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Multiple things can result in a B-12 deficiency

MECHANISM CATEGORIES SAFETY Side effects Generally well-tolerated in trials at the doses tested Injection-site reactions Known interactions Not characterized in Phase 3 Contraindications Pregnancy/lactation (unstudied) REGULATORY STATUS FDA Not FDA-approved as a drug

If its closer to your next scheduled dose, you may be advised to skip the missed one and continue as normal

I may use slightly less in patients that have no pain at all in many areas of the head or shoulders and have a very localized pain (such as just in one side of the forehead), are elderly, or young in late teens or early twenties and have not had it before