The Binding of Isaac: Afterbirth †/Additions

Mechanics

HUD

Found HUD

• Found HUD is a HUD addition that appears on the left side of the screen that gives numerical values to the player's current stats (e.g., damage, luck, speed, devil room chance). It can be enabled through the options menu.
• It is based off of the Missing HUD mod for Rebirth and Afterbirth.

Victory Lap

• A Victory Lap allows you to start a new run with almost all of your final items after completing the Dark Room. Multiple laps can be made as long as the Dark Room is cleared each time.
  • Completion Marks and most Achievements cannot be earned.
  • Isaac will take a full heart of damage on all floors after beginning a victory lap (unless he has The Wafer).
  • Some Items are lost upon starting a victory lap. Items lost this way are added back into their respective item pools and can be acquired again.
  • If the initial run was on normal difficulty, all victory laps will be on hard difficulty.
  • On the third and subsequent victory laps, the character will turn into The Lost. This version of The Lost does not get a Holy Mantle or D4. However, if the run was started as The Lost (or if the Holy Mantle was found) it is possible to keep the Holy Mantle from the previous run.
  • On the third and subsequent victory laps, shops will no longer appear.
  • On the third and subsequent victory laps, red chests in the Dark Room will turn into brown chests and golden chests.
  • Killing any final boss aside from The Lamb will end the game, and the run will not be continued further.

Menus

Options

Charge bars

• Added a new "charge bars" option in the menu, for passive items that need to be charged up before usage.
• This includes:
  • 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. (collectible and Azazel)
  • Cambion ConceptionAfter taking damage a certain amount of times, a permanent demonic familiar spawns.
  • Chocolate MilkGrants charged tears that deal greater damage when fully charged.
  • Cursed EyeGrants charged tears that can be fired in a tight burst of four. Getting hit while charging will teleport Isaac into another room.
  • Lil' BrimstoneA Familiar that shoots a thin Brimstone beam. Must charge like Brimstone before shooting.
  • Lil DeliriumGrants a familiar that transforms into another random familiar every 10 seconds.
  • Lil GurdyGives Isaac a Gurdy familiar that will charge around the room dealing contact damage to enemies. Lil Gurdy is charged by holding down a fire button and letting go. The longer the button is held, the faster Lil Gurdy will fling itself across the screen. Lil Gurdy can pass over objects and obstacles in the room.
  • Lil MonstroSpawns a familiar that fires clusters of tears. Must be charged before shooting.
  • Maw of the Void+1.0 Damage Up. After continuously firing tears for 2.5 seconds, a red cross appears on Isaac's head that, upon releasing the fire button, creates a black ring that rapidly deals damage equal to Isaac's tear damage to any enemies in contact with it.
  • 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.
  • Monstro's LungIncreases damage and grants a charged shot that fires multiple tears in the same fashion as Monstro.
  • 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.

RERUN

• RERUN is unlocked after completing the RERUN achievement.
• After winning a run the Continue option in the main menu will be replaced by Rerun. Selecting it starts a new run using most of the previous won run's items. Isaac will take full heart damage on all floors.

Player

Characters

Character	Apollyon	The Forgotten
Health		(soul)
Damage	3.5 (*1.00)	Forgotten: 3.50 (*1.50) Soul: 3.50 (*1.00)
Tears	+0	+0
Shot Speed	1	1
Range	23.75	23.75
Speed	1.0	Forgotten: 1.00 Soul: 1.30
Luck	0	0
Starting Pickups	None	None
Starting Item(s)	VoidConsumes all pedestal items in the room. Active items will have their effects added to Void, and passive items will grant stat upgrades.	None

Transformations

Name	Appearance	Description	Items
Adult		Grants a heart container.
Bookworm		Roughly 50% of the time, Isaac shoots an extra tear, like 20/20Grants double shot..
Spider Baby		Spawns a spider familiar that applies random status effects to enemies it comes in contact with.
Stompy	None	Taking damage has a chance to spawn rock waves.

Co-op

Special Babies

These Babies have special bonuses that will aid the player in some way.

ID	Appearance	Name	Description
55		Mort Baby	Spawns a blue fly, and spawns a new blue fly whenever its blue fly is destroyed. Defeat Mega Satan as ApollyonMort Baby to unlock it. The sprite greatly resembles Rotten BabyA familiar that spawns blue flies..
56		Apollyon Baby	Spawns with two Pretty Flies. Earn all Hard Mode Completion Marks as ApollyonApollyon Baby to unlock it.
57		Bone Baby	Wields a melee bone club instead of shooting tears, similarly to The Forgotten. Earn all Hard Mode Completion Marks as The ForgottenBone Baby to unlock it.
58		Bound Baby	Is bound to Isaac, similarly to The Forgotten's soul. Shoots spectral tears. Defeat Mega Satan as The ForgottenBound Baby to unlock it.

Normal Babies

These Babies are purely cosmetic and do not have any special behaviors.

