Vaksin Tambahrejo 29-12-21

a Puskesmas/Fasyankes/Pos : PUSKESMAS TUNJUNGAN
Kabupaten/Kota : BLORA
Provinsi : JAWA TENGAN
TGL PELAKSANAAN :
No Hp( HARUS NIK ( HARUS

NO NAMA
DIISI) DIISI)
1 PRIYATINI 085330121313 3316106606950002
2 DWI RAHARJO 081326730808 3311062810840002
3 SUSILOWATI 081326730808 3316165602820003
4 TARNO 08562782043 3316100510550001
5 SITI MUJIATI 082326567836 3316104112800003
6 WAKIMIN 083820258145 3316101202590001
7 SUWIJI 082313738388 3316106712750001
8 SARNI 08562782043 3316104107660117
9 KASIYAH 082313738388 3316104401600001
10 SUPARJAN 082313738388 3316101808670001
11 SISWANTO 085201362411 3316101003850003
12 NGASINAH 081326730808 3316104107380201
13 RUDI KURNIAWAN 08562782043 3316101703020004
14 WASINAH 08562782043 3316104107500137
15 INDAH SETYOWATI 082313738388 331610700895001
16 SUSILO 08562782043 3316080705870006
17 KIRAN 083820258145 3316100107590165
18 RAMAN 083820258145 3316100406590001
19 URIP 083820258145 3316101912660001
20 SAMAN 085201362411 3316101506700003

21 DAMI 081326730808 3316104107460087
22 DINAH 081326730808 3316104903410001
23 SUMARNI 081326730808 3316105005800004
24 SUTARJI 083820258145 3316100107660169
25 LASDI 0882007284232 3316101103680002
26 M. ADI PRAKOSO 08235285400 3316100303990003
27 WAGIMIN 082313738388 3316101210650002
28 SUKIMAN 08562782043 3316100107560187
29 SUGIARTINI 083820258145 3316104102740007
30 RIA 085201362411 3316105906950004
31 SITI KAMSARI 089637764463 3320055412000004
32 RASMI 08562782043 3316104107680250
33 NUR HASAN 089637764463 3316101505880001
34 SUMARNO 082313738388 3316102306730001
35 REGA AJI PANGESTU 085713633957 3316103012040002
36 KARNO 083820258145 3316102604660002
37 BEJO 085201362411 3316100511700001
38 GUNARKO 08562782043 3316102405870002
39 WINANIK PUJI LESTARI 08562782043 3316106303860001
40 PARNI 085201362411 3316104505820004
41 SARMIN 081326730808 3316100205470001
42 RISKI RAHMAT MAULANA 081293451668 3316101508940001
43 SUPARMAN 08562782043 3316100102520001
44 SITI WULANDARI 08562782043 3316104711090001
45 SUNIRWATI 085225447615 3316106707900005
46 SULASIH 085225447615 3316106103840003
47 TARMI 08562782043 3316104107630300
48 SAMINAH 08562782043 3316105606540001
49 DAVIN EKA ARIK WIBOWO 081326730808 3316102212090001

50 MUTTI 082135340883 3522031210850001
51 SUJONO 087724023557 3316100606050001
52 SUPATMI 085329542605 3316104107780081
53 SUPRI 085201362411 3316101709590002
54 SUKIMIN 083820258145 3316100107570002
55 NARINAH 082336156690 3316104805710001
56 DASIMIN 085215097020 3316100203520001
57 VINA SAFA YULIANA 085329542605 3316106802970002
58 SUKONO 085201362411 3316100107460053
59 ABDUL ROCHMAN 085201362411 3316141906880002
60 SIMAN 085201362411 3316100603500001
61 WARSINI 081228257759 3316104205800006
62 SUKIYONO 085328820293 3316090609820007
63 WARTI 083820258145 3316105903800001
64 RAHMA JULIETA POH WEIN 081228257759 3316104407090002
65 SURATI 081326500743 3316105610820001
66 KASNI 08562782043 3316104312740002
67 MARDI 0895396192170 3316110107640211
68 MARIYO 08562782043 3316100809540002
69 MIJAN 08562782043 3316101106580001
70 MARDIONO 082313738388 3316100805780003
71 YAYUK MARLINA 081326730808 3316104101940002
72 MURNININGSIH 081326730808 3316104910740001
73 MOHAMAD IMRON JAMIL 0895383007068 3316103003860004
74 SADIYO 085212518423 3316100201600002
75 SURADI 081228257759 3316102506820002
76 LASMINING 08562782043 3316106806820002
77 SUPARMIN 082313738388 3316100107690185
78 SUKANTO 085201362411 3316101106650001

