 UMUM NANGGALA 08528344774
01-07-2000 UMUM NANGGALA 082111614253
24-01-1984 UMUM NANGGALA 081297800512
02-03-1997 UMUM NANGGALA 081297800512
08-09-1977 UMUM NANGGALA 083896745133
01-07-1971 UMUM NANGGALA 082896745133
12-12-1992 UMUM NANGGALA 082896745133
20-05-1986 UMUM NANGGALA 082896745133
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi
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Dosis I Dosis 2
Tanggal KET
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi
2021081664 I
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2021081664 I
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202108164I
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NO No. Ticke NIK Nama Penerima Vaksin JK

1 3601040107660116 AHDA L
2 3601041204930001 SACA L
3 3601041310820002 USMAN L
4 3601040911020001 RUSLAN L
5 3601041003700003 ASIM L
6 3601040601880001 KADIL L
7 3601040607870007 ARDIPAN L
8 3601046401790002 ANAH P
9 3601044702920008 MAULIDAH P
10 360104460010003 RUYANAH P
11 3601044302850001 YATI P
12 3601045806050001 NENG RINA P
13 3601045102730003 KEKEM P
14 3601046007710001 MARIAM P
15 3601044408650002 ASMAH P
16 360104010810007 NURHAELI L
17 3601045909020002 ROMSIH P
18 3601044104720002 MISNAH P
19 3601040302750002 RANTA B SANURI L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

PETANI 01-07-1966 UMUM CIKDONG 085695331798

PELAJAR 12-09-1998 UMUM CIKDONG 085891708763
WIRASWASTA 13-10-1982 UMUM CIKDONG 085694065965
PELAJAR 09-11-2002 UMUM CIKDONG 081585462849
PETANI 10-03-1972 UMUM CIKDONG 085797175949
BELUM KERJA 06-11-1990 UMUM CIKDONG 085813295343
PETANI 06-07-1987 UMUM CIKDONG 085813295343
IRT 24-01-1979 UMUM CIKDONG 05111406422
IRT 07-02-1992 UMUM CIKDONG 085715270562
IRT 01-06-2000 UMUM CIKDONG 085691308498
IRT 03-02-19885 UMUM CIKDONG 0857736630724
PELAJAR 18-06-2005 UMUM CIKDONG 085781795910
IRT 11-02-1973 UMUM CIKDONG 085890550074
IRT 20-07-1971 UMUM CIKDONG 085811461758
IRT 04-08-1990 UMUM CIKDONG 085351052102
HONORER 09-02-1985 UMUM CIKDONG 085782266752
IRT 19-09-2002 UMUM CIKDONG 085715413185
IRT 01-04-1972 UMUM CIKDONG 081574848317
WIRASWASTA 03-02-1975 UMUM CIKDONG 081413473455
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch No seri
PBI Non PBI Anggota
Vaksinasi
CORONAVAC 24-11-2021 24-11-2021 24203721
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CORONAVAC 24-11-2021
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 21-10-2021 202108145H
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021
CORONAVAC 24-11-2021 29-06-2021 2403121
CORONAVAC 24-11-2021 24-11-2021 24203721
CORONAVAC 24-11-2021
CORONAVAC 24-11-2021 16-09-2021 24201721
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

24-11-2021 24203721

24-11-2021 24203721

24-11-2021 24203721
24-11-2021 24203721

24-11-2021 24203721
24-11-2021 24203721
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601044107760030 IYUM P
2 3601044107580003 EBAH P
3 3601040606760001 JEJEN L
4 3601044107730061 ARWIYAH P
5 3601044107830061 BEKAH P
6 3601040102810001 KUJUM L
7 3601044805980001 UUN UNASIH P
8 3601045603820002 DARWATI P
9 3601044507750004 NAWI P
10 3601041202780002 ROJAI L
11 3601040607840002 IIP IBROHIM L
12 3601044106960001 ROHANAH P
13 3172035010790024 NANI JUNENGSIH P P
14 3601046001710003 EBAH P
15 3601045305850005 JUHENI P
16 3601044407890004 SURYATI P
17 3601044701850012 ANAH P
18 3601044107510009 MINAH P
19 3601040107710019 MARSUDIN L
20 3601040107730066 CARI L
21 3601040107560025 ABAS L
22 3601041211880004 ENDI L
23 3601040107680045 CASIDIN L
24 3601044107770020 JUHARIAH P
25 3601044903790002 CICIH P
26 3601044301800006 MURSINAH P
27 3601040107820005 HENDRA L
28 3601044107630050 SUKANAH P
29 3601044107750040 SARTINAH P
30 3212220911880002 KARYANI L
31 3602211212900000 HAPIPI L
32 3601044601850001 ENI P
33 3601044107510005 JANIMAH P
34 3601041702960004 ARDI L
35 3601046008940003 UUN P
36 3601046705820001 CIAH P
37 3601044703870001 DARSINIH P
38 3601040107770011 ARIP RAHMAN L
39 3601042306010002 ALMAN FAUZAN L
40 3601040107880047 SARNATA L
41 3601044907970004 SANAH P
42 3601040107750020 SARPANI L
43 3601046104920001 AMILIA P
44 3601040107830041 WAHYU L
45 3601045506820005 IPAH P
46 3601040402960008 UMRI L
47 3601040107740020 AMAD L
48 3601044107310004 AMINAH P
49 3601040107610013 H.KARNASIM L
50 3601045509700001 SITI P
51 3601045103730003 UMI P
52 3601044102810001 MULYATI P
53 3601040107720010 PADI L
54 3601045609780001 RUMSIAH P
55 3601044406860008 SAROH P
56 3601044108990004 FITRI YANI P
57 3601040302780002 JUMAR L
58 3601041312660001 SIDIK L
59 3601044107630044 ETI P
60 3601044509920003 SUPI P
61 3601044107830060 SANEHA P
62 3601040601760003 HERMAN L
63 3601044107660013 RUMAAH P
64 3601046910710002 MARHAMAH P
65 3601040107780069 TARDI L
66 3601042102890003 UBAT L
67 3601046003000004 ANI ANGGRAENI P
68 3601046911700001 EMUN P
69 3601044107760025 GANUNG P
70 3601040107530033 SOLE L
71 3601044607750004 RUMSAH P
72 3601040107570020 KAMAD L
73 3601040107780051 ASHARI L
74 3601044210900006 ERAT P
75 3601044107550012 PACAS P
76 3601044107900029 SAWATI P
77 3601045206890006 HOLIFAH P
78 3601041412950005 ASEP KURNIA L
79 3601041207900001 WASAN L
80 3601040202820002 JUNAIDI L
81 3601042407580001 SUPYANI L
87 3601044505880003 NENGSIH P
83 3601044503790001 TARSUMI P
84 3601040107510002 SUHANDI L
85 3601044107230000 ATMAH P
86 3601041501910001 ABDUL LATIF L
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

IRT 05-06-1986 UMUM SUMURBATU 085716591435

IRT 01-07-1958 UMUM SUMURBATU 085718719716
WIRASWASTA 06-06-1976 UMUM SUMURBATU 085714786300
IRT 05-03-1973 UMUM SUMURBATU 081298752147
IRT 01-04-1985 UMUM SUMURBATU 085886096863
WIRASWASTA 27-01-1980 UMUM SUMURBATU 082312886953
IRT 08-05-1999 UMUM SUMURBATU 085718886952
IRT 16-03-1982 UMUM SUMURBATU 085693152642
IRT 05-07-1975 UMUM SUMURBATU 083102633747
WIRASWASTA 16-02-1968 UMUM SUMURBATU 083872917482
WIRASWASTA 06-07-1984 UMUM SUMURBATU 085695148049
IRT 01-06-1996 UMUM SUMURBATU 085695148048
IRT 10-10-1979 UMUM SUMURBATU 085778068373
IRT 20-03-197 UMUM SUMURBATU 083198901027
IRT 13-05-1985 UMUM SUMURBATU 085886096763
IRT 05-07-1989 UMUM SUMURBATU 085217323575
IRT 07-01-1985 UMUM SUMURBATU 082316217872
IRT 01-07-1951 UMUM SUMURBATU 085695907994
WIRASWASTA 30-03-1971 UMUM SUMURBATU 085691054497
PETANI 01-07-1973 UMUM SUMURBATU 085216773398
PETANI 04-07-1956 UMUM SUMURBATU 081511512230
PETANI 12-11-1988 UMUM SUMURBATU 081283759102
PETANI 14-02-1968 UMUM SUMURBATU 085691171727
IRT 05-04-1978 UMUM SUMURBATU 085718265022
IRT 09-03-1979 UMUM SUMURBATU 08572249169
IRT 03-01-1980 UMUM SUMURBATU 085992720194
WIRASWASTA 01-0701982 UMUM SUMURBATU 081280854802
IRT 01-07-1963 UMUM SUMURBATU 081223998366
IRT 01-07-1975 UMUM SUMURBATU 085691054497
PETANI 09-11-1988 UMUM SUMURBATU 085778060373
PETANI 12-12-1990 UMUM SUMURBATU 081391193296
IRT 06-01-1985 UMUM SUMURBATU 085780045170
IRT 01-07-1951 UMUM SUMURBATU 085780045170
WIRASWASTA 17-02-1996 UMUM SUMURBATU 082269891097
IRT 20-08-1994 UMUM SUMURBATU 082269890197
IRT 20-08-1980 UMUM SUMURBATU 085216560352
IRT 07-08-1987 UMUM SUMURBATU 085213478192
WIRASWASTA 01-01-1977 UMUM SUMURBATU 085778068373
WIRASWASTA 23-06-2001 UMUM SUMURBATU 085693152642
WIRASWASTA 01-07-1986 UMUM SUMURBATU 085811012158
IRT 09-07-1997 UMUM SUMURBATU 082312399001
WIRASWASTA 10-10-1976 UMUM SUMURBATU 085817462831
IRT 21-04-1992 UMUM SUMURBATU 085714215411
WIRASWASTA 22-05-1985 UMUM SUMURBATU 085211488882
IRT 15-06-1982 UMUM SUMURBATU 085282324163
WIRASWASTA 04-02-1993 UMUM SUMURBATU 085778678575
WIRASWASTA 08-11-1979 UMUM SUMURBATU 081573628213
IRT 01-07-1977 UMUM SUMURBATU 085773225543
WIRASWASTA 15-12-1961 UMUM SUMURBATU 085219338629
IRT 15-09-1970 UMUM SUMURBATU 085886096863
IRT 11-03-1973 UMUM SUMURBATU 085319169119
IRT 01-02-1981 UMUM SUMURBATU 085771007184
WIRASWASTA 01-07-1972 UMUM SUMURBATU 085319169119
IRT 16-09-1978 UMUM SUMURBATU 085717160311
IRT 04-06-1986 UMUM SUMURBATU 085693560836
IRT 01-08-1999 UMUM SUMURBATU 085782011033
WIRASWASTA 03-02-1978 UMUM SUMURBATU 085773225548
WIRASWASTA 13-12-1966 UMUM SUMURBATU 085692044672
IRT 04-03-1963 UMUM SUMURBATU 0857753943
IRT 05-09-1992 UMUM SUMURBATU 083804752091
IRT 01-5-1987 UMUM SUMURBATU 085695141635
PETANI 06-01-1976 UMUM SUMURBATU 085695148566
IRT 01-07-1966 UMUM SUMURBATU 085782010333
IRT 16-10-1968 UMUM SUMURBATU 085217251752
WIRASWASTA 11-09-1978 UMUM SUMURBATU 085861642511
PETANI 21-02-1989 UMUM SUMURBATU 085811463982
IRT 20-03-2000 UMUM SUMURBATU 085716591435
IRT 29-11-1970 UMUM SUMURBATU 081511690562
IRT 30-01-1978 UMUM SUMURBATU 085861642511
PETANI 01-07-1953 UMUM SUMURBATU 085773751797
IRT 03-05-1988 UMUM SUMURBATU 081250054204
PETANI 01-07-1957 UMUM SUMURBATU 085773751797
PETANI 01-07-1978 UMUM SUMURBATU 085695148566
IRT 02-10-1990 UMUM SUMURBATU 085714378660
IRT 06-01-1956 UMUM SUMURBATU 085214157365
IRT 01-07-1990 UMUM SUMURBATU 083871286556
IRT 12-06-1989 UMUM SUMURBATU 085715847773
WIRASWASTA 14-12-1995 UMUM SUMURBATU 085797413811
WIRASWASTA 06-04-1989 UMUM SUMURBATU 085781549491
WIRASWASTA 02-02-1982 UMUM SUMURBATU 085719019146
WIRASWASTA 04-02-1966 UMUM SUMURBATU 085773668121
IRT 05-05-1988 UMUM SUMURBATU 085695388408
IRT 05-03-1979 UMUM SUMURBATU 085881197221
WIRASWASTA 01-07-1951 UMUM SUMURBATU 085774957762
IRT 24-04-1977 UMUM SUMURBATU 085211564024
WIRASWASTA 03-02-1990 UMUM SUMURBATU 085773226031
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal Tanggal
BPJS BPJS Non Merek Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

CORONAVAC 24-11-2021 24-11-2021

CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
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CORONAVAC 24-11-2021 24-11-2021
CORONAVAC 24-11-2021 24-11-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
Dosis I Dosis 2

Tanggal KET
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
24-11-2021 202109177M
24-11-2021 202109177M
24-11-2021 202109177M
24-11-2021 202109177M
NO No. Ticket NIK Nama Penerima Vaksin

1 3601044507090002 CIKA RAMADANI

2 3601044108780005 NURBAYITI
3 3601040811080001 ADITYA
4 360104110070003 DAYAT
5 3601046701080001 CISTO WANARI
6 3601045708080006 CIKA AGUSTIN
7 3601040806080001 HUMAEDI
8 3601044212080002 SITI NURFADILAH
9 3601042005090003 M RIZKI
10 3601045811080001 SADIAWATI
11 3601041005070001 NENDI
12 3601042501080002 MUHAD
13 3601041501090004 M JAKARIA
14 3601045107080007 LELA KOMALASARI
15 3601044107080033 NENG AYU
16 3601041602080002 AHMAD SAEPUDIN
17 3601045806080001 LESTINA
18 3601040107070002 ROHMAN
19 3601042012070003 LANI
20 3601040812070002 MARSEL HERLANGGA P
21 3601041504090001 JAMANI
22 3601041402080001 RENO ARDIANSYAH
23 3601043010070001 M HENDRI GUNAWAN
24 3601040111080002 ISMAN
25 3601044302080001 MELDA
26 3601044112080002 LENI
27 3601047005080001 IMAS NATALISA
28 3601045407090001 DEWI SARI
29 3601046707080001 DESI RATNASARI
30 3601045301080001 HAJIZAH D
31 3601040410060003 ERDI SUPYANI
32 3601044106080007 ANIH MITALIA
33 3601046205090001 ALYA TUNNISA
34 3601044308080005 AIRIN LIA A
35 3601046806080004 ALIVIA
36 3601044310060004 WULAN
37 3601044702080001 SULISTIAWATI
38 3601046902080001 SOPI FITRIANI
39 3601044101070010 SITI FATIMAH
40 3601044704000001 SAFITRI APRILIANI
41 3601041009070002 FAHMI ROJI
42 3601041205080005 RAKA
43 3601046008050001 DINI
44 2171116811069010 AYUNDA PUSPITA SARI
45 3601046403070002 AMEL
46 3601045502050002 WAHYUNIA SAPITRI
47 3601040105070006 AHMAD
48 3601041103050005 SAPRUDIN
49 3601044505080003 YERNI
50 3601040103070004 M FAISAL FAHMI
51 3601041505080002 SUTIONADIN
52 3601045801090002 SITI LIRIK RISKA
53 3601041105080004 IRMAN
54 3601045008070004 HONIFAH
55 3601046806080003 HERLINA
56 3601040610080001 M RANGGA WIJAYA
57 3601045602080005 ELA LESTARI
58 3601040111060007 SARNA
59 3601047103090001 NENTI
60 3601046607090002 MURNIAH
61 3601042812080002 M QIAN WALYANO
62 3601045006080002 LATIPAH
63 1603204107070004 HANI HELMALIA P
64 3601046206070605 RATMI PUTRI INDAH S
65 3601044908060001 YUYUN KOMALASARI
66 3601044701020001 RUDI IRAWAN
67 3601044612070001 REVI MARISKA
68 3601045504060001 MIRAWATI
69 3601042010070001 JUMADI
70 3601041703070001 GEMPAR BRATA YUDA
71 3601041501070004 MUHAMAD RIFAL
72 3601040309070001 GALUH MAULANA
73 3601045002070002 HERNI MUPLIHAT
74 3601041002170002 FEBI
75 3601041001050002 ERWIN
76 3601044701070004 EMPAI AULIAWATI
77 3601046808070001 DEVI AGUSTIN
 Umur Kelomp
JK Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

P 5/7/2009 UMBULAN 081577488392

P 8/1/1978 UMBULAN 085280006410
L 11/8/2008 UMBULAN 082372422721
L 8/7/2007 UMBULAN 081284438082
L 1/27/2006 UMBULAN 085891625493
P 8/17/2008 UMBULAN 081231419057
L 4/12/2008 UMBULAN 085779950817
P 12/2/2008 UMBULAN 083808954694
L 5/20/2009 UMBULAN 085122880270
P 11/18/2008 RANCASENENG 082312399266
L 5/10/2007 UMBULAN 081284438082
L 1/25/2008 SUMURBATU 085718719605
L 10/15/2009 SUMURBATU 081284438012
P 7/11/2008 UMBULAN 081511690534
P 7/1/2008 UMBULAN 081574883922
L 2/16/2008 SUKASENENG 082312399266
P 6/18/2008 UMBULAN 085718763867
L 12/15/2007 UMBULAN 085772728771
P 12/20/2007 SUKAMULYA 08581119386
L 12/8/2007 UMBULAN 085719435981
L 7/18/2007 SUKAMULYA 085871218993
L 2/14/2008 UMBULAN 08577728771
L 10/30/2007 RANCASENENG 081200000000
L 11/1/2008 SUMURBATU 081511754450
P 2/3/2008 RANCASENENG 08125756641
P 12/1/2008 UMBULAN 082125756817
P 5/30/2008 UMBULAN 082125756817
P 7/16/2009 RANCASENENG 081231414057
P 7/23/2008 RANCASENENG 085897828926
P 1/13/2008 UMBULAN 085719063972
L 10/4/2006 UMBULAN 082125756638
P 6/1/2008 UMBULAN 083891728381
P 5/22/2009 CIKEUSIK 081210558217
P 8/3/2008 SUMURBATU 085881196609
P 6/28/2008 SUMURBATU 085711304710
P 10/3/2006 SUMURBATU 085811282972
P 2/7/2008 UMBULAN 082125756848
P 2/29/2008 UMBULAN 085722049137
P 1/1/2007 UMBULAN 081284438082
P 4/5/2007 UMBULAN 085694941713
L 9/10/2007 SUMURBATU 081349731073
L 5/12/2008 SUKAMULYA 081284438082
P 8/20/2005 UMBULAN 08151969570
P 11/28/2006 UMBULAN 081380199520
P 3/24/2007 SUMURBATU 081585776144
P 9/15/2007 SUKAMULYA 085773225931
L 5/1/2007 SUMURBATU 081511928792
L 3/11/2005 SUMURBATU 081312109805
P 5/5/2008 UMBULAN 0858923626494
L 3/4/2007 UMBULAN 085778980763
L 5/15/2008 SUMURBATU 082125756509
P 1/18/2009 UMBULAN 082125756712
L 5/11/2008 SUMURBATU 082125756638
P 8/10/2007 UMBULAN 081284438082
P 6/28/2008 UMBULAN 081311188472
L 8/6/2008 RANCASENENG 081284438082
P 2/16/2008 RANCASENENG 081284438082
L 11/1/2006 SUMURBATU 081284438082
P 3/31/2009 UMBULAN 085861599183
P 7/26/2009 UMBULAN 085695267307
L 12/28/2008 RANCASENENG 081542346174
P 6/10/2008 RANCASENENG 081284438082
P 7/1/2007 RANCASENENG 085694587210
P 6/22/2007 RANCASENENG 08562323393
P 3/9/2007 SUKAMULYA 087772691175
L 12/3/2004 UMBULAN 085774961443
P 7/15/2007 SUKAMULYA 081351495919
P 4/15/2006 UMBULAN 085591806122
L 10/20/2007 UMBULAN 085774961442
L 3/17/2007 CIKIRUHWETAN 0877605557
L 1/15/2007 UMBULAN 085774961442
L 7/27/2007 SUKAMULYA 085771308692
P 2/17/2007 UMBULAN 087837432722
P 2/13/2007 CIKEUSIK 085773237548
L 6/9/2006 UMBULAN 085771309692
P 1/7/2007 CITEREP 085773525426
P 8/28/2007 CIKEUSIK 085624970471
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
CORONAVAC 11/25/2021
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 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
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NO No. Ticke NIK Nama Penerima Vaksin

1 3601044108670001 EROH ROHAYATI

2 3601274508880001 AISAH
3 3601045503880001 MISNAH
4 3601044206000005 WINDI ASTUTI
5 3601034406000002 ERNI
6 3601040209770002 JUMSIN
7 3601271508010001 SUPRADI
8 3601045107710001 YATI
9 3601046107450003 MISNI
10 3601040711970001 ADING ASMARA
11 3601044203750001 SURYATI
12 3601041008530001 ROSID
13 3601041411690001 ATO
14 3601044306680002 RATMINAH
15 3601045508930006 SAETI
16 3601270207760001 SACA
17 3601042909930001 SANAM
18 3601046101730001 NENGSIH
19 3601045908790001 IROH
20 3601045507850004 ASMI
21 3601046105770001 NONIH
22 3601270107770074 HARTO
23 3601045003910001 SUMYATI
24 3601046709920001 SITI AISAH
25 3601046005650001 KARSIDAH
26 3601044810700003 WATI
27 1801171702950003 RUDI SANTOSO
28 3601046502970001 DEWI S
29 1807121306030002 FATUR ROHMAN
30 3601040107650002 H.ABDUL GAPUR
31 3601040508970009 HAERUDIN
32 3601040106750015 AHYANI
33 3275020802040002 MUHAMMAD DZIKRI AL-WAFFA
34 3602073108970001 DADAN HERDINAR
35 3601046401700002 SARAH
36 3601045210830001 TETI RUSMAYANTI
37 3601041912640001 WARYO
38 3601045001990004 RINDI YANI
39 3601046007600001 UMSAH
40 3601044910720001 MIN
41 3601044304890003 NARPAH
42 3601044803890001 FITRI FITRIYANI
43 3601046512930001 WANAH
44 3601046004020001 PUPUT
45 2172026010860002 OCHA MAHESA
46 3601041405930001 IWAN FALES
47 3601042512590001 SUMANTA
48 3601047009800002 TIAH
49 3601044901650002 SARMI
50 3601045110750001 RUYAT
51 3601044208920002 ETI
52 3601040206790003 MUKTAR
53 1801152307990002 FIRDAUS
54 3601041010760002 MAMAN
55 3601041011920004 DIDING
57 3326073108030001 M.FIRDAUS
58 3602011007990002 DENI
59 3601040412720002 DAPI
60 3601044203020001 ELVI SUKAESIH
61 3329091606040011 ANDRIYAN NUGROHO
62 3674012203040001 SEPTA MAULANA IDRIS
63 3601042003000004 MEDI FERDIANSYAH
64 3601041107750001 KUDIL
65 360104042306710004 RAMAN
66 360104251000001 YAYAN SOPYANO
67 180115180790001 SARYO
68 3601045601800005 NURJANAH
69 3601040607720002 YAYAT S
70 3601046303000003 HERA
71 3601041002010001 ADIN
72 3601045606990003 LENI LIDIANTI
73 3601044707880008 TITIN
74 3601045701760001 SARNATI
75 3601045007000009 ASNAH
76 3601045102630001 UPI
77 3601041011950001 MUSTOFA KAMALUDIN
78 3601042711450001 MISTA
79 3201330100070004 M.DESKA WARDANA
80 3601042012650001 UDIN RAWING
81 3601046411050001 MURNI
82 3601046209960001 ARDI
83 3601044202020006 EVA LUSIANA
84 3601046008800007 JUMI
85 36010446118900004 SUSI SUMIYATI
86 3601041107870005 ENDI
87 1611022210880003 DELI AMARTA
88 3601041102770001 PULUNG
89 3502086610900001 NIHAYAH LU'AILI
90 3601046503780005 jarti
91 3601044707880008 titin
92 360102215309950001 siti fatimah
93 3601046311840001 armi
95 360101045409800001 ida hamidah
96 3601041710730001 parman
97 3601044106810005 Santini
98 3601046704730001 Tini
99 3601041503980007 Jeje
100 3601045602020003 Ucu
101 3601045502930001 Saiah
102 3601041502950002 Bohani
103 3601044302000009 Susi Amelia
104 3601042004030001 Abdurohim Firdaus
105 3601045303930003 Asih
106 2771100510080001 M.Haikal Nidarwan
107 3604280606050002 Rivaldi Regitian
108 3601043012890001 Bustomi
109 '3601040207690002 Kasan
110 3601045608690001 Irna
111 3601045304040005 fatimah
112 3601041009670004 Muslimin
113 3674041611640005 Andi warsidi
114 1471111807040002 m.aulia
115 3601041110970008 atep sapullah
116 360045512530001 Een
117 3601040109040003 Faiz Farhan
118 3601040101810013 Ukat
119 3174041609050001 M daud armando
120 3306134306970001 Sumiati
121 3601041405810002 Saprudin
122 3601045206630001 Suarsih
123 2171112111059003 M.Rafli Aidi
124 3601040607020010 Irwansyah
125 3601046002960007 Siti sowiyah
126 3601040103920008 Hendi
127 3171012211040001 Ridho ahmad kiko
128 3601042007030001 Rahmad Bagus
129 3601042003000001 D.Rudi Sbastian F
130 36044708800001 Arti
131 Diana Sari
132 3601041606830005 Wawan
133 3601041110620001 sahril
134 3601045109710001 Isah
135 3601045006780003 Samsiah
136 3601045007950004 Titin
137 1801150509920003 Dafid Anwar
138 3601045406650001 jumasih
139 3601045102920005 Siti aminah
140 3674012206050004 Arif L
141 3173080205040003 Miftahul rizki
142 3601045807600001 Sarmi
143 1802011708030004 Adi agustin
144 3275051407030010 Angga irawan
145 3601040803940001 Ahid
146 3601046401760001 sarah
147 360104102040004 Itang
148 3601041702700001 Ardi
149 3602010807030001 ayung supriatna
150 3601040407030003 Aan andika
151 3601042808820001 Pupu
152 3601044207730005 Kaswi
153 3601041202920002 Jujun
154 360104551062001 Onih
160 360104600760001 Umsah
162 3601046401700002 Sarah
163 2171110806049006 M.paujan
164 15030103805001 Mahroja
165 321621300103006 ilham n
166 3601044101000002 Hesti
167 360207470703001 Nahdiatus Shopa
168 360104270393008 Ade
169 3601041106920001 Minan
170 360146307670001 TiYah
171 360104520103004 Dede Yanti
172 36104510246005 Elis Isnawati
173 360221160905001 M.haerul
174 3601041502900001 Santana
175 6102010705070002 Arip F
176 3601041105840002 Iilyasa
177 3601046407670002 RakmAAh
178 36010464102540001 Murti
179 3602041007870012 Rohim
180 3602011206990001 Heru
181 317405300704004 M.Arkila
182 3601044406760003 Suarsih
183 1801211012960001 Rahman
184 1671062209090001 FIKRI RAFIANSYAH
185 1801084302080002 SELVI SANDRA A
186 3674074103050001 AJENG RETNO
187 3601042805820001 KARMIN
188 3322125408050001 KHAFIDZOTUL ULYA MUJAHADA
189 3201224909990011 ANGGI ANGGRAENI
190 3601105704070002 APRILIANITA R
191 3601026808080002 VITA OLIVIA
192 3602215501090002 IKA PUSPITA
193 320411501190005 SIREN ALIFAH
194 3603186912090002 RIFATUL JANNAH
195 3216024412040012 ROVIAL YUNAYAH
196 3603186512050001 NOVIA IMANIAR
197 3601021504040001 ERIYANSAYAH
198 1671061105070007 M.DONI
199 1671062204060006 BAHRUL ALAM
200 3601046104960001 IMASLIAH
201 3601046911980001 MELAWATI
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat
ok Umur
tahun)

P 01-08-1967 UMUM KORAMIL TANJUNGAN

P 05-08-1986 KORAMIL TANJUNGAN
P 15-03-1990 KORAMIL TANJUNGAN
P 02-06-2000 KORAMIL TANJUNGAN
P 02-02-2000 KORAMIL TANJUNGAN
P 02-09-1977 KORAMIL TANJUNGAN
L 15-08-2001 KORAMIL TANJUNGAN
P 11-07-1971 KORAMIL TANJUNGAN
P 21-07-1995 KORAMIL TANJUNGAN
L 15-04-1997 KORAMIL TANJUNGAN
P 2/3/1975 KORAMIL TANJUNGAN
L 03-06-1954 LANSIA KORAMIL TANJUNGAN
L 14-11-1969 KORAMIL TANJUNGAN
P 03-05-1988 KORAMIL TANJUNGAN
P 15-08-1993 KORAMIL TANJUNGAN
L 02-07-1980 KORAMIL TANJUNGAN
L 29-09-1933 KORAMIL TANJUNGAN
P 21-01-1951 KORAMIL TANJUNGAN
P 19-08-1979 KORAMIL TANJUNGAN
P 15-07-1985 KORAMIL TANJUNGAN
P 21-05-1977 KORAMIL TANJUNGAN
L 29-03-1969 KORAMIL TANJUNGAN
P 10-03-1991 KORAMIL TANJUNGAN
P 27-09-1992 KORAMIL TANJUNGAN
P 20-05-1965 KORAMIL TANJUNGAN
P 08-10-1970 KORAMIL TANJUNGAN
L 17-02-1995 KORAMIL TANJUNGAN
P 05-02-1997 KORAMIL TANJUNGAN
L 13-06-2003 KORAMIL TANJUNGAN
L 25-07-1966 KORAMIL TANJUNGAN
L 05-08-1997 KORAMIL TANJUNGAN
L 01-06-1975 KORAMIL TANJUNGAN
L 08-02-2004 REMAJA KORAMIL TANJUNGAN
L 31-08-1997 KORAMIL TANJUNGAN
P 06-08-1960 KORAMIL TANJUNGAN
P 25-08-1986 KORAMIL TANJUNGAN
L 05-12-1962 KORAMIL TANJUNGAN
P 10-01-1999 KORAMIL TANJUNGAN
P 20-07-1960 KORAMIL TANJUNGAN
P 14-11-1968 KORAMIL TANJUNGAN
P 03-04-1989 KORAMIL TANJUNGAN
 P 08-03-1989 KORAMIL TANJUNGAN
P 22-06-1993 KORAMIL TANJUNGAN
P 20-04-2002 KORAMIL TANJUNGAN
L 20-10-1986 KORAMIL TANJUNGAN
L 14-05-1993 KORAMIL TANJUNGAN
L 01-11-1959 KORAMIL TANJUNGAN
P 30-09-1980 KORAMIL TANJUNGAN
P 01-09-1970 KORAMIL TANJUNGAN
P 11-10-1975 KORAMIL TANJUNGAN
P 02-08-1992 KORAMIL TANJUNGAN
L 02-06-1979 KORAMIL TANJUNGAN
L 23-07-1999 KORAMIL TANJUNGAN
L 10-10-1976 KORAMIL TANJUNGAN
L 10/11/1992 KORAMIL TANJUNGAN
L 31-08-2003 KORAMIL TANJUNGAN
L 10-07-1998 KORAMIL TANJUNGAN
L 4/12/1972 KORAMIL TANJUNGAN
P 02-03-2002 KORAMIL TANJUNGAN
L 16-06-2004 REMAJA KORAMIL TANJUNGAN
L 22-03-2004 REMAJA KORAMIL TANJUNGAN
L 25-03-2000 KORAMIL TANJUNGAN
L 1973 KORAMIL TANJUNGAN
L 23-06-1971 KORAMIL TANJUNGAN
L 25-10-2000 KORAMIL TANJUNGAN
L 18-07-1997 KORAMIL TANJUNGAN
P 16-01-1980 KORAMIL TANJUNGAN
L 6/7/1972 KORAMIL TANJUNGAN
P 23/03/2000 KORAMIL TANJUNGAN
L 11/8/2000 KORAMIL TANJUNGAN
P 16-06-1999 KORAMIL TANJUNGAN
P 07071988 KORAMIL TANJUNGAN
P 17-01-1976 KORAMIL TANJUNGAN
P 10/7/2000 KORAMIL TANJUNGAN
P 11/2/1963 KORAMIL TANJUNGAN
L 11/8/2001 KORAMIL TANJUNGAN
L 5/6/1998 KORAMIL TANJUNGAN
L 1/6/2007 KORAMIL TANJUNGAN
L 20-12-1965 KORAMIL TANJUNGAN
P 24-11-2005 KORAMIL TANJUNGAN
L 25-12-1995 KORAMIL TANJUNGAN
P 2/2/2002 KORAMIL TANJUNGAN
P 20-08-1980 KORAMIL TANJUNGAN
P 6/11/1989 KORAMIL TANJUNGAN
L 11/7/1987 KORAMIL TANJUNGAN
L 25-11-1987 KORAMIL TANJUNGAN
L 11/2/1977 KORAMIL TANJUNGAN
P 26-100-1990 KORAMIL TANJUNGAN
p 25-03-1978 KORAMIL TANJUNGAN
p 07-07-1968
p 13-09-1995
p 23-11-1982
p 14-09-1980
l 17-10-1971
P 01-06-1981
P 17-03-1961
L 3/15/1998
P 16-02-2002
P 15-02-1993
L 15-02-1995
P 03-02-2000
L 02-01-2003
P 13-02-1993
L 05-10-2008
L 06-06-2005
L 11-1-1990
L 02-07-1969
P 16-08-1969
P 13-04-2004
L 10-09-1997
L 16-11-1964
L 18-07-2004
L 11-10-1997
P 15-12-1953
L 01-09-2004
L 01-01-1981
L 16-09-2005
P 03-06-1997
L 5/14/1981
P 03-01-1967
L 21-11-2005
L 06-07-2001
P 20-02-1986
L 01-03-1992
22-11-2004
L 20-07-2003
L 21-03-2000
P 05-10-1985
P 11/5/2002
l 16-06-1983
l 11-10-1962
10/10/1980
P 10-06-1978
P 10-07-1995
L 05-09-1992
p 14-06-1965
2/11/1992
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
KORAMIL TANJUNGAN
L 22-06-2005 KORAMIL TANJUNGAN
L 02--05-2004 KORAMIL TANJUNGAN
P 18-07-1960 KORAMIL TANJUNGAN
L 17-8-2002 KORAMIL TANJUNGAN
L 14-07-2003 KORAMIL TANJUNGAN
L 08-03-1994 KORAMIL TANJUNGAN
P 24-01-1976 KORAMIL TANJUNGAN
L 21-02-2004 KORAMIL TANJUNGAN
P 17-0201970 KORAMIL TANJUNGAN
l 08-07-2004 KORAMIL TANJUNGAN
L 24-11-2002 KORAMIL TANJUNGAN
P 28-08-1982 KORAMIL TANJUNGAN
P 16-07-1974 KORAMIL TANJUNGAN
L 12-02-1992 KORAMIL TANJUNGAN
P 15-101962 KORAMIL TANJUNGAN
20-07-1960 KORAMIL TANJUNGAN
P 06-08-1970 KORAMIL TANJUNGAN
L 08-06-2004 KORAMIL TANJUNGAN
L 03-08-2005 KORAMIL TANJUNGAN
l 30-01-2003 KORAMIL TANJUNGAN
P 16-09-1999 KORAMIL TANJUNGAN
P 07-07-2003 KORAMIL TANJUNGAN
L 27-03-1990 KORAMIL TANJUNGAN
l 11-06-1987 KORAMIL TANJUNGAN
P 23-07-1967 KORAMIL TANJUNGAN
p 12-01-2003 KORAMIL TANJUNGAN
2/11/1996 KORAMIL TANJUNGAN
L 16-09-2005 KORAMIL TANJUNGAN
L 15-02-1990 KORAMIL TANJUNGAN
07-05-2007 KORAMIL TANJUNGAN
L 11-05-1984 KORAMIL TANJUNGAN
7/24/1967 KORAMIL TANJUNGAN
21-02-1954 KORAMIL TANJUNGAN
0706-1987 KORAMIL TANJUNGAN
-2017 KORAMIL TANJUNGAN
30-07-2004 KORAMIL TANJUNGAN
04-06-1976 KORAMIL TANJUNGAN
10-12-1996 KORAMIL TANJUNGAN
22-09-2009 KORAMIL TANJUNGAN
P 3/2/2008 KORAMIL TANJUNGAN
P 14-09-2004 KORAMIL TANJUNGAN
L 28-05-1982 KORAMIL TANJUNGAN
P 14-08-2005 KORAMIL TANJUNGAN
P 9/9/1999 KORAMIL TANJUNGAN
P 17-04-2007 KORAMIL TANJUNGAN
P 8/8/2008 KORAMIL TANJUNGAN
P 16-08-1999 KORAMIL TANJUNGAN
P 10/11/2009 KORAMIL TANJUNGAN
P 29-12-2009 KORAMIL TANJUNGAN
P 4/12/2004 KORAMIL TANJUNGAN
P 25/11/2007 KORAMIL TANJUNGAN
L 15-04-2004 KORAMIL TANJUNGAN
11/3/2007 KORAMIL TANJUNGAN
L 22-04-2006
P 08071996
p 12/9/16069
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
NO HP BPJS BPJS Non Vaksin*** Screening Pemberian
PBI Non PBI Anggota
Vaksinasi

0857-7322-0852 CoronaVac 25-11-2021 25-11-2021

085214151769 CoronaVac 25-11-2021 25-11-2021
081210777143 CoronaVac 25-11-2021 25-11-2021
0815-74738202 CoronaVac 25-11-2021 25-11-2021
0858-1980-1765 CoronaVac 25-11-2021 25-11-2021
0857-76862929 CoronaVac 25-11-2021 25-11-2021
0812-9508-2016 CoronaVac 25-11-2021 25-11-2021
0857-7678-1971 CoronaVac 25-11-2021 25-11-2021
0877-9446-1339 CoronaVac 25-11-2021 25-11-2021
085694946971 CoronaVac 25-11-2021 25-11-2021
0812-8983-4062 CoronaVac 25-11-2021 25-11-2021
085778239956 CoronaVac 25-11-2021 25-11-2021
085889411089 CoronaVac 25-11-2021 25-11-2021
0857-74521612 CoronaVac 25-11-2021 25-11-2021
0838-9371-2358 CoronaVac 25-11-2021 25-11-2021
0858-9400-2128 CoronaVac 25-11-2021 25-11-2021
0857-74521612 CoronaVac 25-11-2021 25-11-2021
0852-8030-7485 CoronaVac 25-11-2021 25-11-2021
0856-9759-6454 CoronaVac 25-11-2021 25-11-2021
0815-8615-6349 CoronaVac 25-11-2021 25-11-2021
085778225067 CoronaVac 25-11-2021 25-11-2021
085693982645 CoronaVac 25-11-2021 25-11-2021
0852-8225-8581 CoronaVac 25-11-2021 25-11-2021
0857-7062-0894 CoronaVac 25-11-2021 25-11-2021
0852-1251-2363 CoronaVac 25-11-2021 25-11-2021
0815-1462-784 CoronaVac 25-11-2021 25-11-2021
0821-7735-1930 CoronaVac
0856-8831-102 CoronaVac
0813-3088-3102 CoronaVac
0858-9469-5428 CoronaVac 25-11-2021 25-11-2021
0856-9423-0703 CoronaVac
0815-8436-9859 CoronaVac
0852-1512-8400 CoronaVac 25-11-2021 25-11-2021
0856-9245-7017 CoronaVac 25-11-2021 25-11-2021
0815-7488-7518 CoronaVac 25-11-2021 25-11-2021
0857-1906-1371 CoronaVac 25-11-2021 25-11-2021
0855-8546-2459 CoronaVac 25-11-2021 25-11-2021
0815-7488-7518 CoronaVac 25-11-2021 25-11-2021
0852-1251-2363 CoronaVac 25-11-2021 25-11-2021
0838-4124-7097 CoronaVac 25-11-2021 25-11-2021
0857-1980-3499 CoronaVac 25-11-2021 25-11-2021
0858-8612-4704 CoronaVac 25-11-2021 25-11-2021
0813-8380-3575 CoronaVac 25-11-2021 25-11-2021
0815-7463-6531 CoronaVac 25-11-2021 25-11-2021
0815-1185-7508 CoronaVac 25-11-2021 25-11-2021
0812-6676-2113 CoronaVac 25-11-2021 25-11-2021
0856-9494-6971 CoronaVac 25-11-2021 25-11-2021
085779055237 CoronaVac 25-11-2021 25-11-2021
0857-7322- CoronaVac 25-11-2021 25-11-2021
0851-1869-509 CoronaVac 25-11-2021 25-11-2021
0856-9472-3440 CoronaVac 25-11-2021 25-11-2021
0815-1186-9604 CoronaVac 25-11-2021 25-11-2021
0838-94305485 CoronaVac 25-11-2021 25-11-2021
0852-1002-6628 CoronaVac 25-11-2021 25-11-2021
0857-7322-0816 CoronaVac 25-11-2021 25-11-2021
0852-1512-8400 CoronaVac
0856-9164-9302 CoronaVac 25-11-2021 25-11-2021
85776862529 CoronaVac 25-11-2021 25-11-2021
0857-8108-0090 CoronaVac 25-11-2021 25-11-2021
0852-1512-8400 CoronaVac
0895-6368-25973 CoronaVac 25-11-2021 25-11-2021
0858-8244-5969 CoronaVac 25-11-2021 25-11-2021
85697596454 CoronaVac 25-11-2021 25-11-2021
0852-1071-0066 CoronaVac 25-11-2021 25-11-2021
0856-9456-8851 CoronaVac 25-11-2021 25-11-2021
08
0857-771481-79 CoronaVac 25-11-2021 25-11-2021
0857-1456-0722 CoronaVac 25-11-2021 25-11-2021
0816587044 CoronaVac 25-11-2021 25-11-2021
0852-89411-575 CoronaVac 25-11-2021 25-11-2021
CoronaVac 25-11-2021 25-11-2021
CoronaVac 25-11-2021 25-11-2021
0856-9227-3591 CoronaVac 25-11-2021 25-11-2021
85280307405 CoronaVac 25-11-2021 25-11-2021
0852-8030-7405 CoronaVac 25-11-2021 25-11-2021
0857-7734-98442 CoronaVac 25-11-2021 25-11-2021
82258849876 CoronaVac 25-11-2021 25-11-2021
0838-9216-0589 CoronaVac 25-11-2021 25-11-2021
0857-1876-3491 CoronaVac 25-11-2021 25-11-2021
0838-9067-3829 CoronaVac 25-11-2021 25-11-2021
0852-1584-9405 CoronaVac 25-11-2021 25-11-2021
0857-1876-3491 CoronaVac 25-11-2021 25-11-2021
0852-1584-9405 CoronaVac 25-11-2021 25-11-2021
085777638336 CoronaVac 25-11-2021 25-11-2021
82828206020 CoronaVac 25-11-2021
0857-8141-4426 CoronaVac 25-11-2021 25-11-2021
085774324387 CoronaVac 25-11-2021 25-11-2021
0857-3620-5205 CoronaVac 25-11-2021 25-11-2021
081514562784 25-11-2021
 83896971015
085779169970
085773225997
085719131345
081584357291
081514562784
081514562784
085773749197

087794461339
08572031046
085714773549
085714949032
085811284216
081277108355
085215128400
085819533810
085313114391
085793609749
085774779652
083815336120
085777148197
085215128400
085283865056
081211037040
08158271574
085771427457
0857762889299
085779434573
085770680621

085773210270
0881024135953
081511406468

085215128400
085692811795
085892749255
085891152199
08158469371
087094461339
08562461329
0857743243
085719675528
085720321046
081367130035
081584369371
085781405940
081218887052
085229829111

085810910208
085215128400
085774595540
085214083621
085871465486
083161982697
08571927824
085773750301
081250921311
085694531196
085694230745
085780678801
085212512363
081574887518
085215128400
085215128400
08128189470

085776885740
085777587191
085210710642
085890601274
085774324387
085692811750
081910928262
085694609175
081255609881
081585776053
085280006353
089531093742
0857773674703
085691649302
0878880696699
085714560752
085264804166
0857-8141-4426
0878-7325-4900
0838-3133-9833
0852-1921-5752
85802839648
0838-3133-9833
0812-8448-7589
0857-1437-9445
0812-1860-5524
0857-8141-4426
 83831331099
81398522710
0857-8264-5236
0857-8141-4426
0857-8141-4426
0857-8141-4426
081584027762
82312056723
Dosis I Dosis 2
Tanggal
Pemberi KET
No.
No. Batch No seri an No Seri
Batch
Vaksina
si
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
25-11-202 202109177M
25-11-202 202109177M
25-11-202 202109177M
202109177M
25-11-202 202109177M
25-11-202 202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
25-11-202 202109177M
202109177M
202109177M
202109177M
25-11-202 202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
25-11-202 202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
25-11-202 202109177M
202109177M
202109177M
202109177M
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601045503740001 TURAH Y P
2 3601044403720007 NASRIN P
3 3601041107620002 KARTAWI L
4 3601040107710164 DARTIM L
5 3601040207470001 KADIWAN L
6 3601044609860001 JULEHA P
7 3601044107890015 FITRIYANA P
8 360104010780276 ANTONI L
9 3601040211610001 WASKA L
10 3601044107880200 KORIAH P
11 3601045512010001 DESTRI P
12 3601044703670001 JASIH P
13 3601040209930001 SUKIR L
14 3601044007730101 SUNARSIH P
15 3601044103960005 NURYANTI SHINTIA P
16 3601044102840003 ENENG RUMSAH P
17 3601040401750001 YAHYA L
18 3601044107790082 WASTI P
19 3601044605690001 KASMAESIH P
20 3601042001890001 HALIM L
21 3601044208090001 SITI ROHMAH P
22 3601040503900001 MARDIANTO L
23 3601041901990001 ILHAM L
24 3601040807960005 RUDI L
25 3601040107670025 NURHANA P
26 3601041007730007 KADIMAN L
27 3601046411930001 NURATI P
28 3601046711730002 RUMI P
29 3601045405930001 KASIROH P
30 3601042103730001 ALI L
31 3601044107780290 SULAMSAH P
32 3601045506740003 NURYATI P
33 3601045807340001 SUTARAH P
34 3601044107520052 RAMINIH P
35 3601042303850001 WARGANI L
36 3601040511990001 BUDI L
37 3601041004700004 SAMAN L
38 3601045684910006 EMI P
39 3601042401940001 DIDI SUPRIADI L
40 3601045706770001 NANI P
41 3601045303860004 ENI MASIAH P
42 3601040107020229 ALJANI L
43 3601040107550026 RASMITA P
44 3601044107700041 TAWI P
45 3601046710730001 AAN YULIANA P
46 3601041405000003 KUSWANDI L
47 3601044107550077 DANIMAH P
48 3601041801710002 SOBIKIN L
49 3601042408010001 MUKAWAD RENDI L
50 3601040611780001 ASKIM L
51 3601040802930005 WAWAN L
52 3601045507800012 NAPIAH P
53 3601045512790001 DASEM P
54 3601045211850002 KUDSIAH P
55 3601044107780354 AKEM P
56 3601045011670001 KAMSANAH P
57 3601041708940001 ALAN L
58 3601043008900001 YATNO L
59 3601105012990004 ALIAH P
60 3601041606620001 JUHA P
61 3601040711820003 SUNI P
62 3601042111700001 ARMIN L
63 3602011509970003 GIAN L
64 3601044107020156 KHOLIPAH P
65 3601044107750253 WARSIH P
66 3601040905620001 NURYADI L
67 3601044107680277 SUMINI P
68 3601046008730001 TASWEN P
69 3601044406010004 NOK YUYUN K P
70 3601045203980005 HERLINA P
71 3601047108820001 P
72 3601042303740001 DEDI JUNAEDI L
73 3601044312990001 NENG EVA P
74 3601040409600002 NURSIN P
75 3601046707900006 NURHASANAH P
76 3601044101640004 SARIAH P
77 3601045409010003 TITI HUSNIAWATI P
78 3601044107420188 NASIH SETIANINGSIH P
79 3601041903890001 ADE ERIK L
80 3601045507020003 FITRI YANI P
81 3601040608770001 KARYA L
82 3601044703860003 TITIN RUSMAYANTI P
83 3601042504860001 ROHIMAH P
84 3601046512600002 ENOK P
85 3601044805760001 SUMIAH P
86 3601042002090001 NANANG L
87 3601044105730001 MUINAH P
88 3601045404730003 MASKUNAH P
89 3601045303030001 MEGA HASANAH P
90 3601040107040002 MUNADI L
 91 3601046810020001 PITRIYAH P
92 3601046911740002 NIYAH P
93 3601042006740002 RUSMANI L
94 3601045101690001 JARSI L
95 FAJAR L
96 3601040702930009 KASTA L
97 3601041208980003 CASRIAH P
98 3601044311840001 ROHIMAH P
99 3601041208480003 CACA HANDIKA L
100 3601044610990002 NIAH P
101 3601040401800001 JANI L
102 3601044107770158 CASTEM P
103 3601046702780001 NENIH P
104 3601044408000003 NENG IMAS P
105 3601045405810001 SAIRIN P
106 3601045502690001 ARUM P
107 3601046008990003 KRISNAWATI P
108 YANI P
109 3601042301690002 WATA L
110 3601046405920003 KURANESIH P
111 3601042310910001 AHMAD SAEPUDIN L
112 3601041305720002 TAYUDIN L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur sesuai)
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI

15/09/1973 085811460113
04/03/1972 085603401869
11/07/1962 085811460113
10/12/1970 085310907952
02/07/1947 085774956492
06/09/1986 082324149390
20/11/1990 085215786615
02/08/1998 085773220306
02/11/1961 085280250691
01/07/1988 085819341347
19/12/2001 085774956492
07/03/1967 081382598068
23/07/1992 082114960759
01/01/1980 085213350380
15/07/1998 082113959226
01/02/1984 085719636874
04/01/1975 085875797190
01/07/1979 085773491052
06/05/1969 085719069915
20/01/1978 085778967874
02/08/2009 083864161503
05/03/1990 085774797966
19/01/1999 083841503790
08/07/1996 081511791486
25/12/1967 085774325510
10/07/1973 082332933095
24/11/1993 082114267922
27/11/1973 085273176118
04/07/1993 085216217022
21/03/1973 085219331329
01/07/1978 085860730736
15/06/1974 085864161401
18/07/1984 085714979432
01/07/1953 085894180197
23/03/1985 085778216741
20/06/1999 085774685987
10/04/1970 085810104885
16/04/1991 082310578162
24/01/1994 085710363691
17/06/1980 081382339998
13/02/1986 085217038504
21/12/2002 085794437643
01/07/1955 081586283928
11/11/1977 085216426413
23/08/1975 081317538175
14/05/2000 85213305080
01/05/1955 083151383852
18/01/1971 081282295271
24/08/2001 085775219859
06/11/1978 0857732375293
23/04/1988 085882861388
09/09/1989 085654871465
01/04/1977 085216502386
12/11/1985 085718886747
01/07/1978 081219795207
10/11/1967 085810132817
17/08/1995 0857782190777
03/08/1990 085313199325
10/12/1999 1085694527923
16/06/1962 085313338183
07/11/1982 085313197107
21/10/1970 081318829664
15/09/1997 081295075168
10/01/2002 085281459915
01/07/1975 085281459915
09/05/1962 081311425085
01/07/1968 085780431392
20/08/1973 085216167868
04/06/2001 085781206196
12/01/1998 082310578168
31/08/1982 085779570694
23/03/1972 085893089429
01/12/1999 085775234487
04/09/1960 085866761684
27/07/1994 085666761684
01/01/1964 085779570694
14/09/2001 085715411077
01/07/1992 085282389362
19/03/1989 085624461216
28/11/2002 081511690532
13/07/1981 085695274127
20/06/1986 085770621584
17/04/1977 082335295904
25/12/1960 082335295904
08/05/1977 087773611924
20/02/2009 081906158163
01/05/1970 081280313672
14/04/1973 081295091285
03/03/2003 085782491025
07/06/2003 085694239406
28/10/2002 085813293998
29/11/1974 085695274127
02/06/1974 085939990388
11/01/1959 085697591972
10/11/2004 085778212722
07/02/1993 085773238408
07/07/1984 081574922148
03/11/1984 085718256066
08/12/1998 085691054424
06/10/1999 085781660173
04/01/1980 081398108288
01/07/1977
27/02/1978 085860730665
04/08/2000 085860730665
14/05/1973 08581389430
15/02/1969 085775234487
26/12/1999 085703151287
01/07/1960 08129086114
02/10/1969 085132410375
24/05/1992 081314575260
23/11/1991 081398478348
13/05/1972 085212570754
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Tanggal Tanggal
Merek
Non Screenin Pemberia
Vaksin*** No. Batch No seri
Anggota g n
Vaksinasi
CORONAVAC 25/11/21 21/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 21/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/11/21 202108641
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 19/10/21 202108171F
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 21/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 19/10/21 202108171F
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/102/11 202108145H
CORONAVAC 25/11/21 21/10/21 202108145H
CORONAVAC 25/11/21 24/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 20108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 28/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 30/09/21 24200121
CORONAVAC 25/11/21 25/10/21 202108145H
CORONAVAC 25/11/21 25/10/21 202108145H
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CORONAVAC 25/11/21 25/10/21 240051PPP21
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CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 26/11/21 202181641
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CORONAVAC 25/11/21 25/11/21 2021081641
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CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 29/10/21 2021081731
CORONAVAC 25/11/21 23/10/21 2021081546
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
CORONAVAC 25/11/21 25/11/21 2021081641
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601045909900002 AAT ATIYAH P

2 3601044107880048 NENTI P
3 3601045208670002 RUSTINAH P
4 3601044505790003 IIS ERNAWATI P
5 3601040107420007 TAWID L
6 3601040107800095 ENANG L
7 3601045706730001 ATI SARNITI P
8 3601045203890003 NURSANAH P
9 3601040107500026 KARTAM L
10 3601046009630002 MARIAM P
11 3601040107500014 WARDAYA L
12 3601044608860002 SITI ROSITA P
13 3601040705730002 AGUS L
14 3601044107470009 KANISEM P
15 3601040810790001 AZIS KAMALUDIN L
16 3601040107860029 CARLIM L
17 3601044808920004 SENAWATI P
18 3601046007580004 TRISNA NENGSIH P
19 SITI ELISAH P
20 3601044107660028 TARSINIH P
21 3601040810840003 NONO L
22 3601046501880002 NURHAENI P
23 3601044603850013 ARMISAH P
24 3601040707990002 SUDIANTO L
25 3601044410020006 ALIPAH TUNANIPAH P
26 3601040107830104 ARI SUGANDA L
27 3601042201660002 DARTO L
28 360104670292000 KARWINIH P
29 3601044107920061 ATIK P
30 3601350404650001 JUMAD SUANDA L
31 3601044107520085 WASNITI P
32 3313020107950025 BUDI RIYANTO L
33 3601044107700075 MUNIRI P
34 3601041406550002 DURYANA L
35 3601045608460001 TARLEM P
36 3601044707950009 RAHMA YANTI P
37 3601041504840001 EYE SUTRAYA L
38 3601044107800069 ANIMAH P
39 1801106406930002 LILIS HANDAYANI P
40 3601040411970003 ACENG KUSWARA L
41 3601044107890051 HALIAH TRISNAWATI P
42 3601046808880001 ROHAYEM P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur sesuai)
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI
9/19/1990 RANCASENENG 085219655886
4/23/1988 RANCASENENG 085219655886
8/12/1967 RANCASENENG 085219655886
5/5/1979 RANCASENENG 085219655886
7/1/1942 LANSIA RANCASENENG 085219655886
7/1/1983 RANCASENENG 085882158574
6/17/1975 RANCASENENG 085718568786
3/12/1989 NANGGALA 085714771844
7/1/1950 RANCASENENG 085887771699
9/20/1963 RANCASENENG 085787255329
7/1/1950 RANCASENENG 085219655886
12/3/1989 RANCASENENG 085219655886
5/7/1973 RANCASENENG 083890674927
7/1/1947 LANSIA RANCASENENG 081248283337
10/8/1979 RANCASENENG 085219655886
7/1/1986 RANCASENENG 085694942425
8/8/1992 RANCASENENG 085219655886
7/20/1958 LANSIA RANCASENENG 085216602963
2/16/1986 RANCASENENG 085694555988
2/28/1986 RANCASENENG 085773884798
10/8/1984 RANCASENENG 085697188461
10/25/1988 RANCASENENG 085697188461
3/6/1985 RANCASENENG 085691133396
7/7/1999 RANCASENENG 083878312469
10/4/2002 CIKEUSIK 083893644191
7/4/1986 RANCASENENG 085813977211
1/22/1966 RANCASENENG 087773203514
7/4/1991 RANCASENENG 085894828908
2/22/1992 RANCASENENG 085787255329
4/4/1965 BOJEN 083192808570
7/1/1962 RANCASENENG 085219655886
5/3/1996 JATIYOSO 085727089178
7/1/1970 RANCASENENG 085219655886
6/14/1955 RANCASENENG 085219655886
8/16/1946 LANSIA RANCASENENG 085216578605
7/7/1995 RANCASENENG 085692729436
4/15/1984 RANCASENENG 085217413019
10/9/1982 RANCASENENG 083811512422
6/24/1993 SUKARAJA-LAMPUNG 081311188495
11/4/1997 RANCASENENG 085797143441
11/13/1988 RANCASENENG 085718515198
28/08/1988 RANCASENENG 085132458559
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri
Anggota
Vaksinasi
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
CORONAVAC 11/26/2021
CORONAVAC 11/26/2021 11/26/2021 202108164I EUA2057300143A1
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

DUKCAPIL

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

DUKCAPIL
11/26/2021 202108164I EUA2057300143A1

DUKCAPIL

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

11/26/2021 202108164I EUA2057300143A1

 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601045204070009 YUNITARA P
2 3601041708080002 M. AGUS TINO L
3 VANESA P
4 3600140712080003 AGUNG GUNAWAN L
5 3601044307080003 NAZLA P
6 36010450071100002 NURYATI P
7 360104410500002 INDAH. S P
8 3601044606080002 SITI JUBAEDAH P
9 3601045204070009 YUNITAPA P
10 3601040611090001 M. MAULANA L
11 360104511090001 KHARISMA PUTRI P
12 3601046710090001 AYU AULIA P
13 360104170800002 M. AGUS L
14 3601045203090001 SITI MERALITA P
15 3601042610080001 GHEFI L
16 3601044101090001 SERLI P
17 3601042906090001 M. PARIZ L
18 3601044310090003 SITI WAHYUNI P
19 36010468090900002 SHELA P
20 3601041307090005 M. ARYE. F L
21 3601045411090004 DHINDA P
22 3601044703080005 RINI RIYANI P
23 3203284111080005 RAESA P
24 3601047006080001 FAZILLA L
25 3601046001090001 CHANDRA L
26 3601046002090004 MIRAYANTI P
27 3601041205080004 M. RANGGA L
28 367301410909013 PUTRI CAHYA P
29 360104460800004 NIA AGUSTIN P
30 3601044109090007 JULIA P
31 3601045808840002 PUTRI RAHMAWATI P
32 3601044108080014 MAIZA L
33 3601045212080001 SITI HUMAIROH P
34 3601040101080002 M. HADIUL L
35 3601046808070004 SUSI AYU P
36 3601046104080001 INTAN P
37 3601040207100001 RIZKI ADITIA L
38 3601045704080003 AURA KASIH P
39 36010440903090002 SUNENGSIH P
40 3601046809060001 SUNENTI P
41 3601046603090004 SITI AENI P
42 3601046610130002 PUTRI ANA P
43 3601044411070002 AISAH P
44 360104441090001 EKA KARTINI P
45 3601042405080001 WARMIN L
46 3601046110080003 LILIS P
47 3601041210470004 DAPA SOPYAN L
48 3601044309090006 INDRI P
49 3601044103070009 MARSYA P
50 3601042812050001 RENDI L
51 360104560800003 RAHMASARI P
52 3601042503070002 ROIS L
53 3601046608070001 AMANDA P
54 3601046110070002 KARSIH P
55 3601041106060002 ZAENAL L
56 3601045410070002 ELSA FITRIA P
57 3601044511060002 AMELIA P
58 3601046009070003 FERISA P
59 3601044909060009 MILA INDRIANI P
60 3601040606070003 M. HAERUDIN L
61 3601045502080004 SUCI SUSILAWATI P
62 360104040700002 RIKI APENDI L
63 36010453120600001 DELA PUTRI P
64 3601045406070008 DELLA P
65 3601045520070004 RANIA P
66 360104440280001 SITI HAWATI P
67 3601041306080002 M. ALI L
68 3601043108070004 ERWIN L
69 3601044301100001 RINA P
70 3601042310070002 SARYANA L
71 3601040609070001 ALANG SAHID L
72 3601041206090001 AFIF L
73 3601040208080003 RODI SUDRAJAT L
74 3601040406060008 ANDRI L
75 3601041002040006 TANDIKO L
76 3601041104070001 AGUS SUHENDAR L
77 36010441020600010 SRI KOMALASARI P
78 3601044307070001 DEWI P P
79 360104630920700001 MARSINDA P
80 3601045905000001 LASTRI P
81 36010416100700002 M. SUNAH L
87 3601044405070001 SANTI P
83 36010468040800004 PRENGKI L
84 36010407019900047 NANANG L
85 3601046909820001 SITI NURHASANAH P
86 3601046805080001 MEISYA P
87 3601044804070002 DEA P
88 3601040501070001 JUJUN L
89 3601044101080001 DARNESIH P
 90 360104205040003 AYU ANITA P
91 3601041504070004 M. NURIL L
92 3601040107890158 SUBIYAN L
93 360104170850001 DIDI L
94 3601045708720002 DARNIH P
95 3601041110080002 SAHRA P
96 36010413110900004 M. ALI L
97 3601044701720004 LILIS P
98 3601045203940004 IPAH P
99 3601044107760002 CATINIH P
100 '3601044212820001 DEDE P
101 3601044102680311 DASINIH P
102 3601044107760239 CATINIH P
103 3601044212820002 DEDE P
104 3601044701720001 LILIS P
105 3601047103920001 IRMA L
106 3601044107450060 SARI P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

12-04-2007 REMAJA RANCASENENG 085775201088

17-08-2008 REMAJA RANCASENENG 085810876823
25-02-2009 REMAJA UMBULAN 085810876823
07-12-2008 REMAJA RANCASENENG 085810903410
03-07-2008 REMAJA RANCASENENG 085810903410
08-05-2009 REMAJA UMBULAN 085782265760
01-05-2009 REMAJA RANCASENENG 085695267351
10-02-2009 REMAJA SUKAMULYA 081213953744
12-04-2007 REMAJA RANCASENENG 081213953744
15-05-2009 REMAJA UMBULAN 081213953744
15-11-2009 REMAJA RANCASENENG 085718265126
27-10-2008 REMAJA RANCASENENG 085718265126
17-08-2008 REMAJA RANCASENENG 085810876823
12-03-2009 REMAJA RANCASENENG 085810876823
26-10-2008 REMAJA RANCASENENG 081906097434
01-01-2009 REMAJA RANCASENENG 085782131421
29-06-2009 REMAJA RANCASENENG 085782131421
03-10-2009 REMAJA UMBULAN 08159824605
28-09-2009 REMAJA SUKAMULYA 081511407765
13-07-2009 REMAJA RANCASENENG 081511407765
14-11-2009 REMAJA RANCASENENG 085782131421
07-08-2008 REMAJA RANCASENENG 081511407763
CIANJUR 085782131421
30-06-2008 REMAJA CIKEUSIK 085782266276
20-01-2009 REMAJA RANCASENENG 085782266276
20-02-2009 REMAJA RANCASENENG 085782266276
12-05-2008 REMAJA UMBULAN 085782131421
01-09-2009 REMAJA RANCASENENG 085782131421
SUKAMULYA 085782131421
01-09-2009 REMAJA RANCASENENG 085692654734
18-08-2008 REMAJA UMBULAN 085782131421
01-08-2008 REMAJA RANCASENENG 082312053975
17-12-2008 REMAJA CIKEUSIK 082312053975
17-07-2008 REMAJA UMBULAN 085782131421
28-07-2007 REMAJA RANCASENENG 085782131421
06-04-2007 REMAJA SUKAMULYA 085885162845
28-10-2009 REMAJA RANCASENENG 085885162845
17-04-2008 REMAJA UMBULAN 085885162845
09-03-2009 REMAJA UMBULAN 085885162845
28-09-2006 REMAJA RANCASENENG 085810902330
26-03-2009 REMAJA RANCASENENG 085810903436
27-11-2007 REMAJA RANCASENENG 085810903436
04-11-2007 REMAJA RANCASENENG 085810903436
04-01-2009 REMAJA UMBULAN 085810903436
24-05-2008 REMAJA SUKASENENG 081511407763
21-10-2008 REMAJA RANCASENENG 083856819227
10-05-2008 REMAJA RANCASENENG 08589151373
03-09-2009 REMAJA RANCASENENG 085782131421
01-03-2007 REMAJA RANCASENENG 085894272056
28-12-2005 REMAJA RANCASENENG 085894272056
16-02-2008 REMAJA SUKASENENG 081281832928
25-03-2007 REMAJA SUKAMULYA 085719761017
26-08-2007 REMAJA RANCASENENG 085719761017
21-10-2007 REMAJA UMBULAN 085719761017
30-12-2006 REMAJA UMBULAN 08577346339
14-10-2007 REMAJA UMBULAN 0857789871120
05-11-2006 REMAJA UMBULAN 085782264307
20-09-2007 REMAJA RANCASENENG 085782264307
09-09-2006 REMAJA RANCASENENG 085782264307
06-06-2007 REMAJA RANCASENENG 081511407763
15-02-2008 REMAJA SUKAMULYA 0-81511858795
08-08-2007 REMAJA UMBULAN 085694630003
13-12-2006 REMAJA RANCASENENG 08138546249
14-08-2007 REMAJA RANCASENENG 085694529219
15-10-2007 REMAJA UMBULAN 085694529219
04-02-2008 REMAJA UMBULAN 085694529219
13-06-2008 REMAJA RANCASENENG 085584341351
31-08-2007 REMAJA UMBULAN 085584341351
03-10-2010 REMAJA UMBULAN 081276033248
23-10-2007 REMAJA RANCASENENG 085695154752
06-09-2007 REMAJA RANCASENENG 085775201099
30-12-2008 REMAJA RANCASENENG 083133478725
02-08-2008 REMAJA RANCASENENG 083133478725
04-06-2006 REMAJA RANCASENENG 083133478725
10-02-2004 REMAJA RANCASENENG 083133478725
01-08-2006 REMAJA SUKAMULYA 085692653857
10-02-2006 REMAJA RANCASENENG 085692653857
16-02-2007 REMAJA UMBULAN 085692653857
23-09-2007 REMAJA RANCASENENG 085692653857
19-08-2005 REMAJA RANCASENENG 087799104112
16-10-2007 REMAJA RANCASENENG 087799104112
01-07-2007 REMAJA SUKAMULYA 083138038683
12-04-2008 REMAJA RANCASENENG 083138038683
15-10-2007 REMAJA SUKAMULYA 087799104112
29-09-2008 REMAJA RANCASENENG 083138038683
28-09-2008 REMAJA RANCASENENG 083138038683
08-04-2007 REMAJA RANCASENENG 085692653857
05-01-2007 REMAJA UMBULAN 085692653857
01-01-2008 REMAJA UMBULAN 085692653857
02-05-2006 REMAJA SUKASENENG 087799104112
15-04-2007 REMAJA RANCASENENG 087799104112
07-05-1989 UMUM CIKEUSIK 083138038683
15-07-1985 UMUM RANCASENENG 087799104112
17-08-1975 UMUM RANCASENENG 081511407765
11-10-2008 REMAJA SUKAMULYA 081511690493
13-11-2009 REMAJA RANCASENENG 081511690493
12-06-1982 UMUM UMBULAN 081511865847
14-07-1994 UMUM CIKEUSIK 081511865847
UMBULAN 081511865843
02-12-1982 UMUM UMBULAN 081511865843
01-07-1960 LANSIA UMBULAN 081511865843
01-07-1976 UMUM UMBULAN 081511865843
02-12-1982 UMUM UMBULAN 081511865843
12-06-1982 UMUM UMBULAN 081511865843
31-03-1992 UMUM UMBULAN 08577950599
01-07-1945 LANSIA UMBULAN 08577950599
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

