Item: Safety Pin
A white orbiting fly which deals 3 contact damage per tick to enemies. This familiar orbits Isaac at a middle length distance somewhere between Distant Admiration and Forever Alone.
Grants a chance to trigger the Book of Shadows effect upon taking damage, creating a shield that nullifies all types of damage for 7 seconds.
Increases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
Two items spawn in every Treasure Room. Only one can be taken; the other will disappear.
Increases range and shot height.
A purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Grants 7 bombs and allows bombs to be placed rapidly.
+5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects troll bombs.
Contract From Below
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.
Chance upon entering a room to slow down or speed up every enemy and their attacks. The chance to slow enemies is quite higher than the chance to speed them up.
Spawns a flying familiar for the current room that chases enemies whenever Isaac takes damage.
Spawns an orbiting eye familiar that fires tears every 2 seconds.
Adds an extra life; upon death, it respawns Isaac as Black Judas with only two black hearts.
Spear of Destiny
In addition to tears, Isaac now holds a spear in front of him which deals damage equal to 2 times his tear damage, and occasionally inflicts fear. The spear cannot be thrown, but deals damage while it is in contact with an enemy.
A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
When Isaac is hit, 1 point of an item's charge is filled.