Nama Puskesmas/Fasyankes/Pos

Kabupaten/Kota
Provinsi

No No. Tiket NIK

1 3214105105840001

2 3214103010040004

3 3214104506790002

4 3214101608620001

5 3214104803690001

6 32141015504960001

7 3175014507740004
8 3214104101040001

9 3214104111970002

10 3214101012650002

11 3214104110600002

12 3214106611700001

13 3214101501500001

14 3214032009840002

15 3214034508000001

16 3216151305090002

17 3214102907090002

18 SDN CHN 3214012311130002

19 SDN 2 KTJ 3214056705120004

20 SDN 1 LA 3209232904110001

21 MI DAAR EL ILMI 3214104608140001

22 MI DAAR EL ILMI 3214031101150001

23 SDN 2 SLW 3314102002140001

24 SDN 2 SLW 3214101312120001

25 SDN 2 SLW 3214106407110004

26 SDN 1 PSK 3214165305100001

27 SDN 1 PSK 3214101503120002

28 SDN 1 KTJ 3214011903110007

29 SDN 1 PSW 3214102107140002

30 SDN 1 PSW 3214104103120001

31 SDN 1 PSW 3214100304140002

32 32153025110000001

33 3214011211090001

34 3214105612940004

35 3214100301810001

36 3215014811910006

37 3214100411590001

38 3214104204020003

39 32153011010000003

40 3214103112520004

41 3214105403600001
42 3214101705470001

43 3214104102770003

44 3214105006600001

45 3214106410650001

46 3214104408660003

47 3214104509550003

48 3214100207550002

49 3214105308740001

50 3214105209510001

51 3214106405660002

52 3214104101810005

53 3214106705820002

54 3213060603040001

55 3214010305820006
: Puskesmas Pasawahan
: Purwakarta
: Jawa Barat

Jenis Kelompok
Nama Penerima Vaksin
Kelamin Penerima Vaksin*

NENG SINTA ANTIKA P UMUM

FIQRI BENANTA L REMAJA

KHUSIANI P UMUM

H. NANDANG SAPUTRA L RENTAN

SRI DJUNINGSIH P RENTAN

WINDARI P LANSIA

PARTI P UMUM
RINA IRYAWATI P UMUM

TETI KURNIAWATI P UMUM

TURYANA L RENTAN

UNEH P LANSIA

ANI PUJIANTI P RENTAN

SONDI L LANSIA

ENJUH SUHENDI L UMUM

INDRI MULYANTI P UMUM

VIVALDY MANDALA P L REMAJA

M. RICHIE L REMAJA

NABIL HAIKAL FAHREZI L ANAK

RAISYA FADILLA L ANAK

M. HASBI RIZIQ L ANAK

APILIA LAITA ADZKIRA P ANAK

M. FAEYZA ARFA NOOR P L ANAK

PAHMI AZMI AJI L ANAK

CANDRA RISWANA L ANAK

MUTIA KAMILAH P ANAK

AZLIKHA RAYNISSA S P ANAK

EL SHAARAWY MIKAIL L ANAK

ARMAN L ANAK

M. ZAHRAN MULYA R L ANAK

NARAA AULIA SAKHI P ANAK

M. ZHULPAN ZIKRI L ANAK

DEDE PRIYATNA L UMUM

M. IKHSAN DWI L REMAJA

SITI NURHALIMAH P UMUM

WAHYUDIN L UMUM

SITI NOOR LAILA KH P UMUM

DAYAT L LANSIA

WITA ANTIKA R S P UMUM

RAJU SAEPUDIN L UMUM

KOSIM L LANSIA

EMAH P LANSIA
M. ABIDIN S L LANSIA

YUNENGSIH P UMUM

ENOK SITI SARAH P LANSIA

CICIH P RENTAN

ENOK SUMIATI P RENTAN

ENUNG P LANSIA

DIDI L LANSIA

AEDAH P UMUM

HATIMI P LANSIA

ROSTITA P RENTAN

YANTI SUSANTI P UMUM

DEDE ROSMINI P UMUM

ANDY FIRMANSYAH L REMAJA

JEJEN L UMUM
 FORMAT PENCATATAN PELAKSANAAN VAK
TINGKAT PUSKESMAS/FASYANKES/POS

Umur Kelompok