ID	Appearance	Name	Description
428		Magiccat Baby	A baby that resembles the avatar of Tikara, the artist of the Isaac Tarot deck.
429		Little Horn Baby	A baby that resembles Little Horn.
430		Folder Baby	A baby with a folder for a head.
431		Driver Baby	A baby that is driving a car.
432		Dragon Baby	A baby that resembles a dragon.
433		Downwell Baby	A baby that resembles the player character from Downwell.
434		Cylinder Baby	A baby that is shaped like a cylinder.
435		Cup Baby	A baby with a teacup for a head.
436		Cave Robot Baby	A baby that resembles Quote from Cave Story.
437		Breadmeat Hoodiebread Baby	A toothy baby with a slice of toast for a head that resembles Breadmeat, a member of the Isaac community.
438		Bigmouth Baby	A baby with a large, wide-open mouth.
439		Afro Rainbow Baby	A baby with a rainbow colored afro.
440		Afro Baby	A baby with an afro.
441		TV Baby	A baby with a television for a head.
442		Tooth Baby	A baby with a tooth for a head.
443		Tired Baby	A tired-looking baby.
444		Steroids Baby	A muscular baby.
445		Soap Monster Baby	A baby that resembles Balrog from Cave Story.
446		Rojen Whitefox Baby	A baby that resembles a white fox. (might be a reference?)
447		Rocket Baby	A baby that looks like a firework.
448		Nurf Baby	A baby that resembles D.Va from Overwatch.
449		Mutated Fish Baby	A baby that resembles Fish from Nuclear Throne.
450		Moth Baby	A baby that resembles Moth from Creepy Castle.
451		Buttface Baby	A baby with a butt for a face.
452		Flying Candle Baby	A baby that looks like a candle.
453		Graven Baby	A baby with long hair. (might be a reference?)
454		Gizzy Chargeshot Baby	A baby that resembles Gizzy from ChargeShot.
455		Green Koopa Baby	A baby that resembles a green koopa from Mario.
456		Handsome MrFrog Baby	A baby that resembles Handsome Mr. Frog from the game of the same name.
457		Pumpkin Guy Baby	A baby with a pumpkin for a head wearing a purple rag. Possible reference to Terraria's Pumpking.
458		Red Koopa Baby	A baby that resembles a red koopa from Mario.
459		Sad Bunny Baby	A baby that looks like a crying rabbit. This is a reference to the sprites creator, Mort Mort (MnrArt) and their character Sad Bunny Face.
460		Saturn Baby	A baby that resembles the main character from Sgt. Saturn.
461		Toast Boy Baby	A baby with a slice of bread for a head. This is a reference to the sprite's creator, Mort Mort (MnrArt) and their character Toast Boy.
462		Voxdog Baby	A baby that resembles Vox the Dog.
463		404 Baby	A baby that has the Error trinket for a head.
464		Arrowhead Baby	A baby with an arrow through its head.
465		Beanie Baby	A baby wearing a green beanie.
466		Blindcursed Baby	A baby with the Curse of the Blind's question mark for a head.
467		Burning Baby	A baby that's been burnt to a crisp.
468		Cursor Baby	A baby that looks like a mouse cursor.
469		Flybaby	A baby that looks like a fly.
470		Headphone Baby	A baby wearing headphones.
471		Knife Baby	A baby with a knife for a head.
472		Mufflerscarf Baby	A baby wearing a scarf.
473		Robbermask Baby	A baby wearing a stereotypical robber's ski mask.
474		Scoreboard Baby	A baby with a digital number display, like those at a sporting event or on an alarm clock, for a face.
475		So Many Eyes Baby	A baby with eyes all over its body.
476		Text Baby	A baby made out of text characters. (ASCII art)
477		Wing Baby	A baby with wings.
480		Imp Baby	A baby that resembles the modded character Fiend from Devil's Harvest MOD.
481		32bit Baby	A baby that resembles Isaac in a 32 bit style.
482		Adventure Baby	A baby that resembles Finn the Human from Adventure Time.
483		Bubbles Baby	A baby made entirely of tar.
484		Bulb Baby	A baby that's very bright for his age.
485		Cool Orange Baby	A baby that resembles a very cool orange with sunglasses.
486		Crazy Ghost Baby	A baby that resembles Crazy Diamond from JoJo's Bizarre Adventure. (Also possibly a reference to the modded character.)
487		Cursed Pillow Baby	A baby that's unfortunately pillow shaded.
488		Egg Baby	A baby that resembles the modded item Greg the Egg.
489		Factory Baby	A baby that resembles a strange cyborg.
490		Falling Baby	A baby that resembles a white pineapple with goggles.
491		Funny Baby	A baby that resembles Sans from Undertale.
492		Gamer Baby	A baby that resembles an epic gamer. Inspired by a prominent member of the Binding of Isaac community.
493		Glittery Peach Baby	A baby resembling an oddly British Baby Plum from Antibirth.
494		Pompadour Baby	A baby that resembles Josuke from JoJo's Bizarre Adventure. (Also possibly a reference to the modded character.)
495		Head Kick Baby	A baby that resembles the Facepunch Logo.
496		Horn Baby	A baby that resembles the modded character Chronos.
497		Ichor Baby	A baby that resembles Ichor beasts from the game Heckland.
498		Ill Baby	A baby that resembles the modded boss Mahalath.
499		Lazy Baby	A baby that resembles Garfield.
500		Mern Baby	Mern.
501		Necro Baby	A baby that resembles the Xenomorph from the Alien franchise.
502		Peeping Baby	A baby that resembles the modded boss The Peeping.
503		Penance Baby	A baby that resembles the modded character Sarah from Revelations.
504		Psychic Baby	A baby that resembles the modded character Mei.
505		Puppet Baby	A baby that resembles the costume for the modded item Pinhead from Happy Items Pack.
506		Reaper Baby	A baby that resembles the modded character Samael.
507		Road Kill Baby	A baby that got ran over.
508		Sausage Lover Baby	A baby that resembles _Kilburn, the lead developer for Antibirth.
509		Scribble Baby	A baby that resembles the modded character The Drawn.
510		Star Plant Baby	A baby that resembles the main character from Germination.
511		Twitchy Baby	A baby that resembles Twitch from Heckland.
512		Witch Baby	A baby that resembles the modded character Endor from Alphabirth.
513		Workshop Baby	A baby that references a common trope of workshop thumbnails when firing tears.
514		Hooligan Baby	A baby that resembles Čeda from LeatherIceCream's "Poor 4" animations.
515		Half Spider Baby	A baby that resembles Miroslav from LeatherIceCream's "Poor 4" animations.
516		Silly Baby	A baby that resembles Djole from LeatherIceCream's "Poor 4" animations.
517		Master Cook Baby	A baby that resembles Andre from LeatherIceCream's "Poor 4" animations.
518		Green Pepper Baby	A baby that resembles one of _Kilburn's characters.
519		Baggy Cap Baby	A baby that resembles one of _Kilburn's characters.
520		Stylish Baby	A baby resembling the character Ren from the currently unreleased game Shenanigans: World of Illusions.

