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Disruptions in the intrinsic factor (IF) pathway, including impaired IF production due to autoimmune conditions (pernicious anemia), damage to the ileum from diseases like Crohns or celiac disease, or surgical resection of the ileum, can severely impair B12 absorption

A tablet cannot replace an injection if your body physically cannot absorb B12 from your gut (e.g., in pernicious anaemia)

However, the reaction that has been dubbed as COVID arm is unique because it appears about a week after a person gets the vaccine, most commonly after the first dose