Name : JULI SETIANING TYAS

Date Of Birth : : 05 Jul 1986

Sex: : FEMALE
Nationality : : INDONESIA
Vaccine of prophylaxis Meningitis Meningococcus ACYW135
Date : 06 May 2019
Signature and professional status of
supervising clinician

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Manufacture and batch no of vaccine
J201811005

Certificate valid
JULI SETIANING TYAS From : 06 May 2019
KAB. JEPARA Until : 20 Apr 2022
Official stamp of the
1100428684 administering center