79 SARTI KOSARI 081228257759 3316106505750001
80 MARNI 083820258145 3316104301710001
81 M. CANDRA BAGUS SETYAWAN 081326730808 3307073010090002
82 SUNAR 08562782043 3316101505750003
83 SRIYANTO 085201362411 3316102107790001
84 DARNI 085330121313 3316106412890003
85 DARMIN 085330121313 3316101804810003
86 SITI MUKHAROMAH 08562782043 3316105507040002
87 SUKARNO 081228257759 3316100604950003
88 URIP 081228257759 3316100408730003
89 SUSRI ANTOK 082135136346 3316100106890001
90 SUKONO 082136324369 3316100107630227
91 SUDAR 0823288933779 3316104107640168
92 SUNIR 082313738388 3316102506670001
93 NGATMI 081326730808 3316105611630001
94 SUJINAH 082313738388 3316105209580001
95 SUNO 08562782043 3316101508770003
96 SUTINI 08562782043 3316106702530001
97 WAHYU SAPUTRO 082313738388 3316100202000007
98 NYAMINI 083195162309 3316164601930002
99 JOHAN DEWI ASTUTI 08562782043 3316166612080001
100 NGADIYANTO 08562782043 3316100601850003
101 ANGGA TONI PRASETYO 085866252235 3316102809060001
102 MULJANTO 085201362411 3316102608550001
103 GITA RADITYA 085201362411 3316101907070002
104 SUYANTA 08562782043 3316101212770002
105 SUKIYEM 082313738388 3316105001680001
106 PASINI 08562782043 3316104601730001
107 SAPIYAH 082313738388 3316105107700001

108 YAHMAN 082313738388 3316101109700002
109 SUNOTO 085226182827 3316101106780003
110 RASMI 081326730808 3316104306570001
111 KARSIH 082313738388 3316106009650001
112 PURWANTO 082313738388 3316100611750001
113 TUMINAH 083820258145 3316104109690001
114 YAHMIN 083820258145 3316100107630116
115 LIA MUSTAJAB 082313738388 3316101305940002
116 MARJO 082242231212 3316101211920002
117 NASRUDIN 082329484747 3316101310880003
118 SUWARJI 085691581718 3316101002890001
119 SITI NUR ALFIAH 085330121313 3316105004860001
120 SUKARNO 08562782043 3316101307560001
121 ISMUYOTO 082336156690 3316101904620002
122 PASRI 082336156690 3316105609760001
123 SUPARMI 085329542605 3316104107570119
124 KAMTO 083820258145 3316100107540097
125 SULASMI 081326730808 3316104310490001
126 SUGIYONO 082323744127 3316100410790001
127 SUTINI 085330121313 3316104106980003
128 SULINAH 082313738388 3316105809690002
129 SURIPAN 08133210916 3316100509940002
130 MARTIYONO 08562782043 3316100205740004
131 KARSO 082313738388 3316102509720001
132 JAMIN 082313738388 3316100103600001
133 LUKITA PURNAMASARI 081331414063 3316126808000004
134 KARYATI 085201362411 3316104107680271
135 SUTRISNO 085866252235 3316100701680001
136 TIYASNO SUDARNO 081331414068 3316101112950001

137 KASMRAH 085201362411 3316104407640002
138 BAKRI 082313738388 3316100107660162
139 SULASTRI 085201362411 3316104107680281
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FORMAT PENCATATAN PELAKSANAAN VAKSINASI COVID-19
ALAMAT (DESA rt TGL NO

UMUR JENIS VAKSIN DOSIS 1
rw) LAHIR Batch
KENDURUAN 8/2 6/26/1995 27 PFIZER 330408D
TAMBAHREJO 1/1 10/28/1984 38 PFIZER 330408D V
TAMBAHREJO 2/4 12/1/1980 42 PFIZER 330408D
TAMBAHREJO 3/5 2/12/1959 64 SINOVAC 202109105J

