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| Defeat Hush as ???Fate's Reward|
Fate's Reward is an unlockable passive item added in Afterbirth.
- Spawns a familiar that fires tears with the same damage and tear effects as Isaac's tears.
- Fires at half the normal fire rate of a familiar.
- 20/20Grants double shot./ The Inner EyeGrants triple shot but decreases tears./ Mutant SpiderGrants quadruple shot but decreases tears.: Fate's Reward only fires single tears. Does not affect fire rate of Fate's Reward.
- BrimstoneTears 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.: Fate's Reward fires normal tears.
- Chocolate MilkGrants charged tears that deal greater damage when fully charged.: Familiar's tears will turn a brown color but can not be charged.
- Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide a fixed range after being fired.: Fate's Reward fires normal tears.
- Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote.: Fate's Reward fires normal tears.
- The Ludovico TechniqueInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.: Fate's Reward fires normal tears.
- MarkedIsaac will now fire tears automatically directed at a red target on the ground which is controlled by the player. This allows for a full 360 degree tear firing radius. Can be overridden by other tear modifiers such as Mom's Knife or Brimstone.: Fate's Reward will only fire while the crosshair is being moved, and can only fire in cardinal directions.
- Mom's KnifeIsaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.: Fate's Reward fires normal tears.
- Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Fate's Reward fires normal tears. The tear color is now red.
- Soy MilkTears shrink and do much less damage, but fire in very rapid succession.: Does not affect fire rate but does affect damage.
- Tech XTears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.: Fate's Reward fires normal tears.
- Cricket's BodyGrants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's./ The ParasiteIsaac's tears split in two when they hit something./ Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.: Fate's Reward will fire tears that will split into burst tears.
- EuthanasiaAdds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.: Adds a chance to fire needle tears.
- Flat StoneTears bounce off the floor. Tears that hit an enemy after bouncing deal splash damage to all nearby enemies for 25% of Isaac's tear damage.: Familiar's tears will travel very far and then bounce once, travelling up and hitting the nearest wall.
- HaemolacriaTears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.: Will fire tears that burst into split tears. Does not affect fire rate.
- Homing tears/ Baby-BenderGrants Isaac's familiars homing shots.: Grants familiar homing shots.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Will fire explosive tears. Does not affect fire rate.
- LachryphagyIsaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.: Will fire tears that can be fed.
- Pop!Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.: Will fire eyeball tears.
- TrisagionTears are replaced with piercing white blasts of light.: Will fire beams.