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The symptoms of a vitamin B-12 deficiency may include: Fatigue, weakness Memory loss Depression Confusion Insomnia Shortness of breath Poor sense of balance Vision problems Diarrhoea or constipation Loss of appetite Cognitive functioning problems Beefy, red, smooth and sore tongue Sore mouth and/or bleeding gums Numbness and tingling of hands and feet Loss of hearing and tinnitus Pale, possibly yellowish pallor in light-skinned individuals

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What this implies: if the vial remains sealed, in a cool, dry, dark place (ideally under refrigeration or freezing, with minimal humidity), you can reasonably expect 2-3 years of viability in the lyophilized state

Am J Clin Nutr (2009) 89(2):693S6S.10.3945/ajcn.2008.26947A 2 StablerSP