Tanggal Lahir
(18-59 tahun) Umur

11/05/1984 38 31-45

30/10/2004 18 18-30

05/06/1979 43 31-45

16/08/1962 60 ≥60

08/03/1969 53 46-59

15/02/1953 69 ≥60

05/07/1974 48 46-59
01/01/2004 19 18-30

01/11/1997 25 18-30

10/12/1965 57 46-59

01/10/1960 62 ≥60

26/11/1970 52 46-59

15/01/1950 73 ≥60

20/09/1984 38 31-45

05/08/2000 22 18-30

13/05/2009 13 12-17

29/07/2009 13 12-17

23/11/2013 9 6-11

27/05/2012 10 6-11

29/04/2011 11 6-11

06/08/2014 8 6-11

11/01/2015 8 6-11

20/02/2014 8 6-11

13/12/2012 10 6-11
24/07/2011 11 6-11

13/05/2010 12 12-17

15/03/2012 10 6-11

19/03/2011 11 6-11

21/07/2014 8 6-11

01/03/2012 10 6-11

03/04/2014 8 6-11

25/11/2000 22 18-30

12/11/2009 13 12-17

16/12/1994 28 18-30

03/01/1981 42 31-45

08/11/1991 31 31-45

04/11/1959 63 ≥60

02/04/2002 20 18-30

11/01/2000 23 18-30

31/12/1952 70 ≥60

14/03/1960 62 ≥60
 17/05/1947 75 ≥60

01/02/1977 45 31-45

10/06/1960 62 ≥60

24/10/1965 57 46-59

04/08/1966 56 46-59

05/09/1955 67 ≥60

02/07/1955 67 ≥60

13/08/1974 48 46-59

12/09/1951 71 ≥60

24/05/1966 56 46-59

01/01/1981 42 31-45

27/05/1982 40 31-45

06/03/2004 18 18-30

03/05/1982 40 31-45
PENCATATAN PELAKSANAAN VAKSINASI COVID-19
KAT PUSKESMAS/FASYANKES/POS VAKSINASI

Alamat* No. Hp

PSW 015/008 087879701474

PSK 011/006 087826052716

PSA 004/002 0895332779106

WKD 009/004 087778761052

KTJ 012/004 081295405421

PSW 012/006 085721386965

PSW 012/006 085721386965

SWK 006/003 089503751954

MRG 008/004 083817040268

CHR 012/003

PSW 001/001

PSW 011/006 085221020464

SWK 012/006 085926064995

BUNDER 021/008 085862732416

SWK 010/005 081572131920

NAGRIKIDUL 085926064995

PSW 085926064995

CAMPAKASARI 003/001 087718046047

CILALAWI 010/003 083842946829

KREYO 008/004 087776811778

SWK 004/002 085900083755

PARAKANLIMA 001/001 089602895309

SLW 011/006 081908440267

SLW 011/006 081908440267

SLW 010/005 083116552560

PSK 004/002 0878888401919

PSA 001/001 087774434438

SINDANGKASIH 020/004 087749188102

PSW 004/002 083141464317

PSW 009/006 083811793871

PSW 007/004 081316934255

KOSAMBIBATU 003/001 0812213866283

JL. VETERAN 087879935487

PSK 005/003 083878583558

SWK 011/005 083807719400

CIPAISAN 014/006 087760825184

CHN 012/006 087801328746

SWK 007/002 081572603373

KOSAMBIBATU 003/001 081291983788

PSK 011/006 081826052716

PSK 011/006 081826052716

PSK 011/006 087781843601

MRG 001/001 085721150561

SWK 002/001

PSW 008/004 083815668982

PSW 001/001

CHN 002/001

CHN 002/001

CHR 002/001

SWK 003/002 081212637360

PSA 008/004 087879813169

CHR 004/002 085959168601

MRG 001/001 08386359509

PSW 083176150822

MRG 008/004 083823245313

Tekanan Darah Tanggal Screening Nama/Jenis/Merek Vaksin***

110/70 13/01/2022 CORONAVAC

110/70 13/01/2022 CORONAVAC

