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The only definitive sign is the beyond-use date stamped by the pharmacy or a known temperature excursion (vial left out for more than 4 hours or frozen)

Common symptoms of Vitamin B12 deficiency include: Fatigue Nervousness Numbness in the arms and legs Tingling in the arms and legs Anemia and Pernicious Anemia Weakness Neuro-Cognitive Decline There are many common medications, medical procedures and medical conditions that may lead to Vitamin B12 deficiency including: Medications , Prilosec and other proton-pump inhibitors that are used to treat heartburn and ulcers Prevacid , Pepcid and other H2 receptor antagonists that are used to treat ulcers Zantac that is used to treat diabetes Metformin Medical procedures Gastrointestinal surgery such as or surgery to remove all or part of the stomach weight loss surgery Medical conditions Gastrointestinal disorders including Crohns and celiac disease Pernicious anemia Atrophic gastritis Other reasons Age Vegetarian or vegan diet Recent research has also shown that there is an inverse association between Vitamin B12 status and obesity which means that the higher your weight, the more likely you are to be deficient in Vitamin B12 (reference)

This allows researchers to test a range of doses on a smaller cohort, identifying the minimum effective dose and any potential adverse effects before committing to a larger, more resource-intensive study

So be sure you understand any benefits you might have before you pay full price for eye exams and corrective lenses