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Imerslund-Grsbeck syndrome in a 15-year-old German girl caused by compound heterozygous mutations in CUBN

If you dont get enough B12 in your diet or through supplementation, you may develop one or more of the following symptoms [4]: - Mild fatigue during exercise or daily activities - Heart palpitations - Skin paleness or hyperpigmentation - Glossitis (tongue inflammation) - Neurological symptoms such as loss of reflexes, loss of proprioception (knowing where your limbs are without looking at them), forgetfulness Signs that healthcare providers use to detect a B12 deficiency include [4]: - Megaloblastic anemia (abnormally large and nucleated red blood cells) - Abnormal blood work, including decreased levels of haptoglobin

We reiterate that, due to inherent differences in the devices themselves and the supporting documentation submitted, CMS may have different concerns as they relate to the nominated device

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