Items

109 new items were added in the expansion: 29 activated items and 80 passive items.

Activated Collectibles

Name	ID	Icon	Quote	Description
Black Hole	512		Nothing can escape	Throws a black hole on the ground which sucks in and damages enemies.
Book of the Dead	545		Rise from the grave	Upon use, spawns a friendly Bony or an orbital bone for each enemy killed in the current room.
Broken Shovel	550		It feels cursed	While held, causes multiple Mom's Foots to come down and stomp on Isaac. One of two parts necessary to create Mom's Shovel.
Brown Nugget	504		Friendly fly	Spawns a stationary fly familiar that fires tears at nearby enemies.
Clicker	482		Change	Transforms Isaac into another random character.
Compost	480		Gain more friends!	Spawns a blue spider or fly. Turns pickups in the room into blue spiders or flies.
Coupon	521		Allow 6 weeks for delivery	Upon use, makes a random item from a shop, devil deal, or black market free.
Crooked Penny	485		50/50	Spawns a penny and has a 50% chance to double all items and pickups in the room. If the effect fails, the items and pickups disappear.
D Infinity	489		Reroll forever	Grants a random dice item that changes each use.
D1	476		What will it be?	Duplicates a random pickup in the room.
Dataminer	481		109	Displaces enemy sprites for the current room, randomly increases one stat and decreases another.
Delirious	510		Unleash the power!	Spawns a random charmed boss.
Dull Razor	486		I feel numb...	Hurts Isaac without depleting health, activating any items that trigger upon taking damage.
Eden's Soul	490		...	Spawns two item pedestals.
Mama Mega!	483		BOOOOOOOOOM!	Damages all enemies and destroys all obstacles. The effect occurs every time a new room is entered for the rest of the floor. Opens doors to the floor's secret and super secret rooms.
Metronome	488		Waggles a finger	Grants a random item effect for the current room.
Mom's Shovel	552		Lost but not forgotten	Spawns a trapdoor that leads to the next floor upon activation. Unlocks The Forgotten when used on a mound of dirt that appears in The Dark Room.
Moving Box	523		Pack and unpack	If the box is empty, picks up all items and pickups in a room and stores them. If the box is not empty, places all stored items and pickups in the current room.
Mr. ME!	527		Caaan do!	Summons a controllable ghost that can perform various tasks depending on what it targets.
Mystery Gift	515		Wrapped up nice for you!	Upon use, spawns a random item from the current room's item pool, with a chance to spawn A Lump of Coal or The Poop instead.
Pause	478		Stop!	Freezes all enemies until a fire button is pressed.
Plan C	475		Use with caution	Kills all enemies in the room, then kills Isaac three seconds later.
Potato Peeler	487		A pound of flesh	Removes a heart container, increases damage and range, and grants a Cube of Meat.
Sacrificial Altar	536		He demands a sacrifice	Upon use, sacrifices up to 2 familiars and spawns an item from the Devil Room Pool for each familiar sacrificed.
Sharp Straw	507		More blood!	Damages all enemies in the room.
Smelter	479		Trinket melter!	Consumes Isaac's currently held trinket and applies its effect permanently.
Sprinkler	516		Sprinkles.	Upon use, spawns a sprinkler that rotates and fires tears.
Telekinesis	522		Power of the mind	Upon use, for the next two seconds, any enemy shots that come near Isaac are held in place. After the charge is depleted, they are fired back as tears.
Void	477		Consume	Consumes all pedestal items in the room. Active items will have their effects added to Void, and passive items will grant stat upgrades.
Wait What?	484		I can't believe it's not Butter Bean!	Isaac farts, sending out rock waves.

