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Vegans, vegetarians, and people with restrictive diets may not consume enough B12, making ongoing injections valuable

The advice is cautious and sensible rather than absolute

Vitamin B12 deficiency can be caused by several factors, including: Inadequate dietary intake: Since vitamin B12 is naturally found in animal-based foods, strict vegetarians and vegans who do not consume fortified foods or supplements are at risk of developing a deficiency

Nat Rev Gastroenterol Hepatol 2012;9:34554

A common billing mistake (and one that generates a surprising number of denials) reporting 90471 multiple times when a patient receives several injectable vaccines during the same visit