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Injection-site reactions: Mild redness, tenderness or soreness can occur with subcutaneous administration

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The American Academy of Family Physicians and NIH identify the following clinical manifestations: Fatigue and generalized weakness Megaloblastic anemia (abnormally large, immature red blood cells) Tingling or numbness in the hands and feet (peripheral neuropathy) Difficulty walking and balance problems Cognitive disturbances including memory difficulty and confusion Mood changes, including depression and irritability Glossitis (swollen, inflamed tongue) Early symptoms such as fatigue and mild tingling are often attributed to stress, aging, or other conditions

FDA reviewers raised several significant concerns: Inadequate characterisation and missing quality-related data for certain substances reviewed by the agency