Passive Collectibles

Name	ID	Icon	Quote	Description
7 Seals	526		Lil harbingers!	Grants a random Harbinger familiar that changes every 10 seconds.
Acid Baby	491		Pills pills pills!	Spawns a familiar that drops random pills every 2 rooms cleared. Upon using a pill, all enemies in the room are poisoned.
Adrenaline	493		Panic = power	Increases damage based on how many empty heart containers Isaac has.
Analog Stick	465		360 tears!	+0.3 tears up. Allows Isaac to fire tears diagonally.
Angelic Prism	528		Eclipsed by the moon	Grants a prism orbital with a large orbital radius. Tears that pass through the prism split into four multi-colored tears.
Angry Fly	511		He's violent	Spawns a fly familiar that orbits around a random enemy and deals 5 damage per tick to enemies it comes in contact with.
Apple!	443		Trick or treat?	Increases tears. Adds a chance to fire a high-damage razor blade.
Backstabber	506		Watch your back!	Has a chance to fire tears that inflict bleeding on enemies, causing them to slowly take damage over time.
Belly Button	458		What's in there?	Drops a random trinket. Grants a second trinket slot.
Big Chubby	473		Chub chub	Spawns a familiar that slowly charges forward and damages enemies in its path.
Blanket	535		You feel Safe	Grants one soul heart. Upon entering a boss room, grants a shield that blocks one hit, then disappears.
Bloodshot Eye	509		Bloody friend	Spawns an orbiting eye familiar that fires tears every 2 seconds.
Bozo	513		Party time!	Increases damage by a flat 0.1 and grants a soul heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a rainbow poop.
Brittle Bones	549		Everything hurts	Replaces all red hearts with 6 empty bone hearts. Upon losing a bone heart, Isaac fires bones in 8 directions and permanently gains a tears up.
Broken Modem	514		Lag!	Enemies, enemy shots, tears, and pickups will briefly freeze in place at random intervals.
Broken Shovel	551		It feels cursed	One of two parts necessary to create Mom's Shovel.
Buddy in a Box	518		What could it be?!	Grants a familiar with a random tear effect. The familiar is randomized at the start of each floor.
Camo Undies	497		Camo kid	Isaac becomes camouflaged at the beginning of each room. Enemies will not attack Isaac until he starts firing tears.
Compound Fracture	453		Bone tears!	Increases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
Cone Head	457		Hard headed!	Grants a soul heart. Adds a chance to block enemy shots.
Contagion	466		Outbreak!	The first enemy killed in a room explodes and poisons nearby enemies. Poisoned enemies will also explode upon death.
Dad's Lost Coin	455		I remember this...	Increases range by 1.5. Drops a lucky penny.
Dad's Ring	546		Father's blessing	Creates a ring of light around Isaac that petrifies enemies in contact.
Dark Prince's Crown	442		Loss is power	Increases range, tears, and shot speed when at exactly one red heart.
Dead Tooth	446		Halitosis	While firing, Isaac gains a green aura that poisons nearby enemies.
Death's List	530		Just hope you're not next...	Grants a reward if all enemies in a room are killed in the order they are marked.
Depression	469		:(	Spawns a cloud familiar that leaves a trail of tears that damages enemies. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.
Divorce Papers	547		Tears up + you feel empty	Spawns a Mysterious Paper, increases tears, and grants a bone heart.
Dog Tooth	445		Bark at the moon!	Increases damage and speed. Upon entering a room adjacent to a secret room, a howl sound effect will play.
Duality	498		You feel very balanced	Whenever a Devil or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.
Eucharist	499		Peace be with you	An Angel Room door will always spawn after every boss fight, excluding the first floor and floors after Utero II/Womb II.
Euthanasia	496		Needle shot	Adds a chance to fire needles. If a needle kills an enemy, it bursts into more needles.
Eye of Belial	462		Possessed tears!	Grants piercing tears. After piercing one enemy, tears start homing and deal double damage.
Eye of Greed	450		Gold tears!	Adds a chance to fire tears that temporarily stun enemies and turn them into gold. Any enemy killed while in this state will drop coins.
Fast Bombs	517		Rapid bomb drops	Grants 7 bombs and allows bombs to be placed rapidly.
Finger!	467		Watch where you point that!	Spawns a finger familiar that points at enemies, dealing constant damage.
Flat Stone	540		Skipping tears	Tears 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.
Ghost Pepper	495		Flame tears	Adds a chance to shoot a fire that damages enemies and remains in place until it deals enough damage or the room is left.
Glaucoma	460		Blind tears!	Adds a chance to shoot concussive tears, causing enemies to walk around randomly.
Glyph of Balance	464		A gift from above	Grants 2 soul hearts and modifies drops from Champion Monsters based on certain conditions.
Greed's Gullet	501		Money = health!	Grants a heart container for every 25 coins Isaac has.
Haemolacria	531		I'm seeing red...	Tears 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.
Hallowed Ground	543		Portable sanctuary	Spawns a white poop familiar, which turns into a white poop when Isaac is hurt.
Hushy	470		Lil hush!	Spawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
Jacob's Ladder	494		Electric tears	Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
Jaw Bone	548		Fetch!	Spawns a familiar that flies the room while firing, dealing a flat 7 damage to enemies that come in contact and retrieving pickups.
Jumper Cables	520		Bloody recharge	Grants an active item charge every 15 enemies killed.
King Baby	472		Lord of the dead!	Spawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, it stops moving.
Lachryphagy	532		Feed them!	Isaac'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.
Large Zit	502		Creep shots	Adds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.
Lead Pencil	444		He's a bleeder!	After every 15 tears fired, Isaac will fire a high-damage cluster of tears.
Leprosy	525		You're tearing me apart!	Upon taking damage, grants a body part as an orbital, which blocks enemy shots and deals 7 damage per tick to enemies it comes in contact with. The orbitals will be destroyed if they take enough damage from enemies or enemy shots.
Lil Delirium	519		Delirious friend	Grants a familiar that transforms into another random familiar every 10 seconds.
Lil Monstro	471		Ain't he cute?	Spawns a familiar that fires clusters of tears. Must be charged before shooting.
Lil Spewer	537		Puking buddy	Spawns a random pill, and grants a small Spewer familiar that charges up and fires different types of creep.
Linger Bean	447		Crying makes me toot	Adds a chance to fire a gas cloud that damages nearby enemies.
Little Horn	503		Science!	Adds a chance to fire a piercing tear that instantly kills any enemy that it touches.
Marbles	538		Choking hazard	Spawns 3 random trinkets. Taking damage has a small chance to swallow Isaac's currently held trinket, gaining its effect permanently.
Marrow	541		HP up?	Grants one bone heart and spawns three red heart pickups.
Metal Plate	449		It itches...	Adds a chance to reflect enemy shots. Grants one soul heart.
Moldy Bread	456		Midnight snack!	Grants one full red heart container.
Mom's Razor	508		It's sharp!	Spawns an orbiting razor that damages enemies it touches and inflicts bleeding on enemies, causing them to slowly take damage over time.
Mystery Egg	539		Sacrificial insemination	Spawns an egg familiar, which cracks and turns into a random friendly enemy when Isaac is hurt. The egg regenerates upon entering a different room.
Parasitoid	461		Egg tears!	Adds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.
Pointy Rib	544		Stabbing time	Spawns a bone familiar that can be aimed with the fire buttons and does contact damage.
Poke Go	505		Gotta catch em...	Upon entering a room with enemies in it, has a chance to spawn a random friendly enemy that persists across rooms.
Polydactyly	454		Hold me!	Allows Isaac to carry two cards, pills, or any combination of both at the same time. Drops a random card or pill.
Pop!	529		Eyeball tears!	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.
Sack of Sacks	500		Gives sacks	Spawns a sack familiar that has a chance to drop a sack upon clearing a room.
Schoolbag	534		Extra active item room	Allows Isaac to hold two active items.
Shade	468		It follows	Spawns a shadow familiar that follows Isaac's movements on a 1 second delay and deals contact damage to enemies.
Shard of Glass	448		Blood and guts!	Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room.
Sinus Infection	459		Booger tears!	Adds a chance to fire a booger which sticks to enemies and poisons them.
Slipped Rib	542		Projectile shield	Spawns a bone familiar that circles around Isaac and reflects enemy shots.
Sulfuric Acid	463		Acid tears!	Increases damage. Adds a chance to fire acidic tears which can destroy obstacles.
Tarot Cloth	451		I see the future	Drops a random card or rune. Doubles the effects of cards and runes.
Technology Zero	524		Static tears!	Connects Isaac's tears with electricity that can damage enemies.
Tonsil	474		Gross...	Grants a familiar that can block enemy shots.
Trisagion	533		Smite thy enemy	Tears are replaced with piercing white blasts of light.
Varicose Veins	452		I'm leaking...	Taking damage releases a ring of 10 high damage tears.
YO LISTEN!	492		Yo listen!	+1 luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.

