Name  

  : NUR HAYATI BINTI SUPARMU

Date Of Birth    : 14 Feb 1982
Sex     : Female
Nationality     : INDONESIA
1. Vaccine or prophylaxis : Date :
      Meningitis Meningococcus ACYW135 10 May 2023

    Manufacture and batch of vaccine : Valid until :

      j202210003 09 May 2025

    Signature and professional status of supervising Official Stamp

clinician : :

2. Vaccine or prophylaxis : Date :

      COVID-19 1st Dose 17 May 2021

    Manufacture and batch of vaccine : Valid until :

      CTMAV545

    Signature and professional status of supervising Official Stamp

clinician : :

NUR HAYATI BINTI SUPARMU 3. Vaccine or prophylaxis :

      COVID-19 2nd Dose
Date :
09 Aug 2021
KAB. PROBOLINGGO     Manufacture and batch of vaccine : Valid until :
     D005A
1300554050
    Signature and professional status of supervising Official Stamp
clinician : :