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Fruit Cake is a passive item added in Afterbirth.
- Each tear that Isaac fires gains a random effect. The possible effects are:
- Anti-Gravity-2 Tear Delay. Tears float in position until firing ceases, after which they will fly off in the direction they were shot in.
- Continuum+2.25 Range Up. +1.5 Tear Height. Isaac's tears travel through walls and appear out of the opposite wall. Isaac's tears also travel over rocks and objects.
- Cupid's ArrowGrants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
- EuthanasiaAdds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.
- ExplosivoIsaac's tears have a chance to stick to enemies and explode.
- Eye of GreedAdds a chance to fire tears that temporarily stun enemies and turn them into gold. Any enemy killed while in this state will drop coins.
- Fire MindGrants flaming tears that deal burning damage over time. Tears have a chance to explode on impact with an enemy, which creates a fire at the location of the explosion.
- 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.
- Flat WormIsaac's tears take on an oblong appearance. They also push enemies back.
- God's FleshTears now have a random chance to apply a shrinking effect, causing enemies to shrink in size and also run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.
- GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.
- Head of the KeeperIsaac's tears become coins and now have a chance to drop pennies on the floor upon successfully hitting an enemy.
- Holy LightIsaac has a random chance to fire a Holy tear, which, when it hits an enemy, will spawn a Crack the Sky-style light beam on the same enemy, dealing damage.
- Hook WormTears move shifting left to right forming a path of right angles. +10 to Range (effective range remains about the same).
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.
- Iron BarIncreases damage by 0.3 and adds a chance to shoot concussive tears, causing enemies to walk around randomly.
- Jacob's LadderTears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
- 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.
- Little HornAdds a chance to fire a piercing tear that instantly kills any enemy that it touches.
- Mom's ContactsAdds a chance to shoot petrifying tears, which stop enemies in place and prevent them from moving or attacking. Range up.
- Mom's EyeshadowTears have a chance to charm enemies.
- Mom's PerfumeAdds a chance to shoot fear tears and decreases tear delay by 1.
- My ReflectionGives Isaac's tears a boomerang effect, and increases range and shot speed.
- Mysterious LiquidTears leave a small, short lasting pool of creep on impact or when their range is depleted.
- Ouija BoardGrants spectral tears that travel through obstacles (but not enemies) instead of breaking on impact with them.
- Ouroboros WormTears travel in a large spiral pattern and become spectral.
- The ParasiteIsaac's tears split in two when they hit something.
- ParasitoidAdds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.
- 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.
- ProptosisTears start out massive with high damage, and then shrink down and become weaker over a short range.
- Pulse WormShots pulse in size.
- Ring WormGives Isaac spinning shots.
- Rubber CementTears bounce off walls, enemies, and environmental objects.
- Serpent's KissTears now have a random chance to apply a poison effect, causing 4 or 6 damage per tick to enemies (Similar to The Common Cold item). Isaac now deals poison damage on contact with enemies similar to The Virus item (Damage over time 4 or 6 per tick). Enemies that were poisoned have a chance to drop a black heart when killed.
- Sinus InfectionAdds a chance to fire a booger which sticks to enemies and poisons them.
- Spider BiteAdds a chance to shoot slowing tears, reducing speed of enemy movement and any projectile fired by them.
- Strange AttractorPickups, trinkets, and monsters are magnetically attracted to Isaac's tears.
- Sulfuric AcidIncreases damage. Adds a chance to fire acidic tears which can destroy obstacles.
- Technology ZeroConnects Isaac's tears with electricity that can damage enemies.
- Tiny PlanetRange up and makes shot tears revolve around Isaac until they drop.
- TrisagionTears are replaced with piercing white blasts of light.
- Wiggle WormGives Isaac's shots a wave-like trajectory. +0.3 Tears up.
- All items that multiply or add additional tears, such as 20/20Grants double shot., The Inner EyeGrants triple shot but decreases tears., Mutant SpiderGrants quadruple shot but decreases tears., or Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.: Each tear has a random effect.
- 3 Dollar BillGives Isaac a random tear effect every room.
The effect given changes upon entering a room.
The effect changes every 3 seconds.: Multiple effects occur at once.
- Doctor's RemoteSets a big red target on the ground (similar to the Epic Fetus item) which can be controlled with tear controls. After 6 seconds or by pressing space again, a huge explosive missile hits it, which damages all enemies caught in its blast radius., Dr. FetusTears are replaced by bombs that benefit from bomb-enhancing effects and slide for a fixed time after being fired., Epic FetusIsaac's tears are replaced with guided missiles, like those used by the Doctor's Remote., IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Instead of producing random tear effects, Fruit Cake produces random bomb effects.
- Finger!Spawns a finger familiar that points at enemies, dealing constant damage.: Invisible tears fired by the Finger will have a random effect.
- Spoon BenderGrants Isaac homing tears.: Each tear will still have a homing effect.
- Technology 2Decreases damage and replaces right eye tears with a unlimited range, piercing laser which fires continuously.: Each tick of the laser can have a random status effect. This means that it's possible to quickly affect an enemy with multiple status effects.
- 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.: Laser rings receive random effects without a change in color.
- 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.: Tears created by 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. effect hover indefinitely, and each cycle through their own random tear effects. This allows a large buildup of powerful tears on longer rooms. 
Afterbirth item and trinket concepts, including Fruit Cake.
PC 4FDK AX4S (Treasure room adjacent to spawn)
PC VLM3 QQTV (First floor treasure room)