Trinkets

38 new trinkets were added in the expansion.

Name	ID	Icon	Quote	Description
Baby-Bender	127		Feed them magic!	Grants Isaac's familiars homing shots.
Bag Lunch	105		I wonder what it is	Taking damage has a small chance to destroy the trinket and spawn Lunch.
Bat Wing	118		They are growing...	Upon killing an enemy, has a chance to grant flight for the rest of the room.
Black Tooth	95		It looks dead	Adds a chance to fire a black tooth that poisons enemies.
Bloody Crown	111		Drips with blood...	Treasure Rooms appear in Chapter 4.
Butter!	122		Can't hold it!	Using an active item will drop it onto a pedestal on the ground. Taking damage may result in dropping a passive item.
Cracked Crown	92		Stat booster	Grants extra stat upgrades based on Isaac's passive items that increase stats, +0.2 tears, -1 tear delay.
Crow Heart	107		Drain me	Red heart damage will be taken before soul and black heart damage.
Dim Bulb	101		I think it's broken	Provides a boost to all stats when Isaac's active item is completely uncharged.
Door Stop	124		Hold the door!	The last door Isaac went through stays open, allowing him to leave the room even if enemies are in it.
Duct Tape	109		Stuck!	Stops Isaac's familiars from moving.
Equality!	103		=	Turns pickups into their doubled versions while Isaac's numbers of coins, bombs, and keys are equal.
Extension Cord	125		Charged friends	Beams of yellow electricity flow between Isaac and his familiars, damaging any enemies between them.
Filigree Feather	123		Angelic Spoils!	Angels drop items instead of key pieces when defeated.
Finger Bone	128		It looks brittle	Grants a chance to gain a bone heart upon taking damage.
Fish Tail	94		It also stinks!	Items and trinkets that generate blue flies or blue spiders will generate twice as many.
Fragmented Card	102		Double moon	Makes two Secret Rooms spawn on each floor.
Hairpin	120		Danger charge	Fully recharges Isaac's active item upon entering a boss fight.
Locust of Conquest	117		I bring Conquest	Upon entering a room with enemies, spawns 2-5 White Locusts which damage enemies.
Locust of Death	116		I bring Death	Upon entering a room with enemies, spawns a Black Locust that does a very high amount of damage.
Locust of Famine	115		I bring Famine	Upon entering a room with enemies, spawns a Yellow Locust that damages and slows enemies.
Locust of Pestilence	114		I bring Pestilence	Upon entering a room with enemies, spawns a Green Locust which damages and poisons enemies.
Locust of War	113		I bring War	Upon entering a room with enemies, spawns a Red Locust which detonates upon impact with enemies.
Lost Cork	106		Uncorked	Increases the radius of any creep produced by Isaac.
Meconium	91		Eww	Poop has a chance to turn into black poop.
Nose Goblin	98		Seems magic...	Chance to fire a booger that sticks to enemies and deals damage over time.
Ouroboros Worm	96		Foop foop!	Tears travel in a large spiral pattern and become spectral.
Pay to Win	112		...	Restock boxes always spawn in Item Rooms.
Rotten Penny	126		Wealth of flies	Spawns a blue fly every time a coin is picked up.
Silver Dollar	110		Feels lucky...	Shops appear in Chapter 4.
Stem Cell	119		Regen!	Heals for half a heart upon traveling to the next floor.
Super Ball	99		Boing!	Makes tears have a chance to bounce off enemies and obstacles.
Tonsil	97		Sick...	When hit, there is a small chance a removed tonsil familiar starts following Isaac, blocking enemy shots.
Used Diaper	93		You stink	Grants the Skatole effect in some rooms.
Vibrant Bulb	100		It needs power	Provides a boost to all stats when Isaac's active item is fully charged.
Walnut	108		That's a hard nut to crack!	Taking damage has a small chance to destroy the trinket and spawn various pickups.
Wish Bone	104		Make a wish	Taking damage has a small chance to destroy the trinket and spawn a random item.
Wooden Cross	121		My faith protects me	Grants a Holy Mantle shield upon entering a new floor, which protects against one hit of damage.

Pickups

Hearts

Heart	Image	Worth	Additional Info
Scared Heart			Identical to the standard Red Heart, but will run away as the player moves towards it.
Half Soul Heart
Blended Heart		//	Fills up a full red Heart Container, but will act as a Soul Heart when no Containers are free. If you are only missing half a heart, it will fill that half, and give you half a soul heart.
Bone Heart			Takes three hits to deplete and can be refilled with red hearts, but disappears permanently upon depleting.

Keys

Key	Image	Worth	Additional Info
Charged Key		1	Fully charges your currently held active item upon pickup. Can be differentiated from regular keys by having a pulsating white glow while on the ground.

Pills

ID	Pill	Effect
39	X-Lax	Creates a pool of slippery brown creep underneath Isaac.
40	Something's wrong...	Creates a pool of black creep beneath Isaac.
41	I'm Drowsy...	Upon use, slows all enemies for the duration of the room.
42	I'm Excited!!!	Upon use, increases the speed of all enemies for the duration of the room. The effect triggers again 30 seconds after use and 60 seconds after use.
43	Gulp!	Upon use, any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player. Unlocked by acquiring the Once More With Feeling! achievement.
44	Horf!	Upon use, Isaac shoots an explosive tear with the IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth. effect that always deals 200 damage. Unlocked by acquiring the Dedication achievement.
45	Feels like I'm walking on sunshine!	Temporarily makes Isaac invincible, similar to Unicorn StumpUpon use, grants invulnerability and increased speed for five seconds, but removes the ability to shoot tears.. Unlocked by acquiring the Sin Collector achievement.
46	Vurp!	Throws up the last pill you used. Will spawn itself if no other pills were taken beforehand. Unlocked by acquiring the U Broke It! achievement.