CORONAVAC 27-11-2021 27-11-2021 202109177M

CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
CORONAVAC 27-11-2021 27-11-2021 202109177M
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29-06-2021
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28-10-2021
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
27-11-202 202109177M
27-11-202 202109177M

27-11-202 202109177M DOSIS 2 D YONIF

27-11-202 202109177M DOSIS 2 D YONIF
27-11-202 202109177M DOSIS 2 D YONIF
 Nama Umur
Kelomp
NO No. Ticke NIK Penerim JK Pekerjaan* (18-59 INSTANSI
ok Umur
a Vaksin tahun)

1 360104470AMISAH P
2 360104101SUKARJA L
3 360135410NURMI P
4 360209610HENI APRIP
5 360104450SITI HAS P
6 360104410PONAH P
7 360104410DASMI P
8 360104410ASNI P
9 360104450RASINAH P
10 360104650SAETI
11 360104430CARNATI
12 360104471LINA
13 360104520KASTEM SETIAWATI
14 360104610NITA RANI
15 360104410CASNI
16 360103501SUKMA WIJAYA
17 360104540ACIH
18 217103500TAMI
19 360104410SUMARNI
20 360104501DARIH
21 360104130SAHANAHP
22 360104470ARTI P
23 360104530SITI MAE P
24 360104531WARSIH P
25 360104380NURUL NAP
26 360104100SAMAD L
27 360104020SULAEMAL
28 360104701MAELANI P
29 360104410SAMI P
30 360104410WARJEM P
31 360104010USUP SUPRIADI
32 360104470DARNI P
33 360104611ROBIAH P
34 360104480KAPINIH P
35 360104480UTI P
36 360104190RUDI L
37 360104591TATI P
38 360104410HANA P
39 360104410RATINAH P
40 360104550INDRIYANIP
41 360104550KARTIYEMP
42 360104230CARMAN L
43 360104410UNAYAH P
44 360104410PATIMAH P
45 360104410CARWEN P
46 360104040SONI P
47 360104410JUBAEDA P
48 360104650ERNA P
49 360104590JUMAROHP
50 360104410SARPEN P
51 360104410MASNI P
52 360144504WARTINI P
53 360104410ATI P
54 360113170OJI BAROJL
55 360104061OMAN L
56 360104510SARINAH P
57 360104441MARYATI P
58 360104410YUYUN P
59 360419441SUNAETI P
60 360104460MASNAH P
61 360104410RATINI P
62 360104410SANI P
63 360104530IRMAYANTP
64 360104450MARNI P
65 360104521KASIH P
66 360104431HERTI P
67 360104550ASENG P
68 360104410MISJA L
69 360104470ROHENI P
70 360104440CARIKEM P
71 360104470SOLIHAT P
72 360104410DARTEM P
73 360104410ATIH P
74 360104011SUARNA L
75 360104460RASTINAHP
76 360104410TAYIM P
77 367106420RIDAYANTP
78 360104410SUPINAH P
79 360104410SUNARIH P
80 360104131PAMA L
81 360104410ICEU P
82 360104560ANIS SURP
83 360104521JUNI P
84 360104270DENIYAH P
85 360104680AKEM P
86 360104470CICIH P
87 360104620SANAH P
88 360104410SAETI P
 89 360104410SUNIMAH P
90 360104050BENI L
91 360104200OMO L
92 360104681ONIAH P
93 360104410DARSINAHP
94 360104300H. DASPA L
95 360104571Hj. CARNITI
96 360104430IMAS P
97 360221420JASIH P
98 360104460ROSMAYAP
99 360104431ANI P 03-10-197 UMUM
100 ''3601046 DIANA SAFP ''26-05-200UMUM
101 '36010457 NASMI P '17-03-196LANSIA
102 '36010424 ARSID L '24-06-200REMAJA
103 '35601044 RASEM L '01-07-196UMUM
104 '36010444 MARWEN P '04-01-198UMUM
105 '36010442 WINAH P '10-12-198UMUM
106 '36010470 UNASIH P '07-06-199UMUM
107 '36022122 UYUN P ''27-03-198UMUM
108 360104410TURSINAHP '01-07-196UMUM
109 '36010469 HENI P '29-03-199UMUM
110 '36010425 WARYA L '04-07-197UMUM
111 '36010450 ADE P ''10-03-198UMUM
112 '36010441 SAYEM P ''01-07-196LANSIA
113 '36010456 EMAH P '16-07-197UMUM
114 '36010441 IIS P '0-07-1988UMUM
115 '36010457 RIKA YANIP '27-01-200UMUM
116 '36010414 SURNAYI L '02-10-196UMUM
117 '36010443 SURHEMAP '03-10-198UMUM
118 '36010466 TIAH P '26-10-198UMUM
119 ''3601045 MANI P '02-03-196UMUM
120 '36010444 PATIMAH P ''04-07-298UMUM
121 '36010401 WARID L '01-07-197UMUM
122 '36010441 KARNESIHP '02-04-197UMUM
123 '36010419 M. SOPANL '19-09-199UMUM
124 JUMAENAP '20-01-197UMUM
125 360104161SABIKIS L '16-10-198UMUM
126 '36010452 RANI P '01-05-198UMUM
127 JUMAENAP '20-01-197UMUM
128 '36010401 SAHANI L '01-07-195LANSIA
129 '36022105 KARMIN L '05-07-198UMUM
130 '36010455 TARSEM L '15-11-193UMUM
131 360104010SUDIN L '08-09-198UMUM
132 '36010412 JUHRI L '12-05-194LANSIA
133 '36010454 RASMINA P '14-08-196UMUM
134 360104610EDAH P '21-08-198UMUM
135 '36010415 DIWAN L '15-02-197UMUM
136 '36010401 RASEM P '01-07-195LANSIA
137 '36010446 SARNI P '06-05-197UMUM
138 '21205260 ANTHONYL '26-09-199UMUM
139 '36010460 MUNAH P '30-06-198UMUM
140 '36010409 RUSMAN L '09-05-197UMUM
141 '36010417 KADIS L '17-10-197UMUM
142 '36010452 MARSIH P '12-10-196LANSIA
143 '36010465 SUHELAHP '25-03-198UMUM
144 '36010452 MARSITI P '12-06-196UMUM
145 '36010401 TAMIN L '09-03-197UMUM
146 '36010423 DANI L '23-02-198UMUM
147 '36010452 MASTIÁH P '12-04-198UMUM
148 '36010468 ABDUL R L '28-10-199UMUM
149 '36010441 ELA HAYAP '01-01-198UMUM
150 '36010466 SAMUNAHP '26-08-197UMUM
151 360104410ASTI P '11-09-198UMUM
152 '36010444 SUMINAH P 04-10-197 UMUM
153 '36010401 KAMSARI P '01-07-196UMUM
154 360104611ACENG L '10-11-198UMUM
155 '36010403 SARONI L '03-03-196UMUM
156 '36010450 SAENAH P '10-03-199UMUM
157 360104230CARNATAL '23-05-197UMUM
158 '36010450 RATEM L '10-11-197UMUM
159 '36010409 M. MASKUL '09-09-199UMUM
160 '36020149 NITA AMELP 09-03-200 REMAJA
161 '36010401 HOMBINGL '01-12-200UMUM
162 360104240RASDIN L 28-101-19 UMUM
163 '36010417 AGUS MULP '17-08-198UMUM
164 '36010402 IRMANSY L '02-07-200REMAJA
165 '36010462 ANISA P '22-06-199UMUM
166 '36010420 YADI L '11-04-198UMUM
167 '36010402 RENDI L '02-07-200REMAJA
168 '36010401 WARDAM L '04-02-197UMUM
169 '36010441 KAMEN P '01-07-197UMUM
170 360104420CARNITI P '02-04-198UMUM
171 '36010454 KOLIDAN L '02-04-198UMUM
172 '36010458 ROHATI P '18-04-197UMUM
173 '36010414 CASNO L 14-08-197 UMUM
174 '36010452 MUHAMALP '12-07-200UMUM
175 '36010442 KAMINAH P '02-07-198UMUM
176 '36010466 NARSIH P 09-11-199 UMUM
177 '36010450 DARNI P '10-03-198UMUM
178 '36010460 NGKEM P '20-10-197UMUM
179 '36020601 SANTIKA P '30-12-197UMUM
180 '36010405 DARYONOL '05-04-197UMUM
181 '36010460 IMAS P '20-05-199UMUM
182 '36010465 SAROH P '25-06-199UMUM
183 RASID L '07-02-199UMUM
184 '36010443 TARMI P '03-09-195LANSIA
185 '36010451 SITI AISA P '11-05-199UMUM
186 '36010450 SUTINAH P '10-02-198UMUM
187 '36010405 JUNAEDI L '28-05-197UMUM
188 '36010447 OJAH P '26-06-197UMUM
189 '36010445 WASTINI P '05-04-199UMUM
190 '15701190 TINAH P '15-05-198UMUM
191 '36010441 NANI P '29-11-198UMUM
192 '36010455 NURHAYAT P '15-04-197UMUM
193 '36010441 ARNASIH P '01-07-198UMUM
194 '36010451 ARNAH P '11-08-197UMUM
195 '36010441 SARMINA P '01-07-196UMUM
196 '36010441 HASAN L '01-07-197UMUM
197 '36010455 ANI P '15-03-197UMUM
198 '36010401 CASIMAN L '01-07-195LANSIA
199 '36010409 RABAN L '09-11-197UMUM
200 '36010408 WARNA L '13-07-199UMUM
201 '36010447 ARSITI P '07-02-196UMUM
202 '36010413 AGUS L '13-09-198UMUM
203 '36010429 KIKI FIR L '29-07-200REMAJA
204 '36010408 SUDARI L '08-04-200REMAJA
205 '36010411 SUPRIATNL '01-11-200UMUM
206 '36010451 PIAH P '11-08-197UMUM
207 '36010459 NURHAYAT P '27-06-199UMUM
208 '36010455 RATIWEN P '15-01-196UMUM
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
Alamat NO HP Pemberi
BPJS BPJS Non Vaksin** Screeni
* ng an No. Batch
PBI Non PBI Anggota
Vaksina
si
DS. SUKA 087871120431 10/28/2021
CIKEUSIK 081511757240 11/1/2021
CIKEUSIK 085694527923 10/28/2021
CIKEUSIK 085217286307 10/21/2021
DS. NANG081314681535 11/1/2021
DS. NANG085219822493 10/1/2021
CIKEUSIK 081617298861 10/28/2021
CIKEUSIK 085697609152 10/1/2021
CIKEUSIK 085773239346 10/1/2021
DS. NANG085289878194 10/28/2021
CIKEUSIK 081574842103 10/28/2021
DS. NANG082324135220 10/28/2021
DS. UMBU081284910678 10/1/2021
CIKEUSIK 085810918019 10/28/2021
CIKEUSIK 085219869442 10/1/2021
CIKEUSIK 85694527973 10/28/2021
DS. CIKI 085695389679 10/21/2021
DS. SUKA 081212088882 29/21/2021
DS. UMBU085781350437 10/28/2021
CIKEUSIK 085718271268 10/1/2021
DS. CURU085813639968 10/28/2021
DS. NANG085783872092 10/28/2021
CIKEUSIK 085782266712 11/1/2021
DS. CURU085714303942 10/28/2021
CIKEUSIK 085311283338 11/29/2021
DS. CURU085703083363 10/28/2021
CIKEUSIK 085694382775 10/19/2021
CIKEUSIK 085710525631 11/29/2021
DS. UMBU085311513793 10/28/2021
DS. SUKA 085214147336 11/29/2021
DS. UMBU085778242417 11/29/2021
DS. NANG085219736815 10/28/2021
DS. NANG081511862698 10/1/2021
DS. NANG081280546957 10/1/2021
DS. PARK 081381318022 10/1/2021
DS. SUKA 081289199929 10/1/2021
DS. NANG085217970519 10/1/2021
DS. NANG081219418136 10/1/2021
CIKEUSIK 085775202726 10/28/2021
CIKEUSIK 085891580785 11/1/2021
CIKEUSIK 085695409549 10/28/2021
CIKEUSIK 085718271268 11/1/2021
DS. CURU085772730584 10/28/2021
DS. CURU085817975882 10/28/2021
CIKEUSIK 085216746430 10/28/2021
CIKEUSIK 082112308076 11/1/2021
DS. NANG085695268248 10/28/2021
CIKEUSIK 085781549469 11/1/2021
DS. CURU085860730732 10/28/2021
CIKEUSIK 082310863978 11/1/2021
DS. NANG085779170048 10/28/2021
CIKEUSIK 085775233923 10/28/2021
DS. CURU081511868372 10/28/2021
DS. PURW081382354819 6/30/2021
CIKEUSIK 08558159705 11/1/2021
DS. SUKA 085719782995 10/28/2021
DS. SUKA 085882800560 10/28/2021
CIKEUSIK 085217257248 11/1/2021
DS. KADU085719069915 11/29/2021
DS. NANG085283046760 10/28/2021
DS. SUKA 082310991766 10/21/2021
CIKEUSIK 082112308076 01/10/2021
CIKEUSIK 087805683974 10/19/2021
CIKEUSIK 085752346447 01/10/2021
DS. CURU085693759741 10/28/2021
DS. NANG085773624240 11/1/2021
DS. SUKA 085894828214 01/10/2021
CIKEUSIK 8.21E+10 11/1/2021
DS. NANG085717565218 01/10/2021
DS. SUMU082312038601 11/29/2021
DS. NANG081517707611 01/10/2021
DS. RANC085814397861 10/28/2021
CIKEUSIK 081646061709 7/8/2021
DS. CURU085781549477 11/1/2021
DS. NANG087864231748 10/28/2021
DS. SUKA 085212088882 11/29/2021
CIKEUSIK 8.53E+10 9/27/2021
DS. SUKA 083189488059 01/10/2021
DS. SUKA 085214931828 11/29/2021
CIKEUSIK 085713479725 11/29/2021
DS. SUMU087773568938 11/29/2021
CIKEUSIK 085211427239 11/29/2021
DS. SUKA 081382598060 10/28/2021
DS. RANC085814397861 10/28/2021
DS. SUKA 081317454597 11/1/2021
DS. UMBU085810157254 10/28/2021
DS. SUKA 085864161460 11/29/2021
DS. SUKA 085882501947 11/29/2021
DS. NANG085764740593 11/1/2021
DS. UMBU085781350437 11/29/2021
CIKEUSIK 085311554291 11/29/2021
DS. NANG085810910008 11/1/2021
DS. NANG085216915489 11/29/2021
CIKEUSIK 085814309544 11/24/2021
CIKEUSIK 085814309544 11/29/2021
CIKEUSIK 085892059453 10/1/2021
DS. KARA 085864161460 10/28/2021
CIKEUSIK 085284652821 11/29/2021
NANGGAL'083107982856 '01-11-2021
RANCASE'083107982856 '01-11-2021
NANGGAL'083107982856 '28-10-2021
CIKEUSIK '083107982856
CIKEUSIK '085210709108 '01-11-2021
SUKASE '085210709108
CIKEUSIK '085210709108
CIKEUSIK '085210709108
CIKEUSIK '085210709108
SUKASE '085210709108
SUKASE '085210709108 '28-10-2021
CIKEUSIK '085210709108 '28-10-2021
SUKAW '085210709108 '01-11-2021
SUKASEN'085210709108 '01-11-2021
NANGGAL'085210709108 '01-10-2021
NANGGAL'085210709108 '01-11-2021
CIKEUSIK '085210709108 10/28/2021
UMBULAN'085210709108 10/1/2021
NANGGAL'085210709108 '01-11-2021
NANGGAL'085210709108 10/28/2021
CIKEUSIK '085210709108 10/1/2021
CURCI '085210709108
SUKAS '085210709108 '28-10-2021
CIKEUSIK '085210709108 '19-10-2021
CIKEUSIK '085210709108
CIKEUSIK '085210709108 '01-10-2021
RANCASE'085210709108 '25-10-2021
NANGGAL'085210709108 '01-11-2021
CIKEUSIK '085210709108 '01-10-2022
NANGGAL'085210709108
CURCI '085210709108
SUKAS '085210709108
UMBULAN'083874996647
CIKEUSIK '083874996647
SUKAS '083874996647 '01-10-2021
NANGGAL'083874996647 '01-11-2021
CIKEUSIK '083874996647
CIKEUSIK '083874996647
NANGGAL'083874996647 '01-10-2021
SUKAWAR'083874996647 '01-11-2021
NANGGAL'083874996647 '01-10-2021
SUKAWAR'083874996647 01-11-2021
CIKEUSIK '083874996647 01-11-2021
CIKEUSIK '083874996647 28-10-2021
SUKAS '083874996647 28-10-2021
NANGGAL'083874996647 01-10-2021
NANGGAL'083874996647 '28-10-2021
CIKEUSIK '083874996647 01-10-2021
SUKAS '083874996647
CIWET '083874996647 28-10-2021
CIKEUSIK '083874996647
NANGGAL'083874996647 '01-11-2021
NANGGAL'083874996647 '28-10-2021
NANGGAL'083874996647 '28-10-2021
RANCASE'085216426413 '28-10-2021
CIKEUSIK '085216426413 '28-10-2021
SUKAS '085216426413 '25-10-2021
CIKEUSIK '085216426413 '25-10-2021
CIKEUSIK '085216426413
CIKEUSIK '085216426413
NANGGAL'085216426413
CIKEUSIK '085216426413 '01-11-2021
NANGGAL'085216426413 01-11-2021
CIKEUSIK '085216426413 '21-10-2021
CIKEUSIK '085216426413 '01-11-2021
SUKASEN'085216426413
SUMURBA'085216426413 '25-10-2021
CIKEUSIK '085216426413
CIKEUSIK '085216426413
SUKAS '085216426413
CIKEUSIK '085216426413
CIKEUSIK '085216426413
SUKAS '085216426413
SUKASEN'085216426413 '28-10-2021
CIKEUSIK '085216426413 '14-10-2021
CIKEUSIK '085216426413
CIKEUSIK '085216426413 '01-11-2021
CIKEUSIK '085216426413
CIKEUSIK '085216426413
CIKEUSIK '085216426413
LEBAK '085216426413 '16-08-2021
RANCASE'085216426413 25-10-2021
RANCASE'085216426413 '01-11-2021
CIKEUSIK '085216426413
CIKEUSIK '085216426413 '01-10-2021
CIKEUSIK '085216426413
CIKEUSIK '085216426413 '01-11-2021
CIKEUSIK '085216426413
CIKEUSIK 085283710787
CIKEUSIK 085283710787 '01-11-2021
NANGGAL085283710787 '28-10-2021
JAMBI 085283710787 '12-10-2021
NANGGAL085283710787 '28-10-2021
SUKASEN085283710787 '28-10-2021
NANGGAL085283710787 01-11-2021
CIKEUSIK 085283710787
CIKEUSIK 085283710787 '21-10-2021
CIKEUSIK 085283710787 '01-11-2021
SUKAS 085283710787 '28-11-2021
NANGGAL085283710787 '28-11-2021
SUKAS 085283710787 '28-10-2021
CIKEUSIK 085283710787 '01-10-2021
CIKEUSIK 085283710787 '28-10-2021
CIKEUSIK 085283710787
SUKAS 085283710787
SUKASEN085283710787
CIKEUSIK 085283710787
CIKEUSIK 085283710787 '01-11-2021
CIKEUSIK 085283710787 10/28/2021
SUKAS 085283710787
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si

202109177M

202109177M

202109177M

202109177M
202109177M

202109177M

202109177M

202109177M
202109177M
202109177M
202109177M

202109177M
202109177M
202109177M
202109177M

202109177M

202109177M

202109177M
NO No. Ticke NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601043001850001 TOHIRUDIN L
2 3601042119100001 DAELSA P
3 3601044310580001 MARSITI P
4 3601040811780005 IWAN L
5 3601046109810001 ETI P
6 3601045510870007 ASMINAH P
7 3601045704900002 SARNITI P
8 3601044107950228 ATIKAH P
9 3601041707820001 ROHANTA L
10 3601044705780001 ISNAH P
11 3601040107740001 CECEP L
12 3601041102750004 SAHIRA L
13 3601044107830486 LINA P
14 3601045103860007 YANTI P
15 3602076208810001 JUNERAH P
16 3601042106650002 SAEPUDIN L
17 3601044512730001 SARTINAH P
18 3601044509900001 WANAH P
19 3601040107900274 EEP L
20 3601045110820002 MINANTI P
21 3601045707720001 NANI P
22 3601040707830002 RUMAN P
23 3601044304860007 WANAH P
24 3601045507800030 MURTI P
25 3601044101760013 JUHENI P
26 3601044606890005 ERNA P
27 3601046311020001 ARSIH P
28 3601040102000014 HENGKI PERMANA L
29 3601045403990004 OJAH P
30 3601045403830006 DINA P
31 3601045204830008 RATNA P
32 3601041304930002 AHMAD RUYANI L
33 3601045206770001 ROKAYAH L
34 3601044799670001 WARSIH P
35 3601041011800005 SIBLI L
36 3601044811700001 ARYATI P
37 3601046805730001 SUMINAR P
38 3601044508770005 ROROH ST ROHILA P
39 3201154912900006 EMA P
40 3601056012820001 SATI P
41 3210062610030001 RIZAL SLAMET L
42 3601040403790001 ENAN L
43 3601041410620001 UHEN L
44 3601040511820001 JAHAR L
45 3601041507890012 SANDI L
46 3601045007780001 MAEMUNAH P
47 3601044204000003 ROPI SELSA P
48 3601046409980002 EUIS P
49 3601044810820002 ERUM P
50 3601044506970001 SITI WAHYUNI P
51 3601044107830007 SAEMUNAH P
52 3601045208920002 EMAH P
53 3601044402860003 ENI P
54 3601045909010003 LENI P
55 3601040808940005 AGUS SUPRIATNA L
56 3601044411800003 ALIN P
57 3601046606760001 SUNIAH P
58 3601044309700001 SUNI P
59 3601045707760001 WASROH P
60 3601046005910003 MINAH P
61 3601045009740002 EMI P
62 3601040609790001 NADI L
63 3601274107910119 MISRNAH P
64 3601040310680001 JAYADI L
65 3601045011720001 SUTIAH P
66 3601042309860001 TOLIB SAPURA L
67 3601045003760002 MAENAH P
68 3601046506800001 ASMAH P
69 3601046911890002 CICIH SUKAESIH P
70 3601042606850001 WAWAN L
71 3601046207740001 DEHI P
72 3601046007720001 ERI L
73 3601045103520001 ARINAH P
74 3601042411850001 AWANG L
75 3601044101970012 RATIH P
76 3601045204810002 ERIN P
77 3601045006950007 SITI AISAH P
78 3601044507850001 CICIH P
79 3601046409700001 LILIS P
80 3601045909870007 SRI P
81 3601046303890001 EUIS RESMANA P
82 3601046708950002 NANI P
83 1703071307800001 ANDRI L
84 3601045411890001 ODAH P
85 3601044201990064 HERNASANI P
86 3601045711930002 BELA P
87 3601043012800001 JOHADI L
88 3601045410980003 LINDA LINDAWATI P
89 3601045203940002 ATIKAH P
 90 3601274501920002 ASIH P
91 3601044303900004 IROH ROHAYATI P
92 3601045909900001 WATI P
93 3601045304800002 SARNAH P
94 1807046808890002 RIRIN AGUSTINA P
95 3601046511810001 NURBAITI P
96 3601046007890002 IMAS P
97 3601045311850002 RANTI P
98 3601045607870001 ENENG P
99 3202400704860001 AGUNG FITRIYADI L
100 3601045906880001 RITA P
101 3601046802580001 ROSIH P
102 3601041708920002 AGUNG L
103 3601044602810003 ARSIH P
104 3601045408950004 ANJARWATI P
105 3601044405700001 METI P
106 3601045905730001 UMSIAH P
107 3601042405010002 IRFAN KURNIAWAN L
108 3601040610940001 WIRNA L
109 3601044507830013 TRIYANTI P
110 3601046810800001 UNESIH P
111 3601041306960003 DADANG L
112 3601042106010001 JUMANTA L
113 3601040706910001 RODI L
114 3601045606770001 CICIH P
115 360104410190014 ETI MUNAWAROH P
116 3602095205940003 IMAS P
117 3601046607620001 ASMAH P
118 3601044410960001 SUHENAH P
119 3306122210860007 PANJI L
120 3601045108940005 NARSIAH P
121 3601044807770003 LAMRAH P
122 3601045106760001 SUMANAH P
123 3601045010740001 CICICH P
124 3601044405890008 IJAH P
125 3601045003890001 ENI P
126 3601040608720002 AMING L
127 3601045810610001 DASEM P
128 3601045009920001 WANAH P
129 3601041903880004 AGUS L
130 3601040803910001 TASLIM L
131 3601046411010001 NOVA NOVITA P
132 3601040802900001 BAMBANG SETIAWAN L
133 3601041011820002 SAPTAR L
134 3601040511840001 RASJA L
135 3601046507320001 ADNIMAH P
136 3601045504730001 TUNAH P
137 3601045506680002 MARSAH P
138 3601041008820001 SUNANDAR P
139 3602455022830002 ENI P
140 3601046608890001 UCU P
141 3323190606990001 KHAMID SODIKIN L
142 3601044712820002 MARINAH P
143 3601044910610001 ASMINI P
144 3601044703720001 ARTIAH P
145 3601044311940002 FITRI P
146 1801100107690028 SAMAD L
147 3601045103850005 SULASTRI P
148 3601044106840005 UMU L
149 3601044206940003 DANTI P
150 3601044709900004 SUTRIANTI P
151 3601045612700001 RANA P
152 3601045709920001 NENGSIH P
153 3601045804720001 ANYEP L
154 3601044207830003 ACIH P
155 3601046406740001 DARIH P
156 3601027430891001 MISNAH P
157 3601041806670002 JANR L
158 3601046008840001 ROROH P
159 3601040105670001 MUHAMAD MAAF L
160 3601040107900311 NEDI L
161 3601041310610001 SURDI L
162 3601041501040001 KANTA L
163 3601040107570001 SUNA L
164 3602211310000003 SUPENDI L
165 3601041001010006 UDIN L
166 360104331200001 SITI FATIMAH P
167 3601046807580001 ACIH P
168 180905114790002 SAHRUDIN L
169 3601040712000001 WINDI WULANDARI P
170 3601041708980006 MEDI L
171 3601045611810001 YANTI P
172 3601044412840001 YEYEN P
173 3601044608030006 NADILA AYULIANI P
174 3601041908820003 RAHMAT L
175 3601044611820001 SUANAH P
176 3601044606920001 TATI HARTATI P
177 3601047112520001 ERUM P
178 3601044804860006 ETI P
179 3601045907650001 SAWI P
180 3601045608940002 ASRIWAH P
181 3601045006840007 NARSIH P
182 3601045106950001 AAN HAYATI P
183 3601045203690001 IKOH P
184 36010411 RANAH P
185 3601044808760001 NASMI P
186 3601041202830001 BADRI L
187 3601044608620001 JARMAH P
188 3601044106770001 ANISAH P
189 3601040403850004 SAHRI L
190 3601044405550002 SUNIAH P
191 3601045709830001 SIAH P
192 3601044318200001 AAN P
193 3601041211920001 PARDI L
194 3601040508830002 JONI L
195 3601041607930003 TAIP L
196 3601042203190005 UDIN JAYA L
197 ARIYAH P
198 3601044208980001 OMAH P
199 3601041408690001 KARDI L
200 360104069530001 SAMAUN L
201 3601047003770001 SITI P
202 3601045511030004 LASTIA BELA P
203 3601046008620001 ESIH P
204 3601044107800258 JUMANAH P
205 3601044107550003 SURTI P
206 3601045511010001 TIAH P
207 3601045602570002 SUKMARI P
208 3601045201680001 RAIDAH P
209 3601044707880007 ROSITA P
210 3601046206870001 SUTI P
211 3601044701780002 ETI P
212 3601044207920002 ROHANIAH P
213 3601044107750002 KAYAH P
214 3601040804020004 SARDA L
215 3601041705940002 ROBI L
216 3601044107730120 OTIAH P
217 3601045403770001 SUNAH P
218 3601045011840002 JARNI DEDE P
219 3601045712820001 ATIN P
220 360104692741337 SANATI P
221 3601046804750001 ROHANAH P
222 3601046705870004 MANAH P
223 3601045008920004 YUNENGSIH P
224 3601044501840001 SARNATI P
225 360`1045106810001 ROHAYATI P
226 3601040211960006 RUKMAN L
227 3601044902940003 ROHENI P
228 3602015104800003 EHA P
229 3601041803970001 ROHENDI L
230 3601042009990003 KONI L
231 3601046203010002 AAM P
232 3601045203990001 ITA P
233 3601046512960002 ARUM W P
234 3601044904850001 ITI P
235 3327105203860041 RONDIYAH P
236 3601046703700002 ANAH P
237 3601045408770001 ISAH P
238 3601044107870003 YANTI P
239 3601042004550001 ROHAPI L
240 3601045106810001 ROHAYATI P
241 ASMAH P
242 3601046108800001 METI P
243 3601045303840001 YANI P
244 3601045403690001 MENOH P
245 3601046206810001 SAMAH P
246 3601045408870002 KENAH P
247 3601046005780001 AMI P
248 3602035706880003 SITI UMSIAH P
249 3601040607680001 EVI SUHAETI P
250 360104640680001 NATI P
251 3601045208980006 ROHMAH P
252 3601045807850003 RODIAH P
253 3601045105940001 YETI P
254 3601044207840002 AAY P
255 3601044794900007 ARSAH P
256 3601044901650001 SAENAH P
257 3601045901740002 MUSRIATI P
258 3601040302910001 YATI P
259 3601045109700003 MAYUNAH P
260 3601046103870001 JUHETI P
261 3601045007580001 UMINAH P
262 3601045207890002 RUKIAH P
263 3601045504810001 HALIMAH P
264 3601044611060002 SINTA P
265 NENENG P
266 36010447 NANI SETIAWATI P
267 3601044207870005 IMAS P
268 3601046008640001 SARAH P
269 3601044706790004 SANIYAH P
270 3601041208920001 UNUS L
271 3601042407880002 JALI L
272 36010417055950004 EPI RISWARA L
273 3601046805820001 ETI P
274 3601040101800011 DARONI L
275 3601040107800003 ROUP L
276 DEDE ROHAYATI P
277 3601046303840001 MISNAH P
278 3601044206730001 MIMI P
279 3601045303910001 TATI P
280 3601044908950001 BETI P
281 3601044401780001 SARYATI P
282 3601044807780002 SAIDAH P
283 3601044408890003 MISNAH P
284 3601045412870002 IYUM P
285 360104500980001 YANTI P
286 SARNITI P
287 3600104090894003 SUBANDI L
288 3601041012780001 ENDANG L
289 3211220504770001 EKO SUHADA L
290 ETI P
291 3601045404890002 LIA P
292 3601045908720001 SUMYATI P
293 3601044107890005 WARSINI P
294 3601044101920010 INAH P
295 SEPTI PUSPITA SARI P
296 3601046908050001 ILA P
297 3601040107850002 UJANG MARSAT L
298 3601045102050004 ENOK SUNARSIH P
299 3601041306850002 SUNARTO L
300 3601044107870001 ISNA P
301 3601041009870001 PENDI L
302 3601041212860001 OMAN SUDARMAN L
303 3601045604990002 ENAT RATNASARI P
304 3601046801700001 SUMINI P
305 3601041202870001 SIDIK L
306 3601046404830002 NUNUNG KURNIAWATI P GURU
307 3601045708940006 RIA ANITA P WIRASWAS
308 3601044912990001 GITA FITRIYANI P PELAJAR
309 3601046711070003 ANDINI YOPITA P PELAJAR
310 3601045006060005 SARTINI P PELAJAR
311 3202015508070005 MURI FEBRIYANI P PELAJAR
312 3601045001070009 AAN ANDINI P PELAJAR
313 3601271408080002 M.IRPAN L PELAJAR
314 3601040803080003 M.MAULANA YUSUP L PELAJAR
315 3601042507090001 RIAN L PELAJAR
316 3601045510830001 NOPI PRIYANTI P GURU
317 3601042101090002 INDRA L PELAJAR
318 3204170306080002 SANDI SULAIMANSYAH L PELAJAR
319 3601044108060008 SAPNAH P PELAJAR
320 3601045010060002 DEVI NOVITA SUASTUTI P PELAJAR
321 360127601060001 SANTINI HANDAYANI P PELAJAR
322 3601047008070002 TIARA PUTRI P PELAJAR
323 3601045312050003 RIYANTI P PELAJAR
324 3601041501050002 EBOY L PELAJAR
325 3601045204070008 DESTA APRILIA P PELAJAR
326 3601045308080001 RUMI P PELAJAR
327 3601044810070002 YULIAWATI P PELAJAR
328 3601046611060002 SELA NOVITASARI P PELAJAR
329 3601045912060004 LELI SAPUTRI P PELAJAR
330 3601044511070001 SUMAYAH P PELAJAR
331 3601045511070002 NATASYA NOVITA P PELAJAR
332 3601045707070004 ISMA P PELAJAR
333 3601042308670001 NANA SUKMANA L WIRASWAS
334 3601045209070002 OVIYANTI P
335 3601045702080001 EKA PERMATASARI P
336 3601045705090003 INDRIYANI P
337 3601046405070002 SITI KHODIJAH P
338 3601041405060001 TENDY NASTIAR L
339 3601040105090007 MULYADI L
340 3601045010080002 DESI P
341 3601045406100001 RATIH P
342 3601044104080004 FAIRAH P
343 3601044108090005 ERNAWATI P
344 3601044201070001 SOPIA LESTARI P
345 3601046711070006 ICA BELA P
346 3601040310080003 ANTON L
347 3601043108080001 AGUS IRWANSYAH L
348 3601041704070001 IIP IRAWAN L
349 3601041711080001 SAHRULGUNAWAN L
350 3601042411080002 NURKEFIN L
351 3601046106080002 WILDASARI P
352 3601045402070004 PUPUT LOVEL P
353 3601046706070002 EVA P
354 3601040407080001 MUSTIKA P
355 36010401020370006 ADI MAHARDIKA L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS Non
(18-59 tahun) ok Umur
PBI Non PBI Anggota

30/01/1985 TANJUNGAN 085699277230

22/03/1991 TANJUNGAN 081219650819
03/10/1958 TANJUNGAN 085772807359
07/02/1980 TANJUNGAN 085693392505
21/09/1981 TANJUNGAN 085727005962
15/11/1987 TANJUNGAN 085691325663
17/04/1990 TANJUNGAN 085813590292
01/07/1995 TANJUNGAN 083151383118
17/07/1982 TANJUNGAN 083875335266
07/05/1978 TANJUNGAN 085772807359
04/04/1974 TANJUNGAN 085214063622
11/02/1975 TANJUNGAN 081511839001
01/07/1983 TANJUNGAN 081511839101
11/03/1986 TANJUNGAN 081584357313
22/08/1981 TANJUNGAN 085719425803
01/01/1963 TANJUNGAN 085773757718
14/03/1973 TANJUNGAN 085692658962
05/09/1990 TANJUNGAN 085891149059
01/07/1990 TANJUNGAN 085885530554
11/10/1982 TANJUNGAN 085715852964
17/07/1992 TANJUNGAN 085692811810
07/07/1919 TANJUNGAN 085321296795
03/04/1986 TANJUNGAN 085891163453
15/07/1980 TANJUNGAN 085782229442
01/01/1976 TANJUNGAN 085774961641
06/06/1989 TANJUNGAN 085930274029
23/11/1992 TANJUNGAN 081933835303
01/02/2000 TANJUNGAN 081511878825
14/03/1999 TANJUNGAN 085762188190
05/04/1990 TANJUNGAN 083878821849
12/04/1983 TANJUNGAN 081511870146
13/04/1993 TANJUNGAN 081517284007
12/06/1977 TANJUNGAN 085773750305
07/09/1967 TANJUNGAN 085692811810
10/11/1980 TANJUNGAN 085881649476
08/11/1970 TANJUNGAN 083892847757
25/05/1973 TANJUNGAN 085813590292
05/08/1977 TANJUNGAN 085710721611
09/12/1990 TANJUNGAN 085691863498
20/12/1982 TANJUNGAN 085762188190
26/10/2003 TANJUNGAN 0895337966899
04/03/1979 TANJUNGAN 085887771175
10/08/1964 TANJUNGAN 085719275636
03/07/1982 TANJUNGAN 085718505147
15/07/1989 TANJUNGAN 085773220895
10/07/1978 TANJUNGAN 085727005962
02/04/2000 TANJUNGAN 085697596449
24/09/1998 TANJUNGAN 085770620815
08/10/1982 TANJUNGAN 085691872751
05/06/1997 TANJUNGAN 085774961671
01/07/1983 TANJUNGAN 083846027780
12/08/1991 TANJUNGAN 08585157526
04/02/1986 TANJUNGAN 082123158331
03/04/2001 TANJUNGAN 085811462076
08/08/1994 TANJUNGAN 085890109571
04/11/1980 TANJUNGAN 081911832001
26/06/1976 TANJUNGAN 082311677110
03/09/1970 TANJUNGAN 081592876253
17/07/1976 TANJUNGAN 083805383652
20/05/1991 TANJUNGAN 08989373105
10/09/1974 TANJUNGAN 083805383652
14/01/1978 TANJUNGAN 085282258581
08/07/1992 TANJUNGAN 081218605106
03/10/1968 TANJUNGAN 085777740338
10/11/1972 TANJUNGAN 082311446832
06/07/1983 TANJUNGAN 085810462304
03/09/1987 TANJUNGAN 081295006236
25/09/1968 TANJUNGAN 08579805449
29/11/1989 TANJUNGAN 085779158872
26/06/19845 TANJUNGAN 085782645339
25/07/1981 TANJUNGAN 081314490315
20/07/1972 TANJUNGAN 08511857578
11/03/1952 TANJUNGAN 08588545388
24/11/1985 TANJUNGAN 085779055276
07/01/1997 TANJUNGAN 085811462075
12/04/1982 TANJUNGAN 085765562145
10/06/1992 TANJUNGAN 085282258581
05/07/1982 TANJUNGAN 085691858036
05/08/1986 TANJUNGAN 081286509891
11/05/1990 TANJUNGAN 085692811839
23/03/1989 TANJUNGAN 085886172310
27/08/1995 TANJUNGAN 085782645339
13/07/1981 TANJUNGAN 085268954024
14/11/1989 TANJUNGAN 085738021659
04/05/2002 TANJUNGAN 085770620851
12/11/1995 TANJUNGAN 081211037144
30/12/1980 TANJUNGAN 083814556258
14/10/1998 TANJUNGAN 083107524413
12/03/1994 TANJUNGAN 085779691782
04/06/1991 TANJUNGAN 085282390379
08/04/1987 TANJUNGAN 083819456317
10/09/1990 TANJUNGAN 082123158331
13/04/1980 TANJUNGAN 085782260553
28/08/1989 TANJUNGAN 082186400056
25/11/1975 TANJUNGAN 085694723417
20/07/1990 TANJUNGAN 085810462304
13/11/1985 TANJUNGAN 085692811810
18/03/1984 TANJUNGAN 082311677110
07/04/1986 TANJUNGAN 085695273661
19/06/1988 TANJUNGAN 081280562325
28/02/1958 TANJUNGAN 085774961641
17/01/1992 TANJUNGAN 0823802190467
06/02/1981 TANJUNGAN 085319216040
14/08/1995 TANJUNGAN 081234911525
04/05/1970 TANJUNGAN 085810910810
10/01/1975 TANJUNGAN 085280006353
24/05/2001 TANJUNGAN 081574897108
06/10/1994 TANJUNGAN 085892876253
05/07/1983 TANJUNGAN 081574869512
28/10/1987 TANJUNGAN 085774961658
13/06/1996 TANJUNGAN 083107524413
21/06/2001 TANJUNGAN 0856970596381
07/06/1991 TANJUNGAN 085885456388
16/06/1977 TANJUNGAN 082311446832
01/01/1990 TANJUNGAN 08810239390
12/05/1994 TANJUNGAN 085774595503
06/09/1950 TANJUNGAN 085280006355
04/10/1996 TANJUNGAN 083805383652
22/10/1986 TANJUNGAN 087713332342
11/08/1994 TANJUNGAN 085776781971
08/07/1977 TANJUNGAN 085774961641
11/06/1975 TANJUNGAN 085774961641
10/10/1974 TANJUNGAN 085774595503
04/05/1989 TANJUNGAN 081380717252
10/03/1989 TANJUNGAN 085691875205
06/08/1972 TANJUNGAN 085765562145
18/10/1961 TANJUNGAN 081311832449
10/09/1992 TANJUNGAN 085718763780
19/03/1988 TANJUNGAN 088102329390
08/03/1994 TANJUNGAN 085282390379
16/04/2001 TANJUNGAN 085888208132
12/08/1990 TANJUNGAN 085779691782
10/11/1981 TANJUNGAN 081514562451
05/11/1984 TANJUNGAN 083814556258
05/08/1979 TANJUNGAN 081234911525
15/04/1973 TANJUNGAN 08567331661
14/07/1988 TANJUNGAN 085714214613
10/08/1982 TANJUNGAN 085718763780
10/11/1983 TANJUNGAN 085779055303
26/08/1989 TANJUNGAN 082311677110
06/06/1999 TANJUNGAN 085733461725
07/12/1982 TANJUNGAN 083814566258
09/10/1961 TANJUNGAN 082123158331
07/03/1972 TANJUNGAN 0852774694535
03/11/1994 TANJUNGAN 085282258956
01/07/1969 TANJUNGAN 081272681018
11/02/1985 TANJUNGAN 085776845986
01/06/1984 TANJUNGAN 085694232260
02/06/1994 TANJUNGAN 085770972455
07/09/1990 TANJUNGAN 085693584985
16/12/1970 TANJUNGAN 083805383654
03/01/1996 TANJUNGAN 085694276591
18/04/1972 TANJUNGAN 081280853828
03/04/1982 TANJUNGAN 085213649680
10/08/1979 TANJUNGAN 085282259247
12/02/1992 TANJUNGAN 081584369819
18/06/1967 TANJUNGAN 085282258581
20/08/1984 TANJUNGAN 081380166458
01/05/1967 TANJUNGAN 085782645339
09/05/1990 TANJUNGAN 085813590254
13/10/1961 TANJUNGAN 081296009050
15/04/2002 TANJUNGAN 085886425255
01/07/1957 TANJUNGAN 085770620658
13/10/2000 TANJUNGAN 085894539259
10/01/2001 TANJUNGAN 081381088502
13/12/2000 TANJUNGAN 085882494259
28/07/1958 TANJUNGAN 081589357291
11/04/ TANJUNGAN 085770680513
21/05/2000 TANJUNGAN 085649018124
TANJUNGAN 081294917883
12/11/1988 TANJUNGAN 085210708031
04/12/1984 TANJUNGAN 085810910314
06/08/2003 TANJUNGAN 085776846014
19/08/1982 TANJUNGAN 08562811810
06/11/1982 TANJUNGAN 083808892234
30/08/1995 TANJUNGAN 085710746345
31/12/1952 TANJUNGAN 085891597088
08/04/1986 TANJUNGAN 085774961641
12/05/1970 TANJUNGAN 081311832449
16/08/1994 TANJUNGAN 082331153146
10/06/1984 TANJUNGAN 085779595503
03/12/1985 TANJUNGAN 087713332545
12/03/1969 TANJUNGAN 083808892234
11/10/1985 TANJUNGAN 083808892234
08/08/1976 TANJUNGAN 085782645339
12/02/1983 TANJUNGAN 085810910314
06/08/1962 TANJUNGAN 085710746345
11/09/1982 TANJUNGAN 085794449150
04/03/1985 TANJUNGAN 085694761028
20/12/1963 TANJUNGAN 08521586963
17/09/1983 TANJUNGAN 085765562145
03/11/1982 TANJUNGAN 085692811810
12/11/1992 TANJUNGAN 085776701971
05/08/1983 TANJUNGAN 085710721577
16/07/1998 TANJUNGAN 08579885400
10/07/1950 TANJUNGAN
01/07/1984 TANJUNGAN 085313104710
12/03/1997 TANJUNGAN 085694566771
14/08/1969 TANJUNGAN 085774961673
05/03/1970 TANJUNGAN 083893847757
30/03/1977 TANJUNGAN 085773758335
15/11/2003 TANJUNGAN 085781055597
20/08/1962 TANJUNGAN 082311677110
01/07/1980 TANJUNGAN 08218802637
01/07/1955 TANJUNGAN 085770620658
15/11/2001 TANJUNGAN 085774595521
11/02/1957 TANJUNGAN 081589357237
12/10/1958 TANJUNGAN 085774961640
20/11/1983 TANJUNGAN 081517205499
01/01/1986 TANJUNGAN 085892643133
07/01/197 TANJUNGAN 085333319312
02/07/1992 TANJUNGAN 085841470803
01/07/1975 TANJUNGAN 085778225058
01/11/2013 TANJUNGAN 08573757059
17/05/1994 TANJUNGAN 085894432149
01/07/1973 TANJUNGAN 0857166063223
14/03/1977 TANJUNGAN 08573164741
10/11/1988 TANJUNGAN 085283865960
11/08/1982 TANJUNGAN 085780045175
25/03/1995 TANJUNGAN 085692741337
28/04/1975 TANJUNGAN 085889322757
27/05/1987 TANJUNGAN 081584357237
10/08/1992 TANJUNGAN 085774961640
01/07/1976 TANJUNGAN 0856912935687
07/06/1981 TANJUNGAN 085886841357
02/11/1996 TANJUNGAN 082354319443
09/02/1994 TANJUNGAN 081323796423
11/04/1980 TANJUNGAN 085778224989
10/11/1999 TANJUNGAN 081282502552
20/09/1999 TANJUNGAN 081296009050
22/07/1982 TANJUNGAN 0856934766774
15/10/1999 TANJUNGAN 085782163387
25/12/1996 TANJUNGAN 085891152232
09/04/1985 TANJUNGAN 081212501943
12/03/1986 TANJUNGAN 0816706926
27/03/1970 TANJUNGAN 085717828408
14/08/1977 TANJUNGAN 085777504586
01/07/1987 TANJUNGAN 085717618305
20/04/1955 TANJUNGAN 081517360177
07/06/1981 TANJUNGAN 085886841357
18/04/1968 TANJUNGAN 085774595549
12/05/1980 TANJUNGAN 085880242565
13/05/1984 TANJUNGAN 081513961552
14/03/1969 TANJUNGAN 081514572048
22/06/1987 TANJUNGAN 081584026010
14/08/1987 TANJUNGAN 083159453016
20/05/1978 TANJUNGAN 085773668182
17/06/1988 TANJUNGAN 085774961641
06/07/1973 TANJUNGAN 081574502678
24/06/1980 TANJUNGAN 085774567445
12/08/1988 TANJUNGAN 085777468201
18/07/1985 TANJUNGAN 083893712344
08/08/1997 TANJUNGAN 085691866577
02/07/1984 TANJUNGAN 085691863498
02/04/1990 TANJUNGAN 085694566771
09/07/1965 TANJUNGAN 085882201755
19/01/1974 TANJUNGAN 089628293132
02/02/1973 TANJUNGAN 085882749277
16/12/1966 TANJUNGAN 081517360177
21/05/1989 TANJUNGAN 085891152219
10/07/1968 TANJUNGAN 085891260414
12/07/1989 TANJUNGAN 085714197658
15/04.1981 TANJUNGAN 0828761590636
06/11/2006 TANJUNGAN 085691866527
17/09/2001 TANJUNGAN 08159274425
13/11/1972 TANJUNGAN 08569557019
02/07/1987 TANJUNGAN 087818921970
20/08/1964 TANJUNGAN 085719805489
07/06/1979 TANJUNGAN 081517180578
12/08/1992 TANJUNGAN 085714214613
24/07/1988 TANJUNGAN 0856918635509
17/05/1995 TANJUNGAN 085697119028
28/05/1982 TANJUNGAN 083846027792
01/01/1980 TANJUNGAN 081517180578
28/04/1985 TANJUNGAN 085697209270
06/07/1999 TANJUNGAN 081584946181
23/02/1984 TANJUNGAN 085246041383
06/09/1973 TANJUNGAN 085691863514
13/03/1991 TANJUNGAN 083808864844
13/11/1992 TANJUNGAN 082139630272
18/07/1979 TANJUNGAN 083129809224
08/07/1978 TANJUNGAN 085714214613
04/08/1989 TANJUNGAN 085893306970
14/12/1987 TANJUNGAN 085691325663
10/09/1980 TANJUNGAN 085882445933
12/10/1982 TANJUNGAN 085880242584
09/08/1991 TANJUNGAN 08589112232
10/12/1978 TANJUNGAN 085774694535
05/04/1977 TANJUNGAN 081916085137
01/01/1984 TANJUNGAN 081584357186
14/05/1989 TANJUNGAN 081514572050
29/03/1969 TANJUNGAN 081350263519
01/07/1984 TANJUNGAN 08989374610
01/01/1992 TANJUNGAN 085892811142
19/09/2004 TANJUNGAN 081574227637
29/05/1005 TANJUNGAN 085714063246
11/12/1982 TANJUNGAN 085819326609
11/02/2005 TANJUNGAN 085721569289
13/06/1983 TANJUNGAN 085714214407
04/11/1965 TANJUNGAN 0851511857583
10/09/1970 TANJUNGAN 087805629719
11/06/1988 TANJUNGAN 085777760068
16/04/1999 TANJUNGAN 081213551420
28/10/1970 TANJUNGAN 082311265057
12/02/1987 TANJUNGAN 085280006353
4/24/1983 CIIKIRUHWETAN 081510468775
8/17/1994 SUKAWARIS 08134703321
12/9/1999 CIKIRUHWETAN 085219677096
11/27/2007 TANJUNGAN 085773749282
6/10/2009 TANJUNGAN 085773749282
8/15/2007 TANJUNGAN 085773749282
1/10/2007 TANJUNGAN 085773749282
8/14/2008 KUTAKARANG 085773749282
3/8/2008 TANJUNGAN 085773749282
7/25/1989 TANJUNGAN 081574645014
4/20/1989 TANJUNGAN 085719805484
1/21/2009 TANJUNGAN 085771605986
6/3/2008 TANJUNGAN 081280440873
8/1/2006 SUKAWARIS 085773149282
10/10/2006 TANJUNGAN 085773149282
11/20/2006 KUTAKARANG 085773149282
8/30/2007 CIKIRUHWETAN 085773149282
12/13/2005 SUKAWARIS 085773149282
1/15/2005 SUKAWARIS 085773149282
12//04/2007 TANJUNGAN 085773149282
8/13/2008 TANJUNGAN 085773149282
08/19/2007 TANJUNGAN 085773149282
11/26/2006 TANJUNGAN 085773149282
12/19/2006 TANJUNGAN 085773149282
11/5/2007 TANJUNGAN 085773149282
1/15/2007 TANJUNGAN 085773149282
7/17/2007 TANJUNGAN 085773149282
8/23/1967 TANJUNGAN 081311980300
9/12/2007 TANJUNGAN 085773149282
7/19/2007 TANJUNGAN 085773149282
5/17/2009 TANJUNGAN 085773149282
5/24/2007 TANJUNGAN 085773149282
11/12/2007 TANJUNGAN 085773149282
5/1/2009 TANJUNGAN 085773149282
10/10/2007 TANJUNGAN 085773149282
6/14/2010 TANJUNGAN 085773149282
10/15/2008 TANJUNGAN 085773149282
8/1/2009 TANJUNGAN 085773149282
12/12/2007 TANJUNGAN 085773149282
11/27/2007 TANJUNGAN 085773149282
10/3/2008 TANJUNGAN 085773149282
8/31/2008 SUMURBATU 085773149282
4/17/2007 TANJUNGAN 085773149282
11/17/2008 TANJUNGAN 085773149282
11/24/2008 TANJUNGAN 085773149282
6/21/2008 TANJUNGAN 085773149282
2/14/2007 SUKAWARIS 085773149282
6/27/2007 TANJUNGAN 085773149282
7/4/2008 SUMURBATU 085774595470
2/1/2014 CIKIRUHWETAN 085774595470
 Dosis I Dosis 2
Tanggal
Merek Tanggal Tanggal Pemberi
Vaksin*** Screening No. No.
Pemberian No seri an No Seri
Batch Batch
Vaksinasi Vaksina
si
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CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 29/11/21 202109177M
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 20210811641
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
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CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 29/11/21 2021081641
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 29/11/21 02/11/21 202108145H
CORONAVAC 9/2/2021 11/29/2021 202109177 DOSIS 2
CORONAVAC 9/2/2021 11/29/2021 202109177 DOSIS 2
CORONAVAC 25/10/2021 11/29/2021 202109177 DOSIS 2
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
 KET

DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
DOSIS 2
DOSIS 2
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DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2
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DOSIS 2

DOSIS 2
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DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
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DOSIS 2
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DOSIS 2
DOSIS 2
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DOSIS 2
DOSIS 2
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DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
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DOSIS 2

DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2

DOSIS 2
DOSIS 2
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601044211820003 MARWIAH P
2 3601046605860001 IMAS M P
3 3602164806940002 SUMA'AH P
4 3601044406840007 SAROH P
5 3601044107950232 ANI P
6 3601045005770001 ERAH P
7 3601041106570002 MUNAH P
8 3601044107880197 JUMI P
9 3601045704930006 MARNAH P
10 3601040507030007 ARIPUDIN L
11 3601044809990004 M. RUMANI L
12 3601044107780421 JASTI P
13 3601046003800001 RUBIAH P
14 3601044107730412 PATMAWATI P
15 3601040607910004 DUDI L
16 3601040606010002 TAUFIQ HIDAYAT L
17 3601044107620076 SACI P
18 3601040702610001 SARIM L
19 3601041503830003 HASAN L
20 3601043507810005 WARSONO L
21 3601042710030003 SAHRUL L
22 3601040511790001 ADE SAMSUDIN L
23 3601044107130026 SAWI P
24 3601044107770139 RUMSI P
25 3601042908040002 AHMAD HAWASI L
26 3601040107870147 ADE HAETAMI L
27 3601044104900008 ANIS P
28 3601044704830004 KARTINI P
29 3601046107780004 JUMANAH P
30 3601044107870129 MURYATI P
31 3601045107850004 MUMUN P
32 3601042106680001 ASWAD L
33 3601041803650002 ASNAN P
34 3601044107780401 MIMIN P
35 3601044208800003 ANI P
36 3602014908960002 SITI MULYATI P
37 3601045210850003 ATI P
38 3601044107670106 ASRI P
39 3601046106830001 SOPIAH P
40 3601041007820010 SUNARTA L
41 3601040107780384 WASMAN L
42 3601046803010003 ROHENI P
43 3601041103990006 AJAT L
44 3601041103610002 LAMAN L
45 3601040901010004 ANDI L
46 3601044107770122 YANAH P
47 3601046307770003 MURSIAH P
 Kepesertaan BPJS (tuli
'Ya' pada kolom yang
Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI
7/2/1987 DESA SUMURBATU 085282258649
5/26/1986 DESA UMBULAN 082310343599
6/8/1994 DESA UMBULAN 085778220408
6/4/1984 DESA SUMURBATU 085215993149
7/1/1995 DESA UMBULAN 085891154475
5/10/1973 DESA UMBULAN 085214013934
6/11/1957 LANSIA DESA UMBULAN 085718255127
7/1/1988 DESA UMBULAN 085894827427
4/17/1993 DESA UMBULAN 085894827427
7/5/2003 DESA UMBULAN 082310921179
8/9/1999 DESA UMBULAN 085718255127
7/1/1978 DESA UMBULAN 085894827427
3/20/1980 DESA UMBULAN 085718255127
7/1/1973 DESA UMBULAN 081318024055
12/7/1992 DESA UMBULAN 081318024055
6/6/2001 DESA SUMURBATU 085363898826
7/1/1961 DESA UMBULAN 085282388695
2/7/1961 DESA UMBULAN 085778212536
3/15/1980 DESA UMBULAN 085213454583
8/9/1985 DESA CIKEUSIK 085313338182
10/27/2003 DESA SUKAWARIS 081383696049
11/29/1976 DESA UMBULAN 081285872222
7/1/1963 DESA UMBULAN 085710509754
7/1/1977 DESA UMBULAN 085710504754
8/29/2004 REMAJA DESA UMBULAN 082111874872
5/12/1987 DESA UMBULAN 083879024284
4/1/1990 DESA UMBULAN 085810910014
4/7/1987 DESA UMBULAN 085781086743
7/21/1978 DESA UMBULAN 085781350437
7/1/1987 DESA UMBULAN 081912466225
7/11/1985 DESA UMBULAN 081912466225
6/21/1968 DESA UMBULAN 085891807119
3/18/1965 DESA SUMURBATU 085714933177
7/1/1978 DESA UMBULAN 082111972265
8/2/1980 DESA UMBULAN 081511865843
8/9/1996 DESA BOLANG 085211886898
5/3/1984 DESA UMBULAN 081511407830
12/15/1962 DESA UMBULAN 085213478358
6/21/1983 DESA UMBULAN 085694726404
7/10/1982 DESA UMBULAN 087872003873
7/1/1978 DESA UMBULAN 081388138823
3/28/2001 DESA UMBULAN 085775201128
11/17/2000 DESA UMBULAN 081286029538
 3/1/1961 DESA UMBULAN 085775201961
1/9/2001 DESA UMBULAN 085775201128
10/4/1980 DESA UMBULAN 085287658857
7/23/1977 DESA UMBULAN 085775201128
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal Tanggal
BPJS Non Merek Vaksin*** Screening
Pemberian No. Batch
Non PBI Anggota
Vaksinasi
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 11/29/2021 202109177M
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
 Dosis 2
Tanggal KET
No.
No seri Pemberian No Seri
Batch
Vaksinasi
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
11/29/2021 20210917 EUA2057300143A1
NO No. Ticket NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601041803750001 NURHASAN L
2 3601044107570068 WARTINI P
3 3601044610920004 UMIYANI P
4 3601044707560001 RAYEM P
5 3601044205700001 ASINAH P
6 3601044107850254 CARINIH P
7 3601044107730317 CASMI P
8 3601045104780002 SARINIH P
9 3601040902620001 H. MUHAMAD L
10 3601044107780332 DADANG P
11 3601044107950187 TINAH P
12 3601044107630293 AMROH L
13 3601045201640001 ANAH P
14 3601045005670003 ASWITI P
15 3601044107730318 RASEM P
16 3601045010930001 FATMAWATI P
17 3601044107680262 TARMINIH P
18 3601044805700001 TARIMAH P
19 3601044504730001 KUNIROH P
20 3601044107730314 WASTIRI P
21 3601044107830345 KARSINIH P
22 3601044107810157 KASWI P
23 3601040107720083 SAMA B WASMAN L
24 3601040710590001 KARNO L
25 3601044107680258 RESINI P
26 3601284610830001 FADILAWATI P
27 3601044904780005 TANIROH P
28 3601044503710001 MISTEM P
29 3601041102750001 SUPIYANI L
30 3601047110960002 NURLELA P
31 3601040107920208 SABAR L
32 3601040701580004 PARDI L
33 3601042705740001 SAEP L
34 3601044708920002 TITIN P
35 3601044211750001 RATINAH P
36 3601044107740114 WASTI P
37 3601046304720001 NANI P
38 3601046206850002 SAIKAH P
39 3601044705860003 RASKINAH P
40 3601044205870001 RAMINAH P
41 3601044107630418 OMAH P
42 3601044107920156 NASWEN P
43 3601040107810141 SUNTANA L
44 3601040107820100 AKIM RIAKIM L
45 3601040107730315 RANITA P
46 3601040405690003 JUMALI L
47 3601042901800002 MASDUKI L
48 3601042209570001 RASITA P
49 3601045006840001 NARWEN L
50 3601042402970006 SONI WIJAYA L
51 3601041308920002 KARTIMAN L
52 3601040107680275 CARISAN L
53 3601040107980227 ROJIKIN L
54 3601041401000002 CARIPUDIN L
55 3601041108060003 DEDI AFRIYANTO L
56 3602210703940003 SAMDI BADARUDIN L
57 3601040907840006 RASIWAN L
58 3601042803720001 WARDI L
59 3601040301890003 AWAN L
60 3601044907620001 SITI MARIYAM P
61 3601040409700001 ODI P
62 3601041303570003 AJUN HIDAYAT L
63 3601044107630303 TANIYEM P
64 3601045602890004 CASNERI P
65 3601045006770003 UTI P
66 3601046605030002 MENUR MAULANI P
67 3601044107760261 ANTINAH P
68 3601040606000001 ABDUROHMAN L
69 3601044105700005 SUMYATI P
70 3601041604080001 M. AZIS MAULANA L
71 3601044507970001 MARSITA NUR WILASTRI P
72 3601041405720002 MARHUSEN L
73 3601040805930004 KASTURI L
74 3602215005730002 SARWATI P
75 3602210108630001 RUSLAN L
76 1602112011760005 SUWONDO L
77 3601042204520001 KARYO L
78 3601040903760001 CANTEL L
79 3601041902670001 WARKIM L
80 1602110107790075 JATMA L
81 3672061012870002 ATIM L
82 3601045601800003 SANIMAH P
83 3601041110850003 DASUKI L
84 3601040302990007 KARTIM L
85 3601045711020004 TARISAH P
86 3601040107010234 M. MUJAKI L
 87 3601040502700001 SUHARI L
88 3601040107030145 RAMIN L
89 3601040107780386 SARTAMA L
90 3601042304870001 ARSUDIN L
91 3601040804520001 TONDO L
92 3601042312620002 ATING L
93 3601044102820010 CASWATI P
94 3601044405450001 AWENG P
95 3601042008690001 AJID L
96 3601044101870003 KARNITI P
97 3601045103970004 AMSIAH P
98 3601045502530001 WARSEM P
99 3601041208960002 ARIYANTO L
100 3601041008970004 MUJAHIDIN L
101 3601045706020002 SARMILAH P
102 3601046210060001 SUSILAWATI P
103 3601046311910003 WARNIAH P
104 3601046404900001 TASJANI L
105 3601040209900003 USTARA L
106 3601041312670001 SALIKIN L
107 3601040606780002 M. ARIFIN L
108 3601041407990005 KARNAMIN L
109 3601040910910003 ARI L
110 3601045003620001 DARINIH P
111 3601045501470001 RAMINIH P
112 3601044507980001 AYU ASTARI P
113 3601045909770002 RASTINAH P
114 3601046011620001 DANAWATI P
 Kepesertaan BPJS
'Ya' pada kolom ya
Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI
12/15/1972 DESA SUKASENENG 085773210689
1/5/1980 DESA SUKASENENG 081296605082
10/6/1992 DESA SUKASENENG 081296605082
7/7/1956 LANSIA DESA SUKASENENG 083848555490
5/2/1970 DESA SUKASENENG 081284850131
7/1/1985 DESA SUKASENENG 085281760531
7/1/1969 DESA SUKASENENG 085217267576
4/11/1978 DESA SUKASENENG 085707761924
2/9/1962 DESA SUKASENENG 082311404137
7/1/1978 DESA SUKASENENG 085219655965
1/26/1996 DESA SUKASENENG 087780660782
7/1/1958 LANSIA DESA SUKASENENG 083896259674
1/12/1964 DESA SUKASENENG 083848555476
5/10/1967 DESA SUKASENENG 085778986809
7/1/1973 DESA SUKASENENG 083848555476
7/5/1993 DESA SUKASENENG 085715799439
7/1/1968 DESA SUKASENENG 085281760531
5/8/1970 DESA SUKASENENG 082155500460
4/5/1973 DESA SUKASENENG 085283293895
7/1/1973 DESA SUKASENENG 082110991533
7/1/1983 DESA SUKASENENG 085210968173
7/1/1981 DESA SUKASENENG 082297972807
3/2/1974 DESA SUKASENENG 082297972807
10/7/1959 LANSIA DESA SUKASENENG 085219822442
7/1/1968 DESA SUKASENENG 082297972807
8/23/1984 DESA SUKASENENG 085212102826
4/9/1978 DESA SUKASENENG 083811908407
3/5/1971 DESA CIKEUSIK 085235725579
2/11/1975 DESA SUKASENENG 081385169803
10/31/1996 DESA SUKASENENG 085215786585
7/1/1992 DESA SUKASENENG 081326757810
1/7/1958 DESA SUKASENENG 087781009401
10/5/1975 DESA SUKASENENG 085283233148
8/7/1972 DESA SUKASENENG 081511406402
11/2/1975 DESA SUKASENENG 085311841964
7/1/1974 DESA CIKEUSIK 085311640057
4/23/1972 DESA SUKASENENG 085388908679
6/22/1987 DESA SUKASENENG 085213477318
4/12/1985 DESA SUKASENENG 085775202746
5/2/1987 DESA SUKASENENG 087881041062
7/1/1963 DESA SUKASENENG 081511690250
 5/11/1992 DESA SUKASENENG 085247976571
7/1/1978 DESA SUKASENENG 081906047275
2/14/1985 DESA SUKASENENG 085775202741
7/1/1973 DESA SUKASENENG 085219655965
5/4/1969 DESA SUKASENENG 085325748145
1/29/1980 DESA SUKASENENG 085281760531
9/22/1957 LANSIA DESA SUKASENENG 081311188468
6/15/1984 DESA SUKASENENG 085774961481
2/24/1997 DESA SUKASENENG 082311533991
6/18/1994 DESA SUKASENENG 081311979493
7/1/1968 DESA SUKASENENG 085693643272
7/1/1998 DESA SUKASENENG 085693643272
1/14/1999 DESA SUKASENENG 085894698973
8/1/2006 REMAJA DESA SUKASENENG 085778519852
10/11/1996 DESA SUKASENENG 081298792665
7/9/1984 DESA SUKASENENG 085782336781
28/03/0972 DESA SUKASENENG 082324146300
1/3/1989 DESA SUKASENENG 081318269209
7/9/1962 DESA SUKASENENG 085212102826
9/4/1970 DESA SUKASENENG 081511406402
3/3/1957 DESA SUKASENENG 085212102826
7/1/1963 DESA SUKASENENG 081511406388
2/15/1989 DESA SUKASENENG 085280255957
6/10/1970 DESA SUKASENENG 081297935349
5/26/2003 DESA SUKASENENG 081297935349
7/1/1976 DESA SUKASENENG 081511757200
6/6/2000 DESA SUKASENENG 083893086196
5/1/1970 DESA SUKASENENG 085778986809
16/04/2008 REMAJA DESA SUKASENENG 086976449501
27/10/1998 DESA SUKASENENG 081586918242
4/7/1976 DESA SUKASENENG 085710509798
8/5/1993 DESA SUKASENENG 085770705747
5/10/1973 DESA SUKASENENG 085211407939
8/1/1963 DESA SUKASENENG 085211407939
11/20/1976 DESA SUKASENENG 085216246338
4/22/1952 LANSIA DESA SUKASENENG 085161433546
3/9/1965 DESA SUKASENENG 085211572915
2/19/1962 DESA SUKASENENG 085216915430
7/1/1979 DESA SUKASENENG 082312013182
7/21/1987 DESA SUKASENENG 085810876859
1/16/1980 DESA SUKASENENG 085710515952
7/8/1983 DESA SUKASENENG 085782261636
2/3/1999 DESA SUKASENENG 085770649487
12/17/2002 DESA SUKASENENG 085770649487
7/4/2000 DESA SUKASENENG 089523432728
 2/14/1975 DESA SUKASENENG 085813587339
7/1/2003 DESA SUKASENENG 089523432728
5/5/1981 DESA SUKASENENG 085213484066
1/21/1985 DESA SUKASENENG 081380166856
4/8/1952 LANSIA DESA SUKASENENG 085219423907
12/23/1962 DESA SUKASENENG 085691133278
2/1/1982 DESA SUKASENENG 085773239289
4/7/1947 LANSIA DESA SUKASENENG 08591054502
8/20/1969 DESA SUKASENENG 085214063184
1/1/1987 DESA SUKASENENG 081388902075
3/11/1997 DESA SUKASENENG 085691133278
2/15/1942 LANSIA DESA SUKASENENG 082312013182
6/6/1996 DESA SUKASENENG 081584341463
3/9/1996 DESA SUKASENENG 085587114782
9/19/1999 DESA SUKASENENG 085587114822
10/2/2005 REMAJA DESA SUKASENENG 083158038681
11/23/1991 DESA SUKASENENG 085778987199
4/24/1990 DESA SUKASENENG 085778987199
9/2/1990 DESA SUKASENENG 082312285648
12/13/1967 DESA SUKASENENG 085770971946
6/6/1978 DESA SUKASENENG 085217286312
7/14/1999 DESA SUKASENENG 085773884797
7/1/1991 DESA SUKASENENG 085773884797
3/10/1962 DESA SUKASENENG 081336193559
4/14/1965 DESA SUKASENENG 0823121013182
6/9/1995 DESA SUKASENENG 085782490323
9/19/1977 DESA SUKASENENG 082312013182
20/11/1962 DESA SUKASENENG 085778182351
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal Tanggal
BPJS Non Merek Vaksin*** Screening
Pemberian No. Batch
Non PBI Anggota
Vaksinasi
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021 11/30/2021 202109177M
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
CORONAVAC 11/30/2021
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CORONAVAC 11/30/2021
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CORONAVAC 11/30/2021
CORONAVAC 11/30/2021 11/30/2021 202108164I
CORONAVAC 11/30/2021 11/30/2021 202108164I
CORONAVAC 11/30/2021
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CORONAVAC 11/30/2021
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CORONAVAC 11/30/2021 11/30/2021 202108164I
CORONAVAC 11/30/2021
 NO Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
11/30/2021 202109177M EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
 11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
EUA2057300143A1
11/30/2021 202108164I EUA2057300143A1
NO No. Ticke NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601044808800002 NURLAELA P IRT

