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The Pernicious Anaemia Society notes this is well documented but poorly understood, and that some patients self-inject more frequently

and diurnal fluctuations in symptoms with worsening in the evening and at night

Patients should be aware that if they experience concerning symptoms whilst taking B12 supplements, they should discuss this with their GP and report suspected adverse reactions via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk)

Microbiological Testing For capsule and liquid matrices, robust Microbiological Quality Testing functions as the correct measure of cleanliness, sterility and product integrity

In essence- they cant use or absorb this form of B12it just makes for expensive poo

Eur J Dermatol.2007 Nov-Dec;17(6):551-2