Cards

Name	ID	Icon	Message	Effect
Ace of Clubs	27		Convert all	Turns all pickups and chests in the room into bombs.
Ace of Diamonds	28		Convert all	Turns all pickups and chests in the room into coins.
Ace of Hearts	30		Convert all	Turns all pickups and chests in the room into random heart pickups.
Ace of Spades	29		Convert all	Turns all pickups and chests in the room into keys.
Ancient Recall	53		Draw 3 cards	Spawns 3 random cards.
Era Walk	54		Savor the moment	For the current room, enemies are slowed, Isaac's speed is increased, and his shot speed is decreased.
Holy Card	51		You feel protected	Grants the Holy Mantle effect for the current room.
Huge Growth	52		Become immense!	Makes Isaac large for the current room, increasing his range and damage.

Runes

Rune	ID	Icon	Unlock method	Message	Effect
Black Rune	41		Void	Deals 40 damage to all enemies in the room. Consumes all pickups in the room and turns them into blue flies and spiders. Consumes all pedestal items in the room and turns them into random stat upgrades.

Chests

Mimics

• Mimics appear similar to Brown Chests until Isaac moves near, at which point they sprout spikes that damage the player as a Spike Chest would. They can be distinguished from Brown Chests by their darker, purplish-brown coloring, the grayish spot on each side of the latch where the spikes will sprout from and the bloodstain.

Entities

Monsters

Monster	Description
Dank Charger	Slowly moves around the room, charging at Isaac very rapidly when he gets in its line of sight, leaving a trail of slowing black creep.
Mr. Red Maw	Walks towards Isaac and attacks by launching its head towards Isaac. Turns into a Red Maw or Gusher upon death depending on the killed body segment. Occasionally separates at will.
Soul Sucker	Flies slowly towards Isaac. Spawns a vortex that fires four Brimstone beams in the cardinal directions upon death.
Cross Stone Shooter	Stationary and invulnerable monster that continuously fires shots in four directions.
Crispy	Slowly walks towards Isaac, but increases in speed as they take damage. Constantly passively takes damage.
Nerve Ending 2	Static enemy which whips at Isaac if he gets too close.
Tube Worm	Pops out of the ground in random locations and fires a long-range spray of arcing shots.
Mushroom	Stationary enemy that occasionally pops up and fires four shots in the cardinal or diagonal directions. Takes less damage while its head is down.
Poison Mind	Slowly crawls around the room diagonally, leaving a trail of green creep.
Stoney	Chases Isaac and blocks tears, but does not deal contact damage. Temporarily pauses in exhaustion after a certain amount of time. Invulnerable; dies when the room is cleared.
Cross Stoney	Chases Isaac and shoots 4 tears vertically and diagonally like a Cross Grimace. Dies when the room is cleared. Only appears in challenge #32 (Aprils Fool) as replacements to regular Stoneys.
Blister	Slowly hops towards Isaac, occasionally spawning black smoke balls. Spawns a Sack upon death.
The Thing	Crawls along a wall and attempts to line up with Isaac, then spits a line of damaging red creep.
Ministro	Hops towards Isaac, occasionally spitting out a cluster of disorganized shots.
Portal	Spawns various enemies from the current floor until it either vanishes or is killed.
Tar Boy	Pops out of the ground in random locations and fires a short-ranged spray of shots that leave behind slowing black creep. If Isaac stands in the creep, the Tar Boy can fire shots straight upwards out of the creep underneath Isaac.
Fistuloid	Flies towards Isaac in an erratic waving motion, periodically firing a blood shot towards Isaac that also knocks itself back. Upon death, fires a worm that flies off screen.
Gush	Stationary, harmless enemy that continually creates slowing black creep.
Leper	Walks around the room, avoiding Isaac. Releases a Leper Flesh for every 15 damage taken. After being reduced to 15 health, starts chasing Isaac and leaves damaging red creep. Spawns a Leper Flesh and Gusher upon death.
Leper Flesh	Moves erratically and chases Isaac. Fires a blood shot at Isaac upon death.
Mr. Mine	Can only appear in pits. Attempts to launch itself at Isaac if he comes near. Occasionally burrows and pops up in another pit, and fires six shots in all directions upon death.

Bosses

5 bosses were added in Afterbirth †. Additionally, Ultra Greed received a second form in Greed Mode's hard mode.

Rag Mega	Big Horn	Sisters Vis	The Matriarch

Delirium	Ultra Greedier

Environment

Chapters

The Void

The Void

Obstacles

Super special rock

• Super special rocks are tinted rock variants which are much harder to spot, as they have a smaller mark and are not discolored. Super special rocks takes two bombs to blow up, and drop the contents of two tinted rocks.

White poop

• White poop is surrounded by an aura that halves tear delay and has a high chance to block damage like the Cone HeadGrants a soul heart. Adds a chance to block enemy shots. item while Isaac stands within it. The aura disappears if the poop is destroyed.

Dirt patch

• Dirt Patches are a small mound of dirt that can be dug into with certain items. Using Mom's ShovelSpawns a trapdoor that leads to the next floor upon activation. Unlocks The Forgotten when used on a mound of dirt that appears in The Dark Room. on top of a dirt patch will reveal a skeleton and unlock The Forgotten. Once The Forgotten is unlocked, using Mom's Shovel, We Need to Go Deeper!Creates a trapdoor to go to the next floor. If used in The Womb, it will create a trapdoor to Sheol, even if the player hasn't unlocked it., or EhwazCreates a trapdoor leading to the next floor. Has an estimated 1/12 (8%) chance to spawn a door to a Crawl Space instead. on top of a dirt patch will dig up a random chest.

