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Your goal is to make dosing simple

Professional Advocacy: Professional organizations, such as the American Medical Association (AMA) and the American Academy of Orthopaedic Surgeons (AAOS), can advocate for stricter enforcement of regulations and provide guidance to their members on ethical practices

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doi: 10.1002/art.40128 182 ChooQYHoPCTanakaYLinHS

The long answer: Refrigeration is critical because it dramatically slows down two separate but equally problematic processes

True B12 toxicity symptoms are rare but may include skin reactions, mild gastrointestinal disturbances, and headaches, particularly with injections