2 3601045111890004 GINA RAHMAWATI P IRT
3 3601044210670002 SANT P IRT
4 3601045209720001 TASINEM P IRT
5 3601045706910004 NURAENI P IRT
6 3601041208930001 DASTIM L PETANI
7 3601044201790002 TITIN P IRT
8 3601041102830011 ENCEP MAULANA L PETANI
9 3601044204000002 MIMIN P IRT
10 3213046311800001 AAN KARTIKA P IRT
11 3601044104950015 SITI AISYAH P IRT
12 3601045707820005 EKA P IRT
13 3601045510000008 UMIYAH P IRT
14 3601044105820005 NUNUNG P IRT
15 3601041012920003 TARYONO L WIRASWA
16 3601045904730001 RUMIANAH P IRT
17 3601040107690095 JUANDA L PETANI
18 3601041808860003 NUR MOH NURIL L KARYAWA
19 3601045208750007 MARIAH P IRT
20 3601044508620001 OMAH P IRT
21 3601041503580002 SUKATMA L PETANI
22 3601044305800003 NURHASANH P IRT
23 3601044109870004 SITI FATIMAH P IRT
24 3601046908650001 ASIAH P IRT
25 3601044206940004 KARMI P IRT
26 3601042602020005 SANDI L WIRASWA
27 3601044107600131 JUNAH P IRT
28 3601045202000007 SITI TANDIATU JANAH P IRT
29 3601041903640004 JUMALI L WIRASWA
30 360104520398008 ARNI P IRT
31 3601040708900001 NUNUNG ANDRIYANI P IRT
32 3601035204990004 SITI MASITOH P IRT
33 3601044107890181 GEA MAGDALENA P IRT
34 3601044107780082 MIMI P IRT
35 3601041601050602 IPAN RIPAI L PELAJAR
36 3601011605840001 YANTO L WIRASWA
37 3601044107800064 OMI P IRT
38 3601044309930001 TINI P BELUM KE
39 36010441039300003 NENGSIH P IRT
40 360104131181001 SUKMA L WIRASWA
41 3601040107870001 SURYANA HUSEN L WIRASWA
42 3601045104960003 SITI MAESAROH P IRT
43 3601044808900001 HETI P IRT
44 3601044804910008 ACIH SUARSIH P IRT
45 3601044102930013 SARYATI P IRT
46 3275046606840038 RIRIN P IRT
47 3601042803860003 PEPEN EPENDI L WIRASWA
48 3601046503990001 ENOK JUNENGSIH P PELAJAR
49 18042348-05950002 LEVI PURWANTI P PETANI
50 3601044604770004 JUMI P IRT
51 3601045001790005 TARSIH P IRT
52 3601046411030001 FITRI P PELAJAR
53 3275096304760061 SUTINAH P IRT
54 3601045703830002 NURHAYATI P IRT
55 3601040906710001 AJAD SUDRAJAT L WIRASWA
56 3601041505050003 RIANTO SYAFUTRA L PELAJAR
57 3601031809960001 HABIB AMAR L WIRASWA
58 ANDIKA L PELAJAR
59 3601042212010001 AANG DANURI L WIRASWA
60 1811032108000001 AGUS SURYANA L PELAJAR
61 3601046606970001 NUR HOLIFAH P IRT
62 3601045701960001 SITI ROHMAYANTI P IRT
63 MUHAMDA ROLANSYAH L BELUM KE
64 3601045807620001 ANAH P IRT
65 3601044611800001 MINAH P IRT
66 3601046412890003 SUHENAH P IRT
67 3601045002860009 IKA P IRT
68 3602214101060009 SINTIA SARI P PELAJAR
69 3602066201040001 SITI COLIPAH P PELAJAR
70 3601044107040008 AAS MILDAWATI P PELAJAR
71 3602064507040007 LUNA SALMA JULIANTI P BELUM KE
72 3601046106730003 SRI WULAN P IRT
73 3601071411120092 REVA AGUSTIN P PELAJAR
74 360104490103002 ENOK KHORIAH P PELAJAR
75 360104490103002 ROBIATUL AWALIAH P PELAJAR
76 3601045612080001 YUSI NUR KHOLIFAH P PELAJAR
77 3601040102080008 DEPI L PELAJAR
78 3602061804890002 ENCENG KASRUDIN L WIRASWA
79 3601043108050002 YUSUP RIZKI LANZANI L PELAJAR
80 SOLIHIN L PELAJAR
81 3601045304700001 LILIS P IRT
82 3601045009970006 LINA MARLINA P IRT
83 3601040304700002 MUSTOPA L KARYAWA
84 3601041402000003 WASADI L WIRASWA
85 3601044707000006 SRI UTARI P IRT
86 3601044505890006 AAT ATIKAH P IRT
87 36010409061500001 AGUS TINA L BELUM KE
88 3602216805000004 KARTIKA DEWI P IRT
89 3601045812000002 NENG DIAN AMELIA P PELAJAR
90 3601040309510001 TONI L PETANI
91 3601042703950004 UNEN L WIRASWA
 92 3601045301960004 DEVI HERYANI P IRT
93 3601045001000004 SUHANAH P IRT
94 3601045503700004 UCIH P IRT
95 3601045704030002 CICI SINTYA P PELAJAR
96 3601040303700005 SIHABUDIN L WIRASWA
97 3601042105890001 IIM SUHARDI L WIRASWA
98 3601041506050002 JAKA SUGI HARTO L PELAJAR
99 3601044103030006 DEDEH NURHAYATI P PELAJAR
100 3601047101840001 MARNI P IRT
101 3601044702060001 PUSPITA SARI P PELAJAR
102 3601044608930013 ENUR PAIJAH P IRT
103 3601045709010007 SRI DEVI P PELAJAR
104 3601041501980001 AZIS L WIRASWA
105 1871080807880002 RAGIL L WIRASWA
106 3601041212630001 ASEP SAEPUDIN L WIRASWAS
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
Umur Kelomp sesuai)
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI
08-08-1980 UMUM CIWET 085213098704
11-11-1989 UMUM CIWET 085866767684
02-10-1967 UMUM CIWET 081295093751
12-09-1972 UMUM CIWET 085719003128
17-06-1991 UMUM CIWET
18-12-1992 UMUM CIWET 085882795455
02-01-1985 UMUM CIWET 0853891292381
11-07-1983 UMUM CIWET 085866761684
02-04-2000 UMUM CIWET 085882795455
23-11-1980 UMUM CIWET 085866761684
01-04-1995 UMUM CIWET 085894691706
17-07-1982 UMUM CIWET 0853891292381
15-10-2000 UMUM CIWET 083896544533
01-05-1982 UMUM CIWET 085693562845
10-12-1992 UMUM CIWET 085814339724
19-041973 UMUM CIWET 0853891292381
01-07-1969 UMUM CIWET 085773305431
18-08-1986 UMUM CIWET 081372749799
12-08-1975 UMUM CIWET 082254419079
05-081962 UMUM CIWET 085866761684
15-03-1958 UMUM CIWET 085866761684
03-05-1990 UMUM CIWET 085885581612
01-09-1967 UMUM CIWET 081372749799
01-10-1970 UMUM CIWET 081905642922
02-06-1994 UMUM CIWET
05-01-2001 UMUM CIWET 081295807293
01-07-1960 UMUM CIWET 085885591060
12-02-2000 UMUM CIWET 085773639831
19-03-1964 UMUM CIWET 08588559106
12-03-1998 UMUM CIWET 081318024699
11-02-1990 UMUM CIWET 081574884302
12-04-1999 UMUM CIWET 085219655695
01-09-1992 UMUM CIWET 085313927816
01-07-1978 UMUM CIWET 0877411030806
16-01-2005 UMUM CIWET 081318016331
05-09-1985 UMUM CIWET 085720321057
01-07-1973 UMUM CIWET 085866781684
03-09-1993 UMUM CIWET 081281815305
01-03-1993 UMUM CIWET 081283568120
17-08-1979 UMUM CIWET 085494156856
01-07-1987 UMUM CIWET
11-04-1996 UMUM CIWET 085794156990
08-08-1990 UMUM CIWET 081210913277
08-04-1991 UMUM CIWET 085891343844
10-07-1980 UMUM CIWET 08521437196
26-061984 UMUM CIWET
28-03-1986 UMUM CIWET 081283568120
05-05-1999 UMUM CIWET 083812674404
08-05-1995 UMUM CIWET 085267580154
06-04-1977 UMUM CIWET 085714783742
10-01-1979 UMUM CIWET 085714783742
24-11-2003 UMUM CIWET 081311981272
23-04-1976 UMUM CIWET 087819453993
27-03-1987 UMUM CIWET 085716521378
09-06-1971 UMUM CIWET 085217374384
15-05-2004 UMUM CIWET 081382361437
18-09-1996 UMUM CIWET 085695388393
20-10-2008 UMUM CIWET 083895165673
22-12-2001 UMUM CIWET 085778272969
21-08-2000 UMUM CIWET 085158915055
26-07-1997 UMUM CIWET 085814339752
16-10-1996 UMUM CIWET 085719784672
30-06-1999 UMUM CIWET 085813641153
18-07-1962 UMUM CIWET 081617209550
06-11-1980 UMUM CIWET 085697720863
24-12-1989 UMUM CIWET
10-02-1986 UMUM CIWET
01-01-2006 UMUM CIWET 085695147807
22-01-2004 UMUM CIWET 085695147807
02-06-2005 UMUM CIWET 085695147807
05-07-2009 UMUM CIWET 085695147807
21-06-1973 UMUM CIWET 085695388393
04-08-2010 UMUM CIWET 085695147804
09-01-2003 UMUM CIWET 085695147807
12-05-2005 UMUM CIWET 085695147807
16-12-2008 UMUM CIWET 085695147807
06-08-2008 UMUM CIWET 085695147807
18-04-1989 UMUM CIWET 085717555940
31-08-2005 UMUM CIWET 085811460084
;10-02-2002 UMUM CIWET 085814317812
25-08-1971 UMUM CIWET 085219421599
10-09--1997 UMUM CIWET 085716582065
03-04-1970 UMUM CIWET 087763491413
22-02-1997 UMUM CIWET 083109653217
07-07-2000 UMUM CIWET 081388293683
05-05-1989 UMUM CIWET 087763491413
09-06-1998 UMUM CIWET 083109995015
28-05-2000 UMUM CIWET 085219421599
18-12-2006 UMUM CIWET 083893403312
03-09-1951 UMUM CIWET 083109949132
27-03-1995 UMUM CIWET 083106217589
30-11-1996 UMUM CIWET 083813888872
UMUM CIWET 085717608691
15-03-1970 UMUM CIWET 085773488302
03-01-2003 UMUM CIWET 081384074791
03-03-1970 UMUM CIWET 081210788086
05-06-1987 UMUM CIWET 085773488150
15-06-2005 UMUM CIWET 085776879832
01-03-2003 UMUM CIWET 0838020190207
31-01-1984 UMUM CIWET 085773749183
07-02-2006 UMUM CIWET 085779803995
06-08-1993 UMUM CIWET 085776879832
17-09-2001 UMUM CIWET 085885157480
02-02-1997 UMUM CIWET 081213344731
15-051988 UMUM CIWET 081290183794
12-12-1963 UMUM CIWET
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri
Anggota
Vaksinasi
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021
CORONAVAC 30-11-2021 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021
CORONAVAC 30-11-2021 30-11-2021 202108145H
CORONAVAC 30-11-2021 30-11-2021 202108145H
 Dosis 2
Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi
30-11-2021 202108145H
30-11-2021 202108145H
30-11-2021 202108145H
30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H
30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H
30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H
30-11-2021 202108145H

30-11-2021 202108145H
30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H

30-11-2021 202108145H
30-11-2021 202108145H

30-11-2021 202108145H
30-11-2021 30-11-2021
NO No. Ticke NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601045012660001 BAYI P
2 3601041607840001 SAWARI L
3 3602036106810001 ROHANAH P
4 3601045409020002 PARIDA ANJANI P
5 3601064709830005 ARTINI P
6 3601046403870001 SUNARSIH P
7 3601044504990004 RANI P
8 3601042508970001 CAHYO L
9 3601045104850006 NAYATI P
10 3601044104660001 SUARNAH P
11 3601044110890001 SONIA PAUJAH P
12 3601044102730005 EJOH P
13 3601045412790001 RAWI P
14 3601046110650001 PATIMAH P
15 3601040107930040 SODIKIN L
16 3601044907990002 ITA ELIANTI P
17 3601042719820001 JUNED L
18 360104010840006 DENI L
19 3601045111990010 ERLINA P
20 3601041209980006 DEDE AFENDI L
21 3601041606770001 ADANG L
22 '3601042807510001 ACUT P
23 3601044109820003 SARINAH P
24 3601040306950001 AHIM L
25 3601040107790015 ROHMAN L
26 3601040102890003 AMIR L
27 3601044109770002 ETI P
28 3601044512050002 LILS P
29 3601044108640001 ICAH P
30 3601044101020015 SITI MASITOH P
31 3601041104620001 ARSUDIN L
32 3601040403980001 ANDI JATNIKA L
33 3601040506970001 DIK ISMUNANDR L
34 3601041012720006 EDI L
35 3601042402940001 SUTISNA L
36 3601045002820001 IIN P
37 3601040301920003 SUEB SAEPUDIN L
38 3601042010000005 KIKI SUHENDRA L
39 3601041107010006 ESA DAMARA PUTRA L
40 4601044703990003 SITI MARIAH P
41 2601040107730096 AMIN SUHENDI L
42 3601040901770001 ADE SOGIR L
43 3601040602860004 DAYAT SUMIARJA L
44 3601045611910001 TITA ROSITA P
45 3601045107620001 MAESAROH P
46 3601044310790001 JULEHA P
47 3602120503990007 AJUM PRATAMA L
48 3601045101780007 NUNUNG P
49 3601043008990001 KUSNADI L
50 3601044512010004 DARWATI P
51 3601040103980001 ASEP SETIABUDI L
52 3601040705020003 AHMAD MALDINI HIDAYAT L
53 3601045358700002 UNAYAH P
54 3601045703720001 AISAH P
55 3601044104940002 PITRIAH P
56 3601044107830074 NINGRAT P
57 3601044504070003 PATIMAH AZAHRA P
58 3602026012000003 NIA P
59 3601044405010002 KARNIAH P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS Non
ok Umur
tahun) PBI Non PBI Anggota

10/12/1966 UMUM SUKAWARIS 083899455976

11/08/1978 UMUM SUKAWARIS 0838890673302
21/06/1981 UMUM SUKAWARIS 082149935278
14/09/2002 UMUM SUKAWARIS 082149935278
07/09/1983 UMUM SUKAWARIS 085939243662
23/03/1987 UMUM SUKAWARIS 085694089782
05/04/1999 UMUM SUKAWARIS 085939243662
25/08/1997 UMUM SUKAWARIS 085711304504
11/04/1985 UMUM SUKAWARIS 085718751433
01/04/1966 UMUM SUKAWARIS 085777477316
05/06/1989 UMUM SUKAWARIS 086773225516
01/02/1973 UMUM SUKAWARIS 085814397896
14/12/1979 UMUM SUKAWARIS 085773633244
21/10/1965 UMUM SUKAWARIS 085773675649
08/11/1992 UMUM SUKAWARIS 083890673302
09/07/1995 UMUM SUKAWARIS 085797176063
27/10/1982 UMUM SUKAWARIS 082113761023
01/01/1967 UMUM SUKAWARIS 085773225516
11/11/1998 UMUM SUKAWARIS 081511686187
12/09/1998 UMUM SUKAWARIS 085691466395
16/06/1977 UMUM SUKAWARIS 082332932952
28/07/1951 UMUM SUKAWARIS
10/03/1979 UMUM SUKAWARIS 085719800216
03/06/1995 UMUM SUKAWARIS 085724454687
UMUM SUKAWARIS 085866761684
01/02/1989 UMUM SUKAWARIS 085891343844
01/09/1977 UMUM SUKAWARIS 085214083616
05/12/2005 UMUM SUKAWARIS 083890673302
12/08/1963 UMUM SUKAWARIS 085319519048
28/06/2004 UMUM SUKAWARIS
'11/04/1962 UMUM SUKAWARIS 0838890673302
03/04/1997 UMUM SUKAWARIS 083899455976
05/06/1997 UMUM SUKAWARIS 0856928411549
10/12/1972 UMUM SUKAWARIS 083890673302
24/02/1994 UMUM SUKAWARIS 0859866761684
22/06/1982 UMUM SUKAWARIS 081315543448
03/01/1992 UMUM SUKAWARIS 081384839901
20/10/2000 UMUM SUKAWARIS 081382660925
11/07/2001 UMUM SUKAWARIS 081295700116
07/03/1999 UMUM SUKAWARIS 085778986830
04/08/1974 UMUM SUKAWARIS 083890404814
09/01/1977 UMUM SUKAWARIS 083890673302
06/02/1986 UMUM SUKAWARIS 083841443132
16/11/1991 UMUM SUKAWARIS 083841443132
14/10/1968 UMUM SUKAWARIS 081387125484
03/10/1979 UMUM SUKAWARIS 083890673302
05/03/1999 UMUM SUKAWARIS 089810739991
11/0/1978 UMUM SUKAWARIS 085882202029
30/08/1999 UMUM SUKAWARIS 085810735661
05/12/2001 UMUM SUKAWARIS 08565336912
16/11/1997 UMUM SUKAWARIS 085773166705
07/05/2002 UMUM SUKAWARIS 085691745976
13/05/1987 UMUM SUKAWARIS 08589152241
17/03/1972 UMUM SUKAWARIS 083818222424
01/04/1994 UMUM SUKAWARIS 085779562144
01/07/1983 LANSIA SUKAWARIS 085716565081
05/04/2007 UMUM SUKAWARIS 081295084309
20/12/2000 UMUM SUKAWARIS 085282768258
04/05/2001 UMUM SUKAWARIS 081317198940
 Dosis I Dosis 2

Tanggal Tanggal Tanggal

Merek Vaksin*** Screeni Pemberi Pemberi
ng an No. Batch No seri an No. Batch
Vaksina Vaksina
si si
CORONAVAC 30/11/21 02/11/21 2021081454H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 2021081345HY
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202108145H
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 01/11/21 2021081541 30/11/21 2021081541
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 02/07/21 2404021 30/11/21 202109177M
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 2021081541
CORONAVAC 30/11/21 02/11/21 202108145H 30/11/21 2021081541
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 02/11/21 202018145H 30/11/21 2021081541
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 30/11/21 2021081641
CORONAVAC 30/11/21 02/11/21 2021081641
CORONAVAC 30/11/21 30/11/221 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
CORONAVAC 30/11/21 30/11/21 202109177M
 KET
No Seri

DOSIS 2
DOSIS 1
DOSIS 2
DOSIS 1
DOSIS 2
DOISS 2
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 2
DOSIS 1
DOSIS 2
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 2
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 2
DOSIS 1
DOISS 2
DOISS 2
DOSIS 1
DOSIS 1
DOISS 2
DOSIS 1
DOSIS 2
DOISS 2
DOSIS 1
DOISS 2
DOSIS 2
DOISS 2
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOISS 2
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 1
DOSIS 2
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601044102970004 SITI HAERIAH P

2 3601044107600061 NURHAMAH L
3 3601044107740047 MASNI P
4 3601044705890001 UMAH P
5 3601044102970004 SITI HAERIAH P
6 3601044107620037 RUHETI P
7 3601047102820001 PATIMAH P
8 3601044401730001 SUHA P
9 3601041702680002 SARDA L
10 3601044107840100 SARMINAH P
11 3601044107730171 RASMINAH P
12 3601041308470001 SAKARI L
13 3601047183840002 ELA P
14 3601044903950003 SUMINI P
15 3601046406820001 RUMSINAH P
16 3601040403710002 BASUDIN L
17 3601044904860004 UMIYAH P
18 3601044202800003 JUMINAH P
19 3601044107880157 KOKOM P
3601045710020004 IRMAWATI P
21 3601044208000001 SELA SUSILAWATI P
22 3601044301020007 TARSIH P
23 3601044101980008 WASTINAH P
24 3601045003910005 SANAH P
25 3601045805770001 EMAH P
26 3601040107550035 SANTA L
27 3601042909820001 ANWAR L
28 3601040107870084 JEJEN L
29 3601044107570044 JASMI P
30 3601044506820004 SAMEN P
31 3601044912070001 DEDIH L
32 3601044805650001 ONIH P
33 3601044107850137 SAPIAH P
34 3601040904070002 NARDI L
35 3601044412950010 NOVI WIDURI P
36 3601044509600001 JUNAH P
37 3601041608680001 AHMAD SUKARDI L
38 3601040710040002 MUHAMAD DONI SETIA L
39 3601041203600004 AMIR L
40 3601044107870063 ROHIMAH P
41 3601040107760101 SUTARDI L
42 3601044107690051 CASINAH P
43 3602090608720002 AJUM L
44 3601044410720100 ATEM P
45 3601045108850001 RINAH P
46 3601047004830002 SAENAH P
47 3601044605930007 RAMAH P
48 3601046405860002 ARNAH P
49 3601044107850171 ASIH P
50 3601046004870001 MARIAH P
51 3601045703730003 MIMIN P
52 3601041203730003 ROSID L
53 3601040107730201 NURSOLEH L
54 3601040107620033 ARTAJAYA L
55 3601040107370007 SANAKA L
56 3601046410020001 IPAH P
57 3601040107780185 ARHAD L
58 3601044107850161 UMYATI P
59 3601041607850001 SARMAN L
60 3601044107740132 RASILEM L
61 3601045403780002 RONAH P
62 3601040107920136 JAYA APANDI L
63 3601040107590025 PULUNG L
64 3601041202820005 SUPARDI L
65 3601042506690001 MUKRI L
66 360104010770080 RUKMAN L
67 3601130701870002 ADE L
68 3601040607900007 PANDI L
69 3601041606870003 SUPRIYADI L
70 3601040107820048 CITRA P
71 3601041904830002 SARJA L
72 3601040107890103 SAYIDI L
73 3601042101950001 JAMIDUDIN L
74 3601044107301008 RATNA P
75 3601044107670056 INTEN P
76 3601104570560002 DARSINAH P
77 3601047012840003 EHA P
78 3601044707950007 NITA P
79 3601045207840007 SANI P
80 3601044108850022 NARSIH P
81 3601045002890005 ROHANIAH P
82 3601044903800003 ITI P
83 3601044101920008 ETI P
84 3601041610130002 SUKMA L
85 3601041205040001 AHMAD BUKHORI L
86 3601044107990153 NURDIN L
87 3601021012810001 KASMARI L
88 3601040705870010 SUPARMAN L
89 3601040411800004 SURAYADI L
 90 3601045410840001 ROHANIAH P
91 3601042002840001 SUNARYA B HARUN L
92 3601040107650078 KEMUH L
93 3601041209950005 AHMAN L
94 3601045008950001 ARNIATI P
95 3601040305590002 SANURI L
96 3601042703930007 EMAN L
97 3601045110940003 SAEDI L
98 3601046803900001 ELIS P
99 3601044310680003 RAMI P
100 3601044903800003 ITI P
101 3206081209700001 MANSUR L
102 3601041805690001 MUHI L
103 3601040107750106 JAED L
104 3601046104750002 SAENAH P
105 3601040405110003 WAHYU IRAWAN L
106 3601041010960005 YAYAN GUNAWAN L
107 3601046309780001 ASMINAH P
108 3601040408930001 ABDUROHMAN L
109 3601046112080002 ANITA P
110 3601040705790001 SARTU P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS Non
ok Umur
tahun) PBI Non PBI Anggota

12/03/1979 NANGGALA 08561006014

01/03/1966LANSIA NANGGALA 085775871335
01/07/1974 NANGGALA 085781085150
15/09/1990 NANGGALA 085718877044
12/03/1979 NANGGALA 08561006014
01/07/1962 NANGGALA 083875405717
30/12/1982 NANGGALA 085893756942
04/01/1972 NANGGALA 085770147680
17/02/1968 NANGGALA 085779172126
01/07/1964LANSIA NANGGALA
01/07/1973 NANGGALA 085717563941
13/08/1947 NANGGALA 085770773532
31/03/1984 NANGGALA 085810132751
09/03/1995 NANGGALA 085211425239
24/06/1984 NANGGALA 085710140947
04/03/1971 NANGGALA 085211641190
09/04/1986 NANGGALA 085782131280
02/02/1980 NANGGALA 085695409639
01/07/1988 NANGGALA 085219331282
17/10/2002 NANGGALA 085311554759
31/08/2000 NANGGALA 085884656575
03/01/2002 NANGGALA 081213221696
01/01/1998 NANGGALA 085882801953
10/03/1991 NANGGALA 085716785298
18/05/1977 NANGGALA 085770147681
01/07/1955 NANGGALA 085779054294
19/04/1973 NANGGALA 085710140941
28/05/1985 NANGGALA 085695409489
01/07/1957 NANGGALA 085719331282
05/06/1982 NANGGALA 081554080411
19/12/2007REMAJA NANGGALA 081511862698
08/05/1965LANSIA NANGGALA 085810137878
01/07/1985 NANGGALA 085810142870
09/04/2007REMAJA NANGGALA 085783872092
04/12/1995 NANGGALA 085880001901
05/09/1980 NANGGALA 085289878194
16/08/1968 NANGGALA 083151383728
07/10/2004 NANGGALA 085772723079
14/07/1960LANSIA NANGGALA 085710140900
17/06/1986 NANGGALA 0857838722092
01/07/1976 NANGGALA 085211425239
01/07/1969LANSIA NANGGALA 083813522190
06/08/1960 NANGGALA 085893304076
06/09/1992 NANGGALA 085775164124
11/08/1985 NANGGALA 085719604013
04/07/1982 NANGGALA 085717563622
06/05/1993 NANGGALA 081218970552
10/03/1988 NANGGALA 083813522190
17/07/1981 NANGGALA 083813522190
20/04/1987 NANGGALA 085693476855
17/03/1973 NANGGALA 85210707768
10/05/1977 NANGGALA 085773624209
01/07/1973 NANGGALA 085774964755
01/07/1962 NANGGALA 081219418136
07/10/1970 NANGGALA 083813593809
25/06/2000 NANGGALA 085810910008
01/07/1970 NANGGALA 08576128351
01/07/1985 NANGGALA 081511407902
16/07/1985 NANGGALA 081517847687
01/07/1974 NANGGALA 085880004611
20/07/1965LANSIA NANGGALA 085695409489
06/04/1995 NANGGALA 085782271838
01/07/1989 NANGGALA 083813593809
12/02/1982 NANGGALA 085217385070
25/06/1969LANSIA NANGGALA 085779170203
01/07/1977 NANGGALA 085210340662
07/01/1997 NANGGALA 083813424923
03/01/1990 NANGGALA 085813879181
16/06/1987 NANGGALA 085880279815
01/07/1982 NANGGALA 085210493103
19/04/1983 NANGGALA 085793972092
01/07/1989 NANGGALA 085695268466
20/12/2001 NANGGALA 085710721410
01/07/1983 NANGGALA 085219331282
01/07/1976 NANGGALA 08571756394
17/05/1965LANSIA NANGGALA 085710506330
30/12/1984 NANGGALA
07/07/1995 NANGGALA 081380166250
12/07/1984 NANGGALA 085210708052
01/08/1985 NANGGALA 082182034054
10/02/1989 NANGGALA 08157006936
09/03/1980 NANGGALA 085217116990
01/01/1992 NANGGALA 0857175639111
18/10/2010REMAJA NANGGALA 085810132813
12/05/2005 NANGGALA 085810132813
01/07/1979 NANGGALA 085211986593
10/12/1981 NANGGALA 081572076936
07/05/1967LANSIA NANGGALA 085774305375
04/11/1980 NANGGALA 085772723079
14/10/1964LANSIA NANGGALA 087755031451
20/02/1984 NANGGALA 085715458271
05/07/1976 NANGGALA 085718744731
12/09/1995 NANGGALA 085691938630
10/09/1995 NANGGALA 081380145912
03/05/1958 NANGGALA 08521382500
27/03/1993 NANGGALA 085771613795
27/02/1994 NANGGALA 085211986593
28/03/1990 NANGGALA 085779058986
02/10/1968 NANGGALA 082214752255
09/03/1980 NANGGALA 085217116990
12/09/1970 NANGGALA 085691857706
18/05/1969LANSIA NANGGALA 085880004611
01/07/1975 NANGGALA 085880005421
05/12/1978 NANGGALA 085894826313
24/01/2004REMAJA NANGGALA 085311647229
10/10/1996 NANGGALA 085782266720
23/09/1978 NANGGALA 081511407981
28/09/1996 NANGGALA 083182321570
21/12/2008REMAJA NANGGALA 085774607053
07/05/1979 NANGGALA 085880081059
 Dosis I

Tanggal Tanggal
Merek
Screeni Pemberi
Vaksin*** an No. Batch No seri
ng
Vaksina
si
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202109177M
CORONAVAC 01/12/21 28/10/21 202109177M
CORONAVAC 01/12/21 28/10/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 28/10/21 202109177M
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 28/1/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 28/102/21 202108145H
CORONAVAC 01/12/21 01/12/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109177M
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109180M
CORONAVAC 01/12/21 01/12/21 202109180M
CORONAVAC 01/12/21 01/12/21 202109180M
CORONAVAC 01/12/21 01/12/21 202109180M
CORONAVAC 01/12/21 01/12/21 202109180M
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202109180M
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 202108171F
CORONAVAC 01/12/21 01/12/21 20210817F
CORONAVAC 01/12/21 01/12/21 20210817F
CORONAVAC 01/12/21 01/12/21 20210817F
CORONAVAC 01/12/21 01/12/21 20210817F
CORONAVAC 01/12/21 28/10/21 202108145H
CORONAVAC 01/12/21 01/12/21 20210817F
CORONAVAC 01/12/21 01/12/21 20210817F
CORONAVAC 01/12/21 28/10/21 202108145H
 Umur
Nama Penerima
NO No. Ticke NIK JK Pekerjaan* (18-59
Vaksin
tahun)

1 3601040308060001 RIFAN FAIZA L PELAJAR 03-08-2006

2 3601046706090003 ATIKAH FAIRUS KALISA P PELAJAR 27-06-2009
3 3601042511070006 MISWAN L PELAJAR 25-11-2007
4 3601046503080001 SARTIAH P PELAJAR 25-03-2008
5 3601046210090001 LINDA NARULITA P PELAJAR 22-10-2009
6 3601047007080001 RANTIAH P PELAJAR 30-07-2008
7 3601044101030002 LISDAYANTI P PELAJAR 01-01-2009
8 3601046702090001 SITI KHOLISAH P PELAJAR 27-01-2009
9 3601046001080003 PIPIN PUJIANTI P PELAJAR 04-09-2007
10 3601042606060003 ANDIKA L PELAJAR 26-06-2006
11 3601041003080004 M. WILDAN L PELAJAR 10-03-2008
12 3602070109070001 JULIANA HOTIB L PELAJAR 01-05-2007
13 3601270612070001 DION L PELAJAR 06-12-2007
14 3601045203800001 PUTRI DINLI EAMADANIP PELAJAR 20-09-2006
15 3601040207060005 JUJUN ARDIANSYAH L PELAJAR 15-05-2006
16 3601041212080002 NANA MARDIANA L PELAJAR 12-12-2008
17 3601046611070001 ERAH P PELAJAR 26-11-2007
18 3601040801080002 JOKO PRIANTO L PELAJAR 08-01-2008
19 3601044101070009 ELIS P PELAJAR 01-01-2007
20 3601041204060002 SULYANAH L PELAJAR 12-04-2007
21 3601041211080002 RAPI L PELAJAR 12-11-2008
22 3601040411080002 ROMANSAH L PELAJAR 25-09-2009
23 3601041202070001 AJI SUDRAJAT L PELAJAR 9-01-2007
24 3601041710080003 JEKI HAZRUMI L PELAJAR 17-10-2008
25 3601045209860001 TOMI L PELAJAR 24-09-2008
26 3601275110070002 LIA AMELIA P PELAJAR 11-10-2007
27 3601040102040005 DONI SAPUTRA L PELAJAR 01-02-2007
28 3601046306080006 VIKAILA LESTARI P PELAJAR 02-6-2008
29 3601040304070004 YUSRIL L PELAJAR 03-04-2007
30 3601054407080001 AAN KARNAMAH P PELAJAR 14-07-2008
31 3602015702050001 WINDA P PELAJAR 12-12-2005
32 3601044501050005 SITI AZIZAH P PELAJAR 05-01-2005
33 3601046910090001 SISKA RAHMAWATI SILPP PELAJAR 29-10-2009
34 3601041407080006 ARDIAN L PELAJAR 14-07-2008
35 3601045010070003 SAKINAH P PELAJAR 10-10-2004
36 3171034805091004 GESHA DUHAYATI P PELAJAR 08-05-2009
37 3601041007080002 KAIS L PELAJAR 10-07-2008
38 3601045405060003 NATI WIDIYANTI P PELAJAR 14-6-2006
39 3601040803070005 AJI PERMANA L PELAJAR 06-03-2007
40 3601045806090005 NURAENI PERTIWI P PELAJAR 08-06-2009
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 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Kelomp
INSTANSI Alamat NO HP BPJS BPJS Non
ok Umur
PBI Non PBI Anggota

UMUM TANJUNGAN 085697596453

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UMUM TANJUNGAN 085280516181
UMUM TANJUNGAN 085283847991
UMUM TANJUNGAN
UMUM TANJUNGAN 081282873266
UMUM TANJUNGAN 085283046004
UMUM TANJUNGAN 085210710752
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UMUM TANJUNGAN 085282258581
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UMUM TANJUNGAN
UMUM TANJUNGAN
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UMUM TANJUNGAN
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UMUM TANJUNGAN
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UMUM TANJUNGAN 085718696381
UMUM TANJUNGAN 082128800953
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UMUM TANJUNGAN
UMUM TANJUNGAN 081322476486
 Dosis I Dosis 2

Tanggal Tanggal Tanggal

Merek
Screeni Pemberi No.
Pemberi
No. KET
Vaksin*** an No seri an No Seri
ng Batch Batch
Vaksina Vaksina
si si
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-202124203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-2021 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CORONAVAC 01-12-2021 01-12-202 24203021
CORONAVAC 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202 24203021

CoronaVac 01-12-202101-12-2021 24203021

CoronaVac 01-12-2021 01-12-202 24203021

CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021

CoronaVac 01-12-2021 01-12-20224203021

CoronaVac 01-12-2021 01-12-20224203021

CoronaVac 01-12-2021 01-12-202124203021

CoronaVac 01-12-2021 01-12-202124203021

CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-20224203021
CoronaVac 01-12-2021 01-12-20124203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-2021 01-12-202 2.4E+07
CoronaVac 01-12-202101-12-2021 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 2.4E+07
CoronaVac 01-12-2021 01-12-202 2.4E+07
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-2021 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202 24203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-202101-12-2021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
CoronaVac 01-12-2021 01-12-202124203021
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601041510830002 ARSIM L
2 3601042311620001 SUPARDI L
3 3601044703800003 SUTI'AH P
4 3601044901970003 WARSIH P
5 3601041004010003 MADI SUPANDI L
6 3601045703930003 JANIAH P
7 3601040107910054 ARMAN L
8 3601040107870010 BUDIN L
9 3601041808920004 ABDUL ROHIM L
10 3601040205940002 HERMAN L
11 3601040107900021 JALAH L
12 3601044310800007 SARNI P
13 3601040307770001 EMED L
14 3601044107760023 NASITI P
15 3601046305840001 SITI KHODIJAH P
16 3601040107680284 AKO SUHANDI L
17 3601045410880005 CINAH P
18 3601044107630409 ROHENAH P
19 3601040107790010 SANA L
20 3601040107530032 SUMAR L
21 3601045410860003 ISAH P
22 3213250710780001 HADI L
23 3601040107680029 DARSAM L
24 3602210402900001 SUKMA P
25 3601042301860002 SARIP L
26 3601040208750002 KARMA L
27 3601041203800004 ACE ASRORI L
28 3601041105990002 SOPIAN L
29 3601044606040007 SUSILAWATI P
30 3601044703890002 TATI SAVITRI P
31 3601044308300001 BENAH P
32 3601046505000004 SANTI WATI P
33 3601042004680001 CATING L
34 3601040107730047 DARYANTO L
35 3601041204630001 KARYA L
36 3601040705820003 JAHRI L
37 3601040107860042 SANA L
38 3601040107670010 DARNO L
39 3601040107760031 OHIM L
40 3601040107730072 SADI L
41 3601040107820014 SUDIN L
42 3601044107710014 ROPIAH P
43 3601041307650001 SUTARNO L
44 3601044705000004 SITI P
45 3601042509700001 RAKIM L
46 3601046010800003 TARIPAH P
47 3601046808760001 SUKAROH P
48 3601046402990002 WIWIN ROHMAYANTI P
49 3601044107810017 ASMI P
50 3601040210900001 SADIK L
51 3601085206960001 NURAENI P
52 3601040504990002 SUNARA L
53 3601046011970007 DARIYAH P
54 3601044702880002 WARSINIH P
55 3601040102690001 SANUSI L
56 3601044511040002 SITI AISYAH P
57 3601041610010002 AJI RIPANSYAH L
58 3601042504030001 PANDI L
59 3601040812680005 SUKRI L
60 3601044107580058 JUHENAH P
61 3601040107780072 JUMAR HAETAMI L
62 3601042709960005 M. SARJUNI L
63 3601041510920001 rohmanudin L
64 3601049512800003 SITI TUTI P
65 3601046404690001 KASRI P
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI

10/15/1983 DESA SUMURBATU 085218217713

11/23/1962 DESA SUMURBATU 085882501874
3/7/1980 DESA SUMURBATU 085692720207
1/9/1997 DESA SUMURBATU 085773648336
4/10/2001 DESA SUMURBATU 081314604445
3/17/1993 DESA SUMURBATU 081231202820
8/5/1992 DESA SUMURBATU 081231202820
7/1/1987 DESA SUMURBATU 085693481425
7/5/1980 DESA SUMURBATU 085287246153
5/2/1994 DESA SUMURBATU 085781376657
7/1/1990 DESA SUMURBATU 085781376657
10/3/1980 DESA SUMURBATU 081511766530
4/17/1980 DESA SUMURBATU 082353597434
7/25/1974 DESA SUMURBATU 081511766530
5/23/1984 DESA SUMURBATU 085717574519
2/14/1974 DESA SUMURBATU 081223802669
10/4/1988 DESA SUMURBATU 085280516197
10/10/1985 DESA SUMURBATU 085280516197
11/10/1966 DESA SUMURBATU 085718719716
1/2/1953 DESA SUMURBATU 085782010333
10/14/1986 DESA SUMURBATU 085780516197
10/7/1978 DESA SUMURBATU 085717260278
2/1/1969 DESA SUMURBATU 081585119884
2/4/1990 DESA SUMURBATU 081585119884
1/23/1986 DESA SUMURBATU 085780404284
8/2/1975 DESA SUMURBATU 085888351635
3/12/1980 DESA SUMURBATU 085217289091
5/11/1999 DESA SUMURBATU 085888149927
6/6/2004 REMAJA DESA SUMURBATU 085714932602
3/7/1989 DESA SUMURBATU 085217931431
8/3/1930 LANSIA DESA SUMURBATU 085715270636
5/25/2000 DESA SUMURBATU 085888149927
4/20/1968 DESA SUMURBATU 085718719716
7/1/1984 DESA SUMURBATU 085217931431
4/12/1963 DESA SUMURBATU 085771007313
5/7/1982 DESA SUMURBATU 085773757810
7/1/1986 DESA SUMURBATU 081545600265
7/1/1967 DESA SUMURBATU 085871072145
7/1/1982 DESA SUMURBATU 081546891279
 7/1/1973 DESA SUMURBATU 085813108641
9/4/1982 DESA SUMURBATU 083812553937
7/1/1968 DESA SUMURBATU 082332911900
7/13/1965 DESA SUMURBATU 082332911900
5/7/2000 DESA SUMURBATU 085782010333
9/25/1970 DESA SUMURBATU 085211258224
10/20/1980 DESA SUMURBATU 085212516437
8/28/1976 DESA SUMURBATU 085211258224
2/24/1999 DESA SUMURBATU 082119727119
7/1/1981 DESA SUMURBATU 085880513354
10/2/1990 DESA SUMURBATU 085782010333
6/1/1997 DESA SUMURBATU 081290184196
4/5/1999 DESA SUMURBATU 085695089493
11/20/1997 DESA SUMURBATU 085215286457
2/7/1988 DESA SUMURBATU 085694673191
2/1/1969 DESA SUMURBATU 085888351635
3/24/2005 REMAJA DESA SUMURBATU 085692720207
1/24/2001 DESA SUMURBATU 085880720831
4/25/2003 DESA SUMURBATU 081284924037
12/8/1968 DESA SUMURBATU 081323796608
7/1/1981 DESA SUMURBATU 085782010333
3/9/1978 DESA SUMURBATU 085782010333
9/27/1996 DESA SUMURBATU 082124090071
12-04-1993 DESA SUMURBATU 082124090071
23-06-1966 DESA SUMURBATU 082124090071
24-04-1969 DESA SUMURBATU 082124090071
rtaan BPJS (tulis
ada kolom yang Dosis I
sesuai)
Tanggal
Merek Tanggal Pemberi
Non Vaksin*** Screening an No. Batch No seri
Anggota
Vaksina
si
CORONAVAC 12/1/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021 12/1/2021 202109177M EUA2057300143A1
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
CORONAVAC 11/29/2021
 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

12/1/2021 202109177M EUA2057300143A1

12/1/2021 202109177M EUA2057300143A1
NO No. Ticket NIK Nama Penerima Vaksin

1 3601045011690001 EEN HERMAWATI

2 3601040904660001 SUMA
3 3601040107580219 DARPIN
4 3601044107680275 DARINI
5 36010402047300004 SA'I
6 SANA'AH
7 3601040204750005 ROJUDIN
8 3601046611930004 ASIH LESTARI
9 3601040404620001 KADMINAH
10 3601044107890002 ROHENI
11 SARNITA
12 3601045101620001 ICIH
13 3601040107870153 WASBUN
14 3601046303730001 WARKEM
15 3601045701830001 NUNUNG
16 3601045903650001 MARNAH
17 3601045203550002 CASWI
18 3601041109000006 ROY DIKI
19 36010441073850266 KARINIH
20 3601041210780001 JULI
21 3601044107660149 ASMAH
22 3601046503060004 WIDIA PUSPITA
23 MISNAH
24 3601046507500001 AMAH
25 3601045006010008 AAS ROLANI
26 3601042008930003 NURSIN
27 3601046612970002 SINTA DEWI
28 3601044102780002 WASRI
29 3601046607570001 MIRSAH
30 360104510700002 ENTIN
31 3601046402970002 ERMAWATI
32 SUDIRAH
33 3601040566000003 DARKA
34 36010441077690083 TASINAH
35 3601040207940003 SURYANTO
36 3601042401020002 SUPYADI
37 3601045007910001 WARSINI
38 3601044107810103 SURINAH
39 36010465109600001 ERNI
40 3601046006600001 ARNAI
41 3601040502840003 ANDI
42 3601044107870134 ANI
43 360104250502030001 SUNTANA
44 UNAH
45 3601041005030001 APID
46 3601044958700002 IYUM
47 360104611600002 EUIS
48 36010418099300001 ASEP
49 360104110410002 SANTANI
50 3601044506050001 RISKA
51 3601114508920005 UNI
52 3601044107780417 SANTI
53 OCAH
54 3601044107830460 ITI
55 ARTA
56 3601046908990001 RENI
57 3601046228400001 SITI
58 3601042312850001 USUP
59 ROSID
60 3601044107910114 KASTINIH
61 3601045003990007 RESTI
62 MURTI
63 3601046406670001 AMINAH
64 3601041507910005 SIDIK
65 3601041902720002 MUKRI
66 3601043012980003 SUHANI
67 3602144207850010 IIS NAENI
68 3601044107660074 TARWINAH
69 360104200620001 JANA
70 3601040102030010 RADI
71 3601045011960001 EPON
72 3601044107820169 TARSIH
73 3601044107820159 SAMAH
74 SARDAMIN
75 3601044211980001 DAENI
76 360104512420002 TARINIH
77 3601041007800002 KURNATA
78 RAMIN
79 3212211204750005 TARJUKI
80 3601045205870004 IROH
81 LILIS
82 3601040107760201 ABSA
83 ROHENAH
84 3601045504700001 ARSINAH
85 3601041011640001 WASID
86 SUTIYATI
87 3601040405980005 RIDWAN FIRDAUS
88 3601045610840001 SANI
89 3601042701860001 BASRI
 90 3602211704850004 ENDI
91 3601046801900001 RUMANAH
92 3601042807830001 ADIT
93 3601045007920002 SUMINAR
94 3601040101650001 SURYADI
95 3601045408030002 ALISAH
96 3601044406040001 TIA FERAWATI
97 3601044208030001 SITI MAESAROH
98 KARDI
99 3601041506690002 MAMAK
100 36010441077901038 RUMINIH
101 36010442080400001 RINAH
102 KASNI
103 3601046007590001 SAMIRAH
104 3601044401820006 ASIH
105 ANNISA GAM
106 3601041802950001 RAHMAT
107 3601044207850019 SANIMAH
108 YANTI
109 3601041906540001 SUPARDI
110 SAMUDI
111 SURATMI
112 3601041006650001 KALIM
113 3601044611890002 SITI SA'ADAH
114 3601045103820005 TARMINI
115 3601044701200007 SAWI
116 3601045103820005 TARMINI
117 3601045807950004 RANISAH
118 3601044101800003 EROH
119 HERTI
120 36010351005770001 MISTA
121 3603221307800002 ASMALI
122 3601044502800002 WARTEM
123 3601045105850001 ANISAH
124 RUSJA
125 3601044204790002 BAYI
126 3601044704730001 DARMEN
127 3601042008630001 KADINIH
128 3601041102910005 SUHERJA
129 3601040308600001 KARTANI
130 3601044107730312 ROPIAH
131 3601044107800163 HERNI
132 3601044107540046 SAWEN
133 3601046403050001 SISKA
134 3601044306050003 RIFDA
135 3601044412870001 NUR AFIPAH
136 360104010776017 CARSIDI
137 SUGIANTO
138 3601045205680002 DIAH
139 3601044703860005 RINAH
140 3601041511500001 RUMINTA
141 3601046606750001 WINAH
142 3601044107790148 YATI
143 RASMAN
144 3601045505040003 WATI AYU
145 3601045006040004 DIAH P
146 3601044103020005 MAYA
147 AMAH
148 3601044107790150 IYUM
149 36010471100200001 DIAH ANDINI
150 3601045705800002 AISAH
151 36010726079100001 MUKSIN
152 3601042501780001 SARJA
153 3601041798740004 KADMARIH
154 3601040107780113 DASIRIH
155 3601041008980001 RUSTAM
156 ROSANTI
157 3601041004890002 KURDI
158 3601044411020003 SUMARNI
159 3601044512960001 TUTI
160 3601044302730001 TUNI
161 36010469110600001 LENIYAWATI
162 3601040408900001 PENDI
163 36010441038800004 SANITI
164 3601046301850002 DASIMAH
165 3601044107730312 ROPIAH
166 3601040104850003 SAKIM
167 3601045003050001 LINA SURYANI
168 3601041004680004 ENDIN S
169 3601042603770001 KADNAWI
170 3601045507870009 EROM
171 NURYATI
172 3601044107430155 SITI ANISAH
173 3601044606900001 JUHETI
174 3601046509940002 INA. A
175 3601045702780001 AMAH
176 3601040911740001 SUKARDI
177 3601041003920005 AAN ARIPIN
178 3601044107890218 ARNAH
179 3601044112880003 SURHETI
180 3601044107780485 TARIYAH
181 3601046410790003 KUNAH
182 3601044502640001 SUKMANAH
183 3601044802700001 ETI
184 3601044206900002 ERNA
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

P 10-11-1969 UMUM CIKEUSIK 085216626909

L 09-04-1966 UMUM CIKEUSIK 083169794278
L 01-07-1958 LANSIA SUKASENENG 083169794278
P 01-07-1968 UMUM SUKASENENG 083169794278
L 02-04-975 UMUM SUKASENENG 083169794278
P 01-07-1989 UMUM UMBULAN 083169794278
L 02-04-1975 UMUM CIKEUSIK 085693993900
P 26-11-1993 UMUM SUKASENENG 085693993900
P 04-04-1962 UMUM CIKEUSIK 085693993900
P 01-07-1989 UMUM NANGGALA 085693993900
L 01-07-1968 UMUM UMBULAN 085693993900
P 11-01-1962 UMUM TANJUNGAN 081528650462
L 01-07-1987 UMUM UMBULAN 081528650462
P 23-03-1973 UMUM CIKEUSIK 081528650462
P 07-01-1983 UMUM NANGGALA 081513671365
P 19-03-1965 UMUM NANGGALA 081513671365
P 12-03-1983 UMUM RANCASENENG 081513671365
L 11-09-2000 UMUM RANCASENENG 081513671365
P 15-04-1985 UMUM SUKASENENG 081513671365
L 12-10-1978 UMUM SUKASENENG 081513671365
P 01-07-1966 UMUM CURCI 081513671365
P 25-03-2006 REMAJA CIKEUSIK 085281760536
P 02-07-1975 UMUM CURCI 085281760536
P 25-05-1975 UMUM SUKAMULYA 085281760536
P 10-06-2001 UMUM SUKAMULYA 085281760536
L 05-08-1993 UMUM SUKAMULYA 085779170525
P 26-12-1997 UMUM UMBULAN 085779170525
P 01-07-1984 UMUM UMBULAN 085694167875
P 26-07-1957 LANSIA TANJUNGAN 085694167875
P 11-07-1980 UMUM UMBULAN 085694167875
P 24-02-1997 UMUM UMBULAN 081517290787
L 04-02-1984 UMUM CIKEUSIK 081517290787
L 05-06-1960 LANSIA CIKEUSIK 081517290787
P 07-01-1974 UMUM CIKEUSIK 081517290787
L 07-09-1972 UMUM CIKEUSIK 081517290787
L 24-01-2002 UMUM NANGGALA 081517290787
P 10-07-1991 UMUM UMBULAN 081517290787
P 01-07-1981 UMUM UMBULAN 085311513793
P 25-10-1996 UMUM UMBULAN 085311513793
P 20-10-1966 UMUM TANJUNGAN 085311513793
L 05-02-1984 UMUM UMBULAN 085311513793
P 01-07-1987 UMUM SUKASENENG 085311513793
L 25-02-2003 REMAJA SUKASENENG 08528405920
P 06-07-1945 LANSIA UMBULAN 08528405920
L 09-07-2003 REMAJA HARENDONG 081296607377
P 09-05-1987 UMUM CIKEUSIK 081296607377
P 21-11-1996 UMUM CIKEUSIK 081296607377
L 18-09-1979 UMUM TANJUNGAN 085881649436
L 18-04-2001 UMUM SUKAMULYA 085881649436
P 05-06-2005 REMAJA UMBULAN 085881649436
P 05-08-1992 UMUM CIHERANG 085881649436
P 01-07-1978 UMUM UMBULAN 085881649436
P 01-07-1984 UMUM UMBULAN 085881649436
P 01-07-1983 UMUM UMBULAN 085881649436
L 11-05-1999 UMUM SUKAWARIS 085881649436
P 29-08-1999 UMUM TANJUNGAN 085881649436
P 22-02-1984 UMUM UMBULAN 085881649436
L 23-12- HARENDONG 081296607377
L 21-11-1980 UMUM UMBULAN 081296607377
P 01-07-1990 UMUM CIKEUSIK 081296607377
P 10-08-1999 UMUM TANJUNGAN 081296607377
P 12-01-1977 UMUM UMBULAN 081296607377
P 24-06-1967 UMUM CIKEUSIK 081296607377
L 15-07-1991 UMUM TANJUNGAN 081514572157
L 19-02-1972 UMUM UMBULAN 081514572157
L 30-12-1998 UMUM SUKAMULYA 081514572157
P 02-07-1985 UMUM RANGKASBITUNG 081514572157
P 01-07-1966 UMUM CIKEUSIK 081514572157
L 20-01-1962 UMUM CIKEUSIK 085779566898
L 07-07-1999 UMUM UMBULAN 085779566898
P 09-07-1997 UMUM SUKAMULYA 085779566898
P 01-07-1982 UMUM UMBULAN 085779566898
P 11-04-1987 UMUM UMBULAN 085779566898
L 09-07-2005 REMAJA CIKEUSIK 085779566898
L 02-11-1989 UMUM UMBULAN 081382362743
P 15-01-1978 UMUM SUKASENENG 081382362743
L 03-06-1980 UMUM UMBULAN 081382362743
L 17-10-1973 UMUM UMBULAN 081382362743
L 12-04-1975 UMUM RANCASENENG 081382362743
P 12-05-1987 UMUM UMBULAN 081382362743
P 12-12-1981 UMUM NANGGALA 085773624391
L 04-07-1976 UMUM UMBULAN 085773624391
P 08-01-1996 UMUM SUKAWARIS 085773624391
P 15-04-1970 UMUM CIKEUSIK 085773624391
L 10-11-1964 UMUM TANJUNGAN 085773624391
P 36-05-1994 UMUM CIKEUSIK 085773624391
L 04-05-1998 UMUM SUKASENENG 085773624391
P 16-06-1984 UMUM UMBULAN 085773624391
L 27-01-1986 UMUM UMBULAN 085283234204
L 17-04-1985 UMUM UMBULAN 085283234204
P 28-01-1990 UMUM UMBULAN 085283234204
L 12-07-1994 UMUM TANJUNGAN 085283234204
L 26-08-2004 REMAJA CIKEUSIK 085283234204
L 01-01-1965 UMUM SUKAWARIS 085283234204
P 14-08-20003 REMAJA NANGGALA 085283234204
P 16-03-2003 REMAJA CIKEUSIK 085771289803
P 12-07-2003 REMAJA SUKAMULYA 085771289803
L 02-01-1972 UMUM RANCASENENG 085771289803
L 15-06-1969 UMUM SUKASENENG 085771289803
P UMBULAN 085771289803
P UMBULAN 085771289803
P 01-07-1978 UMUM RANCASENENG 085771289803
P 20-07-1959 LANSIA CIKEUSIK 085771289803
P CIKEUSIK 085771289803
P 23-09-1997 UMUM CIKEUSIK 083841405817
L 09-04-1995 UMUM CIKEUSIK 083841405817
P 11-07-1990 UMUM CIKEUSIK 083841405817
P 10-03-1992 UMUM CIKEUSIK 083841405817
L 19-06-1954 LANSIA CIKEUSIK 083841405817
L 05-04-1975 UMUM CIKEUSIK 083841405817
P 06-09-2003 REMAJA CIKEUSIK 083841405817
L 10-06-1965 UMUM TANJUNGAN 083841405817
P 06-11-1989 UMUM CIKEUSIK 083841405817
P 18-03-1982 UMUM RANCASENENG 083841405817
P 07-01-1963 UMUM UMBULAN 083841405817
P 18-03-1982 UMUM RANCASENENG 085813045167
P 18-07-1995 UMUM RANCASENENG 085813045167
P 01-01-1980 UMUM RANCASENENG 085813045167
P 12-07-1992 UMUM RANCASENENG 085281449143
L 10-05-1977 UMUM SUKAMULYA 085281449143
P 17-07-1980 UMUM SUKASENENG 085281449143
P 05-02-1980 UMUM CIKEUSIK 085281449143
P 04-07-1992 UMUM CIKEUSIK 085281449143
L 13-12-1966 UMUM SUKAMULYA 085281449143
02-04-1979 UMUM UMBULAN 085281449143
P 07-04-1973 UMUM CIKEUSIK 085281449143
P 20-08-1963 UMUM SUKAMULYA 085281449143
L 11-02-1982 UMUM SUKAMULYA 085281449143
L 03-08-1960 LANSIA SUKASENENG 085281449143
P 04-05-1973 UMUM RANCASENENG 085281449143
P 11-02-1980 UMUM CIKEUSIK 085281449143
P 01-07-1954 LANSIA SUKASENENG 085281449143
P 24-03-2005 REMAJA CIKEUSIK 085281449143
P 03-08-2005 REMAJA RANCASENENG 085281449143
P 04-12-1987 UMUM CURCI 085281449143
L 08-08-1976 UMUM CIKEUSIK 082310469351
L 10-10-1984 UMUM SUKAMULYA 082310469351
P 12-05-1968 UMUM CIKEUSIK 082310469351
P 07-03-1986 UMUM UMBULAN 082310469351
P 15-11-1950 LANSIA CIKEUSIK 082310469351
P 26-06-1975 UMUM CIKEUSIK 082310469351
P 01-07-1979 UMUM UMBULAN 082310469351
L 17-04-1984 UMUM UMBULAN 082310469351
P 15-05-2004 REMAJA SUKASENENG 082310469351
P 10-06-12004 REMAJA SUKASENENG 082310469351
P 01-03-2002 UMUM SUKASENENG 082310469351
P 01-07-1972 UMUM UMBULAN 082310469351
P 07-01-1979 UMUM UMBULAN 082310469351
P 31-10-2002 UMUM CIWET 082310469351
P 17-05-1980 UMUM UMBULAN 082310469351
L 26-07-1991 UMUM TARAJU 082310469351
L 25-01-1978 UMUM CIKEUSIK 082310469351
P 17-08-1974 UMUM RANCASENENG 082310469351
P 01-07-1978 UMUM RANCASENENG 082310469351
L 13-09-1998 UMUM UMBULAN 082310469351
P 18-05-2000 UMUM CIKEUSIK 082310469351
L 04-07-1988 UMUM CIKEUSIK 082310469351
P 04-11-2002 UMUM CIKEUSIK 082310469351
P 05-12-1996 UMUM SUKAWARIS 085719804938
P 03-02-1973 UMUM CURCI 085694558029
P 29-11-2005 REMAJA UMBULAN 085694558029
L 04-08-1990 UMUM SUKAWARIS 085694558029
P 01-03-1988 UMUM CIKEUSIK 085694558029
P 23-01-1985 UMUM UMBULAN 085694558029
P 04-03-1973 UMUM SUKASENENG 085694558029
L 28-05-1985 UMUM SUKASENENG 085694558029
P 10-03-2005 REMAJA RANCASENENG 085778986747
;L 10-04-1968 UMUM CIKEUSIK 085778986747
L 26-03-1978 UMUM UMBULAN 085778986747
P 15-07-1987 UMUM CIKEUSIK 085778986747
P 07-09-1997 UMUM UMBULAN 085778986747
P 17-05-1976 UMUM UMBULAN 085778986747
P 06-06-1996 UMUM CURCI 085778986747
P 25-09-1994 UMUM CIKEUSIK 085778986747
P 17-02-1978 UMUM UMBULAN 087773382171
L 09-11-1974 UMUM UMBULAN 087773382171
L 16-06-1991 UMUM CIKEUSIK 087773382171
P 01-07-1989 UMUM PARKOS 087773382171
P 01-12-1988 UMUM PARKOS 087773382171
P 01-07-1978 UMUM PARKOS 087773382171
P 24-10-1979 UMUM PARKOS 087773382171
P 05-08-1964 UMUM PARKOS 087773382171
P 08-02-1970 UMUM CIKEUSIK 087773382171
P 02-06-1990 UMUM CURCI 087773382171
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Tanggal
Merek Tanggal Pemberi
BPJS BPJS Non Vaksin*** Screening an No. Batch No seri
PBI Non PBI Anggota
Vaksina
si
CORONAVAC 28-10-2021
CORONAVAC 01-11-2021
CORONAVAC 01-11-2021
CORONAVAC 28-10-2021
CORONAVAC 01-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 28-10-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 28-10-2021
CORONAVAC 28-10-2021
CORONAVAC 28-10-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 03-11-2021
CORONAVAC 03-11-2021
CORONAVAC 03-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 14-10-2021
CORONAVAC 25-10-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 20-10-2021
28-10-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 03-11-2021
03-11-2021
CORONAVAC 02-12-2021 202109177M
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-12-2021 202109177M
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 21-10-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 25-10-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-08-2021
CORONAVAC 11-11-2021
CORONAVAC 11-11-2021
CORONAVAC 04-11-2021
CORONAVAC 21-10-2021
CORONAVAC 04-11-2021
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 28-10-2021
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 21-10-2021
CORONAVAC 02-11-2021
CORONAVAC 02-12-2021 202109177M
02-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 21-10-2021
CORONAVAC 04-11-2021
CORONAVAC 21-10-2021
CORONAVAC 21-10-2021
CORONAVAC 21-10-2021
CORONAVAC 04-11-2021
CORONAVAC 28-10-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 03-11-2021
CORONAVAC 04-11-2021
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
21-10-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 01-11-2021
CORONAVAC 04-11-2021
CORONAVAC 14-10-2021
14-10-2021
CORONAVAC 02-12-2021 202109177M
04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 26-08-2021
CORONAVAC 26-08-2021
CORONAVAC 26-08-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 02-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 28-10-2021
CORONAVAC 19-06-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC
CORONAVAC 04-11-2021
CORONAVAC 11-10-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 03-11-2021
CORONAVAC 02-12-2021 202109177M
CORONAVAC 02-12-2021 202109177M
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021
CORONAVAC 04-11-2021

CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 01-11-2021
 Dosis 2

Tanggal KET
Pemberian No. Batch No Seri
Vaksinasi

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M

02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M

02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M

02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
02-12-2021 202109177M
 Nama Umur
Kelomp
NO No. Ticke NIK Penerim JK Pekerjaan* (18-59 INSTANSI
ok Umur
a Vaksin tahun)