Machines

Mom's Dressing Table

• It appears in the starting room of a floor if Isaac has 8 or more items.
• If Isaac bumps into Mom's Dressing Table, his appearance will be randomly changed so that only a few of his items are displayed.
• Hitting Mom's Dressing Table with an explosive will cause it to vanish and drop 1-4 pills. There is a 1% chance to spawn one of the following items instead: Mom's Underwear, Mom's Heels, Mom's Lipstick, Mom's Bra, Mom's Pad, Mom's Eyeshadow, Mom's Contacts, Mom's Wig, Mom's Perfume or Mom's Pearls.

Challenges

Name	Conditions	Goal	Unlocked by	Unlocks
32. Aprils Fool	Isaac : yes : yes The minimap displays the floor's layout accurately, but displays Isaac's position inaccurately. Pedestal items and pickups are not what they appear to be. Active item, pill, card, and rune effects are randomized upon each use, making them very unreliable or deadly (for example Suicide King). Items with no charge time (i.e. How To Jump, IV Bag, etc) can be used repeatedly for random effects. Stoneys have a chance of being replaced by Cross Stoneys. Every boss is The Bloat. Isaac's health is not what it appears to be. Key and bomb numbers are accurate.	/	Defeat Mom for the 1st timeAprils fool	Maggy Now Holds a Pill!Complete challenge #32
31. Backasswards	Isaac Starts with: 8-10 random items : no : yes All Chapters progress in reverse order, losing 1 item and 1 red heart container each floor ascended.	The Basement/The Cellar/Burning Basement I	Defeat ??? or The Lamb for the 1st timeBackasswards	Laz Bleeds More!Complete challenge #31
33. Pokey Mans	Isaac Starts with: Mom's EyeshadowTears have a chance to charm enemies. : no : yes Each use of Friendly Ball causes a random monster to be spawned. Friendly Ball instantly charges once the spawned monster is killed.		Defeat Mom's Heart 11 timesPokey Mans	Charged KeyComplete challenge #33
35. Pong	Isaac Starts with: Cupid's ArrowGrants Isaac piercing tears that travel through enemies (but not obstacles) instead of breaking on impact with them. Rubber CementTears bounce off walls, enemies, and environmental objects. : no : yes Damage fixed at 100, tear delay fixed at 150.		Defeat Isaac 5 timesPONG	Greed's GulletComplete challenge #35
34. Ultra Hard	Isaac Starts with: Key Piece 1Combined with Key Piece 2, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan. Key Piece 2Combined with Key Piece 1, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan. Curse of the Labyrinth Curse of the Blind Curse of the Lost Curse of the Maze : yes : yes All enemies spawn as champions if possible. Boss fights will be double trouble if possible. No heart pickups drop.		Defeat ??? or The Lamb for the first timeUltra Hard	Samson Feels Healthy!Complete challenge #34

