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The American Academy of Family Physicians and NIH identify the following clinical manifestations: Fatigue and generalized weakness Megaloblastic anemia (abnormally large, immature red blood cells) Tingling or numbness in the hands and feet (peripheral neuropathy) Difficulty walking and balance problems Cognitive disturbances including memory difficulty and confusion Mood changes, including depression and irritability Glossitis (swollen, inflamed tongue) Early symptoms such as fatigue and mild tingling are often attributed to stress, aging, or other conditions

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"Nascobal (Cyanocobalamin, USP) Nasal Spray 500 mcg/spray 0.125 mL Rx only" (PDF)

High-grade fever is more common in mosquito-borne and hemorrhagic viral fevers

Only one of these four, methionine, is an amino acid