MAKLUMAT PENERIMA VAKSIN / VACCINEE DETAILS

Nama / Name
KUKHAN A/L ARJUNAN
Warganegara / Nationality
MALAYSIAN

MALAYSIA No. Kad Pengenalan / Identity No. No. Pasport / Passport No.
861121435807 _

SIJIL DIGITAL Tarikh Lahir / Date of Birth

VAKSINASI COVID-19
DIGITAL CERTIFICATE for COVID-19
VACCINATION
21-Nov-1986
Kementerian Berkuasa / Authority Ministry
KEMENTERIAN KESIHATAN (MINISTRY OF HEALTH)
Negara Pengeluar / Issuing Country
MALAYSIA
Tarikh Dikeluarkan / Date Issued
15-Mar-2022
Page 1 of 2

MAKLUMAT VAKSINASI / VACCINATION DETAILS

Dose 1 of 2 Tarikh Divaksin / Date of Vaccination

07-Jul-2021
Pusat Pemberian Vaksin / Vaccination Center
Ideal Convention Centre Shah Alam
Nama Produk / Product name
COVID-19 Vaccine AstraZeneca Solution for Injection (TH)
Nama Umum / Common Name
AstraZeneca
Pengeluar / Manufacturer Jenis Vaksin / Vaccine Type
Siam Bioscience Co., Ltd. covid-19 vaccines
No. Lot / Batch No.
A1013

Dose 2 of 2 Tarikh Divaksin / Date of Vaccination

08-Sep-2021
Pusat Pemberian Vaksin / Vaccination Center
Ideal Convention Centre Shah Alam
Nama Produk / Product name
COVID-19 Vaccine AstraZeneca Solution for Injection (GB)
Nama Umum / Common Name
AstraZeneca
Pengeluar / Manufacturer Jenis Vaksin / Vaccine Type
AstraZeneca AB, SE-151 85 covid-19 vaccines
Sodertalje Sweden
No. Lot / Batch No.
PV46701
 MAKLUMAT PENERIMA VAKSIN / VACCINEE DETAILS
Nama / Name
KUKHAN A/L ARJUNAN
Warganegara / Nationality
MALAYSIAN

MALAYSIA No. Kad Pengenalan / Identity No. No. Pasport / Passport No.
861121435807 _

SIJIL DIGITAL Tarikh Lahir / Date of Birth

VAKSINASI COVID-19
DIGITAL CERTIFICATE for COVID-19
VACCINATION
21-Nov-1986
Kementerian Berkuasa / Authority Ministry
KEMENTERIAN KESIHATAN (MINISTRY OF HEALTH)
Negara Pengeluar / Issuing Country
MALAYSIA
Tarikh Dikeluarkan / Date Issued
15-Mar-2022
Page 2 of 2

MAKLUMAT VAKSINASI / VACCINATION DETAILS

Booster Dose Tarikh Divaksin / Date of Vaccination

17-Jan-2022
Pusat Pemberian Vaksin / Vaccination Center
Poliklinik We Care
Nama Produk / Product name
Comirnaty
Nama Umum / Common Name
Pfizer
Pengeluar / Manufacturer Jenis Vaksin / Vaccine Type
Biontech Manufacturing GmbH SARS-CoV-2 mRNA vaccine
No. Lot / Batch No.
FM3809