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Acknowledgments The authors would like to thank the other employees of Falsified Medicines and Medical Devices Department of National Medicines Institute for their assistance with preparing photographic documentation of samples and preparing samples for analysis

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Patients and healthcare professionals should report any suspected side effects, adverse reactions, or defective or falsified products to the MHRA via the Yellow Card scheme (available at yellowcard.mhra.gov.uk)

Typical injection dosages can range from: 1,000 mcg (1 milligram) given weekly, monthly, or on a less frequent schedule depending on the severity of the deficiency and the individuals response

Optimising treatment should be a more acceptable means of rationing