Item: Empty Vessel

Combined with Key Piece 2, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.

Increases Tears by 0.7.

Spawns a fly familiar that orbits around a random enemy and deals 5 damage per tick to enemies it comes in contact with.

Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.

While Isaac has no red hearts, this item grants flight and a random chance to activate an invincibility shield for a few seconds. If Isaac gains any red hearts, these benefits will disappear.

Gives one heart container and doubles the healing provided by red hearts.

+0.7 tears, +16% shot speed.

Doubles the number of pickups and chests spawned after clearing a room or performing some other triggering action (such as using a blood donation machine), but reduces the chance for any pickups to spawn at all.

Grants a chance of converting any red hearts pickups into soul hearts instead.

Increases damage and speed, removes all red heart containers, grants six black hearts, and adds a chance to shoot fear tears.

Grants two soul hearts. Isaac now repels enemy projectiles.

+0.7 tears up. Grants a random item at the start of the next run.

Isaac's tears become coins and now have a chance to drop pennies on the floor upon successfully hitting an enemy.

Sets your key count to the maximum of 99.

Increases Damage by 1.5, reduces Tears by 0.3 and increases tear size. Grants piercing tears. Tears are replaced by Death's scythes, which is a cosmetic effect only.

Tears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.

Grants 2 soul hearts and modifies drops from Champion Monsters based on certain conditions.

Tears have a chance to charm enemies.

Adds 1 heart container.

A familiar that follows Isaac and blocks tears. If a tear hits Farting Baby, there is a high chance for it to fart, which will either knock back, poison, or charm all nearby enemies.