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National Library of Medicine, 31 July 2025

However, if the B12 deficiency causes is more acute or if absorption issues exist, such as pernicious anemia or after surgery to the gastrointestinal tract, vitamin B12 may need to be given intramuscularly

rather, its activity is mediated through modulation of multiple intersecting pathways

A COA documents third-party testing of the medication for: Identity (confirming the medication is what the label says) Potency (confirming the concentration matches the label) Sterility (confirming no microbial contamination) Endotoxin levels (confirming safety for injection) pH and stability If your pharmacy cannot or will not provide a COA, consider whether you are comfortable using their products