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What to do when you spot a warning sign Follow this protocol: Do not inject the medication Take a photo of the vial with good lighting for documentation Note the lot number, expiration date, and pharmacy name on the label Contact your compounding pharmacy and describe what you see Ask for a replacement vial If you already injected medication that looked abnormal and experience any unusual symptoms, contact your healthcare provider You are not overreacting by calling your pharmacy about a suspicious-looking vial

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However, the assays fail to detect deficiency in older patients, even when it is severe enough to precipitate neuropsychiatric disease