1 3601046605SARIMAH P 26/05/1989UMUM
2 3601040705BUDI L 12/02/1991UMUM
3 3601041901RANIMAN L 19/01/1972UMUM
4 3601040703DENI RAHA L 06/05/1977UMUM
5 3601041108ALI L 21/08/1983UMUM
6 3601044302ENOK DARSP 03/02/1964UMUM
7 3601044107MINI P 01/07/1984UMUM
8 3601040107ARHADI L 03/07/1971UMUM
9 3601041905RIPAL L 19/05/2004UMUM
10 3602210905KARDI L 09/05/1960UMUM
11 3601081808SURYADI L 18/08/1998UMUM
12 1607100106DENI ANDR L 01/06/2005UMUM
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
Alamat NO HP Pemberi
BPJS BPJS Non Vaksin** Screeni No.
* ng an
PBI Non PBI Anggota Batch
Vaksina
si
CURUGCIUN085692846700 CORONAVA02/12/21 13/11/21 202109177M
CURUGCIUN081511186530 CORONAVA02/12/21 02/12/21 202109177M
CURUGCIUN085779054270 CORONAVA02/12/21 13/11/21 202109177M
CURUGCIUN085886900964 CORONAVA02/12/21 13/11/21 202109177M
CURUGCIUN085813104933 CORONAVA02/12/21 03/11/21 202109177M
CURUGCIUN081283773335 CORONAVA02/12/21 13/11/21 202109177M
CURUGCIUN085882501890 CORONAVA02/12/21 13/11/21 202109177M
CURUGCIUN081517286140 CORONAVA02/12/21 02/11/21 202109177M
CURUGCIUN085772746953 CORONAVA02/12/21 02/11/21 202109177M
CURUGCIUN081295007573 CORONAVA02/12/21 02/12/21 20210917MM
CURUGCIUN085770111027 CORONAVA02/12/21 02/12/21 202109177M
CURUGCIUN081266747216 CORONAVA02/12/21 02/12/21 202109177M
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
20210917MM
202109177M
202109177M
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601040505800001 ABIDIN L
2 3601040607580001 USMAN L
3 3601041407800003 SAEPUDIN L
4 3601047112810002 RAPIAH P
5 3601044111690002 MISNAH P
6 3601044301800003 ASWIAH P
7 3601044504650001 KARSINAH P
8 3601045105560001 URIYAH P
9 3601044301870002 RUMI P
10 3601040109920004 ARSAM L
11 3601041302720001 SUPARDI L
12 3601044903900001 ARNI P
13 3601040404730002 YAMSUDIN B MADLIYAS L
14 3601040404730003 ENDEN L
15 3601040908750001 SAMSURI L
16 1609174106820003 OMAH P
17 3601046702540001 PATIMAH P
18 3601040707860001 ENJUN JUNAEDI L
19 3601045502760002 MARSAETI P
20 3601041110750001 SUBRATA B AHMAD L
21 3601044711550001 RUMSINAH P
22 3601046903804441 NINGSIH SURNAENI P
23 3601045011800001 MASAH P
24 3601040104650002 JUPRI B SOLEMAN L
25 3601044509870001 IIS P
26 3601044703830002 ENAH P
27 10804016105970001 MIRNA SERTIKA P
28 3601045002990004 ULFAH P
29 3601044303800001 SARNAH P
30 3601041606830002 SAEPUDIN L
31 3601044503960004 HETY NURHAYATI P
32 3601041405730001 SUHANDI L
33 3601040402940003 SARKIM L
34 3601040101720002 IDI L
35 3601044702660002 JAWATI P
36 3601045610930001 SITI HASANAH P
37 3601040410850001 SAKIRIN L
38 3601040607560001 KATIB L
39 3601040103950007 HARYONO L
40 3601040307990003 JUMRI L
41 3601045103920001 ADE SAEPUDIN L
41 3601041401830001 FISTA L
42 3601044305800001 TUTI P
43 3601072702800002 ASKADI L
44 3601040707960001 JUMAD L
45 3601044511910001 IPIN P
46 3601040708780001 JAENNUDDIN L
47 3601044604640002 MIMI P
48 3601046003030002 AAL SUPIAH P
49 3601040406020009 SAEFIL BAHRI L
50 1804011006990000 AMRIZAL L
51 3601044507880003 SARWI BT SARIPAN P
52 3601044404870002 JUJU JUHAETI P
53 3601040305430001 ADUNG P
54 3601041201900001 SARBINI L
55 3601041601780002 ADI NURHADI L
56 3601044404900001 RIKAWATI P
57 3601041003730001 JAHALI L
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

WIRASWASTA 05-05-1980 KP.SAWAH 085715440852

PETANI 06-07-1958 KP.SAWAH 085797927553
WIRASWASTA 14-07-1980 KP.SAWAH 085717388364
IRT 31-12-1981 KP.SAWAH 085719423162
IRT 01-02-1975 KP.SAWAH 085885443113
IRT 03-01-1965 KP.SAWAH 085797927553
IRT 05-04-1965 KP.SAWAH 08578490951
IRT 11-05-1956 KP.SUMBER JAYA 081511757158
IRT 03-01-1987 KP.SAWAH 08578490951
WIRASWASTA 06-04-1990 KP.LEUWIBALANG 085797927553
WIRASWASTA 13-02-1972 KP.SAWAH
IRT 09-03-1990 KP.SAWAH 085797927553
WIRASWASTA 07-04-1971 KP.BATU BANTAR 085693594172
PETANI 24-12-1969 KP.LEUWIBALANG 085883201305
PETANI 09-08-1977 KP.LEUWIBALANG 08569540911
IRT 01-06-1982 KP.SAWAH 085669540911
PETANI 12-11-1940 KP.SAWAH 081511707158
WIRASWASTA 04-05-1981 KP.LEUWIBALANG 08593390973
IRT 15-02-1976 KP.SAWAH 081617983809
WIRASWASTA 11-10-1970 KP.SAWAH 081517692283
IRT 07-11-1955 KP.BATU BANTAR 08577219215
IRT 09-04-1985 KP.SAWAH 085715439779
IRT 10-11-1980 KP.SAWAH 081517692283
PETANI 19-11-1961 KP.BATU BANTAR 085295143996
IRT 06-06-1992 KP.SAWAH 085715281943
IRT 07-03-1983 KP.SITUHIYANG 085810541332
IRT 21-03-1997 KP.TULUNG BAAMBA 085810132485
IRT 06-12-2000 KP.LEUWIBALANG 085715073180
IRT 03-03-1987 KP.LEUWIBALANG 081584597841
BURUH TANI 01-06-1978 KP.LEUWIBALANG 085822428936
WIRASWASTA 05-03-1996 KP.SAWAH 085776977475
WIRASWASTA 08-04-1981 KP.SAWAH 085715439778
PELAJAR 04-02-1994 KP.SAWAH 085694473948
PETANI 03-04-1970 KP.SAWAH 085718725093
IRT 07-02-1966 KP.SAWAH 085774760427
IRT 16-10-1993 JL.H JAFAR 08558836340
WIRASWASTA 04-10-1985 KP.BATU BANTAR 085695267645
WIRASWASTA 06-07-1956 KP.SAWAH 085797927553
WIRASWASTA 25-10-1995 KP.SUMBER JAYA 081511791540
WIRASWASTA 03-07-1999 KP.SAWAH 085715281947
WIRASWASTA 07-06-1992 KP.SAWAH 085715440935
PETANI 11-01-1999 KP.SUMBER JAYA 081511757158
IRT 03-05-1980 KP.SAWAH 085797927557
WIRASWASTA 27-02-1980 KP.KADONGDONG 085695267645
WIRASWASTA 13-09-1994 KP.SAWAH 085691096453
IRT 05-11-1991 KP.BATU BANTAR 085770136388
WIRASWASTA 07-08-1978 KP.LEUWIBALANG 081511640002
IRT 06-05-1964 KP.BATU BANTAR 085822428936
PELAJAR 07-05-2003 KP.BATU BANTAR 085817105178
WIRASWASTA 04-06-1997 KP.SAWAH 085810132485
PELAJAR 10-06-1999 KP.TULUNG BAAMBA 082281987396
IRT 05-07-1980 KP.BATU BANTAR 085777565913
IRT 26-10-1984 KP.LEUWIBALANG 081511640002
IRT 03-05-1948 KP.SUMBER JAYA 085882498562
WIRASWASTA 20-03-1988 KP.LEUWIBALANG 085771731589
WIRASWASTA 09-11-1980 KP.BATUBANTAR 085811652590
IRT 02-07-1990 KP.BATU BANTAR 085880004737
PETANI 10-03-1973 KP.SAWAH 085715281948
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis 1
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin** Screenin Pemberia
* g No. Batch No seri
PBI Non PBI Anggota n
Vaksinasi

SINOVAC 02-12-2021 02-12-2022 24203021 DOSIS 1

SINOVAC 02-12-2021 02-12-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 2
SINOVAC 02-12-2021 002-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 2/1/2022 24203021 DOSIS 2
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 242023021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 242023021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 2
SINOVAC 02'12-2021 02-01-2022 24203021 DOSIS 2
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-1021 02-01-2022 24203021 DOSIS 2
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 2
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
SINOVAC 02-12-2021 02-01-2022 24203021 DOSIS 1
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601045001820001 RAMAH P
2 3601042008700005 AMAN L
3 3601040505730001 H. ALI L
4 3601041501010004 NURHANUDIN L
5 3601041405800001 MISJAYA L
6 3601041307950003 FIRMANSYAH L
7 3601041504990003 AGI L
8 3601041007850002 SAMUN L
9 3601044509760001 NUNUNG P
10 3601045406950002 ENUR HOLIPAH P
11 3601046705820002 ITA P
12 3601045908800001 ARTI P
13 3601040806050001 DEDI L
14 3601046410840001 ICIH P
15 3601040404800001 AHMAD L
16 3601044701820008 UMAYAH P
17 36010410003690001 KARNA. S L
18 3601040107720085 TATA L
19 36010414090003 UJANG SAHRUL L
20 3601044107780439 UCU P
21 3601042008690002 SUKARTA L
22 360104404090002 IIS RAHAYU P
23 3601041003550001 UCI L
24 3601041109900006 ARIP L
25 3601042208960001 AGUS L
26 3601040908790001 MARSANI L
27 3601041709030001 ANDI L
28 3601040602990004 MASIS L
29 3601040701790004 IPIN L
30 3601041008820004 SUYONO L
31 3601040107750266 SURTA L
32 360104510800001 NUNUNG P
33 3601040305620001 ADANG L
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI

10-01-1982 UMUM SUKAMULYA 085283233972

20-08-1970 UMUM SUKAMULYA 085891473920
17-05-1972 UMUM SUKAMULYA 081311979513
05-05-2001 UMUM SUKAMULYA 085894669831
14-05-1980 UMUM SUKAMULYA 08154375238
03-01-1996 UMUM SUKAMULYA 08569843722
01-06-1999 UMUM SUKAMULYA 085890308236
10-01-1982 UMUM SUKAMULYA 087855407865
04-05-1978 UMUM SUKAMULYA 085770627047
03-07-1994 UMUM SUKAMULYA 085718230134
08-08-1985 UMUM SUKAMULYA 081311407762
19-08-1980 UMUM SUKAMULYA 081584013533
08-06-1965 UMUM SUKAMULYA 085887771070
24-10-1984 UMUM SUKAMULYA 085771003653
04-04-1980 UMUM SUKAMULYA 085887771070
07-01-1982 UMUM SUKAMULYA 085887771775
04-02-1969 UMUM SUKAMULYA 08569837323
08-03-1992 UMUM SUKAMULYA 085813337385
08-02-1995 UMUM SUKAMULYA 085718708211
01-07-1978 UMUM SUKAMULYA 085714098962
20-08-1969 UMUM SUKAMULYA 081584376700
04-06-2004 REMAJA SUKAMULYA 085778393592
10-03-1955 LANSIA SUKAMULYA 085714098962
11-09-1990 UMUM SUKAMULYA 085774803253
22-04-1996 UMUM SUKAMULYA 085693477478
09-08-1978 UMUM SUKAMULYA 085773750248
17-09-2003 REMAJA SUKAMULYA 085782677264
02-02-2002 UMUM SUKAMULYA 085694418771
07-01-1979 UMUM SUKAMULYA 085695062576
10-08-1982 UMUM SUKAMULYA 085774284798
01-07-1975 UMUM SUKAMULYA 085776827129
05-12-1978 UMUM SUKAMULYA 085693603633
03-05-1962 UMUM SUKAMULYA 085695149273
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal
Merek Tanggal Pemberi Pemberi
Non Vaksin*** Screening No.
an No. Batch No seri an
Anggota Batch
Vaksina Vaksina
si si
CORONAVAC 08-09-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
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CORONAVAC 03-11-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 13-10-2021 03-12-2021202109180M
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CORONAVAC 03-11-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 08-09-2021 03-12-2021202109180M
CORONAVAC 03-10-2021 03-12-2021202109180M
CORONAVAC 29-06-2021 03-12-2021202109180M
CORONAVAC 29-06-2021 03-12-2021202109180M
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CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
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CORONAVAC 03-11-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
CORONAVAC 03-11-2021 03-12-2021202109180M
CORONAVAC 03-12-2021 03-12-2021202109180M
 KET
No Seri

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 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601041001850002 MARNAH P
2 3601040307010002 HENDRIK PRASETYO L
3 3601030107870021 SUANDI L
4 3601031609960002 UNSA L
5 3601040503860005 ODIH L
6 3601044107840207 CICI NASIROH P
7 3601040506830001 RADI L
8 3601044102880012 SUTIANAH P
9 3601040705860001 DADANG L
10 3601045404000003 NISA APRILIA P
11 3601040207070012 M.ARIPIN L
12 3601040108080006 RIKA NURLEA L
13 3601041701080003 RISKI PAUZI L
14 3601044203750002 ENI P
15 3601044105820007 SITI AMINAH P
16 '3601044107850319 HETI P
17 3601045104020004 SURNAHA P
18 3601044107800124 MULYANI P
19 3601040107780143 MA'MUN B ASJA L
20 3601042509000003 HADA MULYANA L
21 3601046906840001 SARIAH P
22 3601045212820002 KOKOM P
23 3601044201570002 SARWI P
24 3601045309840001 ERNA P
25 3601041703020002 NEDI HERDIANSYAH L
26 3601044106760003 PIAH P
27 3601044705900012 MARSITI P
28 3601044204840003 ADAH P
29 3601040107800105 SARMAN L
30 3601045211840001 ENOH P
31 3601046004970004 INAH SUSANTI P
32 3601040107710160 AHMAD L
33 3601041203600001 BAYI L
34 3601045107950001 MELAWATI P
35 3601044406950001 HERTI P
36 3601040203780001 DARSIH P
37 3601046030700001 NURAISAH P
38 3601045307070003 OLIVIA P
39 3601044107900263 IROH P
40 3601044201090006 AMELIA PATIMAH P
41 3601044712040007 RISMA P
42 3601049908050004 WAHYU L
43 3601041501800004 IRJA L
44 3601044906070001 IIS P
45 3601044605130003 YULIANTI P
46 3601044406050006 SRI LENI P
47 3601046712060001 ATI NURHAYATI P
48 3601044507070001 INTAN P
49 3601044502080005 SITI NURKHOLIFAH P
50 3601041701080002 SUNDA L
51 3601040404070001 SITI NURARIN P
52 3601045507080002 ALITA P
53 3601041610070001 M.YUSUP L
54 3601044502080004 RISMA P
55 3601042004080001 REHAN KURNIAWAN L
56 3601046004070007 SURNATI P
57 3601045400600007 MILA P
58 3601045905070005 PATIMAH P
59 3602044505810004 SARWI P
60 3601046009070001 USI P
61 3601046412000001 RATIH P
62 3601044209070003 SITI AISAH P
63 3601046904080002 DESI SAKAUNI P
64 3601041406960002 NUNU P
65 3601045706900002 NIA SUSANTI P
66 3601029109680002 DARUS L
67 3601044507410001 RTUMINAH P
68 3601042508080001 M.SUDAR L
69 3601045206960001 SUSI SUNAYANTI P
70 3601042102820001 ILMI L
71 3602010906860001 SAHIDIN L
72 3601046002860002 RASMI P
73 3601044911000001 LINDA P
74 3601045806710001 EEM P
75 3601045203670001 DEDEH P
 Umur Kelomp
Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

ÍRT 10-01-1985 UMUM PARKOS 085718724735

TDK BEKERJA 20-03-2003 UMUM PARKOS 085715268516
WIRASWASTA 01-07-1987 UMUM PARKOS 085773624256
WIRASWASTA 16-09-1998 UMUM PARKOS 081511125160
WIRASWASTA 05-03-1986 UMUM PARKOS 085718724735
IRT 10-01-1982 UMUM PARKOS 085795632010
WIRASWASTA 05-06-1983 UMUM PARKOS 085694590490
IRT 01-02-1988 UMUM PARKOS 085694590490
PELAJAR REMAJA PARKOS 085710121735
PELAJAR 14-04-2006 REMAJA PARKOS 085778233834
PELAJAR 22-06-2008 REMAJA PARKOS 081511408280
PELAJAR 17-01-2008 REMAJA PARKOS 085871073725
PELAJAR 17-01-2008 REMAJA PARKOS 085871072733
IRT 07-05-1976 UMUM PARKOS 085884397288
IRT 01-05-1982 UMUM PARKOS 085774595623
IRT 01-07-1982 UMUM PARKOS 085773632818
IRT 11-04-2002 UMUM PARKOS 081311814257
IRT 20-11-1978 UMUM PARKOS 085710121735
WIRASWASTA 11-02-1982 UMUM PARKOS 08774595623
TDK BEKERJA UMUM PARKOS 085810142839
IRT 29-06-1990 UMUM PARKOS 085882372450
IRT 12-12-1982 UMUM PARKOS 085775205702
IRT 02-01-1957 UMUM PARKOS 085770136285
IRT 13-09-1984 UMUM PARKOS 085714231167
TDK BEKERJA 17-03-2002 UMUM PARKOS 085714688311
IRT 01-06-1976 UMUM PARKOS 081511863842
IRT 07-05-1990 UMUM PARKOS 081511227810
IRT 22-11-1984 UMUM PARKOS 085715853441
WIRASWASTA 17-07-1984 UMUM PARKOS 085773487006
IRT UMUM PARKOS 085697018197
IRT 20-02-1997 UMUM PARKOS 081646085417
WIRASWASTA 13-08-1985 UMUM PARKOS 082312461122
WIRASWASTA 12-03-1960 UMUM PARKOS 08558165043
IRT 11-07-1995 UMUM PARKOS 085891580702
IRT 09-07-1987 UMUM PARKOS 081219680003
IRT 02-03-21978 UMUM PARKOS 085210374312
PELAJAR REMAJA PARKOS 085716599840
PELAJAR 13-07-2007 REMAJA PARKOS 085811460045
PELAJAR REMAJA PARKOS 085886116725
PELAJAR 02-01-2009 REMAJA PARKOS 085710265475
PELAJAR REMAJA PARKOS 085773884799
PELAJAR REMAJA PARKOS 085775397645
WIRASWASTA 15-01-1980 UMUM PARKOS 085882372450
PELAJAR REMAJA PARKOS 082164165011
PELAJAR REMAJA PARKOS 085718788191
PELAJAR 04-06-2008 REMAJA PARKOS 085881530903
PELAJAR 27-12-2008 REMAJA PARKOS 085811462093
PELAJAR 10-02-2008 REMAJA PARKOS 085719016932
PELAJAR 05-02-2008 REMAJA PARKOS 085774595587
PELAJAR 17-02-2008 REMAJA PARKOS 085774964794
PELAJAR ' REMAJA PARKOS 085710723106
PELAJAR 15-07-2008 REMAJA PARKOS 085882946669
PELAJAR 16-10-2007 REMAJA PARKOS 08151186945
PELAJAR 05-02-2008 REMAJA PARKOS 08570149964
PELAJAR 20-04-2008 REMAJA PARKOS 085882372470
PELAJAR REMAJA PARKOS 085710499284
PELAJAR REMAJA PARKOS 085719069997
PELAJAR 19-05-2007 REMAJA PARKOS 082164164997
PELAJAR REMAJA PARKOS 085771292965
PELAJAR 20-09-2007 REMAJA PARKOS 085773210383
PELAJAR REMAJA PARKOS 081284686133
PELAJAR 02-09-2007 REMAJA PARKOS 085781656232
PELAJAR REMAJA PARKOS 081617125303
PELAJAR REMAJA PARKOS 085715509338
IRT 06-07-1976 UMUM PARKOS 081289750536
WIRASWASTA 15-09-1968 UMUM PARKOS 085117251782
IRT UMUM PARKOS 08558167254
WIRASWASTA UMUM PARKOS 085774964794
IRT UMUM PARKOS 083879968051
WIRASWASTA 21-02-1982 UMUM PARKOS 085695601202
WIRASWASTA 09-06-1986 UMUM PARKOS 085719459658
IRT 20-02-1986 UMUM PARKOS -
IRT UMUM PARKOS 085770620782
IRT UMUM PARKOS 085691137653
IRT 01-06-1966 UMUM PARKOS
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

CORONAVAC 03-12-2021 03-12-2021 202109177M

CORONAVAC 03-12-2021 03-12-2021 202109177M
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CORONAVAC 03-12-2021
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CORONAVAC 03-12-2021
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CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
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CORONAVAC 03-12-2021
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CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
CORONAVAC 03-12-2021
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si

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03-12-202 202109177M
03-12-202 202109177M
03-12-202 202109177M
03-12-202 202109177M
03-12-202 202109177M
03-12-202 202109177M
03-12-202 202109177M
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601040702880003 EVI JUNIAWAN L

2 3601042312860001 KASINIH P
3 3601040107950104 SUPARNA L
4 3601040107780137 RAMCAS L
5 3601040107860084 WASKIM L
6 3601045504040002 SITI MARHAMAH P
7 3601041507910003 PENDI L
8 3601040107700062 SUNIKA L
9 3601040107610036 DARNO L
10 3601040107800066 SUDIRAH L
11 3601040107690023 NARMA L
12 3601040307980003 ARI IPANDI L
13 3601044107420074 WASKEM P
14 3601040802030001 WAHYU MAULANA L
15 3601041204590001 ILYAS L
16 3601050405750007 SARNA L
17 3601045902940001 DARKEM P
18 3601042103880001 JAHAR L
19 3601040107950081 JEFRI HERIYANTO L
20 3601041207980006 SUANTA L
21 3601041103930002 MUJAHIDIN L
22 3601045103600003 SITI ASIAH P
23 3601040107950267 JAJULI JAELANI L
24 3601044501900005 ROHIMAH P
25 3601044107960274 TINI P
26 3601040408990002 SATORI L
27 3212204207550001 RASTEM P
28 3601042505500001 SAMAD L
29 3601040107990092 RAHMAT L
30 3601040107850162 SAJANI L
31 3601040107830117 KURAESIN L
32 3601040711840003 MISRA HERMAWAN L
33 3601045302580002 RUMINAH P
34 3601044211900002 WIDYAWATI P
35 3601045504740001 ROMLAH P
36 3601040107920092 NENI TRIANA P
37 3601042004710001 CARLI L
38 3601041712070002 RAHMAT ADITIA L
39 3601040107940083 CARYONO L
40 3601040107920265 RUSTONO L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI

6/13/1989 DESA CIKADONGDONG 085776131063

12/23/1986 DESA RANCASENENG 085694587316
11/5/1996 DESA RANCASENENG 085894381188
7/1/1978 DESA RANCASENENG 085762187721
7/1/1986 DESA RANCASENENG 085779054211
4/15/2004 REMAJA DESA RANCASENENG 085219655886
6/4/1991 DESA RANCASENENG 082117474807
3/6/1964 DESA RANCASENENG 085219655886
7/1/1964 DESA RANCASENENG 0821174744807 
7/1/1980 DESA RANCASENENG 085694946140
7/1/1969 DESA RANCASENENG 85694904795
7/21/1997 DESA RANCASENENG 08519655886
7/1/1942 LANSIA DESA RANCASENENG 085810913794
2/8/2003 DESA RANCASENENG 081511407846
3/2/1950 LANSIA DESA RANCASENENG 085219655886
4/1/1995 DESA RANCASENENG 085694105290
8/15/1995 DESA RANCASENENG 085695274187
4/3/1993 DESA CIKADONGDONG 081511407931
9/7/1995 DESA RANCASENENG 085694941847
7/12/1998 DESA RANCASENENG 085771972844
8/8/1995 DESA RANCASENENG 085693382965
3/1/1967 DESA RANCASENENG 085782135187
7/9/1994 DESA RANCASENENG 081910999667
9/18/1998 DESA RANCASENENG 085607535083
7/1/1996 DESA RANCASENENG 085782766473
4/9/2000 DESA UMBULAN 085711674751
7/2/1955 LANSIA DESA RANCASENENG 085219655886
5/25/1950 LANSIA DESA RANCASENENG 085695337642
2/2/1999 DESA RANCASENENG 085691133396
7/1/1985 DESA CURUGCIUNG 085772730566
12/5/1980 DESA RANCASENENG 085810913903
11/7/1980 DESA RANCASENENG 085313211922
2/13/1990 DESA RANCASENENG 085770620519
11/8/1991 DESA RANCASENENG 083812881145
4/15/1974 DESA RANCASENENG 083856819300
10/5/1989 DESA RANCASENENG 085714984202
4/20/1971 DESA RANCASENENG 085777750695
12/17/2007 REMAJA DESA CIKEUSIK 085797143457
5/15/1989 DESA RANCASENENG 083872320861
8/21/1995 DESA RANCASENENG 085773491002
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal Tanggal
Merek
Non Screeni Pemberi Pemberi
Vaksin*** an No. Batch No seri an
Anggota ng
Vaksina Vaksina
si si
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021
CORONAVAC 12/3/2021 12/3/2021 202109180M EUA2057300143A1
CORONAVAC 12/3/2021 12/3/2021
Dosis 2

KET
No. Batch No Seri

202109180M EUA2057300143A1
202109180M EUA2057300143A1

202109180M EUA2057300143A1
202109180M EUA2057300143A1

202109180M EUA2057300143A1

DUKCAPIL

202109180M EUA2057300143A1
202109180M EUA2057300143A1

202109180M EUA2057300143A1

202109180M EUA2057300143A1

202109180M EUA2057300143A1
202109180M EUA2057300143A1
202109180M EUA2057300143A1
202109180M EUA2057300143A1
202109180M EUA2057300143A1
202109180M EUA2057300143A1
202109180M EUA2057300143A1
202109180M EUA2057300143A1
NO No. Ticke NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601045005740003 SANAH BT SABAN P IRT

2 3601045210700001 SUKESIH P IRT
3 3601046402760001 KARSIH P IRT
4 3601045011730002 ASINAH P IRT
5 3601044367650001 SUTINAH P IRT
6 3601040107580217 SURYANA L PETANI
7 3601044107670111 TAWI P IRT
8 3601044207020007 CAHYANI P PELAJAR
9 3601040407050001 MARDI L PELAJAR
10 3601040403020003 RAHMAT P PELAJAR
11 3601046004750004 KARTINI P IRT
12 3601040104700002 WARTA L WIRASWA
13 3601044107730093 KASIDEM P IRT
14 3601044107690050 RUSMIAH P IRT
15 3601044109760003 YAETI P IRT
16 3601040107720030 TARKIMAN L PETANI
17 3601044608750002 MARNI P IRT
18 3601044502700002 SUNENTI P IRT
19 3601044105760002 ARCI P IRT
20 3601044911650001 BAYI P IRT
21 3601040207870008 DIDING L PETANI
22 3601045004540002 KARINAH P IRT
23 3601044201750002 SIRKEM P IRT
24 3601044107750070 DASTEM L WIRASWA
25 3601046111780001 UMAMAH P IRT
26 3601040107550104 SARMA L WIRASWA
27 3601045012630001 SAINAH P IRT
28 3601045307900002 ARUM SARI P IRT
29 3601045203010002 UNAH P IRT
30 3601045503050001 ENENG NURHASANAH P PELAJAR
31 3601040501730001 TARSAM L PETANI
32 3601041005760001 KARSID L PETANI
33 3601044302760001 ARNACIH P IRT
34 3601044107550110 HJ. KUSNI P IRT
35 3601044606790001 UMRIAH P IRT
36 3601042603900002 HABIBIH L WIRASWA
37 3601045207770001 SITI FATIMAH P IRT
38 3601045401720001 SURMINAH P IRT
39 3601042001570002 CARWAN L PETANI
40 3601042808880001 SUDIRMAN L WIRASWA
41 3602210412830001 ROMHANI L BURUH
42 3601041303040001 NURJEDI L BELUM KE
43 3601041010850006 SUANDI L WIRASWA
44 3601045104830001 NURYATI P IRT
45 3601044601810004 EROH P IRT
46 3601044605780002 YATI P IRT
47 3601044206900004 ARSINAH P IRT
48 3601046704610002 ASMINAH P IRT
49 3601046105960002 SITI ROHENI P IRT
50 3601041507800007 ISMA P IRT
51 3601040803810001 SUARJA L WIRASWA
52 3601040107740029 ATO SUARTO L WIRASWA
53 3601041207890002 SADRI L WIRASWA
54 3601041006620001 KADI L PETANI
55 3601044107810052 WARSITI P IRT
56 3601040201900004 NASUKA L WIRASWA
57 3601044909720001 LATIKAH P IRT
58 3601045003690001 DASWI P IRT
59 3601040107730359 MUHAMAD L PETANI
60 3601045006960002 SAHYATI P IRT
61 3601044106630001 WARMI P IRT
62 3601046006980002 WARWSINIH P IRT
63 3601044107880209 DARNI P IRT
64 3601044405900006 MASTIRI P IRT
65 3601045007870003 ATIPAH L WIRASWA
66 3601044107830342 TURINIH P IRT
67 3601044704850002 WATI P IRT
68 3601044107630169 MARYEM P IRT
69 3601045508490001 JARTI P IRT
70 3601044107790034 SUTINAH P IRT
71 3601040107550106 CASMA L PETANI
72 3601040107750115 SUKARI L PETANI
73 3601046708830001 SUMYATI P IRT
74 3601045210730003 AMI P PETANI
75 3601045806020001 EEN SUSILAWATI P IRT
76 3601040107800286 RASJAM L WIRASWA
77 3601041203640001 USRI L PETANI
78 3601045003680001 SARIAH P IRT
79 3601047012880001 NUR HAYATI P IRT
80 3601045003680003 KARYEM P IRT
81 3601047005720001 HAMNAH P IRT
82 3601044506640002 AYUHA P IRT
83 3601042110010001 DEDI SAPUTRA L PELAJAR
84 3601044207700002 MISTEM P IRT
85 3601355803760001 SARINI P IRT
86 3601040106920009 WAHYUDI L WIRASWA
87 3601042306090002 ANDRE NARDIANSYAH L PELAJAR
88 360104500390003 WARINAH P IRT
89 3601042507990001 DASMA DARMAWAN L WIRASWA
90 3601042302620001 CARMA L WIRASWA
91 360104201950001 ATI MARSATI P IRT
92 3602212011950002 SAKIB L WIRASWA
93 36010441107950142 TASMI P IRT
94 3601044107680161 WARCI P IRT
95 3601045604990004 LIYAS TUTI P IRT
96 3601045507810002 KARTINIH BT RASBA P IRT
97 3601044107580116 SANIAH P IRT
98 3601045801970002 SAMI PUSPITA SARI P IRT
99 3601044305730001 CASRIAH P IRT
100 3601044107740036 JUMANAH P IRT
101 3601044308760002 SARTI P IRT
102 3601045305020002 INA SUHINA P IRT
103 3601044107760059 TARMI P IRT
104 3601044207650003 PIAH P IRT
105 3601044307990001 ANISAH P IRT
106 3601044107870087 KHOLIDAH P IRT
107 3601045805910001 NURJANAH P IRT
108 3601041703900001 SUMINIH P IRT
109 3601040808970002 JUANDA SAPUTRA L PELAJAR
110 3601045504760002 DARISEM P IRT
111 3601040201710001 KADIS L WIRASWA
112 3601042107650003 ASEN L PETANI
113 3601040603000010 ANDA L PELAJAR
114 3601042011840001 DAYAT L WIRASWA
115 3601046805970003 SATINAH P WIRASWA
116 3601040701700001 DANIYATI P IRT
117 3601045007000007 TANIYAH P PELAJAR
118 3601040402680003 KARIM L PETANI
119 3601044107550072 DARSEM P IRT
120 3601044107750289 RASTINIH P IRT
121 3601044807700002 KARSIAH P IRT
122 3601041511650001 DASTI P IRT
123 3601040107710063 UJA L WIRASWA
124 3601046311630002 ASIH P IRT
125 3601044107930239 RASITI P IRT
126 3601041403620004 TARDI L PETANI
127 3671075608620005 UPIAH P IRT
128 3601351205670003 SALMIN L WIRASWA
129 3601045203810001 EROH P IRT
130 360104412910007 MAESAROH P IRT
131 3601044112510002 IYOT P IRT
132 3601040107870073 ASGAR L WIRASWA
133 3601045105720003 ENENG YUNENGSIH P IRT
134 3601044107830449 YAYAH P IRT
135 3601045507880008 ENAH P IRT
136 3601040405740001 DEDI ASRUDI L PETAMI
137 3601044107780234 SAHAMI P IRT
138 3601041305910001 HANAPI L WIRASWA
139 3601044403830003 KUSNIAH P IRT
140 3601045507820001 TETI HARYATI P IRT
141 3601044309770004 HADIZAH P IRT
142 3601040107630155 KARTIEM P IRT
143 3601040104860009 AMONG L PETANI
144 3601044107790163 DARINIH P IRT
145 3601044107910321 NURMI P IRT
146 3601045401930003 NURUL FATIMAH P IRT
147 360184107800007 SAMINAH P IRT
148 3601044107860225 NAHILAH P IRT
149 3601042904030003 RIO SAPUTRA L PELAJAR
150 3601041001650001 ASDA L PETANI
151 3601046606730002 SANIRAH P IRT
152 3601044103760005 WASNIRAH P IRT
153 3601040107500022 SAHADI L WIRASWA
154 3601041102540001 KARLIM L WIRASWA
155 3601044409770001 NURWITI P IRT
156 3601045207910003 JAMAL L WIRASWA
157 3601046210630001 HADRI L PETANI
158 3601040102710006 NURADI L WIRASWA
159 3601040107720027 KARGANA L PETANI
160 3601040306720002 SAGIRI L WIRASWA
161 3312150601710003 SURATNO L WIRASWA
162 3601045206040002 IROH ROHAYATI P IRT
163 3601045002030004 ANISA LESTARI P IRT
164 3601040410770001 WASKA L IPETANI
165 3601040910810001 RASTAYIM L PETANI
166 3601044901010006 RUSMIYATI P IRT
167 3601040107890161 CASDANI P PETANI
168 3601041001880001 ROIS L PELAJAR
169 3601045810890002 YULI YANI P IRT
170 3601040107640034 KARTONO L PETANI
171 3601045006810001 BAYI YULYATI P IRT
172 3601042810000003 MAEDI RODINI L PELAJAR
173 3601040107770111 HASAN MAULANA L WIRASWA
174 3601044107700048 DARWINAH P IRT
175 3601044805810001 JUNISAH P IRT
176 3601040804960003 DADAN L PELAJAR
177 3601040102920009 ADIN L WIRASWA
178 3601040706760001 ACENG L WIRASWASTA
179 3601041802900001 ADE L PETANI
180 3601045102850002 CASINIH P IRT
181 360221102030001 ENIK P IRT
182 3601040107790159 RADI L PETANI
183 3601046107730003 NURAH P IRT
184 3601044203850006 AMEL P IRT
185 3601040107660172 KUSNADI L WIRASWA
186 3601046802840001 CASINIH P IRT
187 3601041105050005 IMAN CAHYADI L PELAJAR
188 3601042507900002 SUPRIADI L WIRASWASTA
189 3601044107870142 SARNAH P WIRASWA
190 3601040207030008 RESTU KURNIA L PELAJAR
191 3601044507800017 JANATI P WIRASWA
192 360104050595006 SUDARNO L WIRASWA
193 3601044504000009 ALISAH P IRT
194 360104410380002 EEN P IRT
195 3601046104830001 AAT SUMIRAT P IRT
196 3601040602790005 ARMIN L WIRASWA
197 3601040706890001 AMIN JUPRON L WIRASWA
198 3601040407720002 KARSAMIN L WIRASWA
199 3306155205750001 MAMAH P IRT
200 3601045511770001 ASTUTI P IRT
201 3601040307910004 DEDE RIYAN P IRT
202 3601040107730210 KOSIM L PETANI
203 3601046304680001 CARITEM P IRT
204 3601044207830008 FATIMAH P IRT
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI

10-05-1974 UMUM CIKEUSIK 085691153732

12-10-1970 UMUM CIKEUSIK 087741170176
24-05-1980 UMUM CIKEUSIK 085210070986
10-11-1981 UMUM CIKEUSIK 085283710787
03-07-1965 UMUM CIKEUSIK 085210070986
01-07-1958 UMUM CIKEUSIK 081398428633
15-10-1962 UMUM CIKEUSIK 085891377188
15-10-2003 UMUM CIKEUSIK 081219835775
04-07-2005 UMUM CIKEUSIK 082214215651
18-03-2002 UMUM CIKEUSIK 082312296078
20-04-1975 UMUM CIKEUSIK 085810903507
01-04-1970 UMUM CIKEUSIK 085212405212
01-07-1973 UMUM CIKEUSIK 085211513756
01-07-1973 UMUM CIKEUSIK 085888063310
06-09-1976 UMUM CIKEUSIK 085213240201
30-09-1971 UMUM CIKEUSIK 085880099477
06-08-1975 UMUM CIKEUSIK 0852165833049
05-02-1970 UMUM CIKEUSIK 085715282194
01-05-1976 UMUM CIKEUSIK 081584367725
09-11-1965 UMUM CIKEUSIK 085283710787
02-07-1987 UMUM CIKEUSIK 085811464516
10-04-1956 UMUM CIKEUSIK 081228076296
02-01-1975 UMUM CIKEUSIK 085711038584
01-07-1977 UMUM CIKEUSIK 08521993845
21-11-1978 UMUM CIKEUSIK 081646061709
01-07-1955 UMUM CIKEUSIK 085710756776
10-12-1963 UMUM CIKEUSIK 081317454597
13-07-1990 UMUM CIKEUSIK 081511407793
25-09-2001 UMUM CIKEUSIK 085771918274
15-03-2005 UMUM CIKEUSIK 085885201947
05-01-1973 UMUM CIKEUSIK 085891581109
10-05-1978 UMUM CIKEUSIK 085882501947
03-02-1976 UMUM CIKEUSIK 085891581109
01-07-1955 UMUM CIKEUSIK 082155500460
06-06-1979 UMUM CIKEUSIK 085695274145
26-03-1990 UMUM CIKEUSIK 085282598500
12-07-1977 UMUM CIKEUSIK 085771613878
29-08-1976 UMUM CIKEUSIK 082124622187
20-01-1957 UMUM CIKEUSIK 085695272362
28-08-1988 UMUM CIKEUSIK 085774964989
25-05-1963 UMUM CIKEUSIK 085882452044
06-03-2004 UMUM CIKEUSIK 082124622187
10-10-1985 UMUM CIKEUSIK 085813586070
11-04-1983 UMUM CIKEUSIK 08588004765
06-01-1981 UMUM CIKEUSIK 085691096273
06-05-1978 UMUM CIKEUSIK 085771071668
02-06-1990 UMUM CIKEUSIK 085711038527
27-04-1961 UMUM CIKEUSIK 085773227451
21-05-1996 UMUM CIKEUSIK 081228076296
15-07-1980 UMUM CIKEUSIK 085313196963
08-03-1981 UMUM CIKEUSIK 085880005329
10-04-1974 UMUM CIKEUSIK 081584375242
12-07-1989 UMUM CIKEUSIK 085811464572
10-06-1952 UMUM CIKEUSIK 085710756776
01-07-1982 UMUM CIKEUSIK 085894404512
02-01-1992 UMUM CIKEUSIK 081228076296
09-09-1968 UMUM CIKEUSIK 085710756776
10-03-1972 UMUM CIKEUSIK 0852112405212
01-07-1973 UMUM CIKEUSIK 085719474398
10-06-1996 UMUM CIKEUSIK 082149942191
01-06-1963 UMUM CIKEUSIK 081282437692
20-06-1998 UMUM CIKEUSIK 082125599092
01-07-1988 UMUM CIKEUSIK 085782265955
04-04-1990 UMUM CIKEUSIK 085210829896
10-07-1987 UMUM CIKEUSIK 085219532691
07-03-1982 UMUM CIKEUSIK 082113240125
07-04-1985 UMUM CIKEUSIK 085254245799
01-07-1963 UMUM CIKEUSIK 085860730667
15-08-1949 UMUM CIKEUSIK 083306836692
07-11-1982 UMUM CIKEUSIK 085694941688
01-07-1955 UMUM CIKEUSIK 085693541877
22-10-1976 UMUM CIKEUSIK 081219409679
27-08-1983 UMUM CIKEUSIK 0857949615
12-10-1975 UMUM CIKEUSIK 085213557782
01-02-2000 UMUM CIKEUSIK 085772740114
01-07-1980 UMUM CIKEUSIK 085782265955
12-03-1964 UMUM CIKEUSIK 081299127312
10-03-1968 UMUM CIKEUSIK 082115427349
30-12-1988 UMUM CIKEUSIK 085210710635
10-03-1968 UMUM CIKEUSIK 085213477215
30-05-1972 UMUM CIKEUSIK 081210914127
05-06-1964 UMUM CIKEUSIK 085710721429
21-10-2001 UMUM CIKEUSIK 085777730237
30-12-1970 UMUM CIKEUSIK 085283233138
18-03-1976 UMUM CIKEUSIK 081241450892
01-06-1992 UMUM CIKEUSIK 081584376683
23-06-2009 UMUM CIKEUSIK 085699430805
15-03-1993 UMUM CIKEUSIK 081584376683
06-12-2001 UMUM CIKEUSIK 085210229868
23-02-1962 UMUM CIKEUSIK 085710756776
02-06-1994 UMUM CIKEUSIK 085773756237
20-10-1995 UMUM CIKEUSIK 085210920432
02-06-1996 UMUM CIKEUSIK 085210920432
03-07-1968 UMUM CIKEUSIK 082354311830
16-04-1999 UMUM CIKEUSIK 085710721469
03-06-1977 UMUM CIKEUSIK 082310885393
05-11-1952 UMUM CIKEUSIK 085881197244
27-09-1997 UMUM CIKEUSIK 085881197244
03-05-1973 UMUM CIKEUSIK 085773239835
01-07-1974 UMUM CIKEUSIK 085717893263
03-08-1976 UMUM CIKEUSIK 085692651838
13-05-2002 UMUM CIKEUSIK 085880005449
01-07-1976 UMUM CIKEUSIK 085211519356
02-07-1965 UMUM CIKEUSIK 082131670845
07-08-1974 UMUM CIKEUSIK 085772740168
20-04-1986 UMUM CIKEUSIK 085891581134
18-05-1991 UMUM CIKEUSIK 083841491508
10-02-1986 UMUM CIKEUSIK 082312396086
08-08-1997 UMUM CIKEUSIK 0857773763788
15-04-1976 UMUM CIKEUSIK 081280547008
12-12-1969 UMUM CIKEUSIK 085228323318
01-03-1964 UMUM CIKEUSIK 085890645372
06-03-2000 UMUM CIKEUSIK 082188289334
17-02-1984 UMUM CIKEUSIK 081346155371
28-05-1997 UMUM CIKEUSIK 085771972844
08-12-1973 UMUM CIKEUSIK 085219822437
10-07-2000 UMUM CIKEUSIK 085892340803
04-02-1968 UMUM CIKEUSIK 085216426413
01-07-1955 UMUM CIKEUSIK 085773216610
01-07-1963 UMUM CIKEUSIK 085883507949
03-07-1970 UMUM CIKEUSIK 085711038584
15-11-1965 UMUM CIKEUSIK 085772740211
01-07-1971 UMUM CIKEUSIK 085772740168
23-11-1968 UMUM CIKEUSIK 085692651838
17-08-1993 BUMIL CIKEUSIK 085213478204
06-07-1962 UMUM CIKEUSIK 085215115499
16-08-1962 UMUM CIKEUSIK 085214931828
15-06-1965 UMUM CIKEUSIK 085218581845
12-03-1981 UMUM CIKEUSIK 085819421574
01-02-1997 UMUM CIKEUSIK 082114864848
01-12-1951 UMUM CIKEUSIK 085211674741
20-05-1986 UMUM CIKEUSIK 085216428117
11-05-1972 UMUM CIKEUSIK 085283296196
01-07-1983 UMUM CIKEUSIK 085715497465
15-07-1988 UMUM CIKEUSIK 085715497465
04-05-1974 UMUM CIKEUSIK 085643541877
01-07-1978 UMUM CIKEUSIK 085217377690
13-05-1991 UMUM CIKEUSIK 083875337107
05-08-1984 UMUM CIKEUSIK 085887092285
06-03-1983 UMUM CIKEUSIK 081511959592
03-09-1977 UMUM CIKEUSIK 083877369948
01-07-1963 UMUM CIKEUSIK
01-04-1986 UMUM CIKEUSIK 085894827358
01-07-1079 UMUM CIKEUSIK 085692654734
01-07-1991 UMUM CIKEUSIK 081514562749
14-01-1993 UMUM CIKEUSIK 085773649994
01-01-1955 UMUM CIKEUSIK 085719437061
10-04-1988 UMUM CIKEUSIK 085857747323
29-04-2003 UMUM CIKEUSIK 081219721904
10-01-1965 UMUM CIKEUSIK 085691312711
26-06-1973 UMUM CIKEUSIK 08568930366
01-03-1976 UMUM CIKEUSIK 081219721904
29-03-1959 UMUM CIKEUSIK 085718256155
11-02-1954 UMUM CIKEUSIK 085214899499
04-09-1977 UMUM CIKEUSIK 085283862107
12-07-1991 UMUM CIKEUSIK 085773227488
19-04-1966 UMUM CIKEUSIK 085778601248
01-02-1971 UMUM CIKEUSIK 085692654734
01-07-1972 UMUM CIKEUSIK 081398803572
 03-06-1972 UMUM CIKEUSIK 081514541988
06-01-1971 UMUM CIKEUSIK 082261158544
12-06-2004 UMUM CIKEUSIK 085817841923
11-02-2003 UMUM CIKEUSIK 085773227478
04-10-1967 UMUM CIKEUSIK 081398285868
09-10-1981 UMUM CIKEUSIK 081316679661
27-05-2002 UMUM CIKEUSIK 085694904795
01-07-1989 UMUM CIKEUSIK 085715268486
10-01-1998 UMUM CIKEUSIK 085311379205
18-10-1989 UMUM CIKEUSIK 08777256221
01-07-1962 UMUM CIKEUSIK 085710509816
08-05-1979 UMUM CIKEUSIK 085773746188
28-10-2000 UMUM CIKEUSIK 085719063860
09-10-1971 UMUM CIKEUSIK 082324121389
01-07-1970 UMUM CIKEUSIK 085694904795
05-07-1982 UMUM CIKEUSIK 087874721961
08-04-1996 UMUM CIKEUSIK 083808892232
01-02-1992 UMUM CIKEUSIK 081282359823
WIRASWASTA UMUM CIKEUSIK 085212657388
18-02-1990 UMUM CIKEUSIK 081251546095
11-02-1985 UMUM CIKEUSIK 081316679661
UMUM CIKEUSIK 085782131436
01-08-1968 UMUM CIKEUSIK 085813598645
21-07-1973 UMUM CIKEUSIK 0857761311417
02-03-1985 UMUM CIKEUSIK 085794437605
18-08-1974 UMUM CIKEUSIK 081317120300
28-02-1984 UMUM CIKEUSIK 085770620527
11-05-2005 UMUM CIKEUSIK 085782264358
WIRASWASTA UMUM CIKEUSIK 085646087199
02-06-1982 UMUM CIKEUSIK 085890126164
02-07-2003 UMUM CIKEUSIK 085691312711
05-07-1980 UMUM CIKEUSIK 082261158544
05-05-1995 UMUM CIKEUSIK 085215300606
UMUM CIKEUSIK 085215300606
01-03-1980 UMUM CIKEUSIK 085773227505
21-04-1989 UMUM CIKEUSIK 081511334001
06-02-1979 UMUM CIKEUSIK 081381632688
07-06-1989 UMUM CIKEUSIK 085779056642
04-07-1972 UMUM CIKEUSIK 081319127197
12-05-1975 UMUM CIKEUSIK 085218265490
05-04-1980 UMUM CIKEUSIK 085813587339
03-07-1991 UMUM CIKEUSIK 085888410479
08-04-1973 UMUM CIKEUSIK 085778281368
23-04-1960 UMUM CIKEUSIK 085311379320
02-07-1983 UMUM CIKEUSIK 085779161107
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Merek Tanggal Tanggal Tanggal
Non Vaksin*** Screening Pemberian No. Batch No seri Pemberian
Anggota
Vaksinasi Vaksinasi

CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021

CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 28-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 14-10-2021 202108171F 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 2420371 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 01-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-02021 24203721 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 28-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 11/8/2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-07-2021 24002221 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 01-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 06-11-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 05-11-2021 287109149H 06-12-2021
CORONAVAC 06-12-2021 08-04-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24230721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 11/1/2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 01-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 28-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 28-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24205721 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 01-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 14-10-2021 202108171F 06-12-2021
CORONAVAC 06-12-2021 02-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 28-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 02-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 06-12-2021 202109177M
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 21-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 25-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 01-11-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 28-10-2021 202108145H 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24230721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 08-11-2021 24203721 06-12-2021
CORONAVAC 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 11-10-2021 2400514 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 28-10-2021 202108145H 06-12-2021
CoronaVac 06-12-2021 28-10-2021 202108145H 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 28-10-2021 202108145H 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24208721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 02-09-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 02-11-2021 202108145H 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 02-11-2021 202108145H 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 04-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 10-11-2021 24005021 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 08-11-2021 24203721 06-12-2021
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021 202109177M
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
CoronaVac 06-12-2021 06-12-2021
Dosis 2

KET
No. Batch No Seri

202109177M

202109177M
202109177M
202109177M

202109177M
202109177M

202109177M
202109177M
202109177M
202109177M
202109177M
202109177M

202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M

202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M

202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
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202109177M
202109177M
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202109177M

202109177M
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202109177M
202109177M
202109177M
202109177M
202109177M
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202109177M
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202109177M

202109177M

202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
202109177M
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202109177M
202109177M
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202109177M
202109177M
202109177M
202109177M
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202109177M
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202109177M
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 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044206640001 SARTI P
2 3601045708930004 ICA P
3 3601044107830455 KOKOM P
4 3601040107660171 MAHMUD L
5 3601044806670001 IMI P
6 3602076008800001 INA P
7 3601044603900003 SATINAH P
8 3601044107830427 IJAH P
9 3601045108720001 DASMI P
10 3601044607800006 MINI P
11 3601040701990009 DEDI L
12 3601045506740004 SALAMAH P
13 3601040310850001 JAELANI L
14 3601044107790167 TIAH P
15 3601044107480101 SANI P
16 3601046204760001 MURTI P
17 3601040103720001 RAKMAT L
18 3601045006890002 UUM UMYATI P
19 3601041107870003 ABDUL HASIM L
20 3601040107850270 SURNAMAH P
21 3601044107790142 LAMRAH P
22 3604214204950002 AISAH P
23 3601044501760003 MASNI P
24 3601041908670002 DARPIN L
25 3601044807990002 SITI AISAH P
26 3602085106930002 JUJUN P
27 3601044706870003 SUNARTI P
28 3601040107820111 KASDI L
29 3601044107910299 ENENG WARSIH P
30 3601040107990245 FERDIAN FIRMANSYAHL
31 3601041007030004 MUHAMAD TARPIN L
32 3601040701870003 DEDI L
33 3601044701900005 FITRI P
34 3601040104850009 ISNEA P
35 3601044107800274 SANAH P
36 3601045408840002 ERAWATI P
37 3601044107650175 JUMRAH P
38 3601044107130023 AMAH P
39 3601044107830447 SODAH P
40 3601044307550001 TITI P
41 3601046103770002 SAPRAH P
42 3601040702860009 M OPAN L
43 3601044107690071 WAREM P
44 3601040809990004 ADE HERMAWAN L
45 3601040107650190 ARMAN WIJAYA L
46 3601044910760002 TATI P
47 3601044107870130 SUPARIAH P
48 3601044701720002 HJ ENTIN P
49 3601044305770001 ARMAH P
50 3601044306710001 SANARI P
51 3601041007660001 SAHADI L
52 3601042503710001 TASIMAN L
53 3601045212040001 INDRI WULANDARI P
54 3601044107710175 JAMI P
55 3601045506610001 UPIT P
56 1806240707970001 SAHRI L
57 3601043110020001 PAJAR L
58 3601050601930001 SARMAN L
59 3601045012670002 KASTINI P
60 3601046707000005 AGNES SELPIANI P
61 3601045110970002 LESI LESTARI P
62 3601045806840002 JUNANI L
63 3601030406900003 SAMSUDIN L
64 3601044407750003 DARMINIH P
65 3601044701870012 PIAH P
66 3601044808820002 ENENG P
67 3601040207800018 PARTA L
68 3601040107630366 KARDI L
69 3601044201730001 JUNIAH P
70 3601044512840001 ESIH P
71 3217050107910189 ONENG P
72 3601040107730361 SUKARIA L
73 3601045401680001 RUNENTI P
74 3601044107640068 SAMTI P
75 3601044504760002 EDAH P
76 3601041602700002 BAHRUDIN L
77 3601044301700001 WATI P
78 3601044107850134 CICIH P
79 3601044703750001 RANTI P
80 6301071603730001 YANI P
81 3601045810940002 SARIPAH P
82 3601040306850001 SUBRATA L
83 3601044902830001 LENI P
84 3601044201910001 METI P
85 3601040107830350 JUMHI L
86 3601044602880001 CITRA P
87 3601044802620001 ASNAH P
88 3601044507650001 SANATI P
89 3601046711820002 UNENGSIH P
 90 3601044107910261 AAS ASIAH P
91 3601044107510063 JARINAH P
92 3601045203680002 SITI AISAH P
93 3601045112920002 ACIH AFRIYANI P
94 3601041504040008 RIZKI MAULANA L
95 3601041302770001 SUKARYA L
96 3601042201990001 DURYANI L
97 3601040207850014 EJANG L
98 3601104911920001 SANTI P
99 3601044511730003 DASINIH P
100 3601045110560001 ETI NURHAYATI P
101 3601044710870002 RUSTINI P
102 3601041506930002 AANG EFENDIS L
103 3601040107470036 RIJAN L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang

Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP BPJS
ok Umur
tahun) PBI

6/2/1964 DESA UMBULAN 082179034133

8/17/1993 DESA UMBULAN 085716570354
7/1/1983 DESA UMBULAN 085782261522
7/1/1966 DESA UMBULAN 085691735940
6/8/1967 DESA UMBULAN 085771716328
8/20/1980 DESA UMBULAN 085217381826
3/6/1980 DESA UMBULAN 085810903445
7/1/1983 DESA UMBULAN 085280255980
8/11/1972 DESA UMBULAN
7/6/1970 DESA UMBULAN 085779908665
8/25/1999 DESA UMBULAN 085813980105
6/15/1974 DESA UMBULAN 081286951876
10/3/1985 DESA UMBULAN
7/1/1979 DESA UMBULAN 085715496199
7/1/1948 LANSIA DESA UMBULAN 085771716328
4/22/1976 DESA UMBULAN 081584362073
3/1/1972 DESA UMBULAN 081584362073
6/10/1989 DESA UMBULAN 085774525426
7/11/1986 DESA UMBULAN 085319439764
7/1/1985 DESA UMBULAN 085782261594
7/1/1979 DESA UMBULAN 085695264406
4/2/1995 DESA UMBULAN 081317238709
1/5/1976 DESA UMBULAN 085283861718
8/19/1967 DESA UMBULAN 085283861718
10/3/1998 DESA UMBULAN 083169794281
6/11/1993 DESA UMBULAN 085882165477
6/7/1987 DESA UMBULAN 083899139109
7/1/1982 DESA UMBULAN 081511639556
7/18/1993 DESA UMBULAN 085719423109
1/12/1999 DESA UMBULAN 085311481854
8/10/2003 DESA UMBULAN 085695274237
8/8/1986 DESA UMBULAN 085884653818
11/1/1989 DESA UMBULAN 085884653818
4/1/1985 DESA UMBULAN 085882165477
7/1/1980 DESA UMBULAN 081574918388
8/14/1984 DESA UMBULAN 085781085308
7/1/1965 DESA UMBULAN 087829835931
7/1/1953 LANSIA DESA UMBULAN 085860108846
7/1/1983 DESA UMBULAN 085212810735
7/3/1955 LANSIA DESA UMBULAN 085282376034
3/21/1977 DESA UMBULAN 081286951876
 2/7/1986 DESA UMBULAN 085283861718
7/1/1969 DESA UMBULAN 085283234467
9/25/1999 DESA UMBULAN 081511943421
7/1/1969 DESA UMBULAN 085778182854
10/9/1976 DESA UMBULAN 085892448641
4/17/1989 DESA UMBULAN 083874996674
1/9/1972 DESA UMBULAN 085714550738
6/3/1977 DESA UMBULAN 083899139109
6/3/1971 DESA UMBULAN 085772729389
7/10/1968 DESA UMBULAN 081510566872
3/25/1978 DESA UMBULAN 08561171493
12/12/2004 REMAJA DESA UMBULAN 081266785419
7/1/1971 DESA UMBULAN 081266785419
6/30/1950 LANSIA DESA UMBULAN 082310343599
7/7/1997 DESA UMBULAN 087822663298
10/31/2002 DESA UMBULAN 085213872712
3/15/1991 DESA UMBULAN 085781667551
12/10/1967 DESA UMBULAN 082110130288
7/27/2000 DESA UMBULAN 085710307580
10/18/1997 DESA UMBULAN 081995271371
6/18/1984 DESA UMBULAN 085778212550
6/4/1989 DESA UMBULAN 085778212550
7/4/1975 DESA UMBULAN 08569264468
1/7/1987 DESA UMBULAN 085892626543
8/8/1982 DESA UMBULAN 083138862981
7/2/1980 DESA UMBULAN 083138862981
7/1/1963 DESA UMBULAN
1/2/1973 DESA UMBULAN 085717351439
12/5/1984 DESA UMBULAN 085692729274
7/6/1991 DESA UMBULAN 085691144413
7/1/1973 DESA UMBULAN 082111972265
1/13/1968 DESA UMBULAN 0877720366101
7/1/1964 DESA UMBULAN 0857190863979
4/5/1975 DESA UMBULAN 085210339975
7/6/1972 DESA UMBULAN 085210339975
7/1/1991 DESA UMBULAN 085694473696
7/1/1988 DESA PARUNGKOK 085694609172
9/15/1975 DESA PARUNGKOK 085212606402
3/16/1973 DESA SUKAMULYA 085887412177
10/18/1994 DESA PARUNGKOK 085215869363
6/12/1985 DESA PARUNGKOK 085694473696
2/9/1983 DESA PARUNGKOK 085695147573
1/3/1991 DESA PARUNGKOK 088813108722
7/1/1983 DESA PARUNGKOK 081296557716
11/22/1988 DESA PARUNGKOK 081296557716
2/10/1962 DESA PARUNGKOK 085813108722
10/4/1965 DESA PARUNGKOK 085813108722
11/27/1982 DESA UMBULAN 08577599481
 3/4/1990 DESA UMBULAN 085693636891
7/1/1951 DESA UMBULAN 085874952427
3/12/1973 DESA UMBULAN 085778212550
4/12/1992 DESA UMBULAN 081511883932
4/5/2004 REMAJA DESA UMBULAN 085894824931
2/13/1977 DESA UMBULAN 085891580185
9/19/1998 DESA UMBULAN 085891580185
7/3/1982 DESA PARUNGKOK 085715853441
11/9/1992 DESA UMBULAN 081291209193
11/5/1978 DESA UMBULAN 085217277399
10/11/1956 LANSIA DESA UMBULAN 085892746880
8/1/1985 DESA UMBULAN 081511690491
6/15/1993 DESA UMBULAN 085774075363
7/1/1947 DESA UMBULAN 085283861718
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal Tanggal
Merek
BPJS Non Screeni Pemberi No.
Pemberi
No.
Vaksin*** an No seri an
Non PBI Anggota ng Batch Batch
Vaksina Vaksina
si si
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 Nama Penerima
NO No. Ticke NIK JK Pekerjaan*
Vaksin

1 3601040207800014 SUMARDI L
2 3601044506000012 RINA P
3 3601046803780001 AMNAH P
4 3601042603830001 ASRIP PRIAYTNA L
5 3601040107840159 AIM ABDUROHIM L
6 3601042101530002 JUHRI L
7 3602212604920002 SARPIN P
8 3601044301040004 HERNI P
9 3601044107510076 TAMI P
10 3602011205950004 ENCE L
11 3601042508060002 ROMA IRAMA L
12 3601045901630002 SATRIAH P
13 3601041505880004 HENDRA L
14 3601040107830086 ENJAT L
15 3601040407820006 ARMAN L
16 3601044712950002 DUROTULAENI L
17 3601046011970004 SITI FATIMAH P
18 3601042603780003 KUSNADI L
19 3601040207650002 UDIN AFIFUDIN L
20 360104010785007 UHERI L
21 3601040909810002 BADRI L
22 3601044501890005 NURHAYATI P
23 3601045006060004 ICARSIH P
24 3601044811900003 NOVITA NURLIZA P
25 3602211112720001 PARDI L
26 3601044605870001 NANI P
27 3601044702860004 ATIH P
28 3601045005920001 PIJA LIA AMALIA P
29 3601044107710049 HADIJAH P
30 3602092702850001 ROBBY JULIANI L
31 3601047003760002 MIMIN P
32 3601042003610001 MUHID L
33 3601046706950006 DETI P
34 3601042008800003 LILI P
35 3601046603759993 TITIN P
36 3601041710130004 SARNI ELAWATI P
37 3601044206920001 MASITOH P
38 3601044105680002 MAENI P
39 3601041903000001 RUDIN SAEPUDIN L
40 3601045804960004 NUNING HAYATI P
41 3601046704830003 SARNI P
42 3601046312970001 SARTI P
43 3601040107630392 SARMAN L
44 3601044606630001 SARNI P
45 3601041506930003 IDRUS L
46 3601044107830081 SAMINAH P
47 3601044107670125 TIAH P
48 3601042305870003 JAIS MADRAIS L
49 3601044610810001 ELAWATI SYAFEI L
50 3601046510830001 MASRI L
51 3601045102770008 IPAH P
52 3601041009730002 SUHADI L
53 3601041205860004 ASMAN L
54 3601046510830001 MASRI L
55 3601045705580001 ADE YETI P
56 3601041702930003 UJANG L
57 3602265905830001 IROH RAHMAWATI P
58 3602215510770001 NENIH SURYANI P
59 3601045001550001 KUSMANAH L
60 3602215112930005 VIAH SUMINAR P
61 3602010510820005 HERO SLAMET L
62 7206081005630001 FERRY PIYOH L
63 3601045904750003 JUHE P
65 3601045002820002 IDA FARIDA P
66 3601040310840002 CEPI HAKIKI L
67 3601045803900003 SANIAH P
68 3601040804750003 SAMANI L
69 3601044708870005 SARNAH P
70 3601046711950001 YULIANI ENDIANA P
71 3601046901980001 KORIAH P
72 3601041001700002 WALIN L
73 3601042702630001 IPIT L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI

