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Specific clinical scenarios where injections are the standard of care include pernicious anemia, severe malabsorption syndromes, post-bariatric surgery when oral supplementation has failed, and critically low serum B12 levels accompanied by neurological deterioration

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Generalized: Anaphylactic shock and death have been reported with administration of parenteral vitamin B 12(see WARNINGS)

Use needles of shorter length (4 mm or the shortest available) and smaller diameter (highest gauge number), and the tip with the lowest penetration force to minimize pain