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This is especially important for patients with absorption issues such as those with digestive conditions, low stomach acid (common with aging), or MTHFR gene variants who cannot adequately absorb B12 from food or oral supplements

I have also accessed other sites for my B12 injections, including, the upper arm (deltoid), thigh (vastus lateralis), and the buttocks (dorsogluteal)

In my own practice, especially if an older person has risk factors for vitamin B12 deficiency, I consider a vitamin B12 level of 200-400 pg/mL borderline, and I usually order a methylmalonic acid level as a follow-up

All cases for the aforementioned must be handled by the manufacture of the product and we encourage reporting to the FDA website.