02/07/1980 UMUM CIKIRUHWETAN 085219819390

05/06/2000 UMUM CIKIRUHWETAN 087722033091
28/03/1978 UMUM CIKIRUHWETAN 082352128229
12/05/1982 UMUM CIKIRUHWETAN 083873171035
05/04/1983 UMUM CIKIRUHWETAN 083819335647
21/01/1953 UMUM CIKIRUHWETAN 082124059187
26/04/1992 UMUM CIKIRUHWETAN 085705190756
03/01/2004 UMUM CIKIRUHWETAN 085779329037
01/07/1954 UMUM CIKIRUHWETAN 08574324073
12/05/1995 UMUM CIKIRUHWETAN 087722033091
25/08/2006 UMUM CIKIRUHWETAN 085217038458
19/01/1963 UMUM CIKIRUHWETAN 085692052395
15/06/1988 UMUM CIKIRUHWETAN 085219819390
08/11/1981 UMUM CIKIRUHWETAN 085773633251
04/07/1982 UMUM CIKIRUHWETAN 082352128229
07/12/1995 UMUM CIKIRUHWETAN 085217038458
07/01/1989 UMUM CIKIRUHWETAN 081994118721
26/03/1978 UMUM CIKIRUHWETAN 085216588080
02/07/1965 UMUM CIKIRUHWETAN 081805566925
05/07/1981 UMUM CIKIRUHWETAN 085283712425
09/09/1981 UMUM CIKIRUHWETAN 081805566925
05/01/1989 UMUM CIKIRUHWETAN 0857727232118
10/06/2006 UMUM CIKIRUHWETAN 085774324073
08/11/1990 UMUM CIKIRUHWETAN 081805566925
11/12/1972 UMUM CIKIRUHWETAN 08128085917
28/06/1990 UMUM CIKIRUHWETAN 081310368720
07/02/1986 UMUM CIKIRUHWETAN 0838123334029
10/05/1992 UMUM CIKIRUHWETAN 082258459146
05/03/1968 UMUM CIKIRUHWETAN 081805566925
27/02/1985 UMUM CIKIRUHWETAN 085695703872
30/03/1976 UMUM CIKIRUHWETAN 085281724141
20/03/1961 UMUM CIKIRUHWETAN 085888540907
27/06/1995 UMUM CIKIRUHWETAN 081584356971
17/05/1981 UMUM CIKIRUHWETAN 083812334029
26/03/1975 UMUM CIKIRUHWETAN 085888540907
13/05/1994 UMUM CIKIRUHWETAN 085894202729
02/06/1992 UMUM CIKIRUHWETAN 087871646069
01/05/1968 UMUM CIKIRUHWETAN 085719021044
17/07/2000 UMUM CIKIRUHWETAN 085888540907
18/04/1996 UMUM CIKIRUHWETAN 082213974654
27/04/1983 UMUM CIKIRUHWETAN 0857743240773
23/12/1997 UMUM CIKIRUHWETAN 083873621274
09/05/1965 UMUM CIKIRUHWETAN 085289682285
06/06/1963 UMUM CIKIRUHWETAN 082312056746
15/06/1993 UMUM CIKIRUHWETAN 085311841907
01/07/1983 UMUM CIKIRUHWETAN 082149935278
01/07/1967 UMUM CIKIRUHWETAN 08528962285
18/12/1988 UMUM CIKIRUHWETAN 081299734588
24/07/1981 UMUM CIKIRUHWETAN 085217667333
25/10/1983 UMUM CIKIRUHWETAN 089533524907
11/02/1977 UMUM CIKIRUHWETAN 081511862670
10/09/1973 UMUM CIKIRUHWETAN 0895335249207
12/05/1986 UMUM CIKIRUHWETAN 085772729308
25/10/1983 UMUM CIKIRUHWETAN 0896335249207
17/05/1958 UMUM CIKIRUHWETAN 085882443220
02/05/1987 UMUM CIKIRUHWETAN 087720843599
19/05/1983 UMUM CIKIRUHWETAN 085927786769
15/10/1977 UMUM CIKIRUHWETAN 085773883622
UMUM CIKIRUHWETAN 082312056746
11/12/1993 UMUM CIKIRUHWETAN 081295084396
05/10/1982 UMUM CIKIRUHWETAN 083812333957
10/05/1963 UMUM CIKIRUHWETAN 085256227576
19/04/1975 UMUM CIKIRUHWETAN 083110005183
01/05/1981 UMUM CIKIRUHWETAN 085794449080
05/04/1981 UMUM CIKIRUHWETAN 085794449080
18/03/1990 UMUM CIKIRUHWETAN 085694676231
08/04/1975 UMUM CIKIRUHWETAN 085883973101
07/08/1987 UMUM CIKIRUHWETAN 085883973101
14/07/1995 UMUM CIKIRUHWETAN 083893724010
29/01/1998 UMUM CIKIRUHWETAN 082312396878
10/01/1970 UMUM CIKIRUHWETAN 082312396878
27/02/1963 UMUM CIKIRUHWETAN 085711304742
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Merek Tanggal Tanggal Tanggal
Pemberi Pemberi
Non Vaksin** Screeni No. No.
* ng an No seri an No Seri
Anggota Batch Batch
Vaksina Vaksina
si si
CORONAV06/12/21 06/12/21 202109177M
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CORONAV06/12/21 06/12/21 06/12/21 202109177M
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KET
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 36010456087200001 NARSIH P
2 3601044211650001 DARMINIH P
3 3601044507760003 TATI P
4 3601045308650002 RATEM P
5 SUMADI L
6 3404100609740001 WANTA L
7 3601042501810001 SUPARNO L
8 3601044107760274 ESIH P
9 3601045410850003 MURIP P
10 3601044704820003 AMI P
11 36010404010400008 MUHAMMAD L
12 3601042110760001 SURATNA L
13 360104410773-420 UPIT P
14 3601040107780305 TARNO L
15 3601045118000006 RASMINIH P
16 TARDEM P
17 3601041502840003 ARMIN L
18 CASUDIN L
19 3601040107630006 ANA. S P
20 3601044108080013 SITI P
21 WASTIM L
22 SANINGKEM P
23 3601044107730315 KASMI P
24 36010418056700001 SUPARTA L
25 3601045709820003 ROPIAH MUNADI P
26 SUGANDA L
27 3601044117780305 WASTIAH P
28 3601045105850002 ISAH P
29 36032250058560007 KOKOM KOMARIYAH P
30 RATI P
31 360104487770004 DARINAH P
32 ARIPIN L
33 3600140107680260 KARMIN L
34 16070405600001 SANIMAH P
35 WARSIDI L
36 3601044611550001 SARINAH P
37 3601040107500085 TAYANA L
38 3607045803670001 ASMI P
39 3601040107820128 ANDI L
40 3601044606050001 KURNIAH P
41 360104410780171 CASMI P
42 120319640860003 RASIA P
43 3601040107080029 ARDI L
44 3601044107630296 CARSINIH P
45 3601045101810001 RANITI P
46 3601040107880238 RASWA L
47 3601046406910001 IIS SURYANTI P
48 3601044408870003 IDAH P
49 3601045070730001 SARNI P
50 3601041107980003 SARYADI L
51 NAI MARYANI P
52 NASUM P
53 3601046009890001 SUNENTI P
54 1607042606680001 YUNI P
55 360104410530199 NARTI P
56 RAWI P
57 3601041405800002 SARIMAN L
58 360104010773033 DURAKMAN L
59 360104410730291 WARSINAH P
60 3601044210670001 TARKEM P
61 3601044412770002 SAPIAH P
62 3601045002700003 YAYAH P
63 3601041605730001 SUKANAH P
64 P
65 3601045909910001 ITEM P
66 3601040409670001 RAWIN L
67 3601044501970001 RESTI P
68 ROUP L
69 360104591030001 NENG HENI P
70 36011441090001 UTIAH P
71 36010451089600004 DINI ALIFAH P
72 3601040108010001 SOPYAN L
73 3601040107850207 DARPAN L
74 3601044307780001 CASINI P
75 MASRIAH P
76 3601045212720001 KARITEM P
77 3601044101850003 KARTINAH P
78 3601044108960003 ARNI P
79 36010460030001 DAMEN P
80 3601042001030009 NURYANI L
81 3601041112050003 RAMADANI L
82 3601041508000001 CARIDA L
83 3601040107780302 RASTIMAN L
84 3601043101820002 SARTIAH P
 85 3601040505820003 HENDI L
86 3601044107760199 SUMENI P
87 3601047010990002 WASTIAH P
88 3601042108700001 SARWIN P
89 3601044809770002 KADMI P
90 3601044207860010 CARINI L
91 3601042006010001 SUMENDI L
92 3601046105460001 KASUMI P
93 360104171270001 CASMITA L
94 3601045507050001 SITI AYU P
95 ARIMAN L
96 3601040207200012 CARITA P
97 3601044107810161 DASINGKEM L
98 360104010720178 SULEMAN L
99 3601044307830351 SUMINI P
100 3601045010990007 SRI MULYANI P
101 3601045202630002 ERUM P
102 3601044902700001 LIMAH P
103 3601045012980005 CARWINAH P
104 3601044811680004 ECOT P
105 3601045507740003 ROKMAH P
106 SARWINAH P
107 3601044107680263 WASINAH P
108 3601042209690003 KASMA L
109 3601041412660001 SUJAYA L
110 3601045405820031 ENI P
111 3601040210750001 CARIA L
112 3601040167480090 WEJOT L
113 3601040107940109 NASIB L
114 3601045207750002 NASTIKA P
115 3601045509750001 OMAH P
116 3601045212070004 CAHYU P
117
118
119
120
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang

Umur Kelomp
INSTANSI Alamat NO HP BPJS
(18-59 tahun) ok Umur
PBI

16-08-1972 UMUM SUKASENENG 082310972993

02-11-1965 UMUM SUKASENENG 085695388269
05-07-1976 UMUM SUKASENENG 085707761924
SUKASENENG 08521260364
01-07-1958 LANSIA SUKASENENG 085813995691
06-09-1974 UMUM SUKASENENG 085773124732
25-01-1983 UMUM SUKASENENG 085773124732
01-0401982 UMUM SUKASENENG 085773891737
14-10-1985 UMUM SUKASENENG 085773891737
07-04-1978 UMUM SUKASENENG 087827730099
26-11-2008 REMAJA SUKASENENG 082128833283
21-10-1976 UMUM SUKASENENG 085773891737
01-07-1975 UMUM SUKASENENG 085773891737
12-03-1980 UMUM SUKASENENG 085773891737
08-06-1979 UMUM SUKASENENG 085773891737
10-05-1972 UMUM SUKASENENG 081385562885
14-02-1984 UMUM SUKASENENG 081385562885
14-04-1990 UMUM SUKASENENG 081385562885
01-07-1963 UMUM SUKASENENG 081385562885
10-08-2008 REMAJA SUKASENENG 081385562885
01-07-1973 UMUM SUKASENENG 081385562885
01-07-1968 UMUM SUKASENENG 081385562885
01-07-198 UMUM SUKASENENG 085724963415
16-05-1967 UMUM SUKASENENG 085724963415
12-08-1984 UMUM SUKASENENG 085724963415
06-04-1974 UMUM SUKASENENG 085724963415
01-07-1978 UMUM SUKASENENG 085724963415
11-05-1985 UMUM SUKASENENG 085724963415
10-05-1985 UMUM TANGGERANG 085724963415
20-05-1970 UMUM SUKASENENG 085724963415
08-07-1977 UMUM SUKASENENG 085724963415
SUMSEL 085724963415
22-07-1961 UMUM SUKASENENG 085724963415
14-05-1960 LANSIA SUMBERMUKTI 085724963415
02-11-1964 UMUM SUKASENENG 085724963415
06-11-1955 LANSIA SUKASENENG 085724963415
14-07-1957 LANSIA SUKASENENG 085724963415
18-03-1967 UMUM SUMBERMUKTI 085724963415
20-02-1984 UMUM CIKEUSIK 085724963415
06-05-1985 UMUM CIKEUSIK 085724963415
01-07-1957 LANSIA SUKASENENG 085724963415
29-08-1960 LANSIA INDRAMAYU 085724963415
01-07-2008 REMAJA SUKASENENG 085724963415
01-07-1963 UMUM SUKASENENG 085724963415
01-07-1983 UMUM SUKASENENG 085724963415
12-09-1987 UMUM SUKASENENG 085724963415
24-06-1991 BUMIL SUKASENENG 085724963415
04-08-1987 UMUM SUKASENENG 085724963415
10-10-1993 UMUM SUKASENENG 087777151192
19-04-1997 UMUM SUKASENENG 087777151192
10-11-1993 UMUM SUKASENENG 087777151192
07-06-1962 UMUM SUKASENENG 087777151192
24-06-1993 UMUM SUKASENENG 087777151192
20-06-2008 REMAJA SUKASENENG 087777151192
01-07-1953 LANSIA SUKASENENG 087777151192
16-06-1976 UMUM SUKASENENG 085715799439
14-09-1980 UMUM SUKASENENG 085715799439
01-07-1973 UMUM SUKASENENG 085715799439
04-10-1988 UMUM SUKASENENG 085715799439
10-02-1967 UMUM SUKASENENG 085715799439
04-12-1977 UMUM SUKASENENG 085715799439
10-02-1970 UMUM SUKASENENG 085715799439
16-05-1973 UMUM SUKASENENG 085715799439
21-06-1963 UMUM SUKASENENG 085715799439
10-09-1991 UMUM SUKASENENG 085715799439
09-09-1967 UMUM SUKASENENG 085715799439
27-09-1997 UMUM SUKASENENG 085715799439
01-07-1963 UMUM SUKASENENG 085715799439
19-10-1993 UMUM SUKASENENG 085715799439
29-05-1990 UMUM SUKASENENG 085715799439
11-08-1995 UMUM SUKASENENG 085715799439
01-08-1997 UMUM SUKASENENG 085715799439
01-07-1985 UMUM SUKASENENG 085715799439
03-07-1978 UMUM SUKASENENG 081242216990
18-09-1975 UMUM SUKASENENG 081242216990
12-12-1972 UMUM SUKASENENG 081242216990
10-01-1972 UMUM SUKASENENG 081242216990
01-08-1995 UMUM CIKEUSIK 081242216990
20-03-1993 UMUM SUKASENENG 081242216990
20-10-2005 REMAJA SUKASENENG 081213390664
11-12-2005 REMAJA SUKASENENG 081213390664
15-08-2000 UMUM SUKASENENG 081213390664
12-09-1979 UMUM SUKASENENG 081213390664
11-01-1982 UMUM SUKASENENG 081213390664
05-05-1983 UMUM SUKASENENG 081213390664
01-07-1975 UMUM SUKASENENG 081213390664
30-10-1999 UMUM SUKASENENG 085813586150
21-08-1978 UMUM SUKASENENG 085813586150
08-09-1977 UMUM SUKASENENG 085813586150
02-03-1980 UMUM SUKASENENG 085285593438
20-06-2001 UMUM SUKASENENG 085285593438
21-05-1946 LANSIA SUKASENENG 087839436065
17-12-1978 UMUM SUKASENENG 087839436065
15-072005 REMAJA SUKASENENG 087839436065
03-04-1965 UMUM SUKASENENG 087839436065
03-04-1980 UMUM SUKASENENG 087839436065
01-07-1981 UMUM SUKASENENG 087839436065
SUKASENENG 087839436065
07-06-1984 UMUM SUKASENENG 087839436065
10-10-1999 UMUM SUKASENENG 081295091283
12-02-1963 UMUM SUKASENENG 081295091283
09-02-1970 UMUM SUKASENENG 081295091283
10-12-1998 UMUM SUKASENENG 081295091283
08-11-1968 UMUM SUKASENENG 08380625571
15-07-1974 UMUM SUKASENENG 08380625571
01-07-1985 UMUM SUKASENENG 08380625571
01-07-1968 UMUM SUKASENENG 081514562643
22-09-1969 UMUM SUKASENENG 081514562643
14-12-1966 UMUM SUKASENENG 081514562643
14-05-1982 UMUM SUKASENENG 085886821720
02-10-1975 UMUM SUKASENENG 085886821720
01-07-1948 UMUM SUKASENENG 085886821720
12-06-1995 UMUM SUKASENENG 085886821720
12-07-1975 UMUM SUKASENENG 085886821720
05-09-1975 UMUM SUKASENENG 085886821720
12-02-2007 REMAJA SUKASENENG 085886821720
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal Tanggal
Merek
BPJS Non Screeni Pemberi No.
Pemberi
No.
Vaksin*** an No seri an
Non PBI Anggota ng Batch Batch
Vaksina Vaksina
si si
CORONAVAC 08-11-2021 07-12-2021202108177M
CORONAVAC 08-11-2021 07-12-2021202108177M
CORONAVAC 01-11-2021 07-12-2021202108177M
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CORONAVAC 05-11-2021 07-12-2021202108177M
CORONAVAC 07-12-202107-12-2021202108177M
CORONAVAC 08-11-2021 07-12-2021202108177M
CORONAVAC 05-11-2021 07-12-2021202108177M
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CORONAVAC 05-11-2021 07-12-2021202108177M
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CORONAVAC 04-11-2021 07-12-2021202108177M
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28-10-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
05-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
01-11-2021 07-12-2021202108177M
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04-11-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
25-10-2021 07-12-2021202108177M
08-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
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08-11-2021 07-12-2021202108177M
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07-12-202107-12-2021202108177M
05-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
21-10-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
08-11-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
10-04-2021 07-12-2021202108177M
21-10-2021 07-12-2021202108177M
08-11-2021 07-12-2021202108177M
23-09-2021 07-12-2021202108177M
08-11-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
07-12-202107-12-2021202108177M
07-12-202107-12-2021202108177M
05-11-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
08-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
01-11-2021 07-12-2021202108177M
04-11-2021 07-12-2021202108177M
28-10-2021 07-12-2021202108177M
07-12-202107-12-2021202108177M
08-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M
05-11-2021 07-12-2021202108177M

11-11-2021
 KET
No Seri

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202108177M

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202108177M
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202108177M
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NO No. Ticket NIK Nama Penerima Vaksin

1 3601044810810001 RANI
2 3601044303750002 SANTI
3 3601046408920001 NURHALIMAH
4 36010249107810000 ENJUH
5 3601045101610001 MARINAH
6 3601042610450001 MUKHLAS
7 3601040808770002 ATA
8 3601044104870009 BAYI
9 3601041209930001 ENENG SUNARSIH
10 3601046807990004 RINI ANDRIANI
11 3601040206840003 UJANG RUSMAN
12 3601044107710044 PATONAH
13 3601044107920184 JAMSAH
14 3601040011800004 HARIS
15 3601045508610001 AISAH
16 3601040103870001 SOLEH HUDIN
17 3601040301660002 MASKA
18 3601046506600006 SAMAH
19 3601045403780001 NUNUNG
20 3601044104630001 RAWATI
21 3601040110750001 MULYANA
22 3601044107950043 SUNIAH
23 3601044707750007 SUHENI
24 3601046012800001 RUBIHA
25 3601041708760005 MAS'UD
26 3601044102680003 SUANAH
27 3601045905810000 SURYANI
28 3601044306850004 ANAH
29 3601041503060003 RENO
30 3601044103630002 WASEM
31 3601044102880005 RASMI
32 3601041608850003 RUKMAN
33 3601044308060001 RUMSIH
34 3601044107850070 UMIYAH
35 3601040102940001 DARYANA
36 3601044107510020 SAMSIAH
37 '3601045808760001 UNAYAH
38 3601040602950003 JUMAR
39 3601040609970003 ARIPIN
40 3601044110700002 SARTI
41 CARLI
42 3601044902900001 KARNATI
43 3601280107700101 ROPI
44 3601044107840236 HETI
45 3601044109650002 SUWARSIH
46 3601044804730002 NURLENI
47 3601041809900002 DIRMAN
48 3601046408750001 AMINAH
49 3601041008770003 RUKMAN
50 360104010770022 KUSNO
51 3602090303900003 ABDULLAH
52 3601044608030007 SITI PATIMAH
53 3213251110860001 WASIM
54 3209050101600011 IR. SUPARTIJO
55 3601046306880004 TATANG
56 3602012507940002 NARTO
57 3601040104630000 ASJA
58 3601041208700001 ARMAD
59 3601045806310001 DAYI
60 3601040306820001 SURYA
61 3601040107560032 MADSOLEH
62 3601040308980001 AGUS SUPRIANTO
63 3601040306830002 NURDIN
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

P 06-10-1981 SUKAWARIS 083890673302

P 07-05-1982 SUKAWARIS 085693533967
P 24-08-1992 SUKAWARIS 085219531060
P 01-07-1981 SUKAWARIS 085866761684
P 11-01-1961 SUKAWARIS 083890673302
L 26-10-1945 SUKAWARIS 085866761684
L 08-08-1977 SUKAWARIS 085319519048
P 01-04-1987 SUKAWARIS 085319519048
P 12-09-1993 SUKAWARIS 085211887250
P 28-07-1999 SUKAWARIS 081295097769
L 02-06-1984 SUKAWARIS 081932004222
P 01-07-1971 SUKAWARIS 083890673302
P 08-03-1993 SUKAWARIS 085773648356
L 09-11-1980 SUKAWARIS 082130201465
P 15-08-1981 SUKAWARIS 081585819202
L 01-03-1987 SUKAWARIS 085383736443
L 03-01-1966 SUKAWARIS 081310954976
P 25-06-1960 SUKAWARIS 085813107240
P 14-03-1978 SUKAWARIS 082283117735
P 01-04-1963 SUKAWARIS 081295096133
L 01-10-1975 SUKAWARIS 082283117735
P 01-07-1995 SUKAWARIS 085281919599
P 07-07-1975 SUKAWARIS 082312601846
P 20-12-1980 SUKAWARIS 083890673302
L 17-08-1976 SUKAWARIS 082333111067
P 01-02-1968 SUKAWARIS 085866761684
P 19-05-1971 SUKAWARIS 082113260744
P 03-06-1985 SUKAWARIS 085778218873
L 15-03-2006 SUKAWARIS 085894541338
P 15-07-1960 SUKAWARIS 085811459836
P 15-07-1985 SUKAWARIS 085770705039
L 16-08-1985 SUKAWARIS 083890673302
P 03-08-2006 SUKAWARIS 083137546369
P 01-07-1985 SUKAWARIS 082117666119
L 26-12-1992 SUKAWARIS 081294918047
P 13-12-1970 SUKAWARIS 081294918047
P 18-08-1976 SUKAWARIS 085866761604
L 06-02-1995 SUKAWARIS 085694566801
L 05-09-1997 SUKAWARIS 085820037488
P SUKAWARIS 085281919599
L SUKAWARIS 081994117010
P 07-09-1989 SUKAWARIS 081294918046
L 01-07-1970 SUKAWARIS 087772911761
P 01-07-1984 SUKAWARIS 085217105542
P 01-09-1965 SUKAWARIS 081912604774
P 14-06-1975 SUKAWARIS 085719028219
L 18-09-1990 SUKAWARIS 085772729315
P 04-08-1975 SUKAWARIS 085777478479
L 10-08-1977 SUKAWARIS 082113260744
L 07-05-1963 SUKAWARIS 085777478479
L 03-03-1990 SUKAWARIS 082113260744
P 06-08-2003 SUKAWARIS 081219286836
L 11-10-1986 SUKAWARIS 085882760494
L 01-01-1960 SUKAWARIS 082113260744
L 03-06-1988 SUKAWARIS 081617780593
L 25-07-1994 SUKAWARIS 085694568694
L 01-04-1963 SUKAWARIS 083890673302
L 05-10-1968 SUKAWARIS 081511133164
P 16-06-1971 SUKAWARIS 085892748053
L 03-06-1982 SUKAWARIS 085866761684
L 01-07-1955 SUKAWARIS 083890673302
L 03-08-1998 SUKAWARIS 085336240233
L 08-03-1993 SUKAWARIS
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi

CORONAVAC 07-12-2021 07-12-2021 202109177M

CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 05-11-2021
CORONAVAC 07-12-2021 08-11-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 21-10-2021
CORONAVAC 07-12-2021 02-11-2021
CORONAVAC 07-12-2021 02-11-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 25-10-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 7/12/2021 202109177M
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 25-10-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 11-11-2021
CORONAVAC 07-12-2021 02-11-2021
CORONAVAC 07-12-2021 01-11-2021
CORONAVAC 07-12-2021 2/11/2021
CORONAVAC 07-12-2021 05-11-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 07-11-2021 202109177M
CORONAVAC 07-12-2021 02-11-2021
CORONAVAC 07-12-2021 21-10-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 08-11-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 02-11-2021
CORONAVAC 07-12-2021 11-10-2021
CORONAVAC 07-12-2021 11-10-2021
CORONAVAC 07-12-2021 04-11-2021
CORONAVAC 07-12-2021 08-11-2021
CORONAVAC 07-12-2021 09-11-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 07-12-2021 20210917MM
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 07-12-2021 202109177M
CORONAVAC 07-12-2021 07-12-2021 202109177M
 Dosis 2
Tanggal
Pemberi KET
No.
No seri an No Seri
Batch
Vaksina
si

07-12-202 202109177M
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07-12-202 202109177M

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### 202109177M
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### 202109177M
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07-12-202 202109177M

07-11-202 202109177M
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07-12-202 202109177M
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### 202109177M
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### 202109177M
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07-12-202 202109177M

07-12-202 202109177M
 Nama Penerima
NO No. Ticket NIK
Vaksin

1 3601045202770003 LILIS
2 3601040107730068 MARJA
3 3601041210790001 UJANG
4 3601044107860020 RASTINAH
5 36010412037300002 CALAM
6 36010455117000003 SANTI
7 3601046204780002 MUNAH
8 3601040501720001 TATA SUPRIATNA
9 3601042603750001 SUHANDI
10 3601046206050001 IHTAN
11 3601040908890001 CAHEDI
12 3601045002900005 IIS KOKOM
13 3601041610580001 TASLIM
14 3601044409830003 SUKMANAH
15 360104410770015 SAWIANAH
16 3601040107530017 ENTANG
17 3601042202760002 AMIN
18 360104410780033 SARINAH
19 3601044107410004 RAWEN
20 3601045506880003 WAWAS
21 3601044107860232 SITI
22 3601044203700004 ARWANAH
23 3601044107780052 HASANAH
24 3601045702890003 SAROH
25 3601044107430016 WAYEM
26 3601046810870002 SANIRI
27 3601044207900237 WARYONAH
28 3601040107810202 M. ABDUL KARIM
29 360104010320009 NURDIN
30 3601040107850032 CARSONO
31 3601040602520001 ADIL
32 3601044912600002 MINAH
33 3601044107550010 SARNITI
34 3602215803680001 SARAH
35 3601044107580037 RIWEN
36 3601042104750001 ABIDIN
37 3601041810680002 SAKIMAN
38 3601044604690003 NEMAH
39 360104410550011 NARSIH
40 360102420830005 UTIN
41 3601040105680002 AHYANUDIN
42 3601040107570012 SATRA
43 3601040107730004 AHYANI
44 SADAM
45 3601045205950002 RIKA
46 3601044807980005 WARSINAH
47 RICKO ROCHMAT
48 3601040208710001 KOMARUDIN
49 36010401077780071 WARMA
50 3601044102920007 AMINAH
51 3601044710500002 LAMRAH
52 3601045504930001 SUHENI
53 3601045106950007 IDA ISAH
54 3601044902040003 HODIJAH
55 360104410520001 DARTEM
56 3601044107630346 MARSAH
57 3601044404790002 KURNIYAH
58 3601044107710003 RUSNI
59 3601044107680050 KASWEN
60 36010401075920045 SUARI
61 3601040205890001 TONI
62 3601044603850006 KESIH
63 360104118980001 AAN
64 3601045406530001 NAWI
65 3601044107820026 SUMINIH
66 3601044302020001 NURISAH
67 3601045008040004 TARSEM
68 3601046107070002 DEFI. P
69 360104410790010 MURTI
70 3601044609780004 ASIH
71 ROHATI
72 36010405050110006 AGUS
73 3601040912790002 SAMANAN
74 3601044107800036 RASKEM
75 3601041609710001 IDING
76 3601041205690001 JAWARI
77 3601044107760243 ARSIH
78 3601046302870001 AMSIH
79 3601045006760004 UMINAH
80 3601040107610011 DARILAH
81 ADHAR
82 3601045209800005 NIAH
 83 3601044107850054 RUNTAH
84 ODAH
85 360104590840002 TINAH
86 CASTI
87 3601045809860001 RIRIN
88 3601040107730026 SUGAN
89 3601045103860006 ROHMAH
90 360104408600001 SUKMARIAH
91 3601044205800002 ATIAH
92 3601044107860026 KASIH
93 3601040104630004 JUMAN
94 3601046705730001 ANIH
95 3601045104800004 SANI
96 3601044107840021 NURHASANAH
97 3601040208740001 DASMIN
98 3601045603920002 TARMI
99 3601044107780009 YAYAH
100 3601044107810024 RASINAH
101 3601044301740002 MUMUN
102 3601044107710023 ROHATI
103 3601044102630001 SUAH
104 ENIH
105 3601044107760033 HETI
106 3601044107860231 IKAH
107 360104620000001 SANECA
108 3601044201880004 MIMI
109 3601044107840216 SAMA'AH
110 3601045512460002 SITI MINARSIH
111 3601044107720003 AAM
112 360104410720025 SUKARNAH
113 3601040107740008 AJID
114 3601046102770002 BAYI
115 3601041203900006 SUKAEDI
116 3601044107680054 ENANG
117 3601045502830004 JUNAH
118 3601041801980003 JEFRI
119 3601044107960006 MURHENI
120 360104017680054 WADI
121 3601044107130048 DARSINIH
122 360104130710003 ANDRIANSYAH
123 3275075703860009 PARIDA .M
124 360104107780461 AYOH
125 3601041710650001 DASTA
126 3601040107630042 TARSA
127 3601040402610001 WARJA
128 3601045104000006 RITA
129 3601044107780073 SITI
130 3601044108000008 SANAH
131 3601044112800005 YANAH
132 3601041412950003 TATANG
133 3601040107530024 RASWIN
134 3601040802870001 TARIM
135 3601040507610002 PENDI
136 3601045012750006 NITI
137 3601041112570001 SARMAIN
138 3601044403710001 SUKENI
139 3601044107750029 SEWI
140 360104450277 JUHE
141 3601044105630002 ARTI
142 3601041004820003 DIJAH
143 3601046307790002 KUSTINI
144 3601044107680039 KAPSAH
145 3601041008490001 SUKANTA
146 3601046403890005 KESIH
147 3601040504750003 WASLIM
148 3601040107800035 DIRJO
149 3601044701840003 WASIH
150 3601041108730000 EMAH
151 3601046404740001 NYAI
152 360104550774006 NURBAETI
153 3601044403950001 ROSYAWATI
154 3601044107790001 SAWI
155 MUHAMMAD
156 3601046905000001 SASINI
157 3601044107500011 MARSINAH
158 SUKIRNO
159 3601044809910005 SUTIASIH
160 3601040408010002 ENDA
161 3601040104770073 MASDA
162 3601040504750001 MALI
163 3601040712850002 SUHERMAN
164 RASMAN
165 3601041101720002 ROSID
166 360104443880002 BAI
167 3601044103850008 SARNITI
168 AMSINAH
169 3601046011800002 NUNUNG
170 3601044510920004 RASITOH
171 3601045616680001 SITI
172 3601044107750257 WARSIH
173 3601044107790011 WATI
174 3601045508000006 CANI
175 3601044107750026 CARTI
176 3601044107420004 KARSAH
177 3601044107790184 BAYI
178 3601041010800008 E.KUSNADI
179 3601044205010004 RANI
180 3601044107590005 JUNAH
181 36010423081001 ROBIN
182 3601040108020012 RENDI
183 36010440662006 SANEH
184 3601046309900002 WATI
185 3601044102800007 AMSAH
186 360040107760234 ATANG
187 3601045611860002 JUMANAH
188 3601046310690007 SODAH
189 3601044107680055 KOCIH
190 3601045905780001 JUNAH
191 3601044109510001 RASLEM
192 TONI
193 36010459280002 ASNAH
194 3601040107620011 SAMRUDIN
195 3601044107980044 NITA
196 3601044102900020 IIS DAHLIA
197 3601044904060001 KARTINI
198 3601044501800001 BAI
199 3601046008870002 NURSAH
200 3601040107830073 YADI
201 3601045010980002 ARUM
202 3601040807780001 YUSUP
203 3601046505850001 SAENI
204 360104110790003 AJOT
205 36010144107990002 AGUN
206 3601044107770070 NURYATI
207 3601045812860001 SARINAH
208 360104410990001 ENJUM
209 360104491140002 TARNI
210 3601044107080006 SAMI
211 3601044107570012 SAIDAH
212 3601042008670001 NATA
213 SARNIAH
214 3601044709550001 ASNAH
215 3601040107750043 KARIM
216 360104403760001 ELIH
217 3601046006760005 INAH
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 Umur Kelomp
JK Pekerjaan* INSTANSI Alamat NO HP
(18-59 tahun) ok Umur

P 17-02-1977 UMUM SUMURBATU 081805344621

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P 01-07-1985 UMUM SUMURBATU 085817101064
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P 01-07-1986 UMUM SUMURBATU 082332912075
L 10-01-1965 UMUM SUMURBATU 082332912075
P 12-03-1973 UMUM SUMURBATU 082332912075
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P 24-12-1984 UMUM SUMURBATU 082332912075
L 02-08-1974 UMUM SUMURBATU 085282389358
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P 01-07-1942 LANSIA SUMURBATU 085779347840
P 14-08-1978 UMUM SUMURBATU 085779347840
P 01-07-1975 UMUM SUMURBATU 085820112182
P 22-03-1970 UMUM SUMURBATU 085820112182
P 02-01-1988 UMUM SUMURBATU 085820112182
P 10-09-1983 UMUM SUMURBATU 085820112182
P 15-12-1996 UMUM SUMURBATU 085820112182
P 01-01-1965 UMUM SUMURBATU 085820112182
P 19-02-1981 UMUM SUMURBATU 082312066911
L 11-04-1973 UMUM SUMURBATU 082312066911
P 21-02-1977 UMUM SUMURBATU 082312066911
L 12-03-1982 UMUM SUMURBATU 082312066911
P SUMURBATU 082312066911
P SUMURBATU 082312066911
L SUMURBATU 082119771427
P 07-08-1960 LANSIA SUMURBATU 082119771427
L 01-01-1968 UMUM SUMURBATU 085219867854
P 01-07-1973 UMUM SUMURBATU 085219867854
L 13-07-2001 UMUM SUMURBATU 085219867854
P 17-07-1986 UMUM SUMURBATU 085219867854
P 01-09-1978 UMUM SUMURBATU 085219867854
L 17-10-1965 UMUM SUMURBATU 085219867854
L 01-07-1963 UMUM SUMURBATU 085813557736
L 04-02-1961 UMUM SUMURBATU 085813557736
P 11-04-2000 UMUM SUMURBATU 085813557736
P 21-02-1978 UMUM SUMURBATU 085871072150
P 01-08-2000 UMUM SUMURBATU 085871072150
P 01-12-1980 UMUM SUMURBATU 085871072150
L 14-12-1995 UMUM SUMURBATU 085871072150
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P 08-10-1978 UMUM SUMURBATU 085890643849
P 05-02-1977 UMUM SUMURBATU 085890643849
P 01-05-1963 UMUM SUMURBATU 085890643849
P 10-04-1982 UMUM SUMURBATU 085890643849
P 23-07-1979 UMUM SUMURBATU 085890643849
P 01-07-1968 UMUM SUMURBATU 085890643849
L 10-08-1949 LANSIA SUMURBATU 085890643849
P 24-03-1989 UMUM SUMURBATU 085782010335
L 05-04-1975 UMUM SUMURBATU 085782010335
L 01-07-1975 UMUM SUMURBATU 085714565178
P 07-01-1984 UMUM SUMURBATU 085714565178
P 11-08-1973 UMUM SUMURBATU 085714565178
P 24-04-1964 UMUM SUMURBATU 085714565178
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P 08-11-1980 UMUM SUMURBATU 085782010333
L 11-10-1962 UMUM SUMURBATU 081284888639
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P 01-07-1950 LANSIA SUMURBATU 08558168036
L 03-02-1974 UMUM SUMURBATU 08558168036
P 08-09-1991 UMUM SUMURBATU 08558168036
L 04-08-2001 UMUM SUMURBATU 08558168036
L 07-07-1993 UMUM SUMURBATU 08558168036
L 05-04-1975 UMUM SUMURBATU 08582158133
L 07-12-1985 UMUM SUMURBATU 08582158133
L 16-02-1961 UMUM SUMURBATU 085780249228
L 09-04-1983 UMUM SUMURBATU 085813107160
P 04-03-1988 UMUM SUMURBATU 085813107160
P 01-03-1985 UMUM SUMURBATU 085813107160
P 06-11-1981 UMUM SUMURBATU 085813107160
P 20-11-1980 UMUM SUMURBATU 085813107160
P 05-10-1992 UMUM SUMURBATU 085813107160
P 16-10-1968 UMUM SUMURBATU 085813107160
P 01-07-1975 UMUM SUMURBATU 085813107160
P 01-07-1988 UMUM SUMURBATU 085813107160
P 15-08-2000 UMUM SUMURBATU 085813107160
P 01-07-1975 UMUM SUMURBATU 081284998189
P 01-07-1942 UMUM SUMURBATU 081284998189
P 01-07-1979 UMUM SUMURBATU 085714933177
L 10-10-1980 UMUM SUMURBATU 085714933177
P 09-05-2001 UMUM SUMURBATU 085714933177
P 01-07-1959 LANSIA SUMURBATU 085714933177
L 23-03-1981 UMUM SUMURBATU 085714933177
L 01-08-2002 UMUM SUMURBATU 081323916606
P 04-06-1962 UMUM SUMURBATU 081323916606
P 23-09-1990 UMUM SUMURBATU 081323916606
P 01-02-1980 UMUM SUMURBATU 081323916606
L 01-07-1976 UMUM SUMURBATU 085813108619
P 16-11-1986 UMUM SUMURBATU 085813108619
P 23-10-1969 UMUM SUMURBATU 082122100739
P 01-07-1968 UMUM SUMURBATU 082122100739
P 19-05-1978 UMUM SUMURBATU 082122100739
P 01-09-1951 LANSIA SUMURBATU 082122100739
L 01-11-1985 UMUM SUMURBATU 082122100739
P 10-02-1980 UMUM SUMURBATU 082122100739
L 16-05-1975 UMUM SUMURBATU 081511922148
P SUMURBATU 081511922148
P 01-02-1990 UMUM SUMURBATU 081511922148
P 09-04-2006 REMAJA SUMURBATU 081511922148
P 05-01-1994 UMUM SUMURBATU 081511922148
P 20-08-1987 UMUM SUMURBATU 081511922148
L 01-07-1983 UMUM SUMURBATU 081511922148
P 10-10-1998 UMUM SUMURBATU 081511922148
L 08-07-1978 UMUM SUMURBATU 081511922148
P 27-02-1981 UMUM SUMURBATU 08577682514
L 11-03-1979 UMUM SUMURBATU 08577682514
L 13-06-2001 UMUM SUMURBATU 08577682514
P 01-07-1973 UMUM SUMURBATU 08577682514
P 18-12-1985 UMUM SUMURBATU 085282389866
P 04-10-1999 UMUM SUMURBATU 085282389866
P 08-11-1994 UMUM SUMURBATU 08577682514
P 05-04-1988 UMUM SUMURBATU 08577682514
P 01-07-1957 LANSIA SUMURBATU 08577682514
L 20-08-1967 UMUM SUMURBATU 08577682514
P 04-08-1994 UMUM SUMURBATU 08577682514
P 07-09-1967 UMUM SUMURBATU 08577682514
L 01-07-1975 UMUM SUMURBATU 08577682514
P 02-03-1976 UMUM SUMURBATU 08577682514
P 20-06-1976 UMUM SUMURBATU 0852817060546
L 21-05-1977 UMUM SUMURBATU 085281760546
P 16-09-1978 UMUM SUMURBATU 085281760546
L 20-10-1961 UMUM SUMURBATU 085281760546
L 03-07-1980 UMUM SUMURBATU 085281760546
P 13-09-1970 UMUM SUMURBATU 085281760546
P 15-08-1980 UMUM SUMURBATU 085281760546
P 10-06-1974 UMUM SUMURBATU 085281760546
L 15-05-1969 UMUM SUMURBATU 085281760546
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P 07-04-1953 LANSIA SUMURBATU 085281760546
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P 01-07-1981 UMUM SUMURBATU 087776761106
L 02-02-1981 UMUM SUMURBATU 087776761106
P 14-03-1980 UMUM SUMURBATU 087776761106
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P 23-06-1966 UMUM SUMURBATU 087776761106
L 18-03-1979 UMUM SUMURBATU 085773210130
P 20-10-1979 UMUM SUMURBATU 085773210130
P 19-01-1952 LANSIA SUMURBATU 085773210130
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L 10-07-1954 LANSIA SUMURBATU 085773210130
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L 07-09-1989 UMUM SUMURBATU 082358936220
P 14-11-1989 UMUM SUMURBATU 082358936220
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P 01-01-1986 UMUM SUMURBATU 085697633382
P 19-10-1970 UMUM SUMURBATU 085697633382
L 10-06-1983 UMUM SUMURBATU 085697633382
P 19-03-1963 UMUM SUMURBATU 085697633382
P 11-08-2002 UMUM SUMURBATU 085311640048
L 14-08-1996 UMUM SUMURBATU 085311640048
P 15-11-2001 UMUM SUMURBATU 085311640048
P SUMURBATU 085311640048
P 16-06-2008 REMAJA SUMURBATU 085311640048
P 04-08-1967 UMUM SUMURBATU 085311640048
P 01-08-1997 UMUM SUMURBATU 085311640048
P 11-11-1989 UMUM SUMURBATU 085311640048
P 06-05-1997 UMUM SUMURBATU 085311640048
P 20-04-1979 UMUM SUMURBATU 085311640048
P 01-09-1977 UMUM SUMURBATU 085311640048
P 01-07-1964 UMUM SUMURBATU 085311640048
P 01-05-1980 UMUM SUMURBATU 085311640048
L 28-02-1986 UMUM SUMURBATU 085311640048
P 13-03-1951 LANSIA SUMURBATU 085311640048
P 03-05-1977 UMUM SUMURBATU 081311971726
L 01-07-1977 UMUM SUMURBATU 081311971726
P 01-07-1958 LANSIA SUMURBATU 081311971726
P 04-02-1966 UMUM SUMURBATU 081311971726
P 05-10-1981 UMUM SUMURBATU 085797177040
P 08-04-1979 UMUM SUMURBATU 081906335336
L 05-05-1957 LANSIA SUMURBATU 081906335336
L 04-03-1965 UMUM SUMURBATU 081906335336
P 03-06-1970 UMUM SUMURBATU 081906335336
L 20-11-1992 UMUM SUMURBATU 081280312625
P 08-11-1983 UMUM SUMURBATU 081280312625
P 03-11-1987 UMUM SUMURBATU 085888866490
L 09-07-1968 UMUM SUMURBATU 085888866490
L 01-07-1979 UMUM SUMURBATU 085888866490
P 06-06-1969 UMUM SUMURBATU 085888866490
L 20-12-1973 UMUM SUMURBATU 085888866490
P 05-07-1990 UMUM SUMURBATU 085719767715
P 11-06-1978 UMUM SUMURBATU 085719767715
P 10-10-2002 UMUM SUMURBATU 085889408921
L 1968 UMUM SUMURBATU 085889408921
L 02-04-1989 UMUM SUMURBATU 085889408921
P 01-07-1985 UMUM SUMURBATU 085889408921
L 01-06-1976 UMUM SUMURBATU 08558168036
P 04-03-2003 REMAJA SUMURBATU 08558168036
P 03-05-1997 UMUM SUMURBATU 085693637105
P 01-07-1974 UMUM SUMURBATU 085693637105
L 15-10-1980 UMUM SUMURBATU 085693637105
L 03-08-2004 REMAJA SUMURBATU 085693637105
P 0-06-1976 UMUM SUMURBATU 085693637105
P 26-07-1988 UMUM SUMURBATU 085280253861
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Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Tanggal Tanggal
BPJS BPJS Non Merek Vaksin*** Screening
Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
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 Dosis 2
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09-12-2021 202109177M EUA2057300143A1
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09-12-2021 202109177M EUA2057300143A1
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09-12-2021 202109177M EUA2057300143A1
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09-12-2021 202109177M EUA2057300143A1
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09-12-2021 202109177M EUA2057300143A1
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 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601045008820001 SARNAH P
2 3601045402840001 SANASIH P
3 3601041403810001 ROHMAN L
4 3601040107750003 TOHIR L
5 3601045603800001 RUMI P
6 3601044104990001 NINA MARLINA P
7 3601046210750001 ARMAH P
8 3601044204660002 SUKANAH P
9 3601041206780001 ARIS SUTARDI L
10 3601044701680001 EMAH P
11 3601044102680001 SURNI P
12 3601041008880001 ASEP L
13 3601045804770003 RUMYATI P
14 3601042807800002 JOKO SANTOSO L
15 3601041401860004 RAMUN L
16 3601045510870003 APIPAH P
17 3601045104890004 HETI NURHAYATI P
18 3601041207650001 EEM P
19 3601046911830001 NIA P
20 3601041005850001 DERI L
21 3601040107060002 KIMAN L
22 3601044210700001 IJAH P
23 3601044402980004 IIN P
24 3601040601800004 MISTAR L
25 3601042006810001 IWAN B HERI L
26 3601044107710002 SIPAH P
27 3601044807850003 ACIH P
28 3601045509740001 EMET L
29 3601040105630001 JUNED L
30 3601045011770004 ASWDI L
31 3601044307650003 MISNI L
32 3601045109680003 TARSIH P
33 3601045004920007 MURSAH P
34 3601044107910001 SATI P
35 3601045005870009 HENY P
36 3601044112540002 SACI P
37 3601044806820005 AMINAH P
38 3601046909990003 AAP TAPRIZIYAH P
39 3601041110030003 JUHERI L
40 3601044506900005 NENTI P
41 3601044303870002 ETI P
42 3601040201920008 UCI L
43 3601045710780001 SANEMI P
44 3601041506900002 HASAN MAHRUDIN L
45 3601046008990005 TUTI P
46 3601046008630001 EMTAN P
47 3601044604810001 SATUNAH P
48 3601045502710004 UPI P
49 3601042002820002 UCU L
50 3601044806810011 EHA P
51 3601046008930004 TITI P
52 3601044101800004 KESIH P
53 3601046802820005 SACI P
54 3601045906610001 NERI P
55 3601045210850001 MASKARAH P
56 3601046015500001 ATMA P
57 3601046111690001 IYUM P
58 3601040310790001 HASAN BASRI L
59 3601045510940002 ATI ULIANI P
60 3216091903720002 HASOLOAN PURBA L
61 3601040611770001 RUKMINI P
62 3601040801680002 SUTISNA P
63 3601040403800003 SARNA P
64 3601046816690001 JUMI P
65 3601045911780001 ROROH P
66 3601044607740001 SANASIH P
67 3601046007810002 ALIS P
68 3601042408840001 SAPRI L
69 3601040203780002 BADRI L
70 3601044205790002 SARIAH P
71 3601044107780148 PURINAH P
72 3601042110620001 DETI P
73 3601045007830001 CICIH P
74 3601041011600006 MINUNG P
75 3601045012700004 ISAH P
76 3601045406720001 KARTI P
77 3601044105770003 MIMI P
78 3601046311640001 EROH P
79 3601040304550001 SALIMAN L
80 3601041908820002 JAMSAH P
 81 3601043005950001 SANIM L
82 3601045805730002 ROHIMAH P
83 3601044304770001 AMAH P
84 3601045912830001 JUBAEDAH P
85 3601044507780002 MURSIH P
86 3601044303930004 GINA P
87 3601041703900003 AGUS SYAHYUDIN L
88 3601046706930001 HERTI HERMAWATI P
89 3601045510870005 JUMRIAH P
90 3601044205590001 SUKMARIAH P
91 3601045412680001 ARTI P
92 3601045306910001 MIMIN P
93 3210034403960022 TITA NURDIANTI P
94 3601040701740006 HERI L
95 3601042211580001 SANIM L
96 3601272105870001 DAYAT L
97 3601040505040002 IRFAN L
98 3601045206670001 SARNAYA L
99 3601040101030009 DEDEN PERMANA L
100 3601045601750001 SARIPAH P
101 3601040207040029 ANWAR L
102 3601040605780003 MADSOLEH L
103 3601041804880001 TOHIR L
104 3601045608050002 SANTI P
105 3601044207710003 TASEM P
106 3601046104900003 ROHILA P
107 3601046802850001 UNAR P
108 3601044103660002 SAMI P
109 3601044908830002 MASNAH P
110 3601046403910001 DARMI P
111 3601045302570001 RUKMI P
112 3601045306980002 SUSANTI P
113 3601045811800001 BAYI P
114 3601045311810001 ONAH P
115 3601044102960010 ROHAMAH P
116 3601047006880001 NURSIH P
117 3601041207720001 MANGSUR L
118 3601044705710001 SARAH P
119 3601045005800003 SURNI P
120 3601044107710061 SAINAH P
121 3601045301900001 OOM L
122 3601041307930001 SUHERSIH P
123 3601274107880090 MINAH P
124 3601045710880001 HERTI P
125 3320160411120001 AVERILIA BUNGA MEYLAP
126 3601046407970002 ATIN P
127 3601260702900005 ABUN L
128 3601045210640001 JATI P
129 3601041010900001 RAHMAT L
130 3601045708820001 SUKMI P
131 3601040610860001 ENDANG L
132 3601046504980003 ITI P
133 3601040709670001 SUKARTA L
134 3601046802850001 UNAR P
135 3601045503830001 RUKMANAH P
136 3601044405550001 SAMSIAH P
137 3601044309640001 SUANAH P
138 3601046807970001 MISNATI P
139 3601044403780001 ASIH P
140 3601045807930007 JUMYATI P
141 3601044406830001 AMSAH P
142 3601044109800001 MASITOH P
143 3601045807930007 JUMYATI P
144 3601044182890004 ROMSIH P
145 3601042006900009 SUANDI L
146 3601045702800001 ENENG P
147 3601042404730001 DEDI L
148 3601040105970006 HENDRI L
149 3601041007830001 SUMA L
150 3601041808420002 ALIMAH P
151 3601045709720001 MAE P
152 3601044611060005 SITI KARMILA P
153 3601040705720002 ABAD L
154 373020107920155 JUSMAN L
155 3601043004850004 ATA L
156 3601041205710001 AGUS MULYADI L
157 3601041910740002 MUKTI L
158 MUNAH P
159 3601045206610001 SAMAH P
160 3601270705860001 MARDANI L
161 3601042107820002 SABDA L
162 3601042303600023 H MUKTAR L
163 3601045010890003 ASMAH P
164 3320166511880001 WAHYU TRI HANDAYANIP
165 3601047112820001 UNES P
166 3601045112520001 KARTINI P
167 3601046607720001 ASMI P
168 3601044805000001 RODIAH P
169 3601044500190006 MERIANA CANDRA WAR P
170 3601041810990003 MINTA P
171 3601046005010001 DINI P
172 3601041109770002 OMAN L
173 3601041504920001 UMPID L
174 3601041206750001 SUKRAD L
175 3601044107610110 SAEBAH P
176 3601040708760002 ASRUDIN L
177 3602011805870003 ASEP OJAT SUJANA L
178 3601040811950001 DUDI L
179 3601042905680001 UDIN L
180 3601044102830004 ENI P
181 3601046601780001 SARIAH P
182 3601045707750001 ETI P
183 3601045012780002 TURSINAH P
184 3601044502720004 KAYAH P
185 3601042008980001 EMUL L
186 3601041204720005 SUHELI L
187 3601040301760001 PUDIN L
188 3601041301580001 ANING P
189 3601040706730007 MUSA L
190 3601041405970002 WADI L
191 3601042907000001 SANAN L
192 360104101020006 M NURFAUJI L
193 3601041104000007 NM NURHAFID L
194 3601044802630002 IDA P
195 3601041702730001 ANTAJAY L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS
ok Umur
tahun) PBI Non PBI

10/08/1982 TANJUNGAN 085891152166

14/02/1984 TANJUNGAN 081585746739
14/03/1986 TANJUNGAN 085770620746
01/07/1975 TANJUNGAN 085693476552
16/03/1980 TANJUNGAN 085954244827
14/10/1989 TANJUNGAN 085894703156
29/10/1975 TANJUNGAN 085728224992
02/04/1960 TANJUNGAN 083893885845
12/06/1978 TANJUNGAN 083819622443
03/06/1978 TANJUNGAN 085881649475
01/02/1958 TANJUNGAN 082312055943
10/08/1988 TANJUNGAN 081318034095
06/06/1991 TANJUNGAN 081318034095
28/07/1980 TANJUNGAN 081287786988
14/01/1986 TANJUNGAN 085893722785
15/10/1987 TANJUNGAN 085778620879
11/04/1989 TANJUNGAN 085893722785
12/07/1965 TANJUNGAN 085219529551
29/11/1987 TANJUNGAN 08534958742
10/05/1985 TANJUNGAN 08578239964
01/10/1975 TANJUNGAN 081292818466
02/10/1970 TANJUNGAN 081511330800
04/02/1998 TANJUNGAN 089616880995
06/01/1980 TANJUNGAN 085774595586
02/01/1962 TANJUNGAN 085820423599
01/07/1971 TANJUNGAN 081292818466
08/07/1985 TANJUNGAN 085213485006
15/09/1974 TANJUNGAN 085216453778
01/05/1963 TANJUNGAN 085780879513
10/11/1977 TANJUNGAN 081212376455
03/07/1965 TANJUNGAN 085719423921
11/09/1968 TANJUNGAN 085820423599
10/04/1982 TANJUNGAN 081322420732
26/03/1989 TANJUNGAN 085694609244
10/05/1987 TANJUNGAN 085891152166
01/12/1954 TANJUNGAN 082139630205
08/06/1962 TANJUNGAN 085214083557
29/09/1999 TANJUNGAN 085890738025
11/10/2003 TANJUNGAN 085770620746
05/08/1991 TANJUNGAN 085217107852
15/10/1984 TANJUNGAN 085778239964
02/01/1992 TANJUNGAN 085214083557
17/01/1978 TANJUNGAN 081237202914
15/06/1990 TANJUNGAN
20/06/1992 TANJUNGAN 085219083557
20/06/1963 TANJUNGAN 081295255564
06/04/1981 TANJUNGAN 085719425921
15/02/1971 TANJUNGAN 085778224992
20/02/1982 TANJUNGAN
11/09/1988 TANJUNGAN 085695569788
27/08/1990 TANJUNGAN 085773757748
01/01/1980 TANJUNGAN 081295255569
28/02/1982 TANJUNGAN 085218117858
10/02/1962 TANJUNGAN 08120549665
12/10/1985 TANJUNGAN 081310922265
06/01/1955 TANJUNGAN 085891152166
21/11/1969 TANJUNGAN
02/11/1990 TANJUNGAN 085591656530
21/08/1994 TANJUNGAN 081517786745
19/03/1972 TANJUNGAN
06/11/1977 TANJUNGAN 085810910306
22/06/1962 TANJUNGAN 085772833656
04/03/1960 TANJUNGAN 085813590566
10/05/1972 TANJUNGAN 082312056972
19/11/1978 TANJUNGAN 085693559149
06/07/1974 TANJUNGAN 08231206972
25/07/1978 TANJUNGAN
24/08/1984 TANJUNGAN 081514562748
02/03/1979 TANJUNGAN 0856163476648
02/05/1979 TANJUNGAN
01/07/1978 TANJUNGAN
21/10/1972 TANJUNGAN
10/07/1983 TANJUNGAN 085776136708
10/11/1968 TANJUNGAN 08571942592
10/12/1970 TANJUNGAN 085719425921
14/06/1972 TANJUNGAN 085810910297
01/05/1977 TANJUNGAN 082125755403
29/11/1964 TANJUNGAN
03/04/1955 TANJUNGAN
19/06/1978 TANJUNGAN 0895342205068
30/05/1995 TANJUNGAN 0895342205116
18/05/1973 TANJUNGAN 08569443637
03/04/1977 TANJUNGAN 08569473784
19/12/1983 TANJUNGAN 082312056972
05/07/1978 TANJUNGAN
03/06/1995 TANJUNGAN
17/03/1990 TANJUNGAN
27/06/1904 TANJUNGAN 08577824992
15/10/1967 TANJUNGAN 085892876319
02/05/1959 TANJUNGAN
19/05/1972 TANJUNGAN 085774694535
13/06/1991 TANJUNGAN 0858204239599
17/11/1996 TANJUNGAN 081574895661
07/01/1974 TANJUNGAN 081287766988
22/11/1982 TANJUNGAN 085772725191
06/08/1990 TANJUNGAN 08581738544
05/05/2004 TANJUNGAN 085691863514
12/06/1967 TANJUNGAN 0858173685544
03/08/2001 TANJUNGAN 085714302975
16/01/1975 TANJUNGAN
02/07/2004 TANJUNGAN 085694609172
06/05/1978 TANJUNGAN 085773750249
18/05/1988 TANJUNGAN 081296603091
18/08/2005 TANJUNGAN
02/07/1971 TANJUNGAN 083815336123
21/04/1990 TANJUNGAN 083874095628
28/02/1985 TANJUNGAN 085691873495
01/03/1966 TANJUNGAN 085719131345
09/08/1983 TANJUNGAN 081295002056
24/03/1991 TANJUNGAN 085774595554
13/02/1957 TANJUNGAN 085774695088
13/06/1998 TANJUNGAN 085694586498
18/11/1982 TANJUNGAN
13/11/1981 TANJUNGAN 085719291041
01/02/1996 TANJUNGAN 085710721554
30/06/1968 TANJUNGAN 081310982265
12/07/1972 TANJUNGAN 085283233989
07/05/1971 TANJUNGAN 083890248253
10/05/1980 TANJUNGAN 085773750249
01/07/1971 TANJUNGAN 085811282973
10/05/1980 TANJUNGAN 085283233989
10/05/1993 TANJUNGAN 085714061285
01/07/1988 TANJUNGAN 08977416750
17/10/1988 TANJUNGAN 085817368544
23/04/2000 TANJUNGAN 081586127459
24/07/1997 TANJUNGAN 085349518742
07/02/1990 TANJUNGAN 08577274374
12/10/1964 TANJUNGAN 085773750249
10/10/1980 TANJUNGAN
17/08/1982 TANJUNGAN 085893129273
14/05/1989 TANJUNGAN 081528650463
25/04/1998 TANJUNGAN 085694609244
07/09.1967 TANJUNGAN
26/02/1985 TANJUNGAN
15/03/1983 TANJUNGAN 085694609244
04/05/1955 TANJUNGAN 085694473696
03/09/1964 TANJUNGAN 085714215421
22/07/1996 TANJUNGAN 085694609244
0403//1978 TANJUNGAN
18/07/1993 TANJUNGAN
04/06/1983 TANJUNGAN 085776845981
01/09/1980 TANJUNGAN 085777257144
18/07/1993 TANJUNGAN 085210711064
01/02/1969 TANJUNGAN 088809797527
20/06/1990 TANJUNGAN 085788900145
17/02/1978 TANJUNGAN 085714302979
23/11/1973 TANJUNGAN
01/05/1997 TANJUNGAN 085281470267
10/07/1983 TANJUNGAN 083815336123
18/08/1942 TANJUNGAN 085814510777
17/09/1972 TANJUNGAN 0851514562793
05/11/1979 TANJUNGAN 0856975964483
07/05/1972 TANJUNGAN 085216453778
01/07/1995 TANJUNGAN 085796624256
30/04/1985 TANJUNGAN
17/08/1971 TANJUNGAN 085693559147
05/07/1978 TANJUNGAN 085694509186
08/06/1950 TANJUNGAN 085282669442
12/06/1961 TANJUNGAN 085217107852
01/02/1986 TANJUNGAN 085780375302
21/07/1962 TANJUNGAN 085693476774
23/03/1956 TANJUNGAN 081511953006
10/10/1989 TANJUNGAN 081398113320
25/11/1988 TANJUNGAN 081296009052
31/12/1982 TANJUNGAN 085719612367
11/12/1962 TANJUNGAN 085719291041
26/07/1972 TANJUNGAN 081310922265
08/05/2000 TANJUNGAN 08139811339
10/01/1990 TANJUNGAN 081291297188
18/10/1999 TANJUNGAN 085811282973
20/05/2001 TANJUNGAN 08589587781
11/09/1977 TANJUNGAN 082310670393
15/04/1992 TANJUNGAN 081398113320
12/06/1977 TANJUNGAN 08880979752
14/02/1960 TANJUNGAN 081296607354
07/08/1976 TANJUNGAN 085770620782
19/05/1987 TANJUNGAN 085692572771
08/11/1995 TANJUNGAN 08771406382
20/04/1972 TANJUNGAN 085885456376
01/02/1983 TANJUNGAN 088809797527
26/01/1978 TANJUNGAN 085718983455
17/07/1981 TANJUNGAN 085211787511
10/12/1977 TANJUNGAN 0856932489
05/02/1972 TANJUNGAN 085803108814
29/06/2000 TANJUNGAN 081398113390
12/04/1972 TANJUNGAN 0857194257667
31/01/1976 TANJUNGAN 085210710625
13/01/1958 TANJUNGAN 085210710625
01/10/1973 TANJUNGAN 081574639277
14/05/1997 TANJUNGAN 085895877881
03/04/2001 TANJUNGAN 085893129372
10/11/2002 TANJUNGAN 085591293380
11/04/2000 TANJUNGAN
08/02/19863 TANJUNGAN
17/02/1973 TANJUNGAN 085211787511
rtaan BPJS (tulis
ada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal
Merek
Non Screeni Tanggal Pemberia
Vaksin*** Pemberian No. Batch No seri
Anggota ng n
Vaksinasi
Vaksinasi

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CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
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CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
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CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
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CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
CORONAVAC 09/12/21 02/11/2021 202108145 09/12/2021
09/12/2021 202109177M
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Dosis 2

KET
No. Batch No Seri

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 Umur
Nama Penerima
NO No. Ticket NIK JK Pekerjaan* (18-59
Vaksin
tahun)

1 3601045103780008 INAH P 11-03-1978

2 3601046903990002 SUCI ADELA P 29-03-1999
3 3691044508680001 TARSIH P 05-08-1968
4 3601040107590036 SENA P 04-02-1965
5 3601045507610001 SAENI P 19-10-1971
6 3601044107630202 YATI P 01-07-1962
7 3601044107830227 KARMI P 01-07-1983
8 3601044107620051 WARYEM P 01-07-1962
9 3601040107800059 SUNARJA L 25-03-1981
10 3601044107720069 RATINAH P 01-07-1972
11 3601042909790002 TOHIR L 29-09-1979
12 3601044107830193 RUYAT L 01-07-1983
13 3601044107750268 IDAH P 11-04-1973
14 3601045109980004 MARIAH P 11-09-1988
15 360104206600002 MISNAH P 02-06-1960
16 3601046812500001 WARJEM P 28-12-1950
17 3601046707680002 SARWI P 06-10-1970
18 3172021703470002 RITCHY SAYUDIN L 17-03-1947
19 3601041307600001 JASMA L 13-07-1960
20 36010459990007 IROH ROSITA P 19-09-1999
21 3601045507850025 SITI P 15-07-1985
22 3601044107630170 TARSIEM P 01-07-1963
23 3601044402750007 DARIAH P 04-02-1975
24 3601044709910004 TITIN P 07-09-1951
25 360104017630326 DASMA L 01-07-1963
26 3601040203630001 CASMA L 02-03-1963
27 3601040107810143 ALI L 04-05-1983
28 3601047107090002 SOFI P 31-07-2009
29 3601044307740000 DARNI P 03-07-1974
30 360104410783063 TARINI P 11-09-1979
31 3601043103760001 CARSIDI L 31-03-1972
32 3601041707720001 SUTRISNO L 04-05-1977
33 3601046006950002 SINTA OMI P 20-06-1995
34 3601045602730001 MASTEM P 16-02-1973
35 3601042601630001 WARNO L 26-01-1963
36 3601044107680271 IJAH L 01-07-1968
37 3601040811610001 MISTA L 08-11-1961
38 3601044107850261 NURITA P 04-07-1988
39 3601044207850013 ARMASIH P 02-07-1985
40 3601044107680156 TARMI P 12-07-1970
41 3601044404980001 RASNI P 04-04-1998
42 3601045401850003 ARSIH P 14-01-1985
43 3601044107830448 RATINI P 01-07-1983
44 3601044306760001 WARSITI P 22-08-1983
45 3601042208830001 TARMIDI L 22-08-1976
46 3601081203980001 IWAN HERMAWAN L 06-08-1997
47 36010441078510357 SARAH P 10-10-1985
48 3601046007700002 IYAH P 20-07-1970
49 3601042807930001 SOLEMAN L 28-07-1994
50 360104407870061 EMOT L 01-07-1987
51 3601040203900003 KOSASIH L 21-04-1989
52 3601044107780161 MINAH P
53 3601040107530126 TARJA L 12-02-1962
54 3601044207710002 UUNG P 02-07-1971
55 3601041804830002 KIRMAN L 18-04-1983
56 3601042612450001 CARWIN L 26-12-1945
57 3601040107900291 KARLIM P 01-07-1987
58 3213151501810005 DANTO L 15-01-1981
59 3601040806890001 SEGERA L 08-06-1989
60 3601044304860008 WATI P 03-04-1986
61 3601045005750002 SARITEM P 10-05-1975
62 3601045701740001 MUNAH P 17-01-1974
63 3601044204540001 ASINAH P 06-10-1963
64 3601045909700004 SATINAH P 19-09-1970
65 3601044709640001 CUCUM P 07-09-1964
66 3601044107570052 TARCEM P 01-07-1957
67 3601044508810001 RIKA RENIKA P 27-11-1984
68 360104572030001 ELIN HERLINA P 17-12-2003
69 3601045602800001 TARINGKEM P 16-02-1980
70 3601046107950001 ITEM P 21-07-1995
71 3601044107710081 YATI P 01-07-1971
72 360104061170001 MUHAMAD L 06-11-1970
73 3601040107650201 WARDI L
74 3601044107690065 DARSIYEM P 01-07-1969
75 3601044107680272 KASEM P 01-07-1968
76 3601044102980009 ROSITA P 01-02-1998
77 3601046307890002 ROHETI P 16-03-1990
78 3601044207670003 TASWI P 02-07-1967
79 3601046103830004 ROMLAH P 21-03-1983
80 3601080107830039 SANA L 08-05-1973
81 3601044606010002 ROBIAH P 06-06-2001
82 3601044507740003 DARNIAH P 05-07-1974
83 3601040310750004 SAKUR L 03-10-1975
84 3601044408800005 RITA PURNAMASARI P 04-08-1980
 85 3602216204010002 SARID L 27-04-2001
86 3601042601940002 EPUL ANWAR L 26-08-1994
87 3601044107830149 DARNIAH P 01-07-1983
88 3601046810920001 DARMINIH P 28-10-1992
89 360104025810003 MULYADI L 02-05-1981
90 3601044108800007 NARITEM P 01-08-1980
91 3601044206780004 ASNI P 02-06-1978
92 360104410650196 TARSINIH P 15-06-1962
93 3601041507850009 WASTIM P 13-08-1979
94 3601034204740005 WARTIN P 02-04-1974
95 360104070150001 TASKIM L 10-09-1952
96 360104500400003 ELAWATI P 10-04-2000
97 3601040107020235 SINDRI P 01-07-2002
98 3601044107680316 HONI L 01-07-1968
99 3601044107560039 RUMINAH P 01-07-1956
100 3601074203750001 YATI P 05-03-1980
101 3601044504920001 SUKENAH P 05-04-1992
102 3601041807830003 SUHENDI L 18-07-1983
103 3601084906920001 RISDA P 09-08-1994
104 3601040101850004 IWAN L 12-01-1985
105 3276075109820001 ISAH P 11-09-1982
106 3601034704820002 ELISAH P 21-07-2000
107 3601041408920001 KARJAYA L 14-08-1992
108 3671011312020004 RENDI L 13-11-2002
109 3601040107630315 HAMDAN L 01-07-1963
110 3601044307650002 DASMINAH P 03-07-1965
111 3601046503680002 KUSYUNINGSIH P 25-03-1968
112 3601044705590002 SAADAH P 07-05-1959
113 3601040411930002 ADE L 04-11-1993
114 3601042203840001 MULYANA L 22-03-1984
115 3601044107730202 MANIS L 01-07-1979
116 3601041411030002 M. ATMA L 14-11-2003
117 3601042402060001 M. AL-FARIZ L 24-02-2006
118 3601040107650090 KARSAM L 01-07-19654
119 3601043001040001 RIO SAPUTRA L 30-01-2004
120 3601040302930005 BANI L 03-03-1993
121 3601041005830001 CUNAYA P 10-05-1983
122 3601045008770003 WASIAH P 10-08-1977
123 3601040107850115 CARTONO L 07-08-1982
124 3601044606770002 SARAH P 06-06-1977
125 3601040107680301 ROSAD L 01-07-1968
126 3601046107840003 TARMI P 21-07-1984
127 3601044107580101 RATISAH P 01-07-1958
128 3601044111940002 KURNENGSIH P 01-11-1994
129 3601044504520001 WIRI P 05-04-1952
130 3601040107900186 ROSADI L 15-06-1987
131 3601040807020001 WAHYU HIDAYAT L 08-07-2002
132 360104110930002 ADE INDRA L 11-10-1993
133 3601041403940003 HERI SETIAWAN L 14-03-1994
134 3601040601900005 SAMSUL ARIFIN L 06-01-1990
135 3601044107830192 ERNAWATI P 27-08-1983
136 3601040705840005 RAPI P 07-05-1984
137 3601040307700002 TOMI L 03-07-1970
138 3601045708740001 ETIB P 17-08-1974
139 3601044608020001 SURINI P 16-08-2001
140 3601041001720003 CAHYANTO L 10-01-1972
141 3601044107480048 WASTEM P 01-07-1948
142 3601040604910002 SITI NURHASANAH P 06-04-1991
143 3601044107620058 DASMEN P 01-07-1962
144 3601044606970009 SITI NUBAETI P 06-06-1997
145 3601042705950001 MUSLIM L 03-08-1991
146 3601044505020002 MILA P 05-05-2002
147 3601046906010001 NURPITRIANI P 15-02-2000
148 3601045101770001 KAMINIH P 11-01-1977
149 3601044302690001 KAMSANAH P 30-06-1970
150 3601040107810096 JUHAYA L
151 3601045407830002 DARNI P 14-07-1963
152 3601045503790006 ARSIH P 15-03-1979
153 3327080605800044 YATIN L 06-05-1980
154 3601045202880002 RINIH P 28-11-1983
155 3601045503770002 RUHE P 15-03-1977
156 360104500297008 RENI P 10-02-1997
157 3601040107560100 SARMIN L 01-07-1973
158 3601040101830001 RUSLI L 16-12-1980
159 3601045707940001 TASMI P 01-10-1995
160 3601040107860170 KARYO L 16-09-1981
161 3601041503910001 KUSNA L 15-03-1991
162 3601041306780002 BOHIM L 13-08-1978
163 3601044704690002 TANI L 07-04-1969
164 3601044105820001 AMSIH P 14-03-1981
165 3601041103960005 SARMADI L 11-03-1997
166 3601045907540001 KERMI L 19-07-1974
167 3601040107820134 ARSAMAN L 10-04-2000
168 3601044107860239 ROSAH P 01-07-2002
169 3601041701960001 GIANDWI P 01-07-1968
170 3601044107700101 JENAH P 01-07-1956
171 3601045007840004 ESIH P 05-03-1980
172 360104150770006 WAHIDIN L 05-04-1992
173 3601045808970002 TITIN P 18-07-1983
174 360104404850009 RASMI P 09-08-1994
175 3601040107780351 CAMING L 12-01-1985
176 3601047003910001 NANI DARSINIH P 11-09-1982
177 360224712720001 SAMSIAH P 21-07-2000
178 3601040706960004 KARMANI P 14-08-1992
179 3601044107900127 TASRINI P 13-11-2002
180 3601044702720001 UMYATI P 01-07-1963
181 360104190660002 MARHANI L 03-07-1965
182 3601044107900241 ELAH HAYATI P 25-03-1968
183 3601044403810000 SURTINI P 07-05-1959
184 360104405770001 SUNENTI P 04-11-1993
185 3601046607030001 K0MARIAH P 22-03-1984
186 3601040601780002 KARDIAH L 01-07-1979
187 3601085302950001 EMAH P 14-11-2003
188 3601040502830002 ANDI L 24-02-2006
189 3601044103720002 ENTIN P 01-07-19654
190 3601045209820002 NANI P 30-01-2004
191 3601045506880002 DARSINI P 03-03-1993
192 3601045204960006 KARSIH P 10-05-1983
193 3601040402650003 RASMADI L 10-08-1977
194 3601034307700005 IPAH P 07-08-1982
195 3601044108880002 NURHAETI P 06-06-1977
196 360104442740001 HJ. ATIKAH P 01-07-1968
197 1805120206630001 ANTARI P 21-07-1984
198 3601045203930001 RUNASIH P 01-07-1958
199 3601044607910004 CARINIH P 01-11-1994
200 3601044601880001 RASMI P 05-04-1952
201 1602115507940004 NUR LAILA P 15-06-1987
202 3601044107790083 ARWATI P 08-07-2002
203 3601044107790083 JUNIANI L 11-10-1993
204 3601040107750269 ARMAN L 14-03-1994
205 3601045709870003 LESTARI P 06-01-1990
206 3601041001810007 ASTARI L 27-08-1983
207 360104010490003 DEDE L 07-05-1984
208 3601044107780214 NOSAH P 03-07-1970
209 3601040101800001 SARKI L 17-08-1974
210 3601310309770001 SUNA L 16-08-2001
211 3671074407840008 SUNARTI P 10-01-1972
212 3601040107830130 SAMANI L 01-07-1948
213 3601044504540001 ASMERI P 06-04-1991
214 3601041511750002 WARYO L 01-07-1962
215 36010407860218 MARJANI L 06-06-1997
216 3601044910660001 LAMRAH P 03-08-1991
217 3601041107640001 APUD L 05-05-2002
218 3601040709800004 AJA L 15-02-2000
219 3601040510940002 JUBAEDI L 11-01-1977
220 3601044812540001 CASMINAH P 30-06-1970
221 3601045209740001 NENENG S P 10-04-2000
222 3174046102750002 SUHAETI P 01-07-2002
223 3174075003520002 ENONG P 01-07-1968
224 3601044404950008 SANIRAH P 01-07-1956
225 3601044101760001 NESIH P 05-03-1980
226 3601045205700002 SAMAH P 05-04-1992
227 3601044705670001 WARSEM P 18-07-1983
228 3601045706810001 DARWINAH P 09-08-1994
229 3601356803940002 TATI P 12-01-1985
230 3601040702620001 DEDIH L 11-09-1982
231 3601046104800004 SAMINAH P 21-07-2000
232 3601035102900003 NURTI P 14-08-1992
233 3601030408850001 RIKI L 13-11-2002
234 3601041501930003 ULUNG L 01-07-1963
235 3601044107950141 SARWITI P 03-07-1965
236 3601044207670002 MASKINI P 25-03-1968
237 3601041005620001 HIMAN L 07-05-1959
238 3601040107640035 KASIM L 04-11-1993
239 3601041608690001 SATIB L 22-03-1984
240 3601040107710145 SADIRA P 01-07-1979
241 3601045312900001 CARSEM P 14-11-2003
242 3601046011880001 ENI P 24-02-2006
243 36021404068220009 RUSDIANA L 01-07-19654
244 3601044207540003 RAMISAH P 30-01-2004
245 3601044109580001 MISKEM P 03-03-1993
246 3601044704740001 SUKINIH P 10-05-1983
247 3601045110800004 MASNI P 10-08-1977
248 3601045506910006 SITI NURSALAMAH P 07-08-1982
249 3601040107690097 WARIH L 06-06-1977
250 3601040107920212 KUSNADI L 01-07-1968
251 3601044107730326 SUKEMI P 21-07-1984
252 3276074409080003 AI RAHMASARI P 01-07-1958
253 36010425690001 PANIJO L 01-11-1994
254 3601045510800003 AYATI P 05-04-1952
255 3601041405960003 YAYANG P 15-06-1987
256 3601040107680195 KASTAMA L 08-07-2002
257 3601041111740001 KODIM L 11-10-1993
258 2171102308920003 WASMIN L 14-03-1994
259 3601040703870002 SUYATNO L 07-03-1985
260 3601041908700003 UHEN L 19-08-1963
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Kelomp
INSTANSI Alamat NO HP BPJS BPJS Non
ok Umur
PBI Non PBI Anggota