TAMBAHREJO 1/1 3/9/1941 81 SINOVAC 202109105J V
BUSALAH 5/1 12/30/2004 18 PFIZER 330408D V

SONOREJO 1/4 9/6/1982 40 PFIZER 330408D

TAMBAHREJO 3/4 9/12/1958 64 SINOVAC 202109105J V

TAMBAHREJO 2/1 9/16/1976 46
TAMBAHREJO 1/5 7/1/1957 65
TAMBAHREJO 4/5 7/1/1954 68
TAMBAHREJO 1/4 10/3/1949 73 PFIZER V
TAMBAHREJO 3/4 10/4/1979 43 PFIZER
TAMBHAREJO 2/4 9/25/1972 50 PFIZER V
NGAWEN 1/7 8/28/2000 22 PFIZER

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SI COVID-19
TUNDA
SEMEN DOSIS 1 DOSIS 2
DOSIS TARA MAS MAS
KETERANGAN
2 Y DISA Y
REM UMU YAN LANS BUM BILIT REM UMU YAN LANS
AJA M BLIK IA IL AS AJA M BLIK IA
V
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V
0 0 0 0 0 0 0 0 0 0
DOSIS 2
DISA
BUM BILIT
IL AS
0 0

Vaksin Tambahrejo 29-12-21

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a Puskesmas/Fasyankes/Pos : PUSKESMAS TUNJUNGAN

No Hp( HARUS NIK ( HARUS

1 PRIYATINI 085330121313 3316106606950002

2 DWI RAHARJO 081326730808 3311062810840002

3 SUSILOWATI 081326730808 3316165602820003

4 TARNO 08562782043 3316100510550001

5 SITI MUJIATI 082326567836 3316104112800003

6 WAKIMIN 083820258145 3316101202590001

7 SUWIJI 082313738388 3316106712750001

8 SARNI 08562782043 3316104107660117

9 KASIYAH 082313738388 3316104401600001

10 SUPARJAN 082313738388 3316101808670001

11 SISWANTO 085201362411 3316101003850003

12 NGASINAH 081326730808 3316104107380201

13 RUDI KURNIAWAN 08562782043 3316101703020004

14 WASINAH 08562782043 3316104107500137

15 INDAH SETYOWATI 082313738388 331610700895001

16 SUSILO 08562782043 3316080705870006

17 KIRAN 083820258145 3316100107590165

18 RAMAN 083820258145 3316100406590001

19 URIP 083820258145 3316101912660001

20 SAMAN 085201362411 3316101506700003

22 DINAH 081326730808 3316104903410001

23 SUMARNI 081326730808 3316105005800004

24 SUTARJI 083820258145 3316100107660169

25 LASDI 0882007284232 3316101103680002

26 M. ADI PRAKOSO 08235285400 3316100303990003

27 WAGIMIN 082313738388 3316101210650002

28 SUKIMAN 08562782043 3316100107560187

29 SUGIARTINI 083820258145 3316104102740007

30 RIA 085201362411 3316105906950004

31 SITI KAMSARI 089637764463 3320055412000004

32 RASMI 08562782043 3316104107680250

33 NUR HASAN 089637764463 3316101505880001

34 SUMARNO 082313738388 3316102306730001

35 REGA AJI PANGESTU 085713633957 3316103012040002

36 KARNO 083820258145 3316102604660002

37 BEJO 085201362411 3316100511700001

38 GUNARKO 08562782043 3316102405870002

39 WINANIK PUJI LESTARI 08562782043 3316106303860001

40 PARNI 085201362411 3316104505820004

41 SARMIN 081326730808 3316100205470001

42 RISKI RAHMAT MAULANA 081293451668 3316101508940001

43 SUPARMAN 08562782043 3316100102520001

44 SITI WULANDARI 08562782043 3316104711090001

45 SUNIRWATI 085225447615 3316106707900005

46 SULASIH 085225447615 3316106103840003

47 TARMI 08562782043 3316104107630300

48 SAMINAH 08562782043 3316105606540001

49 DAVIN EKA ARIK WIBOWO 081326730808 3316102212090001

51 SUJONO 087724023557 3316100606050001

52 SUPATMI 085329542605 3316104107780081

53 SUPRI 085201362411 3316101709590002

54 SUKIMIN 083820258145 3316100107570002

55 NARINAH 082336156690 3316104805710001

56 DASIMIN 085215097020 3316100203520001

57 VINA SAFA YULIANA 085329542605 3316106802970002

58 SUKONO 085201362411 3316100107460053

59 ABDUL ROCHMAN 085201362411 3316141906880002

60 SIMAN 085201362411 3316100603500001

61 WARSINI 081228257759 3316104205800006

62 SUKIYONO 085328820293 3316090609820007