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After first entry, an opened repeated-entry vial is generally dated and discarded within 28 days unless the manufacturer states another period.

Czlonkowska et al

Contact your healthcare provider promptly if you experience any of the following after injection: significant swelling or hardness at the injection site that does not resolve within 48 hours, redness that expands beyond two inches from the injection point, warmth or heat radiating from the injection site combined with pain, any discharge from the injection site including pus or cloudy fluid, fever following injection, severe allergic reaction signs including hives or difficulty breathing, or persistent pain that intensifies rather than improving over 24 hours

doi: StatPearls

If laboratory testing shows low or low-normal B12 levels despite weekly injections, additional supplementation is appropriate and beneficial

Plain sterile water has no preservative, so anything inside the vial after the first needle stick is at much higher risk of bacterial growth