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CIKDONG 085691767884
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TANGGERANG 083814555972
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CIKEUSIK 08551474996
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ÇIKEUSIK 085774802335
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NANGGALA 085774607036
NANGGALA 081646042889
NANGGALA 085719069448
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CIKEUSIK 081213949161
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PEMATANG SEMPUR 085282258890
NANGGALA 085774607036
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CIKEUSIK 085899932656
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HARENDONG 08317238457
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CIKEUSIK 085381178443
LEUWIBALANG 085718271323
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NANGGALA 085719067449
UMBULAN 082113158997
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LEUWIBALANG 08551474996
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LEUWIBALANG 081646042889
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GUNUNG BATU 085848619396
SUKAMULYA 0852152990030
CIKEUSIK 085774965070
CIKEUSIK 085695571405
LEUWIBALANG 081213949161
CIKEUSIK 082389580225
CIKEUSIK 085282258890
CIBALIUNG 085774607036
CIKEUSIK 085782134519
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SUKASENENG 085210773533
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CIKEUSIK 082113212598
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CIKEUSIK 087871120431
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CIKEUSIK 085899932656
CIKEUSIK 08317238457
CIKEUSIK 085778513916
SUMURBATU 083172384575
SUKASENENG 0885778513916
CIKEUSIK 08521858184
CIKEUSIK 085782264303
NANGGALA 085710506276
CITEREP 085890126204
SUKASENENG 085381178443
CIKEUSIK 085718271323
CIKEUSIK 085771613751
CIKEUSIK 082324153220
SUKASENENG 085719067449
CIKEUSIK 082113158997
SUKASENENG 085810910019
SUKASENENG 085694570421
RANCASENENG 08551474996
RANCASENENG 085778212835
CIKEUSIK 085774802335
NANGGALA 082148371314
NANGGALA 082148371314
NANGGALA 085813587543
SUKASENENG 085774607036
CIKEUSIK 081646042889
CIKEUSIK 085719069448
CIKEUSIK 085848619396
PEMATANG SEMPUR 0852152990030
CIKEUSIK 085774965070
UMBULAN 085695571405
CIKEUSIK 081213949161
SUKASENENG 082389580225
RANGKAS BITUNG 085282258890
CIKEUSIK 085774607036
SUKASENENG 085782134519
SUKASENENG 08129802336
SUKASENENG 085782134519
CIKEUSIK 085781611423
CANGKORE 085216626905
PEMATANG SEMPUR 085210773533
PEMATANG SEMPUR 085210773533
TANJUNG SARI 085861665895
SUKASENENG 082113212598
SUMURBATU 085693476866
SUKASENENG 087871120431
CIKEUSIK 081511412524
CIKEUSIK 085714215218
CIKEUSIK 085717347158
BATUJAYA 085692654028
BATUJAYA 085781667565
 Dosis I Dosis 2

Tanggal Tanggal Tanggal

Merek
Screeni Pemberi No.
Pemberi
Vaksin*** an No seri an No. Batch No Seri
ng Batch
Vaksina Vaksina
si si
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KET
NO No. Ticke NIK Nama Penerima Vaksin JK

1 3601044402670002 DARTI P
2 3601045905560001 JUHRO P
3 3601040107700077 SUKARTA L
4 3602281102920001 MUHAMAD MANSUR L
5 3601044107750057 WARINIH P
6 3601045510840002 ATIAH P
7 3601044107750082 RAMINIH P
8 3601044107740022 SATINIH P
9 3601045407700002 HJ BAYI P
10 3601041711600001 WASTA L
11 3601044410780002 KUNIAH P
12 3601044402600002 WARTIJAH P
13 3601041507600005 H UJANG P
14 3601040107520013 MASTA L
15 3601044205590003 DANI P
16 3601040707860003 DARTI P
17 3601046204720001 SARINGKEM P
18 3601046812940001 PATIRI P
19 3601046805580001 SINIH P
20 3601046803840001 SURIAH P
21 3601045608850004 SRI WATI P
22 3601046707740003 KASEM P
23 3601044107580064 CASWI P
24 3601044811650002 KARNI P
25 3601044802780003 TASIH P
26 3601045002630001 SARTUMI P
27 3601044107230013 TATI P
28 3601045303700002 KARI'AH P
29 3601040107540006 DARWAN L
30 3601040707920007 ATO L
31 3601040107970212 TOHARI L
32 3601040107520027 CARTAM L
33 3601045708670002 DARISEM P
34 3601040107560038 ASWATIM L
35 3601046607690001 WARNI P
36 3601044107750067 ROENIH P
37 3601046301930002 JUARSITA P
38 3601045201780003 TATI P
39 3601044107680081 DARIH P
40 3601040203740002 ALI L
41 3601044107730109 WASEM P
42 3601044107770034 RASMI P
43 3601044107550037 TALEM P
44 3601044107600021 SENI P
45 3601044107700026 SURINIH P
46 3601044107980088 MUTIYAH P
47 3601040107730122 SITO L
48 3601044101970009 EKA SARI P
49 3601044103720004 ITI P
50 3601045706020009 ROSITA P
51 3601044808010005 SUHERAH P
52 3601044107700047 SUMINIH P
53 3601044107530041 CASIH P
54 3601045608990003 ETI CASMIARTI P
55 3601044107560036 TARISEM P
56 3601044107700053 RUSTINAH P
57 3601045107830001 ROISAH P
58 3601044107430023 ISAH P
59 3601040706040005 M.ZAKI L
60 3601042209690002 SOPYAN HADI L
61 3601044208040004 SURTI MAHARANI P
62 3601040107700210 WASNANTO L
63 3601044809700002 KARNATI P
64 3601044411970004 JUJU JUMAROH P
65 3601040701960009 SADAM HUSEN L
66 3601040107850291 DIMAS L
67 3601044707750005 JUHANAH P
68 3603084505860006 UMRONI P
69 3601044107880060 UMINIH P
70 3601045112730002 YATI P
71 3601044107830141 KUNIAH P
72 3601040107950084 OLIK L
73 3601045009920009 AMINIH P
74 3601044107760103 LIAH P
75 3601045009600001 UMINAH P
76 3601044107820053 DARMI P
77 3601044107800303 RATINIH P
78 3601046708940003 WASTURI P
79 3601045711960006 NASIH PUJIANTI P
80 3601044505940002 ANIKAH P
81 3601043004020001 PENDI SETIAWAN L
82 3601041207700005 JAYA L
83 3601045608010003 TUNIROH P
84 3601044301760001 SUTINIH P
85 3601044107000063 KUMAERAH P
86 3601044107800071 TURINIH P
87 3601044109790001 SITI JULAEHA P
88 3601040107740041 SUMANAH L
89 3601042307780002 HASAN L
90 3601041110820003 ADIK L
91 3601040110820011 RASJANA L
 92 3601041904060001 SABANUDIN L
93 3601045111740002 NENGSIH P
94 3601040107600036 WARLAN L
95 3601044107720030 CARTI P
96 3601044107680290 ANIH P
97 3601044107750058 KAPSIAH P
98 3601046802750000 MAENAH P
99 3601040107720023 SARTAMA L
100 3601041903710001 RASDI L
101 3601045310930004 IIS P
102 3601045601830002 MISKEM P
103 3601041703720003 SUBRI L
104 3601044105560002 CASIYEM P
105 3601046108840001 NARISA P
106 3601045007700007 MUNAH P
107 3601040107560040 TARTIB L
108 3601040810840004 PURI HERMAWAN L
109 3601045802760001 SAWATI P
110 3601046805740002 WARKEM P
111 3601044104880005 SULASTRI P
112 3601046709040001 IPIT PITRIANA P
113 3601046606800004 SESTI P
114 3601042910090001 ALAN L
115 3601044203610003 RUMINAH P
116 3601044107710055 WASIH BT ASRA P
117 3601044107760084 SUMIRAH P
118 3601044709940003 WARNITI P
119 3601044107480015 TASINAH P
120 3601046004800004 KARNITI P
121 3601046403750003 NARYATI P
122 3601040304700004 TARINGKEM P
123 3601044108750007 CARTINAH P
124 3601041606040003 LUTFI HIBATULLAH L
125 3601042006040002 AHMAD KUSAERI L
126 3601044807750001 SUMYATI P
127 3601045212980001 WARIAH P
128 3601044501770002 SUTINIH P
129 3601044107800111 RAMINIH P
130 3601040107580071 SARNI SARKINAH P
131 3601044408730002 RUSNITI P
132 3601041311940001 SUPARTA L
133 3601040405700002 KARSUDIN L
134 3601040107820032 TARNO B TAMIR L
135 3601040208530001 KADI L
136 3601044105870004 MARYATI P
137 3601040406860004 RUSDI L
138 3601044603820001 BAYINAH P
139 3601045608080007 NIYAH RAMADANI P
140 3601041908010001 SITI MARYAM P
141 3601045011830005 SUMINAH P
142 3601044904940001 UPI MAYANGSARI P
143 3601044107720103 SURTI P
144 3601044107020005 IDA NURHAPIA P
145 3601041008960001 SUPIYANI L
146 3601041709680001 WARDANA L
147 3601040701800002 KARTO L
148 3601040107660065 SARONI L
149 3601041810870005 NURKAT L
150 3601040107600043 WARYA L
151 3601045208730002 DASNI P
152 3601040305700001 RANDIM L
153 3601040508690003 SARINIH P
154 3601044107960092 DAENAH P
155 3601045507840005 DARSINIH P
156 3601044508920002 TARIH P
157 3601044107760109 NILAM P
158 3601045508920003 SRI WATINAH P
159 3601044107690024 KAMAH P
160 3601044107520020 TARYIMAH P
161 3601040902700001 SARTU L
162 3601041205630002 RASMAN L
163 3601040111760002 AMING L
164 3601040506010001 MAJASARI L
165 3601040107950086 TRISNA WARDANA L
166 3601046904720001 WARTEM P
167 3601042211920001 SUTRISNO WIBUNA ABADI L
168 3601040506000007 KARSANA L
169 3602265506000005 UUM UMAROH P
170 3601044107630076 SATINAH P
171 3601044107810056 RASEM P
172 3601042005010001 ROHMAN L
173 3601042703010002 HAERUL BAHRI L
174 3601044202750003 MARIAH P
175 3601045604850005 KATINI P
176 3601040107630092 TASWIR L
177 3601045111740002 NENGSIH P
178 3601045210970009 ELIAH P
179 3601045708950001 YUNITA P
180 3601041002030004 WIRA ADITIYA L
181 3601040107600036 WARLAN L
182 3601040107920082 SODIKIN L
183 3601044107200003 SITI ALIAH P
184 3601044107790033 REMI P
185 3601040107950082 WAHIDIN L
186 3601044107980086 SYAKIROH HAYANI P
187 3601040107010083 RADI L
188 3601040404660001 TOTON TAJUDIN L
189 3601040111810003 NURJAYA L
190 1603204305850001 SITI MAEMUNAH P
191 3601044107770035 MAUNAH P
192 3601044107760116 KARTEM P
193 3601040107750096 RASI L
194 3601040107740040 SUMANAH L
195 3601041211750005 KARMIN L
196 3601040107880098 TARIPIN L
197 3212190603830006 UMAR LUBIS L
198 3601044610010002 SITI ATIKAH P
199 3601045202770002 KADMINIH P
200 3601042405800001 VANI L
201 3601040107000256 SURYADIN L
202 3601044107770040 NANUNG P
203 3601044107860122 KARSEM P
204 3601041112870001 YAYAH P
205 3601044603690001 JARIAH P
206 3601040205730002 KARTIMAN L
207 3601045205680007 SARI'AH P
208 3601045208030004 ANISYA P
209 3601044107780446 OMAH P
210 3601041603980008 BAHYADI L
211 3601040107990075 FEBRIANA L
212 3601044701690001 TUMI P
213 3601044103700004 CARINI P
214 3601040107860080 SITI NURJAYA P
215 3601044107630087 CARSIAH P
216 3601042803810001 SUWANDI L
217 3601040107650055 TARMA L
218 3601040108730005 AROHMAN L
219 3601046508840003 DEDEH FAUZIAH P
220 3601044108010005 RIAN AGUSTIN L
221 3601040307700003 DAYIM L
222 3601047011800009 RASINIH P
223 36011042309010002 NURIMAN L
224 3601041507800008 SARYONO L
225 3601044307750002 SITI AISYAH P
226 3601040107520013 MASTA L
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

IRT 02-06-1963 UMUM RANCASENENG 085717152418

IRT 19-05-1956 UMUM RANCASENENG 082312010689
WIRASWASTA 16-11-1972 UMUM RANCASENENG 085319359626
WIRASWASTA 04-05-1992 UMUM RANCASENENG
IRT 01-07-1975 UMUM RANCASENENG
IRT 18-08-1985 UMUM RANCASENENG
IRT 01-07-1975 UMUM RANCASENENG 085319359626
IRT 01-07-1979 UMUM RANCASENENG 085219673010
IRT 25-03-1970 UMUM RANCASENENG 085783730200
PETANI 17-11-1960 UMUM RANCASENENG 0813810655650
IRT 08-02-1978 UMUM RANCASENENG 081584367725
IRT 03-03-1962 UMUM RANCASENENG 083892164886
IRT 15-07-1960 UMUM RANCASENENG 085783730200
WIRASWASTA 01-07-1952 UMUM RANCASENENG 085714550736
IRT 02-05-1959 UMUM RANCASENENG 085649936022
IRT 07-07-1986 UMUM RANCASENENG 085714379725
IRT 22-04-1972 UMUM RANCASENENG 0813819336670
IRT 28-12-1994 UMUM RANCASENENG 085892340704
IRT 28-05-1957 UMUM RANCASENENG 08571051985
IRT 28-03-1992 UMUM RANCASENENG 08319336670
IRT 16-08-1985 UMUM RANCASENENG 085811464572
IRT 27-07-1974 UMUM RANCASENENG 085773647851
IRT 01-07-1958 UMUM RANCASENENG 08174835156
IRT 01-11-1965 UMUM RANCASENENG 085773239679
IRT 08-02-1978 UMUM RANCASENENG 085710515961
IRT 10-02-1963 UMUM RANCASENENG 081380165650
IRT 01-07-1923 UMUM RANCASENENG 085779054291
IRT 13-03-1970 UMUM RANCASENENG
PETANI 01-07-1959 UMUM RANCASENENG 085280160957
WIRASWASTA 07-07-1992 UMUM RANCASENENG 085697954446
PELAJAR 18-06-2002 UMUM RANCASENENG 085810876433
PETANI 27-04-1958 UMUM RANCASENENG 085773239679
IRT 17-08-1967 UMUM RANCASENENG 082267357127
PETANI 01-07-1956 UMUM RANCASENENG 085695150031
IRT 26-07-1969 UMUM RANCASENENG 085773491015
IRT 18-01-1980 UMUM RANCASENENG 085810876823
IRT 23-01-1993 UMUM RANCASENENG 085891485051
IRT 12-01-1978 UMUM RANCASENENG 083812324104
IRT 06-12-1973 UMUM RANCASENENG 085811464572
PETANI 02-03-1974 UMUM RANCASENENG 08597824382
IRT 10-07-1972 UMUM RANCASENENG 08577807838
IRT 05-04-1974 UMUM RANCASENENG 081295074798
IRT 01-07-1955 UMUM RANCASENENG 085875894971
IRT 16-07-1970 UMUM RANCASENENG 085811439792
IRT 23-05-1972 UMUM RANCASENENG 085782263075
IRT 18-09-1999 UMUM RANCASENENG 085899932842
PETANI 01-07-1973 UMUM RANCASENENG 085810876823
IRT 01-01-1997 UMUM RANCASENENG 085211406383
IRT 01-03-1972 UMUM RANCASENENG 082267357127
IRT 17-06-2002 UMUM RANCASENENG 085213350380
IRT 08-08-2001 UMUM RANCASENENG 085810876433
IRT 08-12-1975 UMUM RANCASENENG 0815337339
IRT 01-07-1953 UMUM RANCASENENG 085718256155
IRT 16-08-1999 UMUM RANCASENENG 081311188404
IRT 01-07-1956 UMUM RANCASENENG 85887771699
IRT 7/1/1970 UMUM RANCASENENG 085694570536
IRT 11-07-1983 UMUM RANCASENENG 085814314318
IRT 01-07-1943 UMUM RANCASENENG 82311626989
PELAJAR 07-06-2004 BUMIL RANCASENENG 085717351086
WIRASWASTA 30-03-1977 UMUM RANCASENENG 085224853453
PELAJAR 02-08-2004 UMUM RANCASENENG 085695393577
PETANI 01-07-1970 UMUM RANCASENENG 083135106323
IRT 08-09-1970 UMUM RANCASENENG 085219655886
WIRASWASTA 04-11-1997 UMUM RANCASENENG 081282782810
WIRASWASTA 07-01-1996 UMUM RANCASENENG 081282782810
WIRASWASTA 7/1/1985 UMUM RANCASENENG 85771493967
IRT 7/7/1975 UMUM RANCASENENG 085694239405
IRT 05-05-1986 UMUM RANCASENENG 0857790613
IRT 01-07-1988 UMUM RANCASENENG 085891154317
WIRASWASTA 03-07-1986 UMUM RANCASENENG 087773373277
PETANI 01-07-1983 UMUM RANCASENENG 085894381188
PELAJAR 01-07-1995 REMAJA RANCASENENG 085691786554
IRT 10-09-1992 UMUM RANCASENENG 085782266230
IRT 01-07-1976 UMUM RANCASENENG 085782266301
IRT 10-09-1960 UMUM RANCASENENG 086593480805
PETANI 01-07-1982 UMUM RANCASENENG 085775262091
IRT 01-07-1980 REMAJA RANCASENENG 085775262091
IRT 27-08-1994 UMUM RANCASENENG 085273379912
IRT 17-11-1996 UMUM RANCASENENG 085894381188
IRT 05-05-1994 UMUM RANCASENENG 083872320861
PELAJAR 30-04-2002 REMAJA RANCASENENG 085781086839
WIRASWASTA 12-07-1970 UMUM RANCASENENG 085214030945
PELAJAR 16-08-2000 UMUM RANCASENENG 085770972251
IRT 03-01-1976 UMUM RANCASENENG 085215801856
IRT 24-12-1999 UMUM RANCASENENG 085773491002
IRT 01-07-1980 UMUM RANCASENENG 085772740871
IRT 05-05-1988 UMUM RANCASENENG 085888160264
PETANI 17-07-1971 UMUM RANCASENENG
PETANI 17-07-1978 UMUM RANCASENENG 085717152418
WIRASWASTA 22-07-1986 UMUM RANCASENENG 085710509801
WIRASWASTA 01-10-1982 UMUM RANCASENENG 085710515884
PELAJAR 19-04-2006 UMUM RANCASENENG
IRT 11-11-1974 UMUM RANCASENENG
PETANI 01-07-1960 UMUM RANCASENENG 085200160951
IRT 12/12/1984 UMUM RANCASENENG 085894828947
IRT 7/1/1968 UMUM RANCASENENG 085810876433
IRT 7/1/1975 UMUM RANCASENENG 081905552672
IRT 2/28/1975 UMUM RANCASENENG 085693477109
PETANI 7/10/1970 UMUM RANCASENENG 081905552672
WIRASWASTA 3/19/1971 UMUM RANCASENENG 088211822455
IRT 1/15/1993 UMUM RANCASENENG 085692729326
IRT 1/16/1983 UMUM RANCASENENG 08319336670
PETANI 3/17/1972 UMUM RANCASENENG 081413316524
IRT 5/1/1956 UMUM RANCASENENG 081248283337
IRT 11/19/1988 UMUM RANCASENENG 087774108438
IRT 7/10/1970 UMUM RANCASENENG 08159337339
IRT 10/20/1960 UMUM RANCASENENG 085778185471
IRT 10/8/1989 UMUM RANCASENENG 085771003593
IRT 2/18/1976 UMUM RANCASENENG 085899932842
IRT 5/28/1974 UMUM RANCASENENG 082310921057
IRT 4/1/1988 UMUM RANCASENENG 085211269647
BLM BEKERJA 9/27/2004 UMUM RANCASENENG 085770136270
IRT 6/26/1980 UMUM RANCASENENG 085771003592
BLM BEKERJA 10/29/2009 UMUM RANCASENENG 085776862550
PETANI 3/2/1961 UMUM RANCASENENG 081311188404
IRT 7/1/1971 UMUM RANCASENENG 083819827089
IRT 1/18/1970 UMUM RANCASENENG 085693980805
IRT 7/7/1994 UMUM RANCASENENG 085810876433
PETANI 7/1/1948 UMUM RANCASENENG 085281592961
IRT 4/20/1978 UMUM RANCASENENG 081574723327
IRT 3/24/1975 UMUM RANCASENENG 081213438018
PETANI 4/3/1970 UMUM RANCASENENG 085212249479
IRT 8/1/1975 UMUM RANCASENENG 083135106323
PELAJAR 9/16/2004 UMUM RANCASENENG 081514578616
PELAJAR 6/20/2004 UMUM RANCASENENG 085772306614
PETANI 7/8/1975 UMUM RANCASENENG 085945603032
WIRASWASTA 8/25/2000 UMUM RANCASENENG 085770954383
IRT 1/5/1977 UMUM RANCASENENG 085695393577
PETANI 7/1/1980 UMUM RANCASENENG 085695154799
IRT 10/19/1972 UMUM RANCASENENG 085310853031
IRT 7/5/1971 UMUM RANCASENENG 085694521915
WIRASWASTA 11/13/1994 UMUM RANCASENENG 085773892845
WIRASWASTA 5/4/1970 UMUM RANCASENENG 085695274145
WIRASWASTA 6/4/1982 UMUM RANCASENENG 085210947449
PETANI 8/2/1953 UMUM RANCASENENG 081295250868
IRT 5/1/1987 UMUM RANCASENENG 085890125917
WIRASWASTA 7/5/1984 UMUM RANCASENENG 085890125917
IRT 5/6/1982 UMUM RANCASENENG 085782269347
PELAJAR 8/16/2008 UMUM RANCASENENG 083135106323
PELAJAR 8/25/2001 UMUM RANCASENENG 085718256155
IRT 5/7/1983 UMUM RANCASENENG 085890125917
WIRASWASTA 4/9/1994 UMUM RANCASENENG 082117474807
IRT 9/25/1985 UMUM RANCASENENG 081513468420
PELAJAR 4/29/2002 UMUM SUMURBATU 081285461772
PELAJAR 8/10/1996 UMUM CIKEUSIK 085694946190
WIRASWASTA 9/17/1968 UMUM RANCASENENG 085282338982
PETANI 2/6/1982 UMUM RANCASENENG 085773491082
PETANI 11/14/1968 UMUM RANCASENENG 081296010260
BURUH LEPAS 10/18/1987 UMUM RANCASENENG 085782266230
WIRASWASTA 9/5/1970 UMUM RANCASENENG 085216097533
IRT 8/12/1973 UMUM RANCASENENG 085216097533
WIRASWASTA 6/3/1970 UMUM RANCASENENG 085771917499
IRT 8/1/1980 UMUM RANCASENENG 085771917499
WIRASWASTA 8/9/1996 UMUM RANCASENENG 082183767109
IRT 6/29/1983 UMUM RANCASENENG 085813586106
WIRASWASTA 8/5/1992 UMUM RANCASENENG 085212518147
IRT 6/5/1978 UMUM RANCASENENG 085695388398
IRT 8/15/1992 UMUM RANCASENENG 085718042399
IRT 6/12/1975 UMUM RANCASENENG 085710515913
IRT 7/1/1961 UMUM RANCASENENG 085710515913
PETANI 2/9/1970 UMUM RANCASENENG 085894691710
WIRASWASTA 5/12/1963 UMUM RANCASENENG 085283861810
PETANI 11/1/1976 UMUM RANCASENENG 085216954840
BLM BEKERJA 6/4/2001 UMUM CIKEUSIK 083104988750
BLM BEKERJA 5/17/1994 UMUM RANCASENENG 085750189019
IRT 4/29/1972 UMUM RANCASENENG 085891243517
WIRASWASTA 1/22/1992 UMUM RANCASENENG 081382591971
PELAJAR 6/5/2000 UMUM RANCASENENG 083891474447
PELAJAR 6/15/2000 UMUM RANCASENENG 085891312035
IRT 7/1/1963 UMUM RANCASENENG 085891312035
IRT 7/1/1973 UMUM RANCASENENG 085691786554
PELAJAR 5/20/1999 UMUM RANCASENENG 085813980100
PELAJAR 10-02-2001 REMAJA UMBULAN 085891470075
IRT 02-02-1975 UMUM RANCASENENG 085894691710
IRT 16-04-1985 UMUM RANCASENENG
WIRASWASTA 01-07-1963 UMUM RANCASENENG
IRT 11-11-1974 UMUM RANCASENENG 085694379794
IRT 12-10-1997 UMUM RANCASENENG 085819370296
IRT 21-09-1995 UMUM RANCASENENG 085714396773
PELAJAR 10-02-2003 REMAJA RANCASENENG 083806998827
WIRASWASTA 01-07-1960 UMUM RANCASENENG 085200160951
PETANI 17-01-1991 UMUM RANCASENENG 082312010915
IRT 27-07-1985 UMUM RANCASENENG 085894828942
IRT 01-07-1979 UMUM RANCASENENG 083138038712
WIRASWASTA 08-12-1995 UMUM RANCASENENG 081617677889
IRT 15-07-1999 UMUM RANCASENENG 085813892457
PELAJAR 29-04-2002 UMUM RANCASENENG 081545977488
WIRASWASTA 04-04-1966 UMUM RANCASENENG 085795365432
PETANI 01-11-1981 UMUM RANCASENENG 081254042529
IRT 03-05-1985 UMUM RANCASENENG
IRT 13-11-1972 UMUM RANCASENENG 082311699377
IRT 17-08-1979 UMUM RANCASENENG 085894432921
PETANI 01-07-1974 UMUM RANCASENENG 085894432921
PETANI 17-07-1971 UMUM RANCASENENG 083141125050
PETANI 12-11-1975 UMUM RANCASENENG 085695393577
PETANI 02-11-1980 UMUM RANCASENENG 08594828542
WIRASWASTA 08-08-1980 UMUM RANCASENENG 085692729423
IRT 06-10-2001 UMUM RANCASENENG 085882752142
IRT 12-02-1977 UMUM RANCASENENG 081248283337
WIRASWASTA 27-05-1980 UMUM RANCASENENG 081295095990
WIRASWASTA 20-06-2001 UMUM RANCASENENG 081381088561
IRT 01-07-1977 UMUM RANCASENENG 083890674927
IRT 01-07-1986 UMUM RANCASENENG 085773234587
IRT 20-01-1977 UMUM RANCASENENG 085778220414
IRT 06-03-1969 UMUM RANCASENENG 085813586130
PETANI 02-05-1973 UMUM RANCASENENG 085697824382
IRT 12-05-1968 UMUM RANCASENENG 085894826589
BELUM KERJA 12-08-2003 UMUM RANCASENENG
IRT 01-07-1978 UMUM RANCASENENG 085284385225
PELAJAR 16-03-1998 UMUM RANCASENENG 083873933912
BELUM KERJA 22-11-1998 UMUM RANCASENENG 085770971942
IRT 07-01-1979 UMUM RANCASENENG 085880845997
IRT 01-03-1970 UMUM RANCASENENG 085771493967
IRT 20-05-1994 UMUM RANCASENENG 08567317117
IRT 01-07-1963 UMUM RANCASENENG 085215786488
WIRASWASTA 28-03-1984 UMUM RANCASENENG 085855555847
WIRASWASTA 01-07-1965 UMUM RANCASENENG 08569449629
WIRASWASTA 01-08-1973 UMUM RANCASENENG 083192353359
IRT 25-08-1984 UMUM RANCASENENG 083125321536
PETANI 01-08-2001 UMUM RANCASENENG 085313357255
PETANI 03-07-1970 UMUM RANCASENENG
IRT 30-11-1980 UMUM RANCASENENG 081248283337
WIRASWASTA 23-09-2001 UMUM RANCASENENG 085817995437
WIRASWASTA 15-07-1980 UMUM RANCASENENG 085715503380
IRT 03-07-1975 UMUM RANCASENENG 082312010689
WIRASWASTA 01-07-1952 UMUM RANCASENENG 087772872253
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
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CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021 10-12-2021 202109180M
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC 10-12-2021
CORONAVAC
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021
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CORONAVAC 12/10/2021 12/10/2021 202109180M
CORONAVAC 12/10/2021 12/11/2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 10-12-2021 202109180M
CORONAVAC 12/10/2021
CORONAVAC 12/10/2021 10-12-2021 202109180M
CORONAVAC 12/10/2021 10-12-2021 202109180M
CoronaVac 12/10/2021 10-12-2021 202109180M
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021 10-12-2021 202109180M
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021 10-12-2021 202109180M
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021 10-12-2021 202109180M
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
CoronaVac 12/10/2021
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
10-12-2021 202109180M
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10-12-2021 202109180M

10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M

10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
10-12-2021 202109180M
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601040701810003 SUMADI L
2 3602046220060002 HERLINA MEIDA P
3 3601044104790008 MISNAH P
4 3601044306930001 SACCI P
5 3601041804020002 JEJEN L
6 3601041702000002 GERI IRAWAN L
7 3601044107580146 SARMAAH P
8 3601044107530159 RANI P
9 3601041642660001 HAERUDIN L
10 3601040807680001 ENDANG JUANDA L
11 3601044103831002 UNAH P
12 3601044809780004 MAESAROH P
13 36010461000002 TATI HARYATI P
14 3601044107730258 JUMASIH P
15 3601045008860003 GITA TANESA P
16 3601045101900012 SARNI P
17 3601044106840002 SAMAH P
18 3601040107760130 SUBARNA L
19 3601041712680002 EDI RUSWANDI L
20 360104010764004 SAHLI L
21 360104481890002 SUNAAH P
22 3601044406880005 MIMIN P
23 1602214808950002 NENIH P
24 3601042903940002 DENI FEBRIANI L
25 3601042008720001 ATANG L
26 3601044701000008 KASIAH P
27 3601080207770003 UJANG KURNIAWAN
28 3601044201950005 NARSIH P
29 3601044402580002 ICE TRISNAWATI P
30 3601041307880003 ACUNG L
31 3601040405850006 NUR P
32 3601042804890001 ISTAR L
33 3601044607780003 SUMIATI P
34 3602021010720004 SUARDI L
35 3602095603900002 ICAH P
36 3601044804810004 UYUN P
37 3601040610670004 DEDE ARDIANSYAH L
38 3601044701000007 ARTI P
39 3601045207850002 EET P
40 3601041504870005 MARJA L
41 3601044302020002 LINDA WIDIYANINGSIHP
42 3601044410690002 MIMIN P
43 3601044107790091 ITING P
44 3601044701000010 BEDAH P
45 3601045302590001 SAPRAH P
46 3601044403950002 FITRI HANDAYANI P
47 36010402192006 SUPARDI L
48 3601044107730246 UMROH MAGFIROH P
49 3601040107650112 JAI BIN INDRA L
50 3601045405790002 SARWI P
51 3601042503830002 DEDE L
52 3602215906900001 SUARTI L
53 360104010764005 ISHALUDIN L
54 3602216610670001 JAAH P
55 3601040107680208 SYAMSUDIN SPD L
56 3601044107780452 MELI ISMAYA P
57 3601080507960003 MUHAMAD NAWAWI L
58 3601044909080004 NADIA NOVITASARI P
59 3601045207090004 NABILA P
60 3601047008090001 AYU LESTARI P
61 3601045708080005 MEGA P
62 1508095208070002 IRMA SAPITRI P
63 3601045509960002 NURJAENI L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur
Kelomp
(18-59 INSTANSI Alamat NO HP BPJS BPJS Non
ok Umur
tahun) PBI Non PBI Anggota

07/01/1961 CIKADON 081271861147

29/03/2006 CIKADON 085771290490
01/04/1979 CIKADON 08571050862
03/06/1993 CIKADON 085772394368
18/04//2002 CIKADON 085775202701
15/11/2002 CIKADON 085772723169
01/07/1958 CIKADON 085717930624
01/07/1953 CIKADON 081584103827
16/02/1966 CIKADON 085882463941
08/07/1968 CIKADON 085893721193
01/03/1983 CIKADON 081283541681
03/09/1978 CIKADON 085817951846
21/10/2000 CIKADON 081584357077
01/07/1973 CIKADON 081514459362
10/08/1987 CIKADON 085773756299
11/01/1990 CIKADON 085782625457
01/06/1984 CIKADON 081283541681
17/10/1979 CIKADON 085216587092
17/12/1968 CIKADON 085776129470
06/07/1975 CIKADON 085860730699
08/10/1989 CIKADON 085776131126
04/06/1988 CIKADON 085718002752
08/08/1995 CIKADON 085714790040
22/02/1994 CIKADON 081511868410
01/07/1977 CIKADON 085777226195
01/04/1997 CIKADON 0857761129474
07/07/1967 CIKADON 085781667087
02/01/1995 CIKADON 083873769955
02/08/2001 CIKADON 085351052102
13/07/1988 CIKADON 085882158270
04/05/1985 CIKADON 085771290712
1/03/1989 CIKADON 085710343598
08/08/1983 CIKADON 085772740923
10/10/1972 CIKADON 085711090611
16/02/1990 CIKADON 085774263318
08/04/1981 CIKADON 085882463941
06/12/2007 CIKADON 081311836540
05/08/1998 CIKADON 085694413796
12/07/1985 CIKADON 085781667042
15/04/1987 CIKADON 085718002792
24/05/1999 IBU HAMIL CIKADON 085210938497
04/10/1969 081318024370
01/07/1979 081318024370
07/01/1980 085710508657
13/02/1959 081646061709
03/02/1995 085888437244
17/01/1992 085719437073
01/06/1974 085212931851
01/02/1979 085695337046
14/05/1979 081318024370
25/03/1987 085772394366
19/06/1990 085795541995
09/08/1965 085881657424
26/10/1967
27/05/1969 085732997917
12/02/2000 085774393916
05/07/1996 085774393916
09/09/2008 082184397832
12/07/2009 085778277597
30/08/2009 085811459782
17/08/2008 085772740933
12/08/2007 085772394293
15/09/1996 085772228279
 Dosis 1 Dosis 2

Tanggal Tanggal Tanggal

Merek
Screeni Pemberi No.
Pemberi
Vaksin*** an No seri an No. Batch No seri
ng Batch
Vaksina Vaksina
si si
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
CORONAVAC 10/12/21 10/12/21 202109177M
10/12/21
NO No. Ticket NIK Nama Penerima Vaksin JK

1 3601046105960001 YENI P
2 3601044107820062 IPAH P
3 3601044107720038 SARTIAH P
4 3601044102870003 SALSIAH P
5 3601040102800004 RUDI L
6 3601044107600043 ISNAH P
7 3601040102790002 SAHUDI L
8 3601045001810007 LULU P
9 3601041006800007 WARTIM L
10 3601043001000001 APANDI ARDIANSYAH L
11 3601045206750004 RAHATI P
12 3601042001680001 SURYADI L
13 3601044104800002 SUNTI P
14 3601044107700132 NARSIH P
15 3601046008830002 KARTI P
16 3601045003040001 EMAH P
17 3601040107620031 SUKARMA L
18 3601045105650001 GOYI P
19 3601044107020072 SITI NURALIAH P
20 3601040204780005 ANDI L
21 3601040101660002 MAAD L
22 3601044107750088 ISAH P
23 3601044202790001 ARNI P
24 3601040101710004 EDI SOLIHIN L
25 3601044107880068 DARSIH P
26 3601044105830001 SITI P
27 3601044107950098 ENI P
28 3601044107800123 SARHATI P
29 3601045403780005 ETI SULASTRI P
30 3601046002730001 HETI P
31 3601044806830001 UTING P
32 3601044107750087 WATI P
33 3601044704830003 AMAH P
34 3601035503740001 EMAH P
35 3601044904780003 ENI P
36 3601040701085397 TETI P
37 3601040107640064 WASTA L
38 3601044104040005 UUM UMIYATI P
39 3601044107920074 SANATI P
40 3601034107890032 KURIAH P
41 3601044107000113 JUNESIH P
42 3601042701010001 TARSANA L
43 3601040102830010 DIDING L
44 3601041207870004 ASNAWI L
45 3601041103800001 EMUK L
46 3601040507820005 ABDUL ROHMAN L
47 3604224305770001 SAPTI P
48 3601044107840063 ADE P
49 3601034508870003 HASANAH P
50 3601044107730409 SARMAN L
51 3601040107920111 KOJOT L
52 3601044210870002 ASNAH P
53 3601044107660042 UNI P
54 3601044201760001 TATI P
55 3601045504860001 TITI P
56 3601044101000010 ONIP ULFA P
57 3601044107830478 HETI P
58 3601045003090001 SURNAH P
59 3601044107760268 HENAH P
60 3601040605810001 ARHADI L
61 3601044602810001 SARIAH P
62 3601044201860001 ENJUN P
63 3601046302870003 DIAH P
64 3601044207820003 MISNAH P
65 3601040107820039 SAPTA L
66 3601044708780002 ARTI P
67 3601044201680001 ESIH P
68 3601044108640002 SARNAH P
69 3601044702680002 SANIMAH P
70 3601040206830004 ASEP HIDAYAT P
71 3601040107890079 PUDIN ALFARIZI L
72 3601040107000137 DIANA YUSUP L
73 3602216008930003 ERNA JULIYANTI P
74 3601040406770002 SURHANI P
75 3601045103800007 HATIPAH P
76 3601044401820003 MINAH P
77 3601044107860087 RUNTASIH P
78 3601044107850121 UNAYAH P
79 3601044801940001 MAESAROH P
80 3601044105880005 ASNI P
81 3601044802500001 ACIH P
82 3601044107830443 NURIAH P
83 3601045108920003 NIA P
84 3601044103800001 NITI P
85 3601042003660001 SADANI L
86 3601046107780003 ANAH P
87 3601040207680001 SAWIRA L
88 3601040204760003 ANEN L
89 3601044103600003 BAYI P
 90 3601041201800001 TONI L
91 3601041107680001 RAMAN L
92 3601045002950006 NENI P
93 3601350901920001 AMIRUDIN L
94 3601044304870002 SARNI P
95 3601045001800001 EDAH P
96 3601040304790001 DINA L
97 3601044607740002 UUN P
98 3602092406730001 HASAN L
99 3601040608850002 TAYUL L
100 3601040605200006 ENCEP L
101 3601294504970005 MIA ANGGI OKTAPIANI P
102 3601041807010002 SUPARNO L
103 3601040107490047 CARANI L
104 3601040107850082 TISNA L
105 3601040504780003 IDANG L
106 3601040204620001 SURA L
107 3601045102830002 MIMIN P
108 3601044911870001 DAYAH P
109 3601045609710002 ARNAH P
110 3601046403650001 AMIRAH P
111 3602160507870008 JA'I L
112 3601041206700004 AHMAD L
 Umur Kelomp
Pekerjaan* INSTANSI Alamat
(18-59 tahun) ok Umur

5/21/1996 DESA PARUNGKOKOSA

7/1/1982 DESA PARUNGKOKOSA
7/1/1972 DESA PARUNGKOKOSA
2/1/1987 DESA PARUNGKOKOSA
4/9/1992 DESA PARUNGKOKOSA
7/1/1960 LANSIA DESA PARUNGKOKOSA
2/1/1979 DESA PARUNGKOKOSA
1/10/1981 DESA PARUNGKOKOSA
6/10/1980 DESA SUKAMULYA
12/30/2000 DESA SUKAMULYA
6/12/1975 DESA SUKAMULYA
1/20/1968 DESA PARUNGKOKOSA
4/1/1980 DESA PARUNGKOKOSA
7/1/1970 DESA SUKAMULYA
8/20/1983 DESA SUKAMULYA
2/7/2001 DESA PARUNGKOKOSA
2/1/1967 DESA PARUNGKOKOSA
5/11/1965 DESA SUKAMULYA
1/1/2002 DESA PARUNGKOKOSA
4/2/1978 DESA PARUNGKOKOSA
1/1/1966 DESA SUKAMULYA
7/1/1975 DESA PARUNGKOKOSA
3/12/1993 DESA PARUNGKOKOSA
1/1/1971 DESA PARUNGKOKOSA
7/1/1988 DESA PARUNGKOKOSA
4/1/1983 DESA PARUNGKOKOSA
6/11/1992 DESA PARUNGKOKOSA
7/1/1980 DESA PARUNGKOKOSA
3/14/1978 DESA PARUNGKOKOSA
2/20/1973 DESA PARUNGKOKOSA
6/8/1983 DESA PARUNGKOKOSA
7/1/1975 DESA PARUNGKOKOSA
4/7/1988 DESA PARUNGKOKOSA
3/15/1974 DESA CIBALIUNG
4/7/1974 DESA PARUNGKOKOSA
7/7/2001 DESA PARUNGKOKOSA
7/1/1964 DESA SUKAMULYA
4/1/2000 DESA PARUNGKOKOSA
7/1/1992 DESA PARUNGKOKOSA
3/16/1987 DESA PARUNGKOKOSA
9/12/2000 DESA PARUNGKOKOSA
 1/9/2000 DESA SUKAMULYA
2/1/1983 DESA PARUNGKOKOSA
6/12/1988 DESA PARUNGKOKOSA
3/11/1979 DESA PARUNGKOKOSA
7/25/1982 DESA PARUNGKOKOSA
5/3/1972 DESA PARUNGKOKOSA
7/1/1984 DESA PARUNGKOKOSA
8/5/1987 DESA PARUNGKOKOSA
11/17/1986 DESA PARUNGKOKOSA
7/23/1987 DESA PARUNGKOKOSA
7/26/1987 DESA PARUNGKOKOSA
7/1/1966 DESA PARUNGKOKOSA
1/2/1976 DESA PARUNGKOKOSA
4/15/1986 DESA PARUNGKOKOSA
1/1/2000 DESA PARUNGKOKOSA
7/1/1983 DESA PARUNGKOKOSA
3/10/2009 REMAJA DESA PARUNGKOKOSA
7/1/1983 DESA PARUNGKOKOSA
5/6/1981 DESA PARUNGKOKOSA
2/6/1981 DESA PARUNGKOKOSA
1/2/1986 DESA PARUNGKOKOSA
2/23/1987 DESA PARUNGKOKOSA
5/9/1983 DESA PARUNGKOKOSA
2/20/1984 DESA PARUNGKOKOSA
8/7/1978 DESA PARUNGKOKOSA
1/2/1968 DESA PARUNGKOKOSA
8/1/1964 DESA PARUNGKOKOSA
2/7/1968 DESA PARUNGKOKOSA
6/2/1983 DESA PARUNGKOKOSA
8/7/1990 DESA PARUNGKOKOSA
10/12/1999 DESA PARUNGKOKOSA
7/17/1996 DESA PARUNGKOKOSA
6/4/1977 DESA PARUNGKOKOSA
9/11/1980 DESA PARUNGKOKOSA
1/4/1982 DESA PARUNGKOKOSA
7/1/1986 DESA PARUNGKOKOSA
7/1/1985 DESA PARUNGKOKOSA
1/8/1994 DESA PARUNGKOKOSA
5/1/1988 DESA PARUNGKOKOSA
11/9/1985 DESA PARUNGKOKOSA
7/1/1983 DESA PARUNGKOKOSA
8/11/1992 DESA PARUNGKOKOSA
3/1/1980 DESA PARUNGKOKOSA
6/4/1965 DESA PARUNGKOKOSA
7/21/1978 DESA PARUNGKOKOSA
7/2/1968 DESA PARUNGKOKOSA
1/10/1978 DESA PARUNGKOKOSA
5/16/1963 DESA PARUNGKOKOSA
 1/12/1980 DESA PARUNGKOKOSA
8/12/1975 DESA PARUNGKOKOSA
2/10/1995 DESA PARUNGKOKOSA
1/9/1993 DESA PARUNGKOKOSA
4/3/1987 DESA PARUNGKOKOSA
1/10/1980 DESA PARUNGKOKOSA
4/3/1979 DESA PARUNGKOKOSA
7/6/1974 DESA PARUNGKOKOSA
6/24/1973 DESA SUKAMULYA
8/6/1985 DESA SUKAMULYA
10/27/1996 DESA PARUNGKOKOSA
4/5/1997 DESA PARUNGKOKOSA
7/18/2001 DESA SUKAMULYA
7/1/1949 LANSIA DESA SUKAMULYA
7/1/1985 DESA PARUNGKOKOSA
4/5/1978 DESA PARUNGKOKOSA
4/2/1962 DESA PARUNGKOKOSA
2/11/1983 DESA PARUNGKOKOSA
11/9/1981 DESA PARUNGKOKOSA
9/16/1971 DESA PARUNGKOKOSA
4/9/1960 LANSIA DESA SUKAMULYA
7/5/1987 DESA SUKAMULYA
7/14/1970 DESA PARUNGKOKOSA
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)

NO HP BPJS BPJS Non Merek Vaksin*** Tanggal Screening

PBI Non PBI Anggota

083895459309 CORONAVAC 12/10/2021

085389100226 CORONAVAC 12/10/2021
085694590497 CORONAVAC 12/10/2021
085773752090 CORONAVAC 12/10/2021
08558718531 CORONAVAC 12/10/2021
083895459309 CORONAVAC 12/10/2021
085719636874 CORONAVAC 12/10/2021
08521488691 CORONAVAC 12/10/2021
087882755305 CORONAVAC 12/10/2021
085692654675 CORONAVAC 12/10/2021
085782264275 CORONAVAC 12/10/2021
085695285658 CORONAVAC 12/10/2021
085810898342 CORONAVAC 12/10/2021
081210398373 CORONAVAC 12/10/2021
087882755305 CORONAVAC 12/10/2021
085775399205 CORONAVAC 12/10/2021
083808892332 CORONAVAC 12/10/2021
CORONAVAC 12/10/2021
081574855043 CORONAVAC 12/10/2021
085366872267 CORONAVAC 12/10/2021
085887771070 CORONAVAC 12/10/2021
085810876839 CORONAVAC 12/10/2021
085778986744 CORONAVAC 12/10/2021
085820104937 CORONAVAC 12/10/2021
08577387006 CORONAVAC 12/10/2021
08569759337 CORONAVAC 12/10/2021
085718510312 CORONAVAC 12/10/2021
085694522937 CORONAVAC 12/10/2021
085894197932 CORONAVAC 12/10/2021
085774964793 CORONAVAC 12/10/2021
085882448349 CORONAVAC 12/10/2021
085710119963 CORONAVAC 12/10/2021
085882448349 CORONAVAC 12/10/2021
08558655144 CORONAVAC 12/10/2021
085710515586 CORONAVAC 12/10/2021
085773487010 CORONAVAC 12/10/2021
08558655144 CORONAVAC 12/10/2021
085714776077 CORONAVAC 12/10/2021
085714977970 CORONAVAC 12/10/2021
085695271689 CORONAVAC 12/10/2021
085770149958 CORONAVAC 12/10/2021
085710506238 CORONAVAC 12/10/2021
085773752090 CORONAVAC 12/10/2021
085891580691 CORONAVAC 12/10/2021
085691896145 CORONAVAC 12/10/2021
085881649332 CORONAVAC 12/10/2021
081214574557 CORONAVAC 12/10/2021
085710723102 CORONAVAC 12/10/2021
085718505013 CORONAVAC 12/10/2021
085719069994 CORONAVAC 12/10/2021
085714977970 CORONAVAC 12/10/2021
085891580722 CORONAVAC 12/10/2021
085710722310 CORONAVAC 12/10/2021
085810132506 CORONAVAC 12/10/2021
085774964811 CORONAVAC 12/10/2021
085891580704 CORONAVAC 12/10/2021
085719070043 CORONAVAC 12/10/2021
081511863878 CORONAVAC 12/10/2021
085893130571 CORONAVAC 12/10/2021
085694634271 CORONAVAC 12/10/2021
081510284387 CORONAVAC 12/10/2021
081511661778 CORONAVAC 12/10/2021
085777379522 CORONAVAC 12/10/2021
085891580730 CORONAVAC 12/10/2021
085810134018 CORONAVAC 12/10/2021
085280516202 CORONAVAC 12/10/2021
085780867941 CORONAVAC 12/10/2021
081584988389 CORONAVAC 12/10/2021
081511661778 CORONAVAC 12/10/2021
085771549377 CORONAVAC 12/10/2021
085719024916 CORONAVAC 12/10/2021
085724421108 CORONAVAC 12/10/2021
081574855042 CORONAVAC 12/10/2021
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 Dosis I Dosis 2

Tanggal
Tanggal KET
No. Pemberia No.
Pemberian No seri No Seri
Batch n Batch
Vaksinasi
Vaksinasi

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NO No. Ticket NIK Nama Penerima Vaksin

1 3601044108820004 SANAH
2 3601044306770001 SURMAH
3 MISJA
4 KAMHAR
5 36010401046220001 SALI
6 SARNEN
7 3601041011680005 IDA
8 36010441087600004 KASMITI
9 3601040301850008 SARNA
10 ROJI
11 MA'IN
12 1602114606820005 ANIS
13 3601041002790003 TARBAN
14 360104010500072 SAMIN
15 CARILAH
16 WAKIR
17 NURLELI
18 3601040107610127 TARYANA
19 3601046406847001 ROHMAH
20 36010410037700003 ACIM
21 ASJA
22 NADI
23 HETI
24 SERTI
25 36010453078300001 TITI
26 360216600790001 NENGSIH
27 3601044107270016 MUMUN
28 SARWI
29 WASKINAH
30 RASJA
31 360104410758022001 SANI
32 3601044107560110 NAMI
33 ERIH
34 WINATA
35 HERNI
36 YASIN
37 DEDEK
39 36010430107750235 MUKRI
40 3601040107780050 KARWANA
41 36010441079000233 ROHETI
42 3601044806580001 ROHAMAH
43 3601044107540065 ACIH
44 360110440710001 NENG LELI
45 ERUM
46 3601044107030419001 ENI
47 36010401002890001 TATANG
48 SARMI
49 RITMA NOVITA
50 UUN
51 3601044107900194 SUMYATI
52 36010447018701213 ENIS
53 3601044807670001 KASNAH
54 3601044507780008 SUMARNI
55 3601045008540001 MASKUNAH
56 360104306000004 IIN
57 TITIN
58 ESAH
59 SUKMANAH
60 WARDI
61 3601045167570003 DARIH
62 360104010750170 SARTIMIN
63 36010449018200001 ICAH
64 360104410750086 HASANAH
65 3601044107580207 RAMINAH
66 ENTAP
67 3601040904740001 RASMIN
68 BAGAS
69 JURIAH
70 PARMI
71 AYIM
72 MASKUNAH
73 3601045902860001 YATI
74 3601044107580205 MARNASIH
75 DEDE TAHMAN
76 3601044768700001 SACEM
77 3601045804990002 KAMAH
78 360104407800269 NENENG
79 WINAH
80 RAHMAN
81 RAMAN
82 3601044107870144 ROHMAH
83 DASIWAN
84 3601044411830001 TARMENI
85 360104505620002 ENING
 86 3601046803690002 TATI
87 3601046202830001 ERNI YULIA
88 3601040107630355 KATAM
89 3601044107700154 KARTINI
90 3601045401830004 KAMAH
91 3601044107030324 JARMAH
92 OYAH
93 36010403040600003 ISHAK
94 3601044602810002 SUPINAH
95 SARTI
96 TINGGAL
97 WASKIM
98 3601040107900007 ATIM
99 3601046703600001 HJ. RUMYANI
100 SERAH
101 3601044107730361 ASMI
102 DENNY
103 MARTI
104 360104600860006 SARUNAH
105 3601044607740003 SANAH
106 ASRI
107 36010441079001956 SARNAH
108 MISNAH
109 HERMANTO
110 ENOK
111 36010441010000016 SITI NUR ASIYAH
112 BILY
113 SUKENI
114 DEDEN
115 ERAH
116 SURNI
117 36010446128200005 MARSIH
118 NIKY
119 RAHMAT
120 36010401078610123 MARTA
121 ANDI
122 3601040509900001 ASMIR
123 AHMADI
124 RAHMAT
125 AMINAH
126 SARIPUDIN
127 SAID
128 36010441076800001 RAMINIH
129 36010466058600003 MARYAM
130 3601045706500003 SATI
131 YANTI
132 36010450018199994 RATNA
133 ARSIAN
134 KASTEM
135 JUMARI
136 M. ARSO
137 SUHNI
138 3601045611760001 RASINIH
139 SARYATI
140 TOYIB
141 CASIM
142 SADID
143 RASTIWEN
144 ANDRA
145 SITI LATIFAH
146 MUHAD
147 SUNTI
148 AISAH
149 RISTA
150 WAHYU
151 TOBRI
152 TASIAH
153 RATNENGSIH
154 TONI
155 MASAN
156 DARINIH
157 SITI NINGSIH
158 SAEPUDIN
159 WASAM
160 KADIMAN
161 3601044107050353 ENI
162 AMIN
163 360104700400001 SANIAH
164 3601044107920245 KOKOM
165 360104410793000061 LISA
166 MIRNAWATI
167 3601040107820127 RASIMAN
168 IAH
169 AGUS SK
170 ANGGA S
171 JUMEAH
172 SAMAN
173 NENGSIH
174 ASEP DEDI
175 CASTIM
176 TATA
177 ROYONI
178 BAGUS
179 LENI A
180 ASIH
181 YULIANA
182 RATINI
183 LILIS
184 TARINIH
185 RUSNATA
186 ARYADI
187 UPEN
188 ROSMIATI
189 SUKAESIH
190 SUKMA
191 360104010770099 RASMAN
192 RUKMINAH
193 3600144104680009 DARSIH
194 TASMEN
195 TASKEM
196 YULIANASARI
197 3601045010000001 DINI M
198 3601044107840214 TINI
199 360104460180004 LINA
200 AYU LESTARI
201 ENAH
202 EMOT
203 TUTI
204 SAMSURI
205 SITI AMINAH
206 SARAH
207 SELA
208 ULFAH
209 ARSUDIN
210 MISKAT
211 SARAH
212 MASPAN
213 3601044508770004 ALSAH
214 ADE
215 SAMINAH
216 INIH
217 ATI
218 SUNETI
219 AHMID
220 MINAH
221 3601046701780001 ISEM
222 MISKAT
223 JUMRI
224 3601044107730356 SAYANTI
225 3601040903780002 JURTA
226 ANGGA
227 3601045201020002 YUFIH
228 RUSDI
229 JUANDA
230 JARMIN
231 3601044803830001 SURNIAH
232 36010441088200001 SANAH
233 ANI
234 MAMAT
235 AMI
236 MAHPUDIN
237 EEN
238 KAYAH
239 ANDI
240 3601044107750219 RASTINI
241 36010441077000142 SATIRAH
242 RUDI
243 SUPRIA
244 AMSI
245 3601045112040001 M. DETRIS
246 3601040107001081 HAERUDIN
247 3601044107680295 SUKINAH
248 SUNARJA
249 36010456080001 ASMINAH
250 3601044106740002 SUKIMAH
251 36010445049200005 SUSI
 Umur
Kelomp
JK Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