110/80 13/01/2022 CORONAVAC

100/70 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

100/70 13/01/2022 CORONAVAC

130/80 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/70 13/01/2022 CORONAVAC

100/70 13/01/2022 CORONAVAC

170/90 13/01/2022 CORONAVAC

140/90 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

150/80 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

100/70 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

80/60 13/01/2022 CORONAVAC

100/80 13/01/2022 CORONAVAC

110/70 13/01/2022 CORONAVAC

100/60 13/01/2022 CORONAVAC

100/60 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

90/60 13/01/2022 CORONAVAC

110/80 13/01/2022 CORONAVAC

100/70 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

120/80 13/01/2022 CORONAVAC

150/90 13/01/2022 CORONAVAC

140/90 13/01/2022 CORONAVAC

130/60 13/01/2022 CORONAVAC

100/70 13/01/2022 CORONAVAC

100/60 13/01/2022 CORONAVAC

140/90 21/01/2022 CORONAVAC

160/90 21/01/2022 CORONAVAC

100/60 21/01/2022 CORONAVAC

90/60 21/01/2022 CORONAVAC

120/80 21/01/2022 CORONAVAC

130/80 21/01/2022 CORONAVAC

 Dosis I Dosis 2

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

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E
131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E
131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E
 131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

131/1/2022 202109200E

21/01/2022 202109200E 21/01/2022 202109200E

21/01/2022 202109200E 21/01/2022 202109200E

21/01/2022 202109200E 21/01/2022 202109200E

21/01/2022 202109200E 21/01/2022 202109200E

21/01/2022 202109200E 21/01/2022 202109200E

21/01/2022 202109200E 21/01/2022 202109200E

 Keterangan
(Ditunda/Tidak Diberikan/Lanjut)

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT
LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT
LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

LANJUT

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI
SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI
 REKAPITULASI VAKSINASI
21.12.2021
TOTAL

KELOMPOK USIA
NO JUMLAH DOSIS 1
REMAJA UMUM RENTAN LANSIA

1 5 18 7 11 41 31

JUMLAH MENURUT JENIS KELAMIN

LAKI-LAKI 27
PEREMPUAN 28
JUMLAH 55

KRITERIA DOSIS 1 DOSIS 2 JUMLAH

REMAJA 3 2 5
UMUM 7 11 18
RENTAN 4 3 7
LANSIA 3 8 11
JUMLAH 41
 DOSIS 2 JUMLAH

24 55

DI MOHON SANGAT MOHON UNTUK PENGISIAN ALAMAT

SESUAIKAN DENGAN KODE KRITERIA DESA, CONTOH =
KODE KRITERIA SPACE RT/RW (PSW 1/1)
JUMLAH PENDUDUK YANG DI VAKSIN
NAMA DESA KODE KRITERIA JUMLAH
PASAWAHAN PSW 12
PASAWAHAN ANYAR PSA 3
PASAWAHAN KIDUL PSK 6
CIHUNI CHN 3
CIHERANG CHR 3
CIDAHU CDH 0
LEBAK ANYAR LA 0
SAWAH KULON SWK 8
WARUNG KADU WKD 1
MARGASARI MRG 4
SELAAWI SLW 3
KERTAJAYA KTJ 1
LUAR WILAYAH PSW SESUAIKAN
TOTAL 44