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Excessive foam after adding water Foam indicates that water was added too forcefully or that the vial was agitated too aggressively

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If the note says "possible dysphagia" or "rule out dysphagia" in an outpatient setting, you don't code it as confirmed

Signs you may need a booster include recurring fatigue, brain fog, irritability, or trouble sleeping, especially if the injections previously improved these symptoms

Some of these symptoms can also happen in people who have a vitamin B12 deficiency but have not developed anaemia, said Dr Aravinda