P 01-08-1982UMUM UMBULAN 085710721516

L 03-06-1977UMUM UMBULAN 085710721516
L UMBULAN 085891153244
L 01-07-1980UMUM UMBULAN 085891153244
L 01-04-1962UMUM UMBULAN 085891153244
L UMBULAN 085891153244
P 10-11-1968UMUM UMBULAN 085772420611
P 01-08-1976UMUM UMBULAN 085772420611
L 03-01-1985UMUM UMBULAN 085772420611
L UMBULAN 085772420611
L UMBULAN 085772420611
P 06-06-1982UMUM UMBULAN 085772420611
L 10-02-1979UMUM UMBULAN 085772420611
L 01-07-1950LANSIA UMBULAN 085772420611
P 15-02-1982UMUM UMBULAN 085772420611
L UMBULAN 085772420611
P 31-08-2001UMUM UMBULAN 085770720031
L 01-07-1962UMUM UMBULAN 085770720031
P 24-006-198UMUM UMBULAN 085770720031
L 10-03-1977UMUM UMBULAN 085770720031
L 01-07-1963UMUM UMBULAN 085770720031
L UMBULAN 085770720031
P 01-07-1965UMUM UMBULAN 085770720031
P UMBULAN 085770720031
P 13-07-1983UMUM UMBULAN 085283237202
P 20-03-1990UMUM UMBULAN 085283237202
P 01-07-1950UMUM UMBULAN 085283237202
P 01-07-1981UMUM UMBULAN 085283237202
P 01-07-1947UMUM UMBULAN 085283237202
L UMBULAN 085283237202
P 01-07-1958LANSIA UMBULAN 085283237202
P 01-09-1952LANSIA UMBULAN 085283237202
P 04-10-1985UMUM UMBULAN 083811141871
L UMBULAN 083811141871
P UMBULAN 083811141871
L UMBULAN 083811141871
L UMBULAN 083811141871
L 01-07-1975UMUM UMBULAN 083811141871
L 12-06-1977UMUM UMBULAN 083811141871
P 05-08-1969UMUM UMBULAN 083811141871
P 08-08-1990UMUM UMBULAN 083811141871
P UMBULAN 083811141871
P 04-06-1992UMUM UMBULAN 085710779292
P UMBULAN 085710779292
P 01-07-1975UMUM UMBULAN 085710779292
L 10-02-1990UMUM UMBULAN 085710779292
P UMBULAN 085710779292
P 11-08-1989UMUM UMBULAN 085710779292
P 06-05-1981UMUM UMBULAN 085710779292
P 01-07-1990UMUM UMBULAN 085710779292
P 07-01-1987UMUM UMBULAN 085710779292
P 08-07-1967UMUM UMBULAN 085710779292
P 05-07-1978UMUM UMBULAN 085710779292
P 10-08-1954LANSIA UMBULAN 085710779292
P 13-06-2006REMAJA UMBULAN 085710779292
P 01-07-1984UMUM UMBULAN 085710779292
P 11-05-1964UMUM UMBULAN 085710779292
P 06-01-1982UMUM UMBULAN 085710779292
L UMBULAN 085710779292
P 11-07-1957LANSIA UMBULAN 085710779292
L 02-07-2965UMUM UMBULAN 085710779292
P 06-01-1982UMUM UMBULAN 085710779292
P 01-07-1950LANSIA UMBULAN 085710779292
P 01-07-1958LANSIA UMBULAN 085710779292
L UMBULAN 085710779292
L 09-04-1974UMUM UMBULAN 085710779292
L UMBULAN 085710779292
P 01-07-1971UMUM UMBULAN 085710779292
P 01-07-1975UMUM UMBULAN 083871522552
L 12-02-1970UMUM UMBULAN 083871522552
P 10-08-1954LANSIA UMBULAN 083871522552
P 19-02-1986UMUM UMBULAN 083871522552
P 01-07-1958LANSIA UMBULAN 083871522552
L UMBULAN 083871522552
P 07-08-1973UMUM UMBULAN 083871522552
P 18-04-1999UMUM UMBULAN 083871522552
P 01-07-1980UMUM UMBULAN 083871522552
P 05-05-1988UMUM UMBULAN 083871522552
L 18-07-1955LANSIA UMBULAN 083871522552
L UMBULAN 083871522552
P 24-03-1984UMUM UMBULAN 083871522552
L 11-03-1966UMUM UMBULAN 083871522552
L 04-11-1983UMUM UMBULAN 083819820302
P 14-06-1962UMUM UMBULAN 083819820302
P 28-03-1969UMUM UMBULAN 083819820302
P 22-09-1983UMUM UMBULAN 085882795504
L 01-07-1965UMUM UMBULAN 085882795504
P 01-07-1970UMUM UMBULAN 085882795504
P 14-01-1983UMUM UMBULAN 085882795504
P 01-07-1965UMUM UMBULAN 085882795504
P UMBULAN 085882795504
L 03-04-2006REMAJA UMBULAN 085882795504
P 06-02-1981UMUM UMBULAN 081511846843
P 04-10-1960LANSIA UMBULAN 081511846843
L UMBULAN 081511846843
L UMBULAN 081511846843
L 01-07-1990UMUM UMBULAN 081511846843
P 15-05-1960LANSIA UMBULAN 081511846843
P UMBULAN 081511846843
P 01-07-1973UMUM UMBULAN 081511846843
L UMBULAN 081511846843
P 01-07-1963UMUM UMBULAN 081511846843
P 20-01-1986UMUM UMBULAN 081511846843
P 06-07-1974UMUM UMBULAN 081511846843
P UMBULAN 081511846843
P 16-12-1969UMUM UMBULAN 081511846843
P UMBULAN 081511846843
L 09-03-2000UMUM UMBULAN 081511846843
P UMBULAN 081511846843
P 01-01-2000UMUM UMBULAN 081511846843
L UMBULAN 081511846843
P 17-04-1988UMUM UMBULAN 081511846843
L UMBULAN 081511846843
P UMBULAN 081511846843
P UMBULAN 081511846843
P 30-06-1985UMUM UMBULAN 081511846843
L 28-10-2002UMUM UMBULAN 083815428561
L UMBULAN 083815428561
L 10-12-1960UMUM UMBULAN 083815428561
L UMBULAN 083815428561
L 05-09-1990UMUM UMBULAN 083815428561
L UMBULAN 083815428561
L UMBULAN 083815428561
P 07-08-1971UMUM UMBULAN 083815428561
L UMBULAN 083815428561
L UMBULAN 083815428561
P 01-07-1968UMUM UMBULAN 083815428561
P 26-05-1986UMUM UMBULAN 085773219152
P 11-06-1950LANSIA UMBULAN 085773219152
P UMBULAN 085773219152
P 10-01-1981UMUM UMBULAN 085773219152
L UMBULAN 085773219152
P UMBULAN 085773219152
L UMBULAN 085773219152
L UMBULAN 085773219152
P UMBULAN 085773219152
P 16-11-1976UMUM UMBULAN 085773219152
P 0-03-1978 UMUM UMBULAN 085773219152
L 01-07-1962UMUM UMBULAN 085773219152
L 08-03-1969UMUM UMBULAN 085773219152
L 12-09-1966UMUM UMBULAN 085773219152
P 01-07-1973UMUM UMBULAN 085773219152
L UMBULAN 085773219152
P UMBULAN 085773219152
L UMBULAN 085773219152
P 20-01-1980UMUM UMBULAN 085773219152
P 04-07-1992UMUM UMBULAN 085773219152
P 05-08-2000UMUM UMBULAN 085773219152
L UMBULAN 085773219152
L UMBULAN 085773219152
P UMBULAN 085773219152
P UMBULAN 085773219152
L UMBULAN 085773219152
L UMBULAN 085773219152
P UMBULAN 085773219152
P UMBULAN 085773219152
L 07-08-1987UMUM UMBULAN 085773219152
L 01-07-1973UMUM UMBULAN 085773219152
L 06-08-1973UMUM UMBULAN 085773219152
P 01-07-1985UMUM UMBULAN 085773219152
L 01-07-1973UMUM UMBULAN 085773219152
P 30-04-1990UMUM UMBULAN 085773219152
P 14-04-1992UMUM UMBULAN 085773219152
P 16-01-1980UMUM UMBULAN 085773219152
P UMBULAN 085773219152
L 01-07-1982UMUM UMBULAN 085773219152
P TANJUNGAN 085773219152
L 15-07-1962UMUM UMBULAN 085773219152
L 29-08-2001UMUM UMBULAN 085773219152
P UMBULAN 085773219152
L 01-07-1978UMUM UMBULAN 085722049137
P 02-02-1982UMUM UMBULAN 085722049137
L UMBULAN 085722049137
L UMBULAN 085722049137
L UMBULAN 085722049137
L UMBULAN 085722049137
L UMBULAN 085722049137
P UMBULAN 085722049137
P UMBULAN 085722049137
P 03-05-1988UMUM UMBULAN 085722049137
P 23-03-1984UMUM UMBULAN 085722049137
P 12-12-2001UMUM UMBULAN 085722049137
P 01-07-1988UMUM UMBULAN 085722049137
L 05-04-2975UMUM UMBULAN 085722049137
L 01-07-1972UMUM UMBULAN 085722049137
L 17-01-1972UMUM UMBULAN 085722049137
P 01-07-1970UMUM UMBULAN 085722049137
P UMBULAN 085722049137
P UMBULAN 085722049137
L 01-07-1967UMUM UMBULAN 085722049137
P UMBULAN 085722049137
P UMBULAN 085722049137
L 20-10-1980UMUM UMBULAN 085215343730
L 21-01-1989UMUM UMBULAN 085215343730
P UMBULAN 085215343730
P 10-10-2000UMUM UMBULAN 085215343730
P 01-07-1983UMUM UMBULAN 085215343730
P 06-01-1988UMUM UMBULAN 085215343730
P 24-10-1995UMUM UMBULAN 085215343730
P 01-07-1950LANSIA UMBULAN 085215343730
P UMBULAN 085215343730
P 21-09-1989UMUM UMBULAN 085215343730
L UMBULAN 085215343730
P UMBULAN 085215343730
P 13-09-1998UMUM UMBULAN 085215343730
P 11-09-2001UMUM UMBULAN 085215343730
P 11-03-1997UMUM UMBULAN 085215343730
L 01-09-1978UMUM UMBULAN 085215343730
L UMBULAN 085215343730
P 07-03-1961UMUM UMBULAN 085215343730
L UMBULAN 085215343730
P 05-08-1977UMUM UMBULAN 085215343730
L 04-06-1967UMUM UMBULAN 085215343730
P 01-07-1970UMUM UMBULAN 085215343730
P UMBULAN 085215343730
P 20-05-1976UMUM UMBULAN 085215343730
P 27-05-1986UMUM UMBULAN 085215343730
L UMBULAN 085215343730
P UMBULAN 085215343730
P 27-01-1978UMUM UMBULAN 085718270147
P UMBULAN 085718270147
L UMBULAN 085718270147
P 13-04-1975UMUM UMBULAN 085718270147
L 09-08-1978UMUM UMBULAN 085718270147
L UMBULAN 085718270147
P 12-01-2002UMUM UMBULAN 085718270147
L UMBULAN 085718270147
L 10-06-1985UMUM UMBULAN 085718270147
L 07-06-1976UMUM UMBULAN 085718270147
P UMBULAN 085718270147
P 01-08-1982UMUM UMBULAN 085718270147
P UMBULAN 085718270147
L 18-04-1988UMUM UMBULAN 085718270147
P UMBULAN 085718270147
L 07-01-1976UMUM UMBULAN 085718270147
P 15-08-1988UMUM UMBULAN 085718270147
P 20-11-1967UMUM UMBULAN 085718270147
L UMBULAN 085718270147
P 01-07-1975UMUM UMBULAN 085718270147
P 01-07-1970UMU UMBULAN 085781667563
L UMBULAN 085718270147
L 07-07-1980UMUM UMBULAN 085718270147
L UMBULAN 085718270147
L 31-12-2004REMAJA UMBULAN 085718270147
L 20-06-2002UMUM UMBULAN 085718270147
P 02-01-1963UMUM UMBULAN 085718270147
L 15-05-2001UMUM UMBULAN 085718270147
P 16-01-1978UMUM UMBULAN 085718270147
P 01-06-1974UMUM UMBULAN 082241858144
P 05-04-1992UMUM UMBULAN 082241858144
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I Dosis 2
sesuai)
Tanggal Tanggal Tanggal
Merek
BPJS BPJS Non Screeni Pemberi No.
Pemberi
Vaksin*** an No seri an
PBI Non PBI Anggota ng Batch
Vaksina Vaksina
si si
CORONAVAC 01-11-2021 13-12-2021
CORONAVAC 01-11-2021 13-12-2021
CORONAVAC 15-11-2021 13-12-2021
CORONAVAC 10-11-2021 13-12-2021
CORONAVAC 10-11-2021 13-12-2021
CORONAVAC 15-11-2021 13-12-2021
CORONAVAC 08-11-2021 13-12-2021
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CORONAVAC 15-11-2021
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CORONAVAC 15-11-2021
CORONAVAC 08-11-2021
CORONAVAC 10-11-2021
CORONAVAC 10-11-2021
CORONAVAC 15-11-2021
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CORONAVAC 04-11-2021
CORONAVAC 08-11-2021
CORONAVAC 15-11-2021
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CORONAVAC 10-11-2021
CORONAVAC 15-11-2021
CORONAVAC 15-11-2021
CORONAVAC 08-11-2021
CORONAVAC 09-11-2021
CORONAVAC 15-11-2021
CORONAVAC 15-11-2021
CORONAVAC 28-10-2021
CORONAVAC 15-11-2021
CORONAVAC 15-11-2021
CORONAVAC 4/11/2021
CORONAVAC 09-11-2021
CORONAVAC 09-11-2021
CORONAVAC 04-11-2021
CORONAVAC 10-11-2021
CORONAVAC 15-11-2021
CORONAVAC 15-11-2021
CORONAVAC 10-11-2021
CORONAVAC 10-11-2021
CORONAVAC 08--11-2021
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CORONAVAC 10-11-2021
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CORONAVAC
CORONAVAC 13-12-2021
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Dosis 2

No. KET
No Seri
Batch

202109177F
202109177F
202109177F
202109177F
202109177F
202109177F
202109177F
202109177F
202109177F
202109177F
202109177F
202109177F

202109177F
 Nama Penerima
NO No. Ticket NIK JK Pekerjaan*
Vaksin

1 3601040301180001 UJANG ANTON L

2 3601041708670001 JAKARI L
3 3601044505080005 ROHENI SAFITRI P
4 3601085107950001 TRI DESTRIANI P
5 3601042108820001 UDIN S L
6 3601046307730001 RUMANAH P
7 3601045507850024 EHA P
8 3601040107700102 SUHANDI L
9 3601041801650001 DASIM L
10 3601043011750001 CASWEN P
11 3601041507700013 SUKMA JAYA L
12 3601041206890001 MARDA L
13 3601044107750155 ASMIRAH P
14 3601041811630001 SOLEMAN L
15 3601042703720001 SUTIAH P
16 3601045507500002 SARSIH P
17 3601044808790003 IYUN P
18 3601040705780003 PANDI SUTISNA P
19 3601041007810001 ARSUDIN L
20 3601044107890221 ELI L
21 3601040210770005 RAHMAT L
22 '3601044311920003 RUMINI P
23 3601045907940003 TATI ISTIAWATI P
24 3601044107890137 NURHAYATI P
25 3601045907770002 RATNA P
26 3601040810550001 KISAN L
27 3601040107690100 MARKIM L
28 3601041104820004 PULUNG L
29 3601040508690002 DARSIPAN L
30 3601040601960001 SUKARNA L
31 3601046010800005 TINI P
32 3601044503790004 WASRI L
33 3601044107840116 RUMSINAH P
34 3601044507730003 ICIH P
35 3601041110710001 NANO L
36 3601044201750003 SUNAETI P
37 3601044810870004 SARIYAH P
38 3601041202600002 ASNALA L
39 3601041104650004 YAYAN L
40 3601044708010005 TUTI SORAYA P
41 3601044908960002 INAH P
42 3601040409010001 SUANDA L
43 3601044107750252 YATI P
44 3601044509850001 ODAH P
45 3601040503620001 ADIN L
46 3601041302800002 RAYU L
47 3601044107680283 HJ. WARNI P
48 3601041001600007 SARDIMIN L
49 3601045007650002 DARMI P
50 3601040207490001 KASTA L
51 3601046104030006 YUYUN YUNISAH P
52 3212054703760003 SARKEM P
53 3601041102700007 SARMA L
54 3601046511830001 TARYUMI P
55 3601044107730328 RASMINIH P
56 3601041701830001 DARTIM L
57 3601044107430063 RASWEN L
58 6206111007890001 DARPIN L
59 3601045007790002 ENIP P
60 3601041507720001 WARJAN L
61 3671100609820002 RAHMAN L
62 3601041112710001 UTIK P
63 3601045512760002 SUNAYATI P
64 3601042909850001 SAMSUDIN L
65 3601041711870003 ACENG DURAKIM L
66 '3601042309910001 AJAT L
67 3601041011400002 SAPEI L
68 3601041104740001 SAPEG L
69 3601040404710001 CANTEL L
70 3601045002940003 SITI ROHMAH P
71 3601046009800001 SUTINAH P
72 3601045008740001 ASKAH P
73 3601041105640001 KASMINI P
74 3601045602970001 NURSAFITRI P
75 3601044804640001 KARTINAH P
76 3601045205060001 NURHAYATI P
77 3601040704780002 SAMSUDIN L
78 3601045209650001 SAMAH P
79 3601045008820002 NURHAYATI P
80 3601045710800001 JUNESIH P
81 3601045510850002 NURHAYATI P
82 3601049911750001 NURYATI P
83 3601044207670004 ATISAH P
84 3601045507650003 TARJEM P
 85 3601044107650094 SUENAH P
86 3602042505790002 SAEPUL ANWAR L
87 3601085307900001 WARAH P
88 3601044609810001 ESIH P
89 3601041502780001 JCYO TARJA L
90 3601047010820001 DANIRI L
91 3601040510750005 SUHNI P
92 3601046110700002 HJ ISENG P
93 3601045007860001 SUMINAH P
94 3601044711680003 SUMARNI P
95 3601044108690001 RASTI P
96 3601044303800002 KUNARTI P
97 3601040107680274 MENDO L
98 3601041808760001 WARGA L
99 3601045507860009 TITI P
100 3601043101980001 ACENG WAHYUDIN L
101 3601040811770003 DARJI L
102 3601040108870004 SARMIN L
103 3601041505750002 MISTA L
104 3601041107720003 JOHAN L
105 3602044810600001 RASTINA BT SUTA P
106 3601044107650098 CASMIAH P
108 3601042108840001 ÁYIM L
109 3601041103850004 RASNADI L
110 3601043012620003 SABDA L
111 3601044605900001 YATI P
112 3601041106410001 DASUKI L
113 3601044711030001 NURIKA P
114 3601041710030002 IDRIS L
115 3601042507040003 ANDIE SOPIADI L
116 3601040107610109 WARSA L
117 3602121002740002 EBI SUHAEBI L
118 3601044405850003 DARIAH P
119 3601044406340001 WARINAH P
120 3601041602780004 DARSIM L
121 3601040508880004 TOSARI L
122 3601044702930006 RINI P
123 3601045008880011 NURHAYATI P
124 3601042106990003 REDI RIZAL L
125 3601042410030001 ILHAM L
126 3601045901830003 MASNAH P
127 3603276210760001 YATI MULYATI P
128 3601044107580176 CARIMAH P
129 3601040506720001 SAMID RUSDIANA L
130 3601040107690069 CAYA L
131 3601040201870001 ABDUL WAHID L
132 3601044602760001 ADON L
133 3601046307870001 WARMEN L
134 3601045305780003 NURHAETI P
135 3601042010590001 MARDI L
136 3601042611740002 ARMA L
137 3601046005740001 WARKEM L
138 3601045004660002 WASNIPAH P
139 3601045208570001 MULYANAH P
140 3601044207890008 SARI P
141 3601075503990001 ENIS MARSELA P
142 3601045102900002 UMAROH P
143 2601044605870004 LISAH P
144 3601040402690002 MISTRA L
145 3601040309780001 AMAN L
146 3601040107790113 ENUR P
147 3601041803710001 ADNA L
148 3601040107440014 WARSA B CARMADI L
149 3601045105450001 SAROIAH P
150 3601041904460003 TEDI STIA BUDI L
151 3601040205920002 MAJEN L
152 3601044709760002 CASWEN L
153 3601041505680002 SUMANTA L
154 3601041811570002 UJANG HARSONO L
155 3601044704040001 DARSIH P
156 3601045001730003 DEDEH P
157 3601045210850001 ASTI P
158 3601040810780003 MUKSIN L
159 3601040107900104 JUNAEDI L
160 3601042607670002 CARLIM L
161 3601044311970002 IIS DAHLIA P
162 3601042701900001 MASNUR HAERUDIN L
163 3602215002750003 HERMI P
164 3601045003690002 MINI P
165 3601044807910002 JOHANAH P
166 3601040107010296 ANTON L
167 3276065701910006 MELINDA RESTIANI P
168 3601046010730002 MARNI P
169 3601044806880002 CARKINAH P
170 3601042007080002 MUHAMAD LUTHFI L
171 3601040603780005 KIRNATA L
172 3601044107810163 IRAH P
173 3601044107770080 NARDIYAH P
174 3601044301990003 IROH P
175 3601040208050001 DENAWAN SUARJA L
176 3601074412760001 EDAH P
177 3601042806090002 IKBAL M L
178 3601046002950001 RATIH AYUNITA P
179 3601042506040001 JANURI L
180 3601042312660002 SARKA L
181 3601044204760001 SALINAH BT HANAN P
182 3601040201720002 MUHAMAD APIP L
183 3601044105910006 CARSINAH P
184 3601291101940004 JASMAN L
185 3601044107910180 URNI P
186 3601046906020001 DEDE WINENGSIH P
187 3601045609930007 NURHASANAH P
188 3601045210760002 KARISEM L
189 3601040103630001 WASLA P
190 3601042502760001 JUMEDI L
191 3601045507800008 SAPTI P
192 3601040504730006 WARJI L
193 3601041512910001 ASLA P
194 3601044302750001 TARSINIH P
195 3672030102750002 YAHYA L
196 3602091010030002 RIZAL RAMDAN NUGRL
197 3601041711770002 ROHADI L
198 3601045203080003 HASTIKA DEWI P
199 360104010690002 KASIR L
200 3601042102090002 ANISAH WIDIASARI P
201 3601041504030003 LUKMAN L
202 3601045508450002 SARKAMAH P
203 3601046002010004 ENENG SITI NURAENIP
204 3601044207810008 ROHAYATI P
205 3602210507980001 SOUP L
206 3601040105960004 ROHMAN L
207 3601042204840001 ASMAD L
208 3601044107020169 JUPRI L
209 3601040106880004 AMSAR L
210 3601042910950001 ASAN L
211 3601040107840170 ADE BAHRI L
212 3601040107870181 AMSORI L
213 3601040207800006 JUMRI L
214 3601045809810002 MARHAMAH P
215 3601040207880007 CARLIM L
216 3601044309640003 ASTI ENING P
217 3601040901990002 ANDI SAPUTRA L
218 3601045007760001 SAKI AH P
219 3601041706070002 OZI PRITANA L
220 3601044609060001 RASMAH P
221 3601045605000002 RATIAH P
222 3601040303070001 ANDRI HIDAYAT L
223 3601041403830001 KANDI SUHADI L
224 3601042909990002 BARNAS L
225 3601041205030001 JAENUDIN ASIDIK L
226 3601041706900003 PENDI L
227 3601044802930003 MARTI P
228 360104030570009 PURWANI P
229 3601044606890001 SITI HASANAH P
230 3601046403710002 SITI MARIAM P
231 3601040603790002 CARIH P
232 3601036301090001 RINA YUNIAR P
233 3601045112680002 ARMAH P
234 601034107920110 ERNA WANTINI SARI P
235 1506112711030002 MOH RIZKI L
236 3601041907990001 FUJI MUNAJAT L
237 3601043108020003 DEDE JEKI L
238 3601042206840005 SUKANDI L
239 3601042504820001 UJANG L
240 3601041111650001 PARMAN L
241 3172046702841005 SUPRITAIN L
242 3601044911820002 EVON P
243 3601041510670001 SATORI L
244 3601046012000002 RENI ANGGRAENI P
245 3601045003980001 SUSI NURDUANA PU P
246 3601042402950001 DICKY MUHAMAD HIZKL
247 3601042112900002 ASDULLAH L
248 360104060392003 ANDRI L
249 3601044107830261 KIPIT KURNIATI P
250 3601040211940001 REFI ROLIANA P
251 3601041409950001 HERDIANA L
252 3601042106850002 MUSTOFA L
253 3601040507990008 ARDI L
254 3601042604610001 MUSLIM L
255 3601044207900008 IRNA DIANA P
256 360104561100002 NOVITA RIANTII P
257 3601045507950002 RUYANI SAPUTRA L
258 3601042801960001 ARSID L
259 36010445010650001 AMISAH P
260 3601041306780003 MEASTA L
261 3601044207040009 ERNAWATI P
262 3601046204840001 SITI SUARSIH P
263 3601043112010003 KURNIAWAN L
264 YAYAH INAYAH
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS Non
(18-59 tahun) ok Umur
PBI Non PBI Anggota

28/04/1979 CIKEUSIK 085772730353

17/08/1967 CIKEUSIK
05/05/2008 CIKEUSIK 085779062073
04/07/1995 CIKEUSIK '085885876529
21/08/1982 CIKEUSIK 085719069935
23/07/1973 CIKEUSIK 081381084051
08/12/1973 CIKEUSIK 085770149981
15/04/1972 CIKEUSIK
18/01/1965 CIKEUSIK
30/11/1976 CIKEUSIK
08/05/1969 CIKEUSIK
12/06/1967 CIKEUSIK
01/07/1972 CIKEUSIK
18/11/1968 CIKEUSIK 081291684115
27/03/1972 CIKEUSIK 082120538546
05/01/1957 CIKEUSIK 085695382885
08/08/1979 CIKEUSIK
07/05/1978 CIKEUSIK 085871278992
10/07/1961 CIKEUSIK
01/07/1989 CIKEUSIK
02/10/1977 CIKEUSIK 081585670675
03/11/1992 CIKEUSIK 085772730598
27/09/1995 CIKEUSIK 081398827237
05/02/1991 CIKEUSIK
19/07/1978 CIKEUSIK 085960657110
01/07/1952 CIKEUSIK
01/07/1969 CIKEUSIK
11/04/1982 CIKEUSIK
05/08/1969 CIKEUSIK
08/07/1996 CIKEUSIK 085719428846
20/10/1980 CIKEUSIK
06/03/1979 CIKEUSIK 085232667049
01/07/1964 CIKEUSIK 085893307009
05/07/1973 CIKEUSIK 085770972246
11/10/1972 CIKEUSIK 085212516481
02/11/1975 CIKEUSIK 085714215218
08/10/1987 CIKEUSIK 081292833447
12/02/1960 CIKEUSIK
11/04/1965 CIKEUSIK 0878277300999
07/08/2001 CIKEUSIK 085771613861
09/08/1996 CIKEUSIK 085781660659
04/09/2001 CIKEUSIK 085695380747
01/07/1975 CIKEUSIK 085880004783
05/09/1989 CIKEUSIK 085710525776
05/03/1962 CIKEUSIK 081360633040
13/02/1960 CIKEUSIK 085710525776
01/07/1968 CIKEUSIK 085219459801
10/01/1960 CIKEUSIK 085212005835
10/07/1965 CIKEUSIK 085213005835
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21/04//2003 CIKEUSIK 081295074798
07/03/1976 CIKEUSIK 08577898744
11/02/1970 CIKEUSIK 081295704798
25/11/1983 CIKEUSIK 082125677082
01/07/1973 CIKEUSIK 085280253626
17/01/1983 CIKEUSIK 085283234393
01/07/1943 CIKEUSIK 085217249429
10/07/1989 CIKEUSIK 085216915422
10/07/1979 CIKEUSIK 085710506217
15/07/1972 CIKEUSIK 085285593438
06/09/1983 CIKEUSIK 087720843450
11/12/1971 CIKEUSIK
15/12/1976 CIKEUSIK
29/09/1985 CIKEUSIK 082150136554
17/06/1967 CIKEUSIK
23/09/1991 CIKEUSIK 085217136576
10/11/1940 CIKEUSIK 081574896347
11/04/1974 CIKEUSIK 082130940984
04/04/1971 CIKEUSIK 085217249429
10/02/1994 CIKEUSIK
20/09/1980 CIKEUSIK
10/08/1974 CIKEUSIK 083893890548
11/05/1964 CIKEUSIK 081360633040
16/02/1997 CIKEUSIK 08691137706
03/04/1962 CIKEUSIK 085695388285
12/05/2006 CIKEUSIK 085719069915
07/04/1979 CIKEUSIK 085894197948
12/09/1965 CIKEUSIK 081511757240
10/08/1962 CIKEUSIK
17/10/1980 CIKEUSIK 082310789823
15/10/1985 CIKEUSIK 085776597466
09/11/1975 CIKEUSIK 082310921146
07/04/1967 CIKEUSIK 085319140438
01/07/1967 CIKEUSIK 085214887644
01/07/1965 CIKEUSIK 085891137274
25/05/1979 CIKEUSIK 085810134087
13/07/1992 CIKEUSIK 085601045842
06/09/1981 CIKEUSIK 085888157968
19/09/1985 CIKEUSIK
30/10/1986 CIKEUSIK 085219422163
05/10/1975 CIKEUSIK 085693594309
21/10/1970 CIKEUSIK 085771308802
10/07/1986 CIKEUSIK 085813586155
07/11/1968 CIKEUSIK 085775315705
01/08/1969 CIKEUSIK 081383549058
03/03/1990 CIKEUSIK 085775138313
01/07/1968 CIKEUSIK 085773486399
18/08/1976 CIKEUSIK 085718733605
15/07/1986 CIKEUSIK 085717275661
05/06/1998 CIKEUSIK 085216056271
08/11/1977 CIKEUSIK 085282389422
01/08/1987 CIKEUSIK 085718246848
15/05/1975 CIKEUSIK 08575138347
11/07/1972 CIKEUSIK 085893308147
08/10/1960 CIKEUSIK 087884657889
01/07/1965 CIKEUSIK 08138524893
21/08/1984 CIKEUSIK 087805683974
11/03/1985 CIKEUSIK 085882800552
30/12/1962 CIKEUSIK 085883281692
06/05/1987 CIKEUSIK 085224720536
11/06/1941 CIKEUSIK 082353181310
11/07/2003 CIKEUSIK 085891152886
17/10/2003 CIKEUSIK 085776131129
25/07/2004 CIKEUSIK 081385563641
01/07/1961 CIKEUSIK 085891581134
10/02/1974 CIKEUSIK 085219335882
04/05/1979 CIKEUSIK 087774108438
08/03/1976 CIKEUSIK 085211891513
16/02/1978 CIKEUSIK 085280253606
05/08/1988 CIKEUSIK 08182773434
07/02/1993 CIKEUSIK 081584376665
10/08/1938 CIKEUSIK 085882452047
21/06/1999 CIKEUSIK
26/10/2003 CIKEUSIK 082256809406
19/01/1983 CIKEUSIK 085810708156
22/10/1976 CIKEUSIK 085695382155
01/07/1958 CIKEUSIK 085280253626
05/06/1972 CIKEUSIK 085894845267
21/02/1965 CIKEUSIK 085280253626
02/10/1985 CIKEUSIK 085891076190
06/02/1976 CIKEUSIK 085215497465
17/07/1986 CIKEUSIK 085861145350
13/05/1978 CIKEUSIK 081296008148
20/10/1959 CIKEUSIK 081282773434
26/11/1974 CIKEUSIK 085229062003
20/05/1974 CIKEUSIK 085781515323
10/04/1966 CIKEUSIK 081316753034
12/08/1957 CIKEUSIK 085719437061
02/03/1982 CIKEUSIK 085881997268
07/09/1997 CIKEUSIK 085776131207
11/02/1990 CIKEUSIK 085319075951
06/05/1987 CIKEUSIK 082122995870
04/02/1969 CIKEUSIK 085752346447
03/09/1978 CIKEUSIK 081932799620
01/07/1977 CIKEUSIK 081372595337
18/03/1971 CIKEUSIK 085782468144
17/05/1971 CIKEUSIK 0852116754741
11/05/1945 CIKEUSIK 082312074864
19/04/1996 CIKEUSIK 085883201692
02/13/1993 CIKEUSIK 08521241547
07/09/1976 CIKEUSIK 08190658162
08/05/1975 CIKEUSIK 085211674741
18/11/1957 CIKEUSIK 085801459868
07/04/2004 CIKEUSIK 085694706961
10/01/1973 CIKEUSIK 083873618781
13/10/1985 CIKEUSIK 085694473907
08/10/1978 CIKEUSIK 085214153258
09/06/1991 CIKEUSIK 085772740190
26/07/1967 CIKEUSIK
03/10/1997 CIKEUSIK 085891152886
11/07/1991 CIKEUSIK 085718568649
10/02/1975 CIKEUSIK 08560105040
10/03/1969 CIKEUSIK 081315849914
08/08/1960 CIKEUSIK 085780744430
08/12/2000 CIKEUSIK 081415562811
17/01/1991 CIKEUSIK 085717350484
20/10/1973 CIKEUSIK 081319536394
08/06/1998 CIKEUSIK 082124622187
20/07/2008 CIKEUSIK 085694527948
06/03/1978 CIKEUSIK 085694570421
01/07/1981 CIKEUSIK 05776136400
08/10/1972 CIKEUSIK 085695264330
03/01/1999 CIKEUSIK 085719428846
13/11/2006 CIKEUSIK 085285593438
04/12/1976 CIKEUSIK 085776131207
28/06/2009 CIKEUSIK 081219721904
20/02/1995 CIKEUSIK 0838713342
25/06/2004 CIKEUSIK 085718271260
23/13/1966 CIKEUSIK
02/04/1976 CIKEUSIK 085210705213
06/02/1971 CIKEUSIK 083812917243
01/05/1991 CIKEUSIK 085319358175
11/01/1994 CIKEUSIK 085775138147
01/07/1991 CIKEUSIK
29/06/2002 CIKEUSIK 085782773249
16/09/1993 CIKEUSIK 081266758353
12/10/1976 CIKEUSIK 082297972839
01/03/1963 CIKEUSIK 085313536025
25/02/1976 CIKEUSIK
15/07/1960 CIKEUSIK 085810907306
05/06/1973 CIKEUSIK 085891580785
15/12/1991 CIKEUSIK 081266758353
03/02/1975 CIKEUSIK 085891580785
01/02/1973 CIKEUSIK 085215203937
10/10/2003 CIKEUSIK 085691312673
17/11/1977 CIKEUSIK 087772000622
CIKEUSIK 081323900288
01/07/1965 CIKEUSIK 085235725579
CIKEUSIK 08585747323
15/04/2003 CIKEUSIK 085691096364
15/08/1945 CIKEUSIK 085778282449
20/02/2001 CIKEUSIK 0812295006144
15/06/1972 CIKEUSIK 085211722423
01/10/1999 CIKEUSIK 0856976019152
01/05/1996 CIKEUSIK 08129925548
22/04/1984 CIKEUSIK 085773807029
03/03/2003 CIKEUSIK 085718763856
01/06/1988 CIKEUSIK 082311540122
23/06/1995 CIKEUSIK 08588119744
08/11/1985 CIKEUSIK 085212733056
01/07/1987 CIKEUSIK 082312285533
02/07/1960 CIKEUSIK 085719437065
18/09/1981 CIKEUSIK 085797144398
02/07/1988 CIKEUSIK 085884397307
04/09/1964 CIKEUSIK 081910819917
09/01/1999 CIKEUSIK 081584362041
10/07/1976 CIKEUSIK 085774965070
17/06/2007 CIKEUSIK 085282389852
02/04/2006 CIKEUSIK 085211616402
16/05/2000 CIKEUSIK 081584362041
03/03/2007 CIKEUSIK 0858138922450
14/03/1983 CIKEUSIK 08577447615
29/09/1999 CIKEUSIK 085717565213
25/04/2003 CIKEUSIK 085716772448
17/06/1990 CIKEUSIK
08/02/1993 CIKEUSIK '082311548122
03/05/1970 CIKEUSIK 081218721904
06/06/1994 CIKEUSIK 085311482451
24/03/1972 CIKEUSIK 08214931828
06/05/1979 CIKEUSIK 081241065092
23/01/2009 CIKEUSIK 085810903563
11/12/1988 CIKEUSIK
12/06/1995 CIKEUSIK 085210614178
27/11/2003 CIKEUSIK 083871877215
19/07/1999 CIKEUSIK 081382869232
31/08/2002 CIKEUSIK 085776131224
22/06/1984 CIKEUSIK 081517843623
06/19/1982 CIKEUSIK 081382598100
11/11/1965 CIKEUSIK 08236845895
27/02/1984 CIKEUSIK 085819577404
09/11/1982 CIKEUSIK 085714153258
15/10/1967 CIKEUSIK 081317816636
20/12/2002 CIKEUSIK 085219869487
'02/05/19967 CIKEUSIK 085214025199
19/12/1995 CIKEUSIK 081295006144
21/12/1990 CIKEUSIK 08577538350
06/03/1992 CIKEUSIK 085781660255
17/09/1983 CIKEUSIK 087709958555
29/09/1994 CIKEUSIK 085219539359
14/09/1995 CIKEUSIK 085217821409
01/01/1986 CIKEUSIK 085854161446
05/07/1999 CIKEUSIK 085246944675
26/01/1991 CIKEUSIK 085717347159
15/12/1991 CIKEUSIK 085280679935
16/11/2001 CIKEUSIK
12/09/1995 CIKEUSIK 085775261638
20/08/1995 CIKEUSIK 085774305395
25/04/1966 CIKEUSIK 085772756562
13/06/1978 SUKAMUL0858945266245
05/06/2004 CIKEUSIK 085773226575
21/04/1984 CIKEUSIK 0885210709599
31/12/2001 CIKEUSIK
CIKEUSIK
 Dosis I Dosis 2

Tanggal Tanggal Tanggal

Merek Vaksin*** Screeni Pemberi No.
Pemberi
No.
ng an No seri an No Seri
Batch Batch
Vaksina Vaksina
si si
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 KET

DUKCAPIL
 Nama Penerima
NO
No. Ticket NIK
Vaksin
1 3601041112090004GERY AKBAR FIKHAM
2 3601042307860001LUKI NURKHOLIS
3 3601044406620004KEBAH
4 3601045501780002SARTINI
5 3601044904850008SITI FATIMAH
6 3601045407780002SUMYATI
7 3601044709880003IMAS
8 3601044609010001SRI HESTINA
9 3601045511950001RINA
10 3601044508770001TITIN
11 3601042711630002UJANG ROHMAT
12 3329087011710001TOHIROH
13 3601045808980006JUMI RISNAWATI
14 3601046405790001SUKAESIH
15 3601045008830004SITI
16 3601045205710001UAT SUHAWATI
17 3601041601630001OJAT
18 3601041307100004AGUN GUNAWAN
19 3601046711760001AMI
20 3601044607990005NENTI YULIYANTI
21 3601044905900002YULI SUSILAWATI
22 3214034101800005YUYUN
23 3601041609040005ERWIN MAULANA
24 3601042703660001USRI
25 3601046901940001MILA ISMU NURUL W
26 3601044111970001RANI YULIANTI
27 3601045007940001DEWI
28 3601046502990004NINING YUNENGSIH
29 3601040101940003IYAN SOPYAN
30 3602016105950002DEWI ANGGITA
31 3601043101860001MUHAMAD BAGINDA
32 3601044510730003NASIH
33 3601044812930001MASRIAH
34 3601045708970005WINDRI YANI
35 3601041304900001FIRMAN KOSWARA
36 3601040303990007M. ABDUH MUHAJIR
37 3601174107900026SUTIAH
38 3601045504860004DEDE SITI
39 3601172102790002SARKUM
40 3601045909830001SAPTI
41 3601040104960006JAENAL ARIPIN
42 3601046011720001JUMALI
Umur
JK Pekerjaan*
(18-59 tahun)
L 12/11/2009
L 7/23/1986
P 6/4/1962
P 1/9/1981
P 4/9/1985
P 7/14/1984
P 9/7/1988
P 9/9/2001
P 11/15/1995
P 8/5/1977
L 11/27/1963
P 11/30/1971
P 8/18/1998
P 5/24/1979
P 8/10/1983
P 5/12/1971
L 1/16/1963
L 7/18/2004
P 11/27/1976
P 7/6/1999
P 5/9/1990
P 1/1/1980
L 9/16/2004
L 3/27/1966
P 1/29/1994
P 1/20/1997
P 7/5/1996
P 2/25/1999
L 9/10/1993
P 5/21/1995
L 1/31/1986
P 10/5/1973
P 8/24/1993
P 8/17/1997
L 4/13/1990
L 3/3/1999
P 7/1/1990
P 4/15/1986
L 2/21/1979
P 9/19/1983
L 8/19/1996
L 11/20/1965
43 3601045707630001SARNECA P 7/17/1963
44 3601045706050003MELI OKTAVIANI P 6/17/2005
45 3601046412020002NUR HOLIDAH P 12/24/2002
46 3601044806080005BUNGA NUR HALIZAH P 6/8/2007
47 3601046901800001TATI P 1/29/1980
48 3601045403990003ENOK WASNI H P 12/20/2002
49 3601046503810002RASNAH P 3/25/1981
50 3601042406050004DEDEN L 6/24/2005
51 3601045510730002ENENG SULIANAH P 10/15/1976
52 3601044911880002DARMI P 11/9/1988
53 3601044606880001OJAH MARDIANA P 2/18/1986
54 3601041012530001SIDIK L 12/10/1953
55 3601044507800014SATI P 7/5/1980
56 3601045705510002SARBAH P 5/17/1951
57 3601044901630001AMNAH P 1/9/1963
58 3601045308930003YULI P 8/13/1993
59 3601041410670001SARMIN L 10/14/1967
60 3601044107800249NACI P 7/1/1980
61 3601045405040001VINA MEYLANI P 5/14/2004
62 3601041901830003SAM'UN L 1/19/1978
63 3601041203660002KADAR L 3/12/1966
64 3601046606720002ANI P 6/26/1972
65 3601045404580002SARNITI P 4/14/1958
66 3601044306810001WARSIH P 6/3/1981
67 3601044607790007ROHAYATI P 7/6/1979
68 3601040903820004APUD L 3/9/1982
69 3601015808840002LAENAH SUSILAWATI P 8/18/1984
70 6301075008410001YATI P 8/10/1971
71 3505062909720001AGUS KUSWANTO L 9/29/1972
72 3601043101790001MISNEN L 1/31/1979
73 3601046301780002SUPIAH P 1/23/1978
74 3601040107920036CAHYONO L 6/3/1991
75 3601045005710008WIYAH P 5/10/1981
76 3601044503820007NATI ANDINI P 3/5/1982
77 3601040804780008PULUNG L 4/8/1978
78 3601041711760001NEDI L 11/17/1977
79 3601044505900004WATRI DAMAYANTI P 5/5/1990
80 3601044107680331SANIMAH P 7/1/1977
81 3601045102680003JUNAYAH P 2/11/1968
82 3601041610630001JUHDI L 10/16/1963
83 3601040307700005AHMAD L 7/3/1970
84 3601045908720002SAMI P 4/5/1973
85 3601045404850002ABSAH P 4/14/1985
86 3601040810530001NURDIN L 10/8/1953
87 3601044708800004INAR P 8/7/1980
88 3601045303780001JUMIYATI P 5/16/1979
89 3601040503780003SAPARUDIN L 3/5/1978
90 3601046702750001ASTI P 9/7/1975
 91 3601044306850001MAESAROH P 6/3/1985
92 3601044302850002NINING MAIDA P 2/3/1987
93 3601046009820002HAMDIAH P 9/20/1982
94 3601044706870004YUYUN P 7/6/1987
95 3601043003050001MOHAMAD RIFALDO L 3/30/2005
96 3601044508870008SUKANAH P 5/1/1968
97 3601046512950003ELAH HAYATI P 12/25/1995
98 3601045209820004SITI KHODIJAH P 9/12/1982
99 3601044203850010UNAYAH P 3/2/1985
100 3601044910680001YATI P 10/9/1968
101 3601046509900001MIMI MARYAMI P 9/26/1990
102 3601042104960001SAPRI L 4/4/1995
103 3601040304510001DANI L 4/3/1951
104 3601045012800007ERI P 12/10/1980
105 3601044312900004DESI IRAWAN P 12/3/1990
106 3601044410530001NACI P 10/4/1953
107 3601046709950002RASINAH P 9/27/1995
108 3601047005840001MURTI P 5/30/1984
109 3601046306970001ASNIAH P 12/3/1997
110 3601045502730003RASNAH P 2/15/1973
111 3601041006700003ROHEDI L 6/10/1970
112 3601045909780002ENENG P 9/19/1978
113 3601042510640002AJAN P 10/25/1964
114 3601046106870002YANTI P 5/6/1987
115 3601046005720001LEHA P 5/20/1972
116 3601040608900003AJAT SUDRAJAT L 10/4/1984
117 3601045809740002SANAH P 9/18/1975
118 3601045207790002ISAH P 7/12/1979
119 3601045408420002POPON PATIMAH P 8/14/1972
120 3601041718500002HAETAMI L
121 3601044209840003HENI P 9/2/1984
122 3601046207030001ENDELITA NUR P 7/23/2003
123 3601046003350002JUHA P 3/20/1935
124 3601045304950003YENI SUSANTI P 8/13/1994
125 3601045108710001JAWENAH P 8/11/1971
126 3601044402040003SITI NURAENI P 2/4/2004
127 3601044101850013RUMI P 1/1/1985
128 3601045404940003LULU P 4/14/1994
129 3601041903640003KAMONG L 3/19/1964
130 3601044107800246NITA HERDIYANTI P 8/10/1986
131 3601044802970003IRA P 2/8/1997
132 3601044107790143DANIRAH P 7/1/1979
133 3601040205830005HANI L 5/2/1983
134 3601045112770004ARNAH P 12/1/1977
135 3602211209980003PARTA WIJAYA L 7/1/1998
136 3601047005660001DARSINAH P 3/4/1973
137 1607025004700004JANI P 9/10/1970
138 3601045004780003ICAH P 5/10/1978
139 3601045201690003PARTI P 1/12/1969
140 3601044410760001SUTARTI P 10/4/1976
141 3601046706730001RUMANAH P 3/2/1978
142 3601045510970006SITI BADRIAH P 10/15/1997
143 3601044504720002BAINAH P 4/5/1972
144 3601046111670001RUKMI P 11/21/1967
145 3601045008820005IIS SULISTIAWATI P 8/10/1982
146 3601040903670003ARNAPI L 3/9/1967
147 3601045509880001TINAH P 9/15/1988
148 3601045606040002SUMI LESTARI P 6/16/2004
149 3601041903940001NURMAN L 3/19/1994
150 3601042606800001ASEP SUNARTA L 8/28/1989
151 3601034406900004RASWATI P 6/7/1993
152 3604286002800079ARIE FENTY SUTANTI P 2/20/1980
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Kelompok BPJS Non
INSTANSI Alamat NO HP BPJS
Umur Non Anggot
PBI
PBI a

DESA CIKIRUHWETAN 082299424146

DESA CIKIRUHWETAN 087820116556
DESA CIKIRUHWETAN 085693558408
DESA CIKIRUHWETAN 085774595706
DESA CIKIRUHWETAN 085714783214
DESA CIKIRUHWETAN 085714783214
DESA CIKIRUHWETAN 085693558408
DESA CIKIRUHWETAN 085710492066
DESA CIKIRUHWETAN 085693558408
DESA CIKIRUHWETAN 087773871977
DESA CIKIRUHWETAN 08558719317
DESA CIKIRUHWETAN 085216910189
DESA CIKIRUHWETAN 085781008975
DESA CIKIRUHWETAN 085692966129
DESA CIKIRUHWETAN 085891007664
DESA CIKIRUHWETAN
DESA CIKIRUHWETAN 085775204673
REMAJA DESA CIKIRUHWETAN 085773669705
DESA CIKIRUHWETAN 085811460039
DESA CIKIRUHWETAN 085773669705
DESA CIKIRUHWETAN 085691274121
DESA CIKIRUHWETAN 082258022157
REMAJA DESA CIKIRUHWETAN 085814397852
DESA CIKIRUHWETAN 085811462109
DESA CIKIRUHWETAN 085782381777
DESA CIKIRUHWETAN 085719648938
DESA CIKIRUHWETAN 085710490759
DESA CIKIRUHWETAN 085773210466
DESA CIKIRUHWETAN 085718763716
DESA CIKIRUHWETAN 085280256796
DESA CIKIRUHWETAN 085289594365
DESA CIKIRUHWETAN 085321298877
DESA CIKIRUHWETAN 083875405584
DESA CIKIRUHWETAN 085693582368
DESA CIKIRUHWETAN 085710490759
DESA CIKIRUHWETAN 085714287120
DESA CIKIRUHWETAN 083110005183
DESA CIKIRUHWETAN
DESA CIKIRUHWETAN 085240852296
DESA CIKIRUHWETAN 087772713751
DESA CIKIRUHWETAN 085273330675
DESA CIKIRUHWETAN 085332502517
 DESA CIKIRUHWETAN 081910822244
REMAJA DESA CIKIRUHWETAN 085609821560
DESA CIKIRUHWETAN 085211701139
REMAJA DESA CIKIRUHWETAN 085781545481
DESA CIKIRUHWETAN 085695147638
DESA CIKIRUHWETAN 085813104009
DESA CIKIRUHWETAN 08577278864
REMAJA DESA CIKIRUHWETAN 085703151295
DESA CIKIRUHWETAN 085886129990
DESA CIKIRUHWETAN 085894005649
DESA CIKIRUHWETAN 085715544358
LANSIA DESA CIKIRUHWETAN
DESA CIKIRUHWETAN
LANSIA DESA CIKIRUHWETAN 085960106310
DESA CIKIRUHWETAN 085694438450
DESA CIKIRUHWETAN 085710363766
DESA CIKIRUHWETAN 085891992814
DESA CIKIRUHWETAN
REMAJA DESA CIKIRUHWETAN 085861153774
DESA CIKIRUHWETAN 085759552920
DESA CIKIRUHWETAN 085614397852
DESA CIKIRUHWETAN 083808164015
LANSIA DESA CIKIRUHWETAN 085695000981
DESA CIKIRUHWETAN 085695000981
DESA CIKIRUHWETAN 085772728873
DESA CIKIRUHWETAN 085609821560
DESA CIKIRUHWETAN 085694438450
DESA CIKIRUHWETAN 085813639928
DESA CIKIRUHWETAN 085691080993
DESA CIKIRUHWETAN 085691080993
DESA CIKIRUHWETAN 085697594269
DESA CIKIRUHWETAN 083875405584
DESA CIKIRUHWETAN 085694567509
DESA CIKIRUHWETAN 085694567509
DESA CIKIRUHWETAN 083841467563
DESA CIKIRUHWETAN 085711491727
DESA CIKIRUHWETAN 083109654917
DESA CIKIRUHWETAN 0859610106310
DESA CIKIRUHWETAN 085773674648
DESA CIKIRUHWETAN 08569403145
DESA CIKIRUHWETAN 085774653213
DESA CIKIRUHWETAN 085960106310
DESA CIKIRUHWETAN 085813104054
LANSIA DESA CIKIRUHWETAN 085773674648
DESA CIKIRUHWETAN 085211706742
DESA CIKIRUHWETAN 085814339743
DESA CIKIRUHWETAN 085211706742
DESA CIKIRUHWETAN 083874666448
 DESA CIKIRUHWETAN 085695384034
DESA CIKIRUHWETAN 085695384034
DESA CIKIRUHWETAN 085782630008
DESA CIKIRUHWETAN 085960106310
REMAJA DESA CIKIRUHWETAN 083874029704
DESA CIKIRUHWETAN 085695000981
DESA CIKIRUHWETAN 083815214648
DESA CIKIRUHWETAN 085972802472
DESA CIKIRUHWETAN 081296011496
DESA CIKIRUHWETAN 083893402079
DESA CIKIRUHWETAN 083872721740
DESA CIKIRUHWETAN 085694438450
LANSIA DESA CIKIRUHWETAN 081511861449
DESA CIKIRUHWETAN 085773669201
DESA CIKIRUHWETAN 081511861449
LANSIA DESA CIKIRUHWETAN 085882451732
DESA CIKIRUHWETAN 085692735179
DESA CIKIRUHWETAN 085960106310
DESA CIKIRUHWETAN 085668789202
DESA CIKIRUHWETAN 085715411810
DESA CIKIRUHWETAN 085695000981
DESA CIKIRUHWETAN 087773871977
DESA CIKIRUHWETAN 081585259837
DESA CIKIRUHWETAN 085716363944
DESA CIKIRUHWETAN 085960106310
DESA CIKIRUHWETAN 083848122793
DESA CIKIRUHWETAN 085715543752
DESA CIKIRUHWETAN 081224951660
DESA CIKIRUHWETAN 085778988432
DESA CIKIRUHWETAN 085782631409
DESA CIKIRUHWETAN 085719021044
DESA CIKIRUHWETAN 083814556259
LANSIA DESA CIKIRUHWETAN 081224951660
DESA CIKIRUHWETAN 085695599080
DESA CIKIRUHWETAN 085960106310
REMAJA DESA CIKIRUHWETAN 085779695625
DESA CIKIRUHWETAN 085813104054
DESA CIKIRUHWETAN 085759552931
DESA CIKIRUHWETAN 085960106310
DESA CIKIRUHWETAN 082217686127
DESA CIKIRUHWETAN 081511690546
DESA CIKIRUHWETAN 085862716230
DESA CIKIRUHWETAN 081296011496
DESA CIKIRUHWETAN 085961006310
DESA CIKIRUHWETAN 081908179766
DESA CIKIRUHWETAN 085649018072
DESA CIKIRUHWETAN 082350591119
DESA CIKIRUHWETAN 081585259837
 DESA CIKIRUHWETAN 085775202811
DESA CIKIRUHWETAN 085770623481
DESA CIKIRUHWETAN 085693558408
DESA CIKIRUHWETAN 085711304576
DESA CIKIRUHWETAN 085695000981
DESA CIKIRUHWETAN 083872721740
DESA CIKIRUHWETAN 083848122793
DESA CIKIRUHWETAN 083891042064
DESA CIKIRUHWETAN 081514579180
REMAJA DESA CIKIRUHWETAN 083841378200
DESA CIKIRUHWETAN 0859102637559
DESA CIKIRUHWETAN 085773225742
DESA CIKIRUHWETAN 085880588386
DESA CIKIRUHWETAN 087774316000
 Dosis I Dosis 2

Tanggal Tanggal Tanggal

Merek Vaksin***
Screening Pemberian No. Batch No seri Pemberian
Vaksinasi Vaksinasi

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Dosis 2

KET
No. Batch No Seri

202109199EEUA2057300143A1
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202109199EEUA2057300143A1

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202109199EEUA2057300143A1
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202109199EEUA2057300143A1

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202109199EEUA2057300143A1
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202109199EEUA2057300143A1
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202109199EEUA2057300143A1
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202109199EEUA2057300143A1
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202109199EEUA2057300143A1
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202109199EEUA2057300143A1
202109199EEUA2057300143A1
 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601040106690001 BAHIM L
2 3601046510960004 RASINIH P
3 3601040808880001 SUKARDI L
4 3601044107780328 MASTUROH P
5 3601040107630316 DASILAH L
6 3601040107720096 BAHRUDIN L
7 3601045611890002 WATI'AH P
8 3601040107600089 SARWAN L
9 3601046903940001 DESI P
10 3601042501940001 JAMALUDIN L
11 3601040107830256 RASWIDI L
12 3601044403890001 SARI WATI P
13 3601044107850365 AYUNAH P
14 3601040211850004 MAMAD L
15 3601046710930001 IS SUPIYANTI P
16 3601041701800001 DINAH L
17 3601046006530001 ARSIH P
18 3601044107780362 CARSINAH P
19 3601041507000004 RIYANTO L
20 3601040107630327 SALIM L
21 3601044103880003 SADIAH P
22 3601040612630001 SAMAIN L
23 3601046303670001 ARTI P
24 3601044107700122 NIROH P
25 3601040107840171 SANA L
26 3601045707950006 SUNITI P
27 3601044107870131 SURINIH P
28 3601044503720002 KHODIJAH P
29 3601046811020002 SAMINAH P
30 3601044305760001 NURYATI P
31 3601044401880002 MARSIH P
32 3601044707830006 SANIMAH P
33 3601044207880004 ROSINAH P
34 3601044503830004 UNASIH P
35 3601044207840005 AISAH P
36 3601044910910001 RIYANTI P
37 3602211307920002 JULI L
38 3601040107800267 JUJU L
39 3601040107810138 DENDI L
40 3601040107900224 TARKIM L
41 3601040712820001 TASNO L
42 3601040607850004 ADE L
43 3601040706720002 SELAMET L
44 3601044107850246 IDA UMAMI P
45 3601045410000005 LILIS P
46 3601042007050001 DENI L
47 3601041705670002 CASMA L
48 3601040107910248 ENDA L
49 3601040107810198 JAENAL L
50 3601041001380002 RABAN L
51 3601041107800007 ROJIKIN L
52 3601045205560001 IRAH P
53 3601046001530003 WARINAH P
54 3601040107710123 RASID L
55 3601044808790007 SIKE P
56 3671050508020019 ARIPIN L
57 3601040107750243 SOLIKIN L
58 3601045605910002 MASKAH P
59 3601042111040001 KELPIN L
60 3601042007970002 ADE CAHYONO L
61 3601044206710001 SUKESIH P
62 3601041410030002 IRWANSYAH L
63 3601045709770004 MUMUN P
64 3601041911040002 ANSORI L
65 3601041602900002 M. JUNAEDI L
66 3601040304890003 USNADI L
67 36010401077300325 DURMA L
68 3602215110990001 NUR HASANAH P
69 3601041403770001 AJID L
70 3601040107900223 DULWAHID L
71 3601044304810001 UTIYAH P
72 3601042107360001 KARNA L
73 3601044107730324 YENI P
74 3601040308970002 SUWANDI L
75 3601041001030005 YOGI L
76 3601044506980003 DIAH SUSANTI P
77 3601041907920002 KARDI L
78 3601045406970003 NENENG P
79 3601044510800001 ARIMAH P
80 3601040902800003 JONI L
81 3601044101780015 CARSINIH P
82 3601040107730314 MARJUKI L
83 3601040107650199 MATORA P
84 3601046808040001 TIA P
85 3601044107680269 TARSINAH P
86 3601040107780298 RASTA L
87 3601040910830002 SARHANI L
88 3601044107830344 JULEHA P
89 3601044310960003 PIPIH P
90 3601046112000001 PUTRI P
91 3601044107850247 SODAH P
 92 3601041003970001 RAHMAN FAUZI L
93 3601046307840001 TARSIH P
94 3601044805850004 ENUR P
95 3601045102810001 YUYUN P
96 3601041109650002 JUHRA L
97 3601041310770001 K. UJANG L
98 3601045407780004 JUNESIH P
99 3601045308720003 ICEU P
100 3601044705500004 SUKAEMAH P
101 360220617910001 IIN P
102 3601040704520003 SAKURI L
103 3601046712690001 ARTA P
104 3601042207620002 DULHANAN L
105 3601046110880002 ERNA P
106 3601044203820002 NURSITI P
107 3601046411870001 ENENG P
108 3601045508670001 ARNAH P
109 36010434507840005 ROKAYAH P
110 3601044409860003 MARYAM P
111 3601046203920001 SITI SUHALIYAH P
112 3601044509750001 NURSITI P
113 3601044302040001 LIA SARI P
114 3601045401750001 SARNAWATI P
115 3601044312850003 EHA J U
116 3601044107680361 ASBAH P
117 3601044807550001 JUNI P
118 3601045009770001 ROHAMAH P
119 3601044209790002 TARSIAH P
120 3601044705790001 MURNI P
121 3601044705880002 UMDAH P
122 3601045002790001 BAI P
123 3601041803610001 HADI L
124 3601040409650001 ADANG L
125 3601040705840003 SARIPUDIN L
126 3601040503860004 MUHAMAD L
127 3601042008870002 KOMARUDIN L
128 3601031508910001 AMIRUDIN L
129 3601041209720003 UCI L
130 3601040908820002 SUDIN L
131 3601040403740001 SUANDRA L
132 3601040403820003 HASIM L
133 3601041907800002 CEPRUDIN L
134 3601040302800002 SANUDIN L
135 3601044407650001 AMINAH P
136 3601034507840005 KARSIM L
137 3601044403720003 ENUR P
138 3601044907670001 HAERIAH P
139 3601044107900177 KURNAESIH P
140 3601046708020002 LELA P
141 3601042205740001 TOWI L
142 3601040977200001 KARSUDIN L
143 3601045808890002 RODIAH P
144 3601045805020001 SELI P
145 3601044110760001 DESI P
146 3601045003830003 WATI P
147 3601045609070002 KORIAH P
148 3601045205740002 ARMAH P
149 3601045602090001 SITI WAHYUNI P
150 3603326109890002 JAMSITI P
151 3601045603980009 ROPIAH P
152 3601042005650001 HJ. SOHALI L
153 3601040504970002 IRFAN L
154 3601045204630002 RUMSIH P
155 3601046207800001 RASMINAH P
156 3601042904920001 RATIH P
157 3601045111050000 NURAENI P
158 3601045111710001 LILIS P
159 360044205750001 RAMI P
160 3601041610880001 RAHMAT L
161 3601045404000003 SINTIA P
162 3601044101950017 KARSIH P
163 3601040904850002 ROEPI L
164 3601040456700002 SUKARI L
165 3601044111550001 ANIMAH P
166 3601045403710003 WARINIH P
167 3601044104670001 IJAH P
168 3601042703600001 WARSINTA L
169 3601041102840001 WITA L
170 3601045304720001 KARMINIH P
171 1602115907800002 MARIAM P
172 3601045502590001 KARTINI P
173 3601044812940001 OTIMAH P
174 3601045104700003 MUANAH P
175 3276025401660004 RUSYATI P
176 360104490760001 UNASIH P
177 36010412002780004 LETIW L
178 3601044203960009 RAMAH ARNI P
179 3601040411040002 SARIP HIDAYAT L
180 3601041504970003 MISANA L
181 3601042212620002 WARSITA L
182 3601041611970001 JUNEDI L
183 3601046008750002 KARSIH P
184 3601040601860003 YANTO L
185 3601045107810005 DARNI P
186 3601041209720002 TARDA L
187 3601040811640001 CARSAM L
188 3601040609040003 TARWAWI L
 Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP
ok Umur
tahun)

01-06-1969 UMUM SUKASENENG 083802190104

25-10-1996 UMUM SUKASENENG 081284850131
08-08-1988 UMUM SUKASENENG 085813590566
01-07-1978 UMUM SUKASENENG 085813590566
03-10-1960 LANSIA SUKASENENG 085813590566
14-08-1973 UMUM SUKASENENG 085813590566
22-11-1990 UMUM SUKASENENG 085718271216
08-07-1960 LANSIA SUKASENENG 085718271216
29-03-1994 UMUM SUKASENENG 085718271216
25-01-1994 UMUM SUKASENENG 085718271216
01-07-1983 UMUM SUKASENENG 085213864485
04-03-1989 UMUM SUKASENENG 085213864485
07-04-1990 UMUM SUKASENENG 08578266483
02-11-1985 UMUM SUKASENENG 081218199477
27-10-1992 UMUM SUKASENENG 081218199477
04-02-1979 UMUM SUKASENENG 081218199477
20-06-1953 LANSIA SUKASENENG 081218199477
20-02-1974 UMUM SUKASENENG 081218199477
15-07-2000 UMUM SUKASENENG 08129894747
01-07-1963 UMUM SUKASENENG 081211481848
12-04-1989 UMUM SUKASENENG 081211481848
03-06-1965 UMUM SUKASENENG 081211481848
23-03-1967 UMUM SUKASENENG 085281761023
21-07-1970 UMUM SUKASENENG 085281761023
04-04-1976 UMUM SUKASENENG 085770130952
17-07-1995 UMUM SUKASENENG 085770130952
01-07-1987 UMUM SUKASENENG 085770130952
05-03-1972 UMUM SUKASENENG 085284015920
28-11-2002 UMUM SUKASENENG 085284015920
03-05-1978 UMUM SUKASENENG 085284015920
04-01-1988 UMUM SUKASENENG 085213864485
07-07-1983 UMUM SUKASENENG 085213864485
02-07-1990 UMUM SUKASENENG 085213864485
05-03-1983 UMUM SUKASENENG 085776864406
06-08-1980 UMUM SUKASENENG 085776864406
09-10-1991 UMUM SUKASENENG 087773344556
13-07-1992 UMUM SUKASENENG 087773344556
06-06-1984 UMUM SUKASENENG 087773344556
01-07-1981 UMUM SUKASENENG 087773344556
27-07-1991 UMUM SUKASENENG 082312280242
07-12-1982 UMUM SUKASENENG 082155500960
08-07-1985 UMUM SUKASENENG 082155500960
07-06-1972 UMUM SUKASENENG 082155500960
01-07-1995 UMUM SUKASENENG 082155500960
14-10-2000 UMUM SUKASENENG 082155500960
20-07-2005 REMAJA SUKASENENG 082155500960
17-05-1967 UMUM SUKASENENG 082155500960
25-08-1991 UMUM SUKASENENG 085718707967
10-10-1985 UMUM SUKASENENG 085718707967
10-01-1983 UMUM SUKASENENG 085281760531
11-07-1980 UMUM SUKASENENG 085281760531
12-05-1956 LANSIA SUKASENENG 085281760531
20-01-1953 LANSIA SUKASENENG 085281760531
01-07-1971 UMUM SUKASENENG 085281760531
08-08-1979 UMUM SUKASENENG 085281760531
05-08-2002 UMUM SUKASENENG 085281760531
12-04-1978 UMUM SUKASENENG 085281760531
16-05-1991 UMUM SUKASENENG 085281760531
21-11-2004 REMAJA SUKASENENG 08577323741
20-07-1997 UMUM SUKASENENG 08577323741
02-06-1971 UMUM SUKASENENG 08577323741
25-10-2009 REMAJA SUKASENENG 081510281518
17-09-1977 UMUM SUKASENENG 081510281518
19-11-2004 REMAJA SUKASENENG 081510281518
16-02-1990 UMUM SUKASENENG 085713271099
12-05-1989 UMUM SUKASENENG 085713271099
01-07-1993 UMUM SUKASENENG 085713271099
11-01-1999 UMUM SUKASENENG 085713271099
14-03-`977 UMUM SUKASENENG 085773237471
09-10-1989 UMUM SUKASENENG 085773237471
03-04-1981 UMUM SUKASENENG 081283853919
21-07-1989 UMUM SUKASENENG 081283853919
01-07-1973 UMUM SUKASENENG 081283853919
11-10-1960 LANSIA SUKASENENG 081283853919
10-01-2003 REMAJA SUKASENENG 081283853919
05-06-1998 UMUM SUKASENENG 087761678921
15-03-1981 UMUM SUKASENENG 087761678921
14-06-1997 UMUM SUKASENENG 087761678921
05-10-1980 UMUM SUKASENENG 087761678921
09-02-1980 UMUM SUKASENENG 087761678921
01-01-1978 UMUM SUKASENENG 087761678921
01-07-1973 UMUM SUKASENENG 087761678921
01-07-1965 UMUM SUKASENENG 087761678921
28-08-2004 REMAJA SUKASENENG 085778299815
01-07-1968 UMUM SUKASENENG 085778299815
01-07-1978 UMUM SUKASENENG 085778299815
09-10-1983 UMUM SUKASENENG 085778271979
01-07-1983 UMUM SUKASENENG 085778271979
03-10-1989 UMUM SUKASENENG 085778271979
21-12-2001 UMUM SUKASENENG 085778271979
01-07-1985 UMUM SUKASENENG 085778271979
20-03-1997 UMUM SUKASENENG 08770973132
03-07-1984 UMUM SUKASENENG 08770973132
08-05-1985 UMUM SUKASENENG 08770973132
27-08-1988 UMUM SUKASENENG 08770973132
11-06-1965 UMUM SUKASENENG 08770973132
13-10-1977 UMUM SUKASENENG 083890674117
14-07-1978 UMUM SUKASENENG 083890674117
13-08-1972 UMUM SUKASENENG 085212609501
07-05-1960 LANSIA SUKASENENG 085212609501
21-07-1991 UMUM SUKASENENG 0856644055466
07-04-1952 UMUM SUKASENENG 0856644055466
27-12-1986 UMUM SUKASENENG 085886172287
22-07-1962 UMUM SUKASENENG 085886172287
04-04-1989 UMUM SUKASENENG 085886172287
02-03-1982 UMUM SUKASENENG 085776136396
24-11-1987 UMUM SUKASENENG 085776136396
19-08-1972 UMUM SUKASENENG 085776136396
05-07-1984 UMUM SUKASENENG 085776136396
04-09-1986 UMUM SUKASENENG 085882498532
22-03-1992 UMUM SUKASENENG 085882498532
05-09-1975 UMUM SUKASENENG 085882498532
25-04-2004 REMAJA SUKASENENG 081213069484
14-01-1975 UMUM SUKASENENG 081213069484
27-07-1988 UMUM SUKASENENG 081213069484
05-06-1960 LANSIA SUKASENENG 085779245719
08-07-1965 UMUM SUKASENENG 085779245719
10-09-1977 UMUM SUKASENENG 085779245719
02-09-1979 UMUM SUKASENENG 085779245719
07-05=1969 UMUM SUKASENENG 083878400111
07-05-1988 UMUM SUKASENENG 085717521740
10-02-1979 UMUM SUKASENENG 085717521740
18-03-1981 UMUM SUKASENENG 085717521740
04-09-1965 UMUM SUKASENENG 085717521740
07-05-1984 UMUM SUKASENENG 085717521740
07-01-1979 UMUM SUKASENENG 085213113854
20-08-1967 UMUM SUKASENENG 085213113854
15-08-1987 UMUM SUKASENENG 085694055436
12-09-1972 UMUM SUKASENENG 085694055436
15-03-1982 UMUM SUKASENENG 085694055436
04-03-1974 UMUM SUKASENENG 085216583013
04-03-1984 UMUM SUKASENENG 085216583013
19-07-1980 UMUM SUKASENENG 085216583013
03-02-1980 UMUM SUKASENENG 085211458922
04-07-1965 UMUM SUKASENENG 085211458922
05-01-1965 UMUM SUKASENENG 085211458922
04-03-1972 UMUM SUKASENENG 085211458922
09-07-1967 UMUM SUKASENENG 083879023909
05-09-1986 UMUM SUKASENENG 083879023909
27-08-2002 UMUM SUKASENENG 083879023909
22-05-1974 UMUM SUKASENENG 083879023909
09-07-1972 UMUM SUKASENENG 083879023909
18-08-1989 UMUM SUKASENENG 083879023909
18-05-2002 UMUM SUKASENENG 085890125073
01-10-1976 UMUM SUKASENENG 085890125073
22-07-1984 UMUM SUKASENENG 085890125073
16-09-2007 REMAJA SUKASENENG 085283233148
16-05-1974 UMUM SUKASENENG 085283233148
14-02-2004 REMAJA SUKASENENG 085283233148
21-09-1989 UMUM SUKASENENG 085283233148
15-03-1998 UMUM SUKASENENG 085770702232
20-05-1965 UMUM SUKASENENG 085770702232
28-01-1998 UMUM SUKASENENG 085770702232
12-04-1957 LANSIA SUKASENENG 085213476318
22-07-1980 UMUM SUKASENENG 085213476318
31-12-1997 UMUM SUKASENENG 085213476318
19-06-2008 REMAJA SUKASENENG 085213476318
11-11-1971 UMUM SUKASENENG 085213476318
02-05-1975 UMUM SUKASENENG 085213476318
16-10-1989 UMUM SUKASENENG 082319733730
18-02-2008 REMAJA SUKASENENG 082319733730
01-01-1995 UMUM SUKASENENG 082319733730
09-04-1985 UMUM SUKASENENG 082319733730
01-07-1971 UMUM SUKASENENG 082319733730
01-11-1955 LANSIA SUKASENENG 082319733730
14-03-1961 UMUM SUKASENENG 082319733730
01-04-1967 UMUM SUKASENENG 082319733730
08-07-1962 UMUM SUKASENENG 082319733730
11-03-1966 UMUM SUKASENENG 087827730099
13-04-1972 UMUM SUKASENENG 087827730099
10-07-1980 UMUM SUKASENENG 087827730099
15-02-1959 LANSIA SUKASENENG 087827730099
08-12-1994 UMUM SUKASENENG 087827730099
11-04-1970 UMUM SUKASENENG 087827730099
14-01-1966 UMUM SUKASENENG 081283239929
11-06-1977 UMUM SUKASENENG 081283239929
12-02-1978 UMUM SUKASENENG 081283239929
02-03-1996 UMUM SUKASENENG 081283239929
11-04-2004 REMAJA SUKASENENG 081283239929
15-04-1997 UMUM SUKASENENG 081283239929
22-12-1962 UMUM SUKASENENG 085693645905
02-06-1990 UMUM SUKASENENG 085693645905
20-08-1975 UMUM SUKASENENG 085693645905
06-01-1986 UMUM SUKASENENG 085693645905
16-11-1988 UMUM SUKASENENG 085693645905
08-01-1975 UMUM SUKASENENG 085693645905
08-11-1964 UMUM SUKASENENG 081584376665
06-09-2004 REMAJA SUKASENENG 081584376665
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai) Merek Tanggal Tanggal
BPJS BPJS Non Vaksin*** Screening Pemberian No. Batch
PBI Non PBI Anggota
Vaksinasi
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021 14-12-2021 202108171F
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC 14-12-20221
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC 14-12-2021
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC 14-12-2021
CORONAVAC 14-12-2021
 Dosis 2
Tanggal KET
No seri Pemberian No. Batch No Seri
Vaksinasi
14-12-2021 202108171F
14-12-2021 202108171F

