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Signs and symptoms include (but are not limited to): Extreme tiredness (fatigue) Tiredness / lack of energy Pale skin Numbness and / or tingling (paraesthesia) Feeling faint Noticeable heartbeat (palpitations) Feeling short of breath Loss of appetite Ringing in your ears (tinnitius) Unintended weight loss Changes in your vision A yellow tinge to the skin Depression Irritability Changes in the way you feel, behave, and think ('brain fog') A decline in mental function, such as changes to your memory, judgement and understanding (dementia) How long do B12 injections last