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In such patients, it is necessary to try to establish whether there is significant cobalamin deficiency, e.g., by careful examination of the blood film, tests for serum gastrin level and for antibodies to IF or parietal cells, along with serum methylmalonic acid (MMA) measurement if available

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I dont know if it has anything to do w vaccine but timing is suspect

This proposed Overall Hospital Quality Star Rating methodology update is meant to complement and support other efforts within CMS to drive improvements in patient safety, most notably the HACRP

While specific protocols vary, a general rule of thumb isn't universally applicable for research compounds