14-12-2021 202108171F
NO No. Ticket NIK Nama Penerima Vaksin JK Pekerjaan*

1 3601046511860003 JUMIATI P
2 3601044107730185 SAMEN P
3 3601044505720001 IPAH P
4 3601040107690046 DULHADI L
5 3601034107920218 UYUM P
6 3601042301650002 WANDI L
7 3601045808920005 CASIROH P
8 3601044107730188 JUJU P
9 3601044107660058 TARINIH P
10 3601040107650085 KARBIN L
11 3601044107790060 CASRI P
12 3601044905020005 DEWI SAFITRI P
13 3601044107010129 UNAYAH P
14 3601044107030105 MERI ANDANI P
15 3601045509020001 IIN LAATIFAH P
16 3601040612810004 ASMAR HERMAWATI P
17 3601040108710001 SUNARTA L
18 3601041203800003 TARNO L
19 3601045403050002 SRI HARDIANTI P
20 3601044107550054 SALAMAH P
21 3603235307820004 JARNAH P
22 3601040107510059 EDI BET L
23 3601044506720002 RUMSANAH BT ASTARI P
24 3601046409940001 WASTINI P
25 3601045512870002 EEN P
26 3601040107820070 SUKIRMAN L
27 3601044107430045 CARKEM P
28 3601045512870001 SUMINAH P
29 3601044503940001 UMYANAH P
30 3601044102780003 SUKAESIH P
31 3601045302750001 UMI P
32 3601044107750113 UMIAH P
33 3601040160040001 NENTI P
34 3601045105900005 MARINIH P
35 3601044406700003 ETI SUHETI P
36 3601044902080001 MARNAH P
37 3601046903990003 SITI HODIJAH P
38 3601046606000002 R0SALINDA P
39 3601044107000293 MISTA P
40 3601047004980001 SITI MAESAROH P
41 3601031406980001 UMRI L
42 3601044905950002 YANTI P
43 3601046207740001 RUSTIAH P
44 3601044808000003 SANIMAH P
45 3601044809600001 JUMINAH P
46 3601043004150003 NURYATI P
47 3601045608010002 NURHAYATI P
48 3601044107770068 MARYATI BT KASWAN P
49 3601044109960004 AMAH P
50 3601040107580118 KASWARI L
51 3601044107780190 BAWON L
52 3601044608660001 RASMI P
53 3601040105900001 RASMIN WIRAYUDA L
54 3601044708960006 RESNAWATI P
55 3601044107750119 TARSINIH P
56 3601044107850151 SUMARNI P
57 3601040508960002 ASEP P
58 3601042211010001 MOH RAHMAT L
59 3601046102860003 TINI P
60 3601044808740001 SANAH P
61 3601045807780001 ANAH P
62 3601045205790003 INAH P
63 3601040205650001 JAYA B BUKING P
64 3601040107780208 DARKIM L
65 3601046401980004 RISNAWATI P
66 3601040107760114 RASDA L
67 3601044506040005 NOVI UNIA PUTRI P
68 3601045203030007 NURHASANAH P
69 3601048710040061 SITI NURBAYA P
70 3601044202200003 NURWANI P
71 3601044101890010 SOLEKA P
72 360104512970006 SITI JUNENGSIH P
73 360104111760002 CARMI P
74 3601044101890010 EMI P
75 3601040107630139 JAHRUN L
76 3601040706500002 MARHAPI L
77 3602214206760003 YULAENI P
78 3601044107630131 KATIMAH P
79 3601044107870166 ENONG P
80 3601044107570042 AMINAH P
81 3601044107620036 SAYU P
82 3601044107780183 WARTI P
83 3601040107740065 SARDANI L
84 3601044107540031 KADIEM P
85 3601047012840002 UMYATI P
86 3601044107930170 MIMIN P
87 3601044107690053 NINGRAT P
88 3601046305910001 ENI P
89 3601045304930002 SURNI P
 90 3601044107750281 MASNI P
91 3601040107010162 SARMITA P
92 3601044406800001 RANI P
93 3601046104050002 SARWATI P
94 3602215402950001 RANI P
95 3601044107600119 SAENAH P
96 3601045205650001 MARNAH P
97 3601046001770006 SURYATI P
98 3601044305710003 KASTIRI P
99 3601045607500001 JASTI P
100 3601045402890001 IDA MASTUROH P
101 3601040912770002 HASAN BUKHORI L
102 3601040107580293 ACANG L
103 3601040107670037 SUNI P
104 3601044308950001 TUTI P
105 2171024409799005 DINDA P
106 3601044911770005 MIMIH P
107 3601044107750127 WASNINGKEM P
108 3601044107720048 WIWI P
109 3601040501690001 KUSNI L
110 3601034107010271 IDA LAELA P
111 3601024506890004 NENGSIH YUNENGSIH P
112 3601044107810106 SUTINAH P
113 3601044102810002 ENI P
114 3601045611080002 NIA NOPIAYANTI P
115 3601044102740002 ICAH P
116 3601045203860002 YENI WIDAYANTI P
117 3601044406780007 SUKANAH BT H TOHI P
118 3601040187920164 ASEP SURYANA L
119 3601046308950002 KANAH P
120 3601046411070002 ALVIE P
121 3601040107630104 ASTAM L
122 3601046307880002 SANTI P
123 3601045911890001 MASNAH P
124 3601040302040001 AJENG TRI P
125 3601045507970008 IPAH HATIPAH P
126 3601045004650002 TARSINIH P
127 3601044107630150 RUMINAH P
128 3601045204730006 ARSIAH P
129 3601084107020052 SITI KHOLIPAH P
130 3601041511720004 ADZOM P
131 3601044107810108 BUTINAH P
132 3601040102750006 SARIP L
133 3601041007650003 SURYA L
134 3601041408750001 MAMAD L
135 3601041002780003 YAYA SUNARYA L
136 3601041506000001 EKI RIFALDO L
137 3601030107860326 JAMSANI L
138 3601040902890001 ASRI P
139 3601042502710002 SARDIMAN L
140 3601030207660002 EMAN P
141 3601040107630122 WARJI L
142 3601040506650001 TOBRI L
143 3601040107780211 SARDA L
144 3217075011790021 ABSAH P
145 3217075607980007 EVA TIURIDA P
146 3601042404940003 HALIMI L
147 3601041312600001 ARSID B NARSA L
148 3601046310790001 KOMARIAH P
149 36010401300013 ROSANDI L
150 3601040405000005 YUSRIL MAHENDRA L
151 36010410107760091 SUGRIA L
152 3601040104990014 UJANG SAEPUL L
153 3601041403910002 DEDE L
154 3601041708020002 BAMBANG KASMALA L
155 3601041109000005 ARI RUSPANDI L
156 3601040107010142 RENO RIANTO L
157 3601044107710082 SURINIH P
158 3601040107910171 HERI L
159 3601040802020005 DENTA L
160 3601044107000311 NINIH P
161 3601045409950006 NENI MARYANI P
162 3601045503700005 ISAH P
163 3601044707070004 WARNI P
164 3602211207970002 RIMA MELATI P
165 3601043107860001 ADE SUBHAN L
166 3601044107420041 SONAH P
167 3601042611940082 NENDI L
168 3601041502850002 AGUS GUNAWAN L
169 3601040804800002 JUMRI L
170 3601042005690002 JUMRI L
171 3601040107540023 MASKUN L
172 3601045002600002 ADE P
173 3601040107740110 SUDIN L
174 3601045103790001 YATI P
175 3601041102780005 TAMAL L
176 3601042404040002 APIT PIRMANSYAH L
177 3601044307840005 SUMINAH P
178 3601040905070001 YASMIN L
179 3601030107810140 SARDI L
180 3601045602980002 ENI L
181 3601045401790002 NUNUNG KASMERI L
182 3601034105880001 WASTINI P
183 LIAWATI P
184 3601046707040003 DELA P
185 3601044107730195 DASIEM P
186 3601042305960003 ENDI L
187 3601044306080000 LINDA P
188 3602090810920002 SUHADI L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang
sesuai)
Umur Kelomp
INSTANSI Alamat NO HP BPJS BPJS
(18-59 tahun) ok Umur
PBI Non PBI

25/11/1986 NANGGALA 082311810813

01/07/1973 NANGGALA 081511406435
05/09/1972 NANGGALA 085717564786
06/09/1964 NANGGALA 085774504127
01/07/1992 NANGGALA 085772832699
29/01/1965 NANGGALA 085772832699
18/08/1992 NANGGALA 083147294125
01/07/1973 NANGGALA 085773624427
01/07/1966 NANGGALA 085283236054
01/07/1965 NANGGALA 085778281050
21/04/1979 NANGGALA 085693603645
09/05/2002 NANGGALA 085695153368
17/04/2001 NANGGALA 085813892507
26/09/2000 NANGGALA 085773624427
NANGGALA 0857736224351
NANGGALA 082111549336
12/08/1971 NANGGALA 085215836872
12/03/1980 NANGGALA 085871616853
14/03/2005 NANGGALA 085710515568
01/07/1955 NANGGALA 085891605386
13/07/1962 NANGGALA 085774624412
01/07/1951 NANGGALA 085215836872
05/06/1972 NANGGALA 081219406923
24/09/1994 NANGGALA 081284910166
15/12/1987 NANGGALA 085691137614
03/02/1983 NANGGALA 081243017226
NANGGALA 081296529792
15/12/1987 NANGGALA 083878954629
11/10/1994 NANGGALA 085697188446
04/04/1979 NANGGALA 085771613835
13/02/1975 NANGGALA 085695409639
01/07/1975 NANGGALA 085777216800
NANGGALA 085710506527
05/06/1965 NANGGALA 085880004779
04/06/1970 NANGGALA 085693542174
01/07/1955 NANGGALA 08568003044
29/03/1999 NANGGALA 081381088255
26/06/2001 NANGGALA 085718774874
07/06/2005 NANGGALA 085695268294
30/04/1998 NANGGALA 085779170313
14/06/1998 NANGGALA
09/05/1995 NANGGALA 085778282035
23/07/1974 NANGGALA 085283044320
08/08/2000 NANGGALA 085219690435
08/09/1960 NANGGALA 082374627524'
NANGGALA 085880846235
26/08/2001 NANGGALA 085210935570
06/04/1980 NANGGALA 085219736811
01/09/1996 NANGGALA 083151383667
01/07/1968 NANGGALA 085771613799
01/07/1978 NANGGALA 085771613799
NANGGALA 082114451345
01/05/1990 NANGGALA 085866558990
07/08/1996 NANGGALA 082374627534
01/07/1975 NANGGALA 085771613891
01/07/1985 NANGGALA 081511899205
05/08/1996 NANGGALA 085814303405
22/11/2001 NANGGALA 085778281050
21/02/1986 NANGGALA
08/08/1974 NANGGALA 085880005318
15/03/1984 NANGGALA 085710506298
12/05/1979 NANGGALA 085782134800
02/05/1965 NANGGALA 085693603518
01/07/1983 NANGGALA 085718877208
24/01/1998 NANGGALA 085717893630
01/07/1976 NANGGALA 081511959178
01/03/1975 NANGGALA 085773236576
NANGGALA 085215145670
27/10/2004 NANGGALA 081574851030
08/01/1995 NANGGALA 085710506261
08/07/2007 NANGGALA 086565268218
12/12/1997 NANGGALA 085213078966
01/07/1953 NANGGALA 087754421677
01/01/1989 NANGGALA 081213381070
NANGGALA 085218982043
07/06/1950 NANGGALA 082310769551
24/04/1976 NANGGALA
01/07/1963 NANGGALA 081382564692
01/07/1987 NANGGALA 085711038584
01/07/1957 NANGGALA 085210571146
01/07/1962 NANGGALA 085817969945
11/07/1978 NANGGALA 085782266645
15/05//1974 NANGGALA 085782266641
01/07/1954 NANGGALA 085695268248
15/01/1963 NANGGALA 085717132536
01/07/1993 NANGGALA 085781192765
02/03/1969 NANGGALA
23/05/1995 NANGGALA 085214000540
13/04/1993 NANGGALA 081511412432
01/07/1975 NANGGALA 085770913167
NANGGALA
NANGGALA 085693603585
21/04/2005 NANGGALA 085703083400
NANGGALA
01/07/1960 NANGGALA 085880005421
12/05/1995 NANGGALA 085774903298
20/01/1977 NANGGALA 085691159062
03/05/1971 NANGGALA 085283045058
16/07/1950 NANGGALA
14/02/1989 NANGGALA 085774595417
08/12/1977 NANGGALA 085771613822
01/07/1958 NANGGALA 085703083400
06/07/1979 NANGGALA 085771613480
03/08/1995 NANGGALA 085211038584
04/09/1979 NANGGALA 085211137515
09/11/1977 NANGGALA 085771613822
01/07/1975 NANGGALA 085703083400
01/07/1972 NANGGALA
05/01/1969 NANGGALA 082312256882
06/07/2009 NANGGALA
05/06/1989 NANGGALA 081213393548
01/07/1981 NANGGALA 085715851364
01/02/1981 NANGGALA 085762187721
07/11/2008 NANGGALA
NANGGALA
10/05/1996 NANGGALA 085694944726
08/09/1980 NANGGALA 085694945446
18/04/1982 NANGGALA 085218206825
23/08/1995 NANGGALA 085771613840
24/11/2007 NANGGALA
01/07/1963 NANGGALA 085773624138
23/07/1988 NANGGALA 085695001802
07/11/1980 NANGGALA 081511408027
NANGGALA 085717563929
15/07/1997 NANGGALA 085715337195
10/04/1965 NANGGALA 085711432955
12/04/1960 NANGGALA 085715496882
NANGGALA
26/07/2003 NANGGALA 081511868382
15/11/1972 NANGGALA 085772740173
01/07/1961 NANGGALA 085715851364
01/02/1975 NANGGALA 085777563490
10/07/1965 NANGGALA 081289662791
14/08/1975 NANGGALA 08583753560
10/02/1978 NANGGALA 082310794533
NANGGALA
01/07/1986 NANGGALA 085703083400
09/02/1989 NANGGALA
25/02/1971 NANGGALA 085283444123
28/02/1968 NANGGALA
01/07/1963 NANGGALA 082311810870
05/06/1965 NANGGALA 08155138731
27/05/1978 NANGGALA 085213007825
10/11/1979 NANGGALA 081511408017
16/07/1998 NANGGALA
24/04/1994 NANGGALA 082172169451
13/12/1960 NANGGALA 085773624371
NANGGALA
03/03/2000 NANGGALA 085217120693
04/05/2000 NANGGALA 085695601346
01/07/1976 NANGGALA 085771308738
01/04/1998 NANGGALA 083110459266
24/03/1991 NANGGALA 082374627534
17/08/2002 NANGGALA 085691857697
11/09/2000 NANGGALA 085772730569
28/12/2001 NANGGALA 085880033655
01/07/1971 NANGGALA 082311810870
01/07/1991 NANGGALA 081388280716
08/02/2002 NANGGALA 085771588608
01/07/1995 NANGGALA 085782266642
14/09/1995 NANGGALA 085719637292
06/08/1968 NANGGALA 085218982043
07/07/2007 NANGGALA 085710506327
27/07/1997 NANGGALA 081511690448
31/07/1986 NANGGALA
01/07/1953 NANGGALA 082310769551
26/11/1994 NANGGALA 085814303389
15/02/1985 NANGGALA 085776597409
08/04/1980 NANGGALA 085715458224
13/04/1968 NANGGALA 085813587543
01/07/1954 NANGGALA 085813587543
10/02/1960 NANGGALA 085887771330
01/07/1974 NANGGALA 085211667757
21/03/1979 NANGGALA 081994118157
11/02/1978 NANGGALA 081994118157
24/04/2003 NANGGALA 085319298908
NANGGALA 083873752813
09/05/2007 NANGGALA 083873752813
01/07/1981 NANGGALA 081511868802
NANGGALA 085782490403
14/01/1979 NANGGALA 085773634423
10/01/1988 NANGGALA 081511868802
NANGGALA 08581430367
NANGGALA
NANGGALA
17/04/1995 NANGGALA 085717563965
NANGGALA
08/10/1992 NANGGALA 083899726781
rtaan BPJS (tulis
ada kolom yang Dosis 2
sesuai)
Tanggal Tanggal
Non Merek Vaksin*** Screeni Pemberi No.
ng an No seri
Anggota Batch
Vaksina
si
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 Nama Penerima
NO No. Ticket NIK JK
Vaksin

1 3601044107100001 KONOL P
2 3601044103750001 TIHAT P
3 3601044610750002 SAROH P
4 3601041003570001 H. TARYA L
5 3601040102670002 MAHDI L
6 3601045207840008 ANAH HAYATI P
7 3601040910900001 JOHANA L
8 3601044102670001 YAYAH P
9 3601044606890003 NUNUNG NURASIAH P
10 3601044102730002 SAYEM P
11 3601040102560005 SUKIA L
12 3601041307890002 HERI L
13 3601044102720001 ACIH P
14 3601044111700002 SURTIAH P
15 3601041807520002 SUMARIH L
16 3601040305780003 ROHMAN L
17 3601040102730004 SUKARDI L
18 1404150505930004 RUDI PRAYOGA L
19 3601045407840002 NIA P
20 3601047012710003 ECIH P
21 3601045601850001 INAH P
22 3601044607820007 KESIH P
23 3601044107720024 JUMANAH P
24 3601040104990007 JUJUN JUNAEDI L
25 3601040107900042 HENDRA L
26 3601040607020008 TEDI PERMANA L
27 3601044802880001 ATI P
28 3601046011730004 ENENG YUYUN P
29 3601040707950003 JAYANA L
30 3601041309700001 ABIDIN L
31 3601044107870028 AMINAH P
32 3601045901850002 TARISEM P
33 3601044107860037 KARIDAH P
34 3601046710820003 JUARSIH P
35 3601044805650001 RASTINI P
36 3602210207750013 SUPARJO L
37 3601044109720001 AAN P
38 3601040102730007 TIBI L
39 3601040107520009 PAYUMI L
40 3601044103780004 SUKARAH P
41 3601044101660002 JUMENAH P
42 3601046704900002 ENOK MAEMUNAH P
43 3601044107590007 SUDJIMAH P
44 3601040807800003 JUMALI L
45 3601045203830006 ENOK PURBASARI P
46 3603084609780002 IKAH WARTIKAH P
47 3601044302050007 JUMI P
48 3213055207820027 ROSITA P
49 3213056704030004 IRNA ROSALINA P
50 3601040102770001 ATANG L
51 3601040910870001 ENANG L
52 3601040603870003 AGUS L
53 3601045507940003 ELIS ERNASIH P
54 3601046006840004 RIRIN P
55 3601044907780002 SITI SOPIAH P
56 3601044103780003 KEBOT P
57 3601042003000003 DEDE JUNAEDI L
58 3601044107760024 WASTIAH P
59 3601044909780001 ROSIAH P
60 3601045708040006 MELI AGUSTIN P
61 3601046111080001 SINTA P
62 3601042601890002 SANUSI L
63 3601044103780001 JUHA P
64 3601040104730002 SALIM L
65 3601041012770001 TASMAN L
66 3601042803030001 AA GIBRAN L
67 3601046605780003 TATI P
68 3601045705820004 ENJUN P
69 3601040107040035 ARDIYANSAH L
70 3601040109980001 DIDIN WAHYUDIN L
71 3601041907770002 SAKMAN L
72 3601040102660001 BARUDIN L
73 3601044107820046 ENONG NURHAENI P
74 3601044712980007 SURYATI P
75 3601044512790003 IJAH HADIJAH P
76 3601046912060001 ILA PADILAH P
77 3601046704850001 ENENG TATI N P
78 3601044102870005 AMELIA P
79 3601042004000007 JUN SETIA PRATAMA L
80 3601040207620004 PARDI L
81 3601040107750037 NURCAHYA L
82 3601044511630002 HATI P
83 3601045211790001 NENENG RUSNAENI P
84 3601040107640005 BADRI L
85 3601045012720002 SUHETI P
86 3602010602830006 ASEP L
87 3601044812030001 SUMYATI P
88 3601040803530002 MUKTAR L
89 3602210712600006 RABUN L
 90 3601044107700018 CASNITI P
91 3601044107490006 SULASTRI P
92 3601041906650001 JAKARIA L
93 3602165611830003 HERLIS P
94 3601041111000008 MOH. SAMI'AN L
95 3601042506980003 SAEFUL L
96 3601045010050005 GITA RHAMDHANI P
97 3601045206790007 WATI WIDYAWATI P
98 3601046509940003 INA P
99 3601045708920007 DEWI SAPTARI P
100 3601044109000002 LIA FATARANI P
101 3601041007680003 CEMONG L
102 3601044107870143 PATMAWATI P
103 3601045310010002 RUMINAH P
104 3601041806710001 KARIAH P
105 3601046908910001 MAESAROH P
106 3601046004860001 SANI P
107 3602216603940001 NENTI P
108 3601040607790002 YUSRI L
109 3601046404870002 SATINAH P
110 3602214305880001 ENI ANDRAENI P
111 3601040107030133 JAENUDIN L
112 3601040708030002 RAHMAT HIDAYAT L
113 3601040107690007 ALISAM L
114 3601046307840002 SITI MAEMUNAH P
115 3601044107830075 MURSINAH P
116 3602084607030004 NURINDAH P
117 3601044111000001 LINDA SAFITRI P
118 3601045402830006 HENI P
119 3601040102830002 ENCUP L
120 3601042804050001 ARYA WIGUNA L
121 3601041306020002 SUNARTO L
122 3601041303040003 MUSTOFA L
123 3601041701040006 ANGGA L
124 3601044611050004 FITRI ALAIDZA M P
125 3601044107650017 SARIJAH P
126 3601045909890004 ANI YULIANI P
127 3601045910790003 RUKIAH P
128 3601046702820001 AHDI L
129 3601045406890004 IDA ROYANI P
130 3601045207050002 AMELIA P
131 3601045008980003 MELISA P
132 3601041705920001 WIGUNA L
133 3601044107810035 ARNAH P
134 3601040407820002 RASAM L
135 3601045601010003 LUSIANA CHASMITA P
136 3601042310030001 HAPID L
137 3601046906770001 ETI P
138 3601040107760024 ACENG ALEX CHASMITAL
139 3601040401670002 RASIDI L
140 3601046407790001 ESIH P
141 3601046104850003 MUNAROH P
142 3601045110860001 JUNIAH P
143 3601044401890006 NURHAYATI P
144 3601045603780002 ATIKAH P
145 3601040112930001 YAHYA L
146 3601045910970002 PATIMAH AZZAHRA P
147 3601045102860002 UTI P
148 3601044106820002 SUHA P
149 3601040104800001 SAYUTI L
150 3601046102380001 MUNAH H P
151 3601045201000006 DEDE RIKA P
152 3601044603750002 IYAH P
153 3601044405570002 SARNI P
154 3601045207050005 ELSA YULIA PUTRI P
155 3602211470890001 JUMHATI METI P
156 3601043005900003 SARIM L
157 3601044107790016 ARNI RAHMAWATI P
158 3601044308040001 SITI NURASIAH P
159 3601040304030004 ASMIN L
160 3601045504870005 NENG UTAMI P
161 3601045010770003 AMI P
162 3601042701780002 HENDI L
163 3601042802890001 RASIM L
164 3601042303760001 TONI L
165 3601040705810003 RUSMAN L
166 3601040411950003 ARDI L
167 3601041012730004 IBROHIM L
168 3601044107680053 SAEBAH P
169 3601044306820004 ELAH HAYATI P
170 3601045901020002 NENA RUKPIYANTI P
171 3601044107810021 ASNI KOMALASARI P
172 3601044204810006 SAHANAH P
173 3601044407720001 HJ. ENENG YUNENGSIH P
174 3601040107860050 JAKRIM L
175 3601044107580005 JUMANAH P
176 3601041603900001 ENJANG SUJANA L
177 3601045703890001 ENAY P
178 3601044907900003 PATIMAH P
179 3601041209830004 IBROHIM L
180 3601041512800001 HAMZAH L
181 3601044101850001 TRISNA P
182 3601044901890005 EUIS FARIHAH P
183 3601041701900001 IWAN L
184 3601041206000003 ANDRI PRATAMA L
185 3601040910000004 ANANG L
186 3602210602920006 HADI TOHARI L
 Kepesertaan BPJS (tulis
'Ya' pada kolom yang

Umur
Kelomp
Pekerjaan* (18-59 INSTANSI Alamat NO HP BPJS
ok Umur
tahun) PBI

7/1/1935 LANSIA DESA SUKAWARIS 081511586211

3/1/1975 DESA SUKAWARIS 085866761684
10/6/1975 DESA SUKAWARIS 085773257805
3/10/1957 DESA SUKAWARIS 085866761684
DESA SUKAWARIS 085866761684
7/12/1984 DESA SUKAWARIS 085711304620
10/9/1980 DESA SUKAWARIS 082310314466
7/2/1965 DESA SUKAWARIS 085286880579
6/6/1989 DESA SUKAWARIS 087882158812
2/1/1973 DESA SUKAWARIS 085738262044
8/1/1950 LANSIA DESA SUKAWARIS 087772911761
7/13/1989 DESA SUKAWARIS 083892646761
12/4/1959 LANSIA DESA SUKAWARIS 087773240191
11/1/1970 DESA SUKAWARIS 085281760547
7/18/1982 DESA SUKAWARIS 085960049891
5/3/1978 DESA SUKAWARIS 082181321357
12/12/1972 DESA SUKAWARIS 085283848014
8/6/1993 DESA SUKAWARIS 085693515447
7/14/1984 DESA SUKAWARIS 085774662134
12/30/1971 DESA SUKAWARIS 082130201465
11/16/1985 DESA SUKAWARIS 085794110993
7/6/1982 DESA SUKAWARIS 085219819390
7/1/1972 DESA SUKAWARIS 085774840618
7/13/1999 DESA SUKAWARIS 085774840618
1/27/1990 DESA SUKAWARIS 085773105809
7/20/2002 DESA SUKAWARIS 085695150038
2/8/1988 DESA SUKAWARIS 085891607162
4/9/1976 DESA SUKAWARIS 085219424033
7/7/1995 DESA SUKAWARIS 083874406508
9/13/1970 DESA SUKAWARIS 085866761684
7/1/1987 DESA SUKAWARIS 083804547731
1/19/1985 BUMIL DESA SUKAWARIS 085714949397
7/1/1986 DESA SUKAWARIS 083804547731
10/27/1982 DESA SUKAWARIS 085219819340
5/9/1965 DESA SUKAWARIS 081313022525
7/2/1975 DESA SUKAWARIS 085771007269
9/1/1972 DESA SUKAWARIS 082149935278
2/1/1975 DESA SUKAWARIS 085894548273
7/1/1952 LANSIA DESA SUKAWARIS
3/1/1978 DESA SUKAWARIS 085894948273
1/1/1966 DESA SUKAWARIS 085717330713
 2/10/1990 DESA SUKAWARIS 082124059187
3/15/1955 LANSIA DESA SUKAWARIS 081398116710
7/8/1980 DESA SUKAWARIS 085888233720
3/12/1983 DESA SUKAWARIS 081411132024
9/6/1978 DESA SUKAWARIS 085624109991
2/3/2005 REMAJA DESA SUKAWARIS 085894180265
2/12/1982 DESA SUKAWARIS 081313022525
4/27/2003 DESA SUKAWARIS 081214247933
2/1/1977 DESA SUKAWARIS 085714234967
10/9/1987 DESA SUKAWARIS 081382863124
7/18/1984 DESA SUKATANI 085817388270
11/5/2001 DESA SUKAWARIS 085890583219
6/20/1984 DESA SUKAWARIS 085774324414
7/9/1978 DESA SUKAWARIS 085866761684
3/1/1978 DESA SUKAWARIS 085714234967
3/20/2000 DESA SUKAWARIS 081220848858
7/27/1980 DESA SUKAWARIS 085770677455
9/9/1978 DESA SUKAWARIS 081218307390
8/17/2004 REMAJA DESA SUKAWARIS 085691857620
11/21/2008 REMAJA DESA SUKAWARIS 087773920556
1/26/1989 DESA SUKAWARIS 085770691155
3/1/1978 DESA SUKAWARIS 083818222424
4/1/1973 DESA SUKAWARIS 083818222424
12/10/1977 DESA SUKAWARIS 085695147609
3/25/2003 DESA SUKAWARIS 082283117735
5/26/1978 DESA SUKAWARIS 085773762964
5/17/1982 DESA SUKAWARIS 085774324414
12/12/2004 DESA SUKAWARIS 081295096046
9/7/2000 DESA SUKAWARIS 081514585903
7/19/1977 DESA SUKAWARIS 082124059187
2/1/1966 DESA SUKAWARIS 085773633262
12/14/1978 DESA SUKAWARIS 085624925123
12/7/1998 DESA SUKAWARIS 085210327280
12/5/1979 DESA SUKAWARIS 085214153097
12/29/2006 REMAJA DESA SUKAWARIS 083801470134
11/8/1985 DESA SUKAWARIS 085219673094
2/1/1987 DESA SUKAWARIS 085776826943
4/20/1999 DESA SUKAWARIS 085691080993
7/2/1962 DESA SUKAWARIS 085866761684
7/1/1975 DESA SUKAWARIS 085770639055
11/5/1963 DESA SUKAWARIS 08551481116
1/12/1979 DESA SUKAWARIS 082332913039
7/1/1967 DESA SUKAWARIS 085775404071
12/10/1972 DESA SUKAWARIS 085813108407
2/6/1983 DESA SUKAWARIS 085819162007
8/1/2003 DESA SUKAWARIS 083192353720
3/8/1953 LANSIA DESA CIKIRUHWETAN
12/7/1960 DESA SUKAWARIS
 7/1/1970 DESA SUKAWARIS 085866761684
7/1/1970 DESA SUKAWARIS 081212817349
6/19/1965 DESA SUKAWARIS 085886297938
11/16/1983 DESA SUKAWARIS 085694308835
11/11/2000 DESA SUMURBATU 085889408921
6/25/1998 DESA SUKAWARIS 083818222424
10/19/2005 DESA SUMURBATU 085882445922
6/12/1979 DESA SUKAWARIS 087888155331
9/25/1994 DESA SUKAWARIS 085717217098
8/17/1992 DESA SUKAWARIS 083873640301
2/10/2001 DESA SUKAWARIS 083871876443
7/10/1968 DESA SUKAWARIS 085866761684
7/1/1987 DESA SUMURBATU 085849027482
10/13/2001 DESA SUMURBATU 085778509786
6/18/1971 DESA SUMURBATU 085624109991
8/29/1991 DESA SUKAWARIS 082149935278
4/20/1986 DESA SUKAWARIS 081382341569
3/26/1994 DESA SUKAWARIS 085863461560
7/6/1979 DESA SUKAWARIS 085695154818
4/24/1987 DESA SUKAWARIS 081575879126
3/20/1988 DESA UNYUR 085718204284
10/3/2004 REMAJA DESA SUKAWARIS 083104008081
8/7/2003 DESA SUKAWARIS 085861602078
7/1/1969 DESA SUKAWARIS 085694952218
6/9/1984 DESA SUKAWARIS
7/1/1983 DESA SUKAWARIS 085774394414
7/6/2003 DESA BULAKAN 087881640939
4/5/2001 DESA SUKAWARIS 085714215447
2/14/1983 DESA CIKIRUHWET 083856598724
2/1/1979 DESA SUKAWARIS 085866761684
4/28/2005 REMAJA DESA SUKAWARIS 08572156946
6/3/2002 DESA SUKAWARIS 081381089893
3/13/2004 REMAJA DESA SUKAWARIS 082115191743
1/17/2004 REMAJA DESA SUKAWARIS 081291948077
11/6/2005 REMAJA DESA SUKAWARIS 085892748078
IRT 7/1/1965 UMUM BIDUR, SUMURBATU085770639055
IRT 9/19/1989 UMUM SUKAWARIS 087772911761
IRT 10/10/1979 UMUM SUKAWARIS 083873171035
WIRASWA 4/14/1997 UMUM SUKAWARIS 085893380690
IRT 8/14/1989 UMUM SUKAWARIS 082149935278
PELAJAR 7/12/2005 UMUM SUKAWARIS 085714214967
IRT 8/10/1998 UMUM SUKAWARIS 083892646761
WIRASWA 5/17/1992 UMUM SUKAWARIS 085892826916
IRT 3/18/1985 UMUM SUKAWARIS 082181321357
WIRASWA 7/4/1984 UMUM SUKAWARIS 085738262044
IRT 1/16/2001 UMUM SUKAWARIS 083150931838
BELUM BE 10/23/2003 UMUM SUKAWARIS 081280854890
IRT 8/29/1977 UMUM SUKAWARIS 085773105835
WIRASWA 8/9/1970 UMUM SUKAWARIS 083841531742
WIRASWA 7/3/1979 UMUM SUKAWARIS 085217320852
IRT 7/24/1979 UMUM SUKAWARIS 085280519393
IRT 4/21/1985 UMUM CIKIRUHWETAN 085311841907
IRT 2/16/1986 UMUM SUKAWARIS 081574892357
IRT 7/3/1992 UMUM CIKIRUHWETAN 085719805340
IRT 3/16/1978 UMUM CIKIRUHWETAN 083890673302
WIRASWA 4/1/1993 UMUM SUKAWARIS 085890125659
IRT 6/2/1996 UMUM CIKIRUHWETAN 085311841907
IRT 5/15/1982 UMUM SUKAWARIS 085217377159
IRT 6/1/1982 UMUM SUKAWARIS 085717330713
WIRASWA 4/1/1980 UMUM SUKAWARIS 081617198225
IRT 2/21/1938 LANSIA SUKAWARIS 085866761684
IRT 1/12/2000 UMUM SUKAWARIS 081276945238
IRT 3/6/1976 UMUM SUKAWARIS 085697428965
IRT 5/4/1957 UMUM SUKAWARIS 085866761684
BELUM BE 7/12/2005 REMAJA SUKAWARIS 085282258968
IRT 8/7/1993 UMUM SUKAWARIS 085882201746
WIRASWA 5/30/1990 UMUM SUKAWARIS 085773498349
IRT 8/7/1980 UMUM SUKAWARIS 085310666007
BELUM BE 8/3/2004 REMAJA SUKAWARIS 083879981504
BELUM BE 4/3/2003 UMUM SUKAWARIS 085866761684
IRT 4/15/1987 UMUM SUKAWARIS 087773346100
IRT 10/10/1977 UMUM SUKAWARIS 083109806131
PETANI 1/27/1978 UMUM CIKIRUHWETAN 085212563605
WIRASWA 2/28/1989 UMUM CIKIRUHWETAN 085217038459
WIRASWA 3/23/1975 UMUM CIKIRUHWETAN 085693826583
PETANI 5/7/1981 UMUM CIKIRUHWETAN 085775673818
BELUM BE 11/4/1995 UMUM SUKAWARIS 085776172822
WIRASWA 12/10/1973 UMUM SUKAWARIS 085217039548
IRT 7/1/1970 UMUM SUKAWARIS 083841531742
IRT 6/3/1982 UMUM SUKAWARIS 081398285492
BELUM BE 12/31/2002 UMUM SUKAWARIS 083893712375
IRT 9/28/1984 UMUM SUKAWARIS 085770639055
IRT 4/2/1981 UMUM SUKAWARIS 081287276658
IRT 7/4/1974 UMUM SUKAWARIS 081519588365
WIRASWA 7/1/1979 UMUM SUKAWARIS
WIRASWA 2/16/1981 UMUM SUKAWARIS 085215312069
WIRASWA 3/16/1992 UMUM CIKIRUHWETAN 082112047076
IRT 11/15/1982 UMUM SUKAWARIS 082149935278
IRT 7/9/1990 UMUM SUKAWARIS 082310864049
WIRASWA 9/12/1983 UMUM 085849027482
WIRASWA 7/17/1983 UMUM SUKAWARIS 08551481116
IRT 4/15/1985 UMUM SUKAWARIS
IRT 1/9/1989 UMUM SUKAWARIS 082123545462
WIRASWA 1/17/1990 UMUM SUKAWARIS 085694026750
BELUM BE 4/9/2000 UMUM SUKAWARIS 083102453545
BELUM BE 10/9/1998 UMUM SUKAWARIS 08134499567
2/6/1992 SUKAWARIS 083870874818
Kepesertaan BPJS (tulis
'Ya' pada kolom yang Dosis I
sesuai)
Merek Tanggal Tanggal
BPJS Non Vaksin*** Screening No.
Pemberian No seri
Non PBI Anggota Batch
Vaksinasi

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 Dosis 2
Tanggal
Pemberi KET
No.
an No Seri
Batch
Vaksina
si
EUA2057300143A1
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EUA2057300143A1
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### 202109199EUA2057300143A1
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### 202109199EUA2057300143A1
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### 202109199EUA2057300143A1
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### 202109199EUA2057300143A1
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### 202109199EUA2057300143A1
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### 202109199EUA2057300143A1
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### 202109199EUA2057300143A1
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EUA2057300143A1
 Kelo
mpo
Nama Penerima Umur
NONo. Ticket NIK JK
Pekerjaan* kINSTANSI
Vaksin (18-59 tahun)
Umu
r

1 3601040406820001 JUNADI L 04-06-1982

2 3601042802730002 KARMIN L 05-06-1978
3 3601041605820003 ASEP L 16-05-1982
4 3601041501660001 SARMAD L 15-01-1966
5 3601040705600001 WARDA L 07-05-1960
6 3601041503920003 SAMAN L 15-03-1993
7 3601040107800264 SUNARDI L 01-07-1980
8 3601045209850007 ENTIN P 12-09-1985
9 3601045804630003 SANAH P 18-04-1963
10 3601046211750001 TASINGKEM P 22-11-1975
11 3601045103000004 SUNARTI P 11-03-2000
12 3601044512830003 KASTINI P 05-12-1983
13 3601044107760164 SURENI P 01-07-1976
14 3601041110720002 TURNA L 11-10-1972
15 3601044910850001 KARMIN L 02-03-1975
16 3601046005830001 ENENG P 08-09-1978
17 3601040705750003 DASIRIN L 07-05-1975
18 3601041308890003 MUNAWAR L 03-08-1989
19 3602095210764948 LINA P 12-10-1976
20 3601044101000013 BELA SAPIAH P 01-01-2000
21 3601040702050005 M. RIPAI L 07-02-2005
22 3601046405670001 DARINGKEM P 24-05-1967
23 3601044610720003 TIAH P 04-08-1974
24 3601045308030002 SRI RAHAYU P 13-08-2003
25 3601045902670001 KUSIRI P 19-02-1967
26 3601040107680261 WARSA L 01-07-1968
27 3601040510830006 UUS L 05-10-1983
28 3601042005050002 SAHRUL GUNAWAN L 20-05-2006
29 3601046209720002 RASTINAH P 22-08-1972
30 3601042612990003 SARUDIN L 23-09-1999
31 3601044705730002 PATONAH P 07-05-1963
32 3601040104780006 SAMAD L 01-04-1978
33 3601041011530001 KARMIN L 10-11-1953
34 3602095003990004 ITA ROSITA P 10-03-1999
35 3601040305990003 RASMADI L 21-08-1999
36 3601040511000001 KADMAN L 05-09-1999
37 3601041705980001 TARYADI L 04-06-1999
38 3601045011870002 NURSIH P 10-11-1987
39 3601042609900001 RAPUDIN L 26-09-1990
40 3601044402750002 SURINI P 12-07-1980
41 3601042812020001 DIKI L 28-12-2002
42 3601041801760001 CARIDI L 18-01-1976
43 3601040105060003 LODI L 01-05-2006
44 3601040106010003 MUHAMAD SOLEH L 01-06-2001
45 3602016111820002 RIRIN P 21-11-1982
46 3601041405070002 IRFAN L 14-05-2007
47 3601040704420001 WARPAN L 07-04-1942
48 3601044704780003 AMINAH P 07-04-1978
49 3601044107730319 NENAH P 01-07-1973
50
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 BPJS (tulis 'Ya'
Dosis I
pada kolom

BPJ Merek Tanggal Tanggal

Alamat NO HP BPJ Non
S Vaksin*** Screening Pemberia
S Angg
Non n
PBI ota
PBI Vaksinasi

SUKASENENG 085319186316 CORONAVAC 21-12-2021

SUKASENENG 082312569165 CORONAVAC 21-12-2021
SUKASENENG 081242216990 CORONAVAC 21-12-2021
SUKASENENG 085819518692 CORONAVAC 21-12-2021 21-12-2021
SUKASENENG 085210065141 CORONAVAC 21-12-2021
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SUKASENENG 081517284140 CORONAVAC 21-12-2021
SUKASENENG 085778279631 CORONAVAC 21-12-2021
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SUKASENENG 085697592232 CORONAVAC 21-12-2021
SUKASENENG 085891326281 CORONAVAC 21-12-2021
SUKASENENG 081242216990 CORONAVAC 21-12-2021
SUKASENENG 082311533991 CORONAVAC 21-12-2021
SUKASENENG 081284559992 CORONAVAC 21-12-2021
SUKASENENG 083848555476 CORONAVAC 21-12-2021
SUKASENENG 085247976571 CORONAVAC 21-12-2021
SUKASENENG 082297972843 CORONAVAC 21-12-2021
SUKASENENG 081513872994 CORONAVAC 21-12-2021 21-12-2021
SUKASENENG 085219655951 CORONAVAC 21-12-2021
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SUKASENENG 083115548640 CORONAVAC 21-12-2021
SUKASENENG 085810876909 CORONAVAC 21-12-2021
SUKASENENG 085778279631 CORONAVAC 21-12-2021
SUKASENENG 085819518692 CORONAVAC 21-12-2021
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SUKASENENG 083817715737 CORONAVAC 21-12-2021
SUKASENENG 082120335150 CORONAVAC 21-12-2021 21-12-2021
SUKASENENG 082310578171 CORONAVAC 21-12-2021 21-12-2021
CIKEUSIK 085714399929 CORONAVAC 21-12-2021
MALINGPING 081325832001 CORONAVAC 21-12-2021
SUKASENENG 081511865825 CORONAVAC 21-12-2021
SUKASENENG 085281449160 CORONAVAC 21-12-2021
SUKASENENG 085216585253 CORONAVAC 21-12-2021
SUKASENENG 085210952945 CORONAVAC 21-12-2-21
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CORONAVAC
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Dosis I Dosis 2

Tanggal KET
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

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 Ke
lo
Umur mp
Nama Penerima
NO
No. Ticket NIK JK
Pekerjaan* (18-59 ok
INSTANSI
Vaksin
tahun) U
mu
r

1 3601040511740001 IKIN NASIKIN L 05-11-1974

2 3601040107910044 JASID L 05-09-1989
3 3601044607860002 LINDA P 22-07-1992
4 3601041408580002 SANTA L 14-08-1958
5 3601040107780051 ASHARI L 01-07-1978
6 3601040107620002 SUPYA L 21-07-1963
7 3601040107530033 SOLE L 01-07-1953
8 3601044103710002 ARSINAH P 01-03-1`971
9 3601044607750004 RUMSAH P 03-05-1988
10 3601040101980002 ARDIN L 09-01-1998
11 3601044107580003 EBAH P 01-07-1958
12 3674014204930003 JUHETI P 02-04-1993
13 3601044207840008 NARMI P 02-07-1988
14 3601041807630001 A. SUKARI L 03-04-1954
15 3601046505990001 ERLIS P 25-05-1999
16 3601040601760003 HERMAN L 06-01-1976
17 3601044401140003 PARWATI P 22-07-2004
18 3601046910710002 MARHAMAH P 16-10-1978
19 3601040107820005 HENRA L 01-07-1982
20 3601045302860003 ECIH P 13-02-1986
21 3601044107790160 TINI P 01-12-1979
22 3601044107780035 SAIYAH P 01-07-1978
23 3601040402960008 UMRI L 04-02-1993
24 3601041201810001 HILMI L 12-01-1981
25 3601046705820001 CIAH P 20-08-1980
26 3601044507750004 NAWI P 05-07-1975
27 3601040107400005 KARMIN L 30-09-1971
28 3601040107610013 H. KARNASIM L 15-12-1961
29 3601044210900006 ERAT P 02-10-1990
30 3601045007850008 TATI P 10-07-1985
31 3601044107730064 SAPRAH P 01-07-1973
32 3601040404820002 IYUS L 04-04-1982
33 3601044107770024 ARNISAH P 01-07-1977
34 3601042006010002 M.SUHENDRA L 20-06-2001
35 3601041308090001 HERU L 13-08-2009
36 3601042009810003 EDI EPENDI L 20-09-1981
37 3601044107680065 SUHA P 01-07-1968
38 3601045109880002 ELIS NURAENI P 01-04-1999
39 3601045512690001 ETI P 15-12-1969
40 3601040602960001 IRWAN L 14-03-1996
41 360104521076003 ACIH P 12-10-1976
42 3601045006860003 IPAH P 10-06-1986
43 3601044107830060 SANEHA P 01-05-1987
44 3601044107780047 KURSIH P 01-07-1978
45 3601044903790002 CICIH P 09-03-1979
46 3601044705870007 SUHETI P 07-05-1987
47 3601045107660002 ASKANAH P 11-07-1966
48 3601046010800002 ATI P 20-10-1980
49 3601044107730061 ARWIAH P 05-03-1973
50 3601040107780069 TARDI L 11-09-1978
51 3601045008870003 ARNASIH L 10-08-1987
52 3601045505650002 SUMINAH P 15-05-1965
53 3601044107550017 ARIAH P 05-12-1980
54 3601041506960008 DEDE ROSADI L 15-06-1996
55 3601044107820019 SAMINAH P 01-07-1982
56 3601044405910002 TUTI P 04-05-1991
57 3601044107660013 RUMAAH P 01-07-1966
58 3601044107760025 GANUNG P 30-01-1978
59 3601044701850012 ANAH P 07-01-1985
60 3601040107710019 MARSUDIN L 30-03-1971
61 3601041511810003 ELUT L 15-11-1981
62 3601040809890001 SARTA L 08-09-1989
63 3601040511060001 ENANG L 20-08-2005
64 3601044502860006 MISNAH P 05-02-1986
65 3601045603790003 RASCI P 16-03-1979
66 3601044107760030 IYUM P 05-06-1986
67 3601044805980001 UUN UNASIH P 08-05-1999
68 3601044407890004 SURYATI P 04-07-1989
69 3601046604870004 UUN UNAYAH P 26-04-1977
70 3601046911700001 EMUN P 29-11-1970
71 3601046003000004 ANI ANGGRAENI P 20-03-2000
72 3601040107730060 TARNA L 10-07-1962
73 3602211212900003 HAPIPI L 12-12-1990
74 3601040107570020 KAMAD L 01-07-1957
75 3601044107650022 MURNI P 01-07-1965
76 3601045205750003 TINAH P 12-05-1975
77 3601044107830054 RUMSIH P 01-07-1963
78 3601044107530015 SAWI P 28-01-1953
79 3601044204910001 MASHERLINA P 02-04-1991
80 3601044107630044 ETI P 04-03-1963
81 3601040107710016 SUNTANA L 01-07-1971
82 3601045205920005 KAYAH P 12-05-1992
83 3601044107790013 SAIMAH P 18-06-1978
84 3601045603820002 DARWATI P 16-03-1982
85 3601044406860008 SAROH P 04-06-1986
86 3601042306010002 ALMAN FAUZAN L 23-06-2001
87 3601044703870001 DARSINIH P 07-03-1987
 88 3601045610800002 JUMRIAH P 16-10-1980
89 3601044111760003 ENCUM P 01-11-1976
90 3601042102890003 UBAT L 21-02-1989
91 3601040107960037 JAEYUNI L 16-02-1996
92 3601044907000004 ACIH P 09-07-2000
93 3601044610780005 SANIAH P 06-10-1978
94 3601040307820006 JOHAR L 03-07-1982
95 3329141711790005 TARJONO L 17-11-1979
96 3601041409960001 JUMHADI L 14-09-1996
97 3601044310930005 ROHENAH SAFITRI P 03-10-1993
98 3601046204750001 TASIH P 22-04-1975
99 3601044510790003 EEN P 05-10-1979
100 3601044710820001 CARTI P 07-10-1982
101 3601044107630050 SUKANAH P 01-07-1963
102 3601040107660030 JUMALI L 21-05-1975
103 3601041607950005 AGUS L 16-07-1996
104 3601044705830001 ANAH P 07-05-1983
105 3601045609780001 RUSIAH P 16-09-1978
106 3601044107900029 SAWATI P 01-07-1990
107 3601040705730003 AYAT L 07-05-1973
108 3601040205680001 PADIL L 02-05-1969
109 3601040107730049 SURYANA L 01-07-1973
110 3601040107870038 TIMONG L 01-07-1987
111 3601041710650001 DASTA L 17-10-1965
112 3601040107680045 CASIDIN L 14-02-1968
113 3172035010790024 NANI P 10-10-1979
114 3601045002450001 KECUN P 10-02-1945
115 3601040107770011 ARIP L 01-01-1977
116 3601040107790016 SARMADI L 01-07-1979
117 3601040107760012 ENDANG L 01-07-1981
118 3601040107860283 ROHADI L 01-07-1986
119 3601041712920005 ADE L 17-12-1992
120 3212220911880002 KARYANI L 09-11-1968
121 3601040206770002 RAMANI L 02-06-1977
122 3601040107880047 SARNATA L 01-07-1986
123 3601040107010009 AAP L 26-06-2001
124 3601040107910005 SUPANDI L 06-04-1990
125 3601041309990002 SAMSUDIN L 20-02-1992
126 3601045604780003 ATI P 16-04-1976
127 3601045001750001 RUMI P 10-01-1975
128 3601046804830006 UMSARI P 28-04-1983
129 3601040606760001 JEJEN L 06-06-1976
130 3601040107560025 ABAS L 04-07-1956
131 3601044505810001 TATI P 05-05-1981
132 3601041512910001 ASLA L 15-12-1991
133 3601040107740005 JOHAR ARIPIN L 08-08-1968
134 3601040102680004 ERYANTO L 30-12-1974
135 3601041704640001 UDIN SAEPUDIN L 17-04-1964
136 3601040504940002 TARSONO L 05-04-1994
137 3601046909840001 UUM HUMAEROH P 05-06-1985
138 3601044704930003 SUMIYATI P 07-04-1993
139 3601044503770005 HJ. SOHIPAH P 05-03-1977
140 3601040602810004 IDRIS AFANDI L 06-02-1981
141 3601044107340001 EEN P 01-01-1981
142 3601044107790017 CARSITI P 01-07-1979
143 3601040107910042 KARIM L 18-02-1979
144 3601040107320003 MUKTAR L 27-01-1973
145 3601044107720022 ARNAH P 01-07-1972
146 3601040102800018 RASMUDI L 01-02-1980
147 3601041407820003 PAHRUDIN L 14-07-1982
148 3601041807860002 SAI'IN L 18-07-2000
149 3601041505850009 JUMALI L 15-05-1985
150 3601044602800001 SARPAH P 06-02-1980
151 3601040911800001 ARKANI L 09-11-1980
152 3603016704840002 ROSITA P 27-04-1984
153 3601041404080009 MARIK L 14-04-2008
154 3601040101800003 KUSNADI L 02-02-1980
155 3601044108990004 FITRI YANI P 01-08-1999
156 3601040107900008 ISRA L 04-05-1990
157 3601046001840003 SARNI P 20-01-1984
158 3601042512020003 RUSNA L 25-12-2002
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
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 (tulis 'Ya'
pada Dosis I
kolom
BP No
BP Merek Tanggal
Alamat NO HP JS n Tanggal
JS Vaksin*** Screening Pemberian
No An
PB
n gg Vaksinasi
I
PBI ota

SUMURBATU 081313614814 CORONAVAC 22-12-2021 22-12-2021

SUMURBATU 081385168158 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 08571657873 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085719767720 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085695148566 CORONAVAC 22-12-2021
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SUMURBATU 085773751797 CORONAVAC 22-12-2021
SUMURBATU 081511928795 CORONAVAC 22-12-2021
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SUMURBATU 085719784640 CORONAVAC 22-12-2021
SUMURBATU 085718719716 CORONAVAC 22-12-2021
SUMURBATU 085715264049 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081312109805 CORONAVAC 22-12-2021
SUMURBATU 085811462049 CORONAVAC 22-12-2021
SUMURBATU 081295096738 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085217251752 CORONAVAC 22-12-2021
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SUMURBATU 085718678575 CORONAVAC 22-12-2021
SUMURBATU 085774675546 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085216560352 CORONAVAC 22-12-2021
SUMURBATU 085217249377 CORONAVAC 22-12-2021
SUMURBATU 082311249914 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085219338629 CORONAVAC 22-12-2021
SUMURBATU 085861642511 CORONAVAC 22-12-2021
SUMURBATU 081213584433 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085875895105 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081213584433 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085894828276 CORONAVAC 22-12-2021
SUMURBATU 085693636483 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085212687065 CORONAVAC 22-12-2021
SUMURBATU 085770972970 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085882501874 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081546891282 CORONAVAC 22-12-2021
SUMURBATU 08572059159 CORONAVAC 22-12-2021
SUKAWARIS 081546891282 CORONAVAC 22-12-2021
SUMURBATU 081213584433 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 0857749579331 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085695141635 CORONAVAC 22-12-2021
SUMURBATU 085715264049 CORONAVAC 22-12-2021
SUMURBATU 085722049169 CORONAVAC 22-12-2021
SUMURBATU 085813892471 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085695001158 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085213638701 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081298752147 CORONAVAC 22-12-2021
SUMURBATU 085861642511 CORONAVAC 22-12-2021
SUMURBATU 081210778946 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081649471822 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 082311249914 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081382863483 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 082312398984 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085882443080 CORONAVAC 22-12-2021
SUMURBATU 085782010333 CORONAVAC 22-12-2021
SUMURBATU 085794157006 CORONAVAC 22-12-2021
SUMURBATU 085722049169 CORONAVAC 22-12-2021
SUMURBATU 085871072147 CORONAVAC 22-12-2021
SUMURBATU 081213584433 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085718264997 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085691134227 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085861089682 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085870072144 CORONAVAC 22-12-2021
SUMURBATU 085716591435 CORONAVAC 22-12-2021
SUMURBATU 085718886952 CORONAVAC 22-12-2021
SUMURBATU 085217323575 CORONAVAC 22-12-2021
SUMURBATU 085773624145 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085695148566 CORONAVAC 22-12-2021
SUMURBATU 085716591435 CORONAVAC 22-12-2021
SUMURBATU 085866761684 CORONAVAC 22-12-2021
SUMURBATU 081546891282 CORONAVAC 22-12-2021
SUMURBATU 085773751797 CORONAVAC 22-12-2021
SUMURBATU 083848122787 CORONAVAC 22-12-2021
SUMURBATU 085813108823 CORONAVAC 22-12-2021
SUMURBATU 081382863483 CORONAVAC 22-12-2021
SUMURBATU 085716244016 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081284644599 CORONAVAC 22-12-2021
SUMURBATU 0857753942 CORONAVAC 22-12-2021
SUMURBATU 0858113865588 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085845150145 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081313614814 CORONAVAC 22-12-2021
SUMURBATU 085693152642 CORONAVAC 22-12-2021
SUMURBATU 085693560836 CORONAVAC 22-12-2021
SUMURBATU 085693152642 CORONAVAC 22-12-2021
SUMURBATU 085213478192 CORONAVAC 22-12-2021
SUMURBATU 085695142953 CORONAVAC 22-12-2021
SUMURBATU 085894828276 CORONAVAC 22-12-2021
SUMURBATU 085811463982 CORONAVAC 22-12-2021
SUMURBATU 085899515542 CORONAVAC 22-12-2021 22-12-2021
SUKAMULYA 085894669855 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085714379660 CORONAVAC 22-12-2021
SUMURBATU 085813892471 CORONAVAC 22-12-2021
SUMURBATU 081511690569 CORONAVAC 22-12-2021
SUMURBATU CORONAVAC 22-12-2021
SUMURBATU 08569833332 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 08385598689 CORONAVAC 22-12-2021
SUMURBATU 081585553890 CORONAVAC 22-12-2021
SUMURBATU 083856598689 CORONAVAC 22-12-2021
SUMURBATU 081223998366 CORONAVAC 22-12-2021
SUMURBATU 085697185077 CORONAVAC 22-12-2021
SUMURBATU 085774957815 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081517241502 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085772725246 CORONAVAC 22-12-2021
SUMURBATU 083871286556 CORONAVAC 22-12-2021
SUMURBATU 085772725246 CORONAVAC 22-12-2021
SUMURBATU 085773225972 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085214157365 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 081219606901 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 082312398984 CORONAVAC 22-12-2021
SUMURBATU 081617200625 CORONAVAC 22-12-2021
SUMURBATU 085778068373 CORONAVAC 22-12-2021
SUMURBATU 085776197550 CORONAVAC 22-12-2021
SUMURBATU 085778068373 CORONAVAC 22-12-2021
SUMURBATU 085215738716 CORONAVAC 22-12-2021
SUMURBATU 085716244014 CORONAVAC 22-12-2021
SUMURBATU 081350024513 CORONAVAC 22-12-2021
SUMURBATU 083891136223 CORONAVAC 22-12-2021
SUMURBATU 085778060373 CORONAVAC 22-12-2021
SUMURBATU 0856263525 CORONAVAC 22-12-2021
SUMURBATU 085811012158 CORONAVAC 22-12-2021
SUMURBATU 085718264997 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085780469296 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085722397246 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085894669855 CORONAVAC 22-12-2021 2212-2021
SUMURBATU 085694241434 CORONAVAC 22-12-2021
SUMURBATU 085283234188 CORONAVAC 22-12-2021
SUMURBATU 085714786300 CORONAVAC 22-12-2021
SUMURBATU 081511512230 CORONAVAC 22-12-2021
SUMURBATU 085773220370 CORONAVAC 22-12-2021
SUMURBATU 081266758353 CORONAVAC 22-12-2021
SUMURBATU 085813108751 CORONAVAC 22-12-2021
SUMURBATU 085283234188 CORONAVAC 22-12-2021
SUMURBATU 085816907343 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085219863975 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085624586631 CORONAVAC 22-12-2021
SUMURBATU 0852194240411 CORONAVAC 22-12-2021
SUMURBATU 081386078807 CORONAVAC 22-12-2021
SUMURBATU 085811462217 CORONAVAC 22-12-2021
SUMURBATU 085697633382 CORONAVAC 22-12-2021
SUMURBATU 085216915407 CORONAVAC 22-12-2021
SUMURBATU 081585553890 CORONAVAC 22-12-2021
SUMURBATU 085811026119 CORONAVAC 22-12-2021
SUMURBATU 085810728528 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085972804994 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085692563824 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085817451733 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085845150145 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 082128431741 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085782010333 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085774957828 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 082128431741 CORONAVAC 22-12-2021 22-12-2021
SUMURBATU CORONAVAC 22-12-2021 22-12-2021
SUMURBATU 085782010333 CORONAVAC 22-12-2021
SUMURBATU 085773751841 CORONAVAC 22-12-2021
SUMURBATU 081645456735 CORONAVAC 22-12-2021
SUMURBATU 085781080106 CORONAVAC 22-12-2021 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC 22-12-2021
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
Dosis I Dosis 2

Tanggal KET
No No
No. Batch Pemberian No. Batch
seri Seri
Vaksinasi

202109199E
202109199E

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021

22-12-2021
22-12-2021

22-12-2021

22-12-2021

22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021

22-202021 202109199E
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021
22-12-2021

22-12-2021
22-12-2021
22-12-2021
 K
el
o
m
Umur
Nama Penerima p
NO
No. Ticket NIK JK
Pekerjaan*(18-59 INSTANSI
Vaksin o
tahun)
k
U
m
ur

1 3601044107830113 ERNAWAATI P 21-07-1986

2 3601040107690023 NARMA L 01-07-1969
3 3601044107690101 KASINAH P 01-0701969
4 3601045609820002 SUNARIAH P 16-09-1982
5 3601046410040002 KARTIKA P 24-10-2004
6 3601044511560001 ASMI P 05-11-1956
7 3601040107800066 SUDIRAH L 01-07-1980
8 3601044605030002 ANISA P 06-05-2003
9 3601041312790001 PAMA L 13-12-1979
10 3601040810790001 AZI KAMALUDIN L 08-10-1979
11 3601041504910003 PENDI L 04-06-1991
12 3601045911030001 CUCU CAHYATI P 19-11-2003
13 3601040107880042 WARTO L 25-04-1986
14 3601042505500001 SAMAD L 25-05-1950
15 3601044107600033 ITIAH P 01-07-1960
16 3601044102910113 CARTIAH P 06-07-1992
17 3601045711810001 SARTINI P 17-11-1981
18 3601041103930002 MUJAHIDIN L 08-08-1995
19 3601045902940001 DARKEM P 15-08-1995
20 3601044105850006 WATI P 01-05-1985
21 3212204207550001 RASTEM P 02-07-1955
22 3601046003880002 IYUNG P 20-03-1988
23 3601044107910088 HERIYANSYAH L 24-11-1989
24 3601040105800006 ATIAH P 01-05-1980
25 3601044107630093 ARSAH P 01-07-1971
26 3601046210720001 RASINIH P 22-10-1972
27 3601041209910002 WASJUDI L 12-09-1991
28 3601040411970003 ACENG L 04-11-1997
29 3601040107610036 DARNO L 01-07-1964
30 3601042208010002 MUHAMAD ARIF L 22-05-2004
31 3601044308630001 ITI P 02-08-1964
32 3601040107940083 CARYONO L 15-05-1989
33 3601044107010268 VINA P 17-04-2000
34 3601044111030003 TURINAH P 01-11-2003
35 36010441078900035 WAWAS P
36 3601046802750002 MAENAH P 28-02-1975
37 3601040107000098 TARSONO L 10-10-2001
38 3601044107750063 ROMLAH P 02-10-1966
39 3601045910080001 ZAHRA P 18-10-2006
40 3601045910080002 ZAHWA P 19-10-2008
41 3601046104810001 CASINAH P 21-04-1981
42 3601040107700083 WASIM L 03-04-1965
43 3601045112650005 SARAH P 11-12-1965
44 3601041504070004 M. NURIL WAHID L 15-04-2007
45 3601044107860062 ERTI P 26-03-1987
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
 84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
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
 (tulis
'Ya' Dosis I
pada
B
P
N
J
BP on Merek Tanggal
Alamat NO HP S Tanggal
JS A Vaksin*** Screening Pemberian
N
PB ng
o Vaksinasi
I go
n
ta
P
BI

RANCASENENG 085782135187 CORONAVAC 31-12-2021

RANCASENENG 085694904795 CORONAVAC 31-12-2021
RANCASENENG 085811924620 CORONAVAC 31-12-2021
RANCASENENG 085894980650 CORONAVAC 31-12-2021
RANCASENENG 085691043400 CORONAVAC 31-12-2021
RANCASENENG 085894980650 CORONAVAC 31-12-2021
RANCASENENG 085694946140 CORONAVAC 31-12-2021
RANCASENENG 085883201880 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 085714379725 CORONAVAC 31-12-2021
RANCASENENG CORONAVAC 31-12-2021
RANCASENENG 082117474807 CORONAVAC 31-12-2021
RANCASENENG 085697417101 CORONAVAC 31-12-2021
RANCASENENG 085215864009 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 085695337642 CORONAVAC 31-12-2021
RANCASENENG 085311380400 CORONAVAC 31-12-2021
RANCASENENG 085691133313 CORONAVAC 31-12-2021
RANCASENENG 087887539000 CORONAVAC 31-12-2021
RANCASENENG 085693382965 CORONAVAC 31-12-2021
RANCASENENG 085695274187 CORONAVAC 31-12-2021
RANCASENENG 085603838949 CORONAVAC 31-12-2021
RANCASENENG 085219655886 CORONAVAC 31-12-2021
RANCASENENG 085692729231 CORONAVAC 31-12-2021
RANCASENENG 085707776711 CORONAVAC 31-12-2021
RANCASENENG 085695267448 CORONAVAC 31-12-2021
RANCASENENG 081513549747 CORONAVAC 31-12-2021
RANCASENENG 081584367725 CORONAVAC 31-12-2021
RANCASENENG 082260110937 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 085797143441 CORONAVAC
RANCASENENG 085219655886 CORONAVAC
RANCASENENG 081323595098 CORONAVAC
RANCASENENG 085215596629 CORONAVAC
RANCASENENG CORONAVAC
RANCASENENG 085711826359 CORONAVAC
RANCASENENG 085282526455 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 085214886813 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 085693477709 CORONAVAC
RANCASENENG 081584368605 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 083871494440 CORONAVAC
RANCASENENG 085718515198 CORONAVAC
RANCASENENG 085718515198 CORONAVAC
RANCASENENG CORONAVAC
RANCASENENG 083892812691 CORONAVAC 31-12-2021 31-12-2021
RANCASENENG 081314608531 CORONAVAC
RANCASENENG 085691857948 CORONAVAC
RANCASENENG 08561501581 CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
CORONAVAC
Dosis I Dosis 2

Tanggal KET
No. Batch No seri Pemberian No. Batch No Seri
Vaksinasi

31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
31-12-2021 202109199E
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