Achievements

Name	Image	Description	Unlock	In Game Secret Number	Platforms
1000000%		Just Stop!	Collect every item in the game, unlock all secrets and endings, and complete the Bestiary (minus anything added in Booster Packs)	339
5 Nights at Mom's		Unlocked super special rocks.	Get a 5-win streak, using a different character for each win	323
7 Seals		Unlocked a new item.	Defeat all 5 Harbingers	372
Ancient Recall		Unlocked a new item.	Use cards and runes 20 times	362
Angelic Prism		Unlocked a new item.	Defeat an Angel 10 times	373
Angry Fly		Unlocked a new item.	Become Beelzebub	352
Apollyon		Unlocked a new character.	Defeat Mega Satan for the 1st time	340
Apollyon Baby		Unlocked a new co-player baby.	Earn all Hard Mode Completion Marks as Apollyon	319
Aprils fool		Unlocked a new challenge.	Defeat Mom for the 1st time	278
Baby-Bender		Unlocked a new item.	Use I - The Magician or Telepathy for Dummies while already having homing tears (Sources of this effect include I - The Magician, Telepathy for Dummies, Spoon Bender, Sacred Heart, or Godhead).	389
Backasswards		Unlocked a new challenge.	Defeat ??? or The Lamb for the 1st time	277
Bat Wing		Unlocked a new item.	Defeat Ultra Greedier as Azazel	304
Black Hole		Unlocked a new item.	Defeat 20 portals	349
Black Rune		Unlocked a new item.	Defeat Ultra Greedier as Apollyon	309
Blanket		Unlocked a new item.	Sleep in 10 beds	385
Bloody Crown		Unlocked a new item.	Defeat Delirium as Samson	287
Bone Baby		Unlocked a new co-player baby.	Earn all Hard Mode Completion Marks as The Forgotten	402
Bone Heart		Unlocked a new item.	It's complicated	391
Book of the Dead		Unlocked a new item.	Defeat Delirium as The Forgotten	401
Bound Baby		Unlocked a new co-player baby.	Defeat Mega Satan as The Forgotten	403
Bozo		Unlocked a new item.	Destroy 5 rainbow poops	353
Brittle Bones		Unlocked a new item.	Defeat The Lamb as The Forgotten	396
Broken Modem		Unlocked a new item.	Complete 7 (30 on console) daily challenges (by touching the trophy at the end)	354
Brown Nugget		Unlocked a new item.	Defeat Ultra Greed as Apollyon	316
Buddy in a Box		Unlocked a new item.	Pick up 5 familiars in a single run	355
Burning Basement		Alt stage to the basement.	Defeat Mom's Heart 11 times	342
Butter!		Unlocked a new item.	Complete 2 Victory Laps and start a 3rd	360
Charged Key		Unlocked a new item.	Complete challenge #33	333
Compound Fracture		Unlocked a new item.	Defeat Delirium as Lazarus	291
Coupon		Unlocked a new item.	Purchase from shops 50 times	364
Crooked Penny		Unlocked a new item.	Defeat Delirium as Keeper	294
Crow Heart		Unlocked a new item.	Defeat Ultra Greedier as Eve	302
D Infinity		Unlocked a new item.	Defeat Delirium as Isaac	282
D1		Unlocked a new item.	Defeat Ultra Greedier as Isaac	296
Dad's Lost Coin		Unlocked a new item.	Defeat Ultra Greedier as The Lost	307
Dad's Ring		Unlocked a new item.	Defeat Ultra Greedier as The Forgotten	400
Dank Depths		Alt stage to the depths.	Defeat It Lives 21 times	344
Dark Prince's Crown		Unlocked a new item.	Defeat Delirium as Azazel	290
Death's List		Unlocked a new item.	Take 25 devil deals	376
Dedication		Unlocked a new item.	Participate in 31 Daily Challenges (they don't have to be consecutive; it will still count if you die in the first room)	325
Delirious		Unlocked a new item.	Defeat Delirium for the first time as any character	338
Divorce Papers		Unlocked a new item.	Complete the Boss Rush as The Forgotten	397
Door Stop		Unlocked a new item.	Blow up doors and secret room walls 50 times	375
Duality		Unlocked a new item.	Defeat Ultra Greedier as Lilith	306
Dull Razor		Unlocked a new item.	Defeat Delirium as Eve	288
Eden's Soul		Unlocked a new item.	Defeat Delirium as Eden	289
Era Walk		Unlocked a new item.	Have both the Broken Watch and the Stop Watch in your collection	363
Eucharist		Unlocked a new item.	Defeat Delirium as Magdalene	283
Euthanasia		Unlocked a new item.	Defeat Delirium as Lilith	292
Extension Cord		Unlocked a new item.	Have The Battery, 9 Volt, and Car Battery in your collection	381
Eye of Belial		Unlocked a new item.	Defeat Ultra Greedier as Judas	299
Eye of Greed		Unlocked a new item.	Defeat Ultra Greedier as Keeper	308
Fast Bombs		Unlocked a new item.	Defeat Little Horn 20 times	356
Filigree Feather		Unlocked a new item.	Acquire both key pieces	370
Finger Bone		Unlocked a new item.	Defeat Ultra Greed as The Forgotten	399
Flat Stone		Unlocked a new item.	Acquire Rubber Cement 5 times	382
Flooded Caves		Alt stage to the caves.	Defeat It Lives 16 times	343
Glyph of Balance		Unlocked a new item.	Defeat Ultra Greedier as Magdalene	297
Greed's Gullet		Unlocked a new item.	Complete challenge #35	335
Greedier!		New mode unlocked!	Donate 500 coins to the Greed Machine	341
Haemolacria		Unlocked a new item.	Acquire Blood Clot 10 times	377
Hairpin		Unlocked a new item.	Recharge using batteries 20 times	358
Hallowed Ground		Unlocked a new item.	Defeat Hush as The Forgotten	398
Hat trick!		Unlocked a new item.	Get a 3-win streak	322
Holy Card		Unlocked a new item.	Defeat Delirium as The Lost	293
Huge Growth		Unlocked a new item.	Increase in size 5 times in a single run. Sources of increased size include "One Makes you Larger" pills, XI - Strength, and Magic Mushroom	361
Hushy		Unlocked a new item.	Defeat Hush as Apollyon	315
It's the Key		Unlocked a new item.	Defeat The Lamb without taking hearts, coins, and bombs through an entire run	327
Jaw Bone		Unlocked a new item.	Defeat ??? as The Forgotten	395
Jumper Cables		Unlocked a new item.	Pick up any 3 of the following items/trinkets in a single run: 9 Volt, The Battery, Car Battery, AAA Battery, Watch Battery	367
King Baby		Unlocked a new co-player baby.	Defeat Delirium as ???	286
Lachryphagy		Unlocked a new item.	Collect 10 "tears up" items or pills in one run	378
Laz Bleeds More!		Unlocked a new starting item.	Complete challenge #31	331
Leprosy		Unlocked a new item.	Beat Chapter 3 without taking damage	368
Lil Delirium		Unlocked a new item.	Defeat Delirium for the 1st time	357
Lil Spewer		Unlocked a new item.	Die to your own explosion from Ipecac, Bob's Rotten Head, or Horf! pill	384
Living on the Edge		Unlocked a new item.	Complete a floor after Basement I, start-to-finish, with only half a heart of health (can use The Lost)	329
Locust of Conquest		Unlocked a new item.	Complete the Boss Rush as Apollyon	314
Locust of Death		Unlocked a new item.	Defeat The Lamb as Apollyon	313
Locust of Famine		Unlocked a new item.	Defeat ??? as Apollyon	312
Locust of Pestilence		Unlocked a new item.	Defeat Satan as Apollyon	311
Locust of War		Unlocked a new item.	Defeat Isaac as Apollyon	310
Maggy Now Holds a Pill!		Unlocked a new starting item.	Complete challenge #32	332
Marbles		Unlocked a new item.	Use 5 Gulp! pills in one run	386
Marrow		Unlocked a new item.	Defeat Mom's Heart or It Lives! on hard mode as The Forgotten	392
Meconium		Unlocked a new item.	Defeat Ultra Greedier as ???	300
Metronome		Unlocked a new item.	Defeat Ultra Greedier as Eden	303
Mort Baby		Unlocked a new co-player baby.	Defeat Mega Satan as Apollyon	317
Moving Box		Unlocked a new item.	Use Pandora's Box in the Dark Room	366
Mr. ME!		Unlocked a new item.	Open 20 locked chests	371
Mr. Resetter!		Unlocked a new item.	Reset 7 times in a row  Switch   PS4  Get a minus 10-win streak	328
Mystery Egg		Unlocked a new item.	Spawn three charmed enemies in the same room	387
Mystery Gift		Unlocked a new item.	Destroy 500 rocks	350
New Area		Unlocked a new area.	Defeat Hush for the 1st time	320
Once More with Feeling!		Unlocked a new item.	Complete a Victory Lap, defeating The Lamb	321
Plan C		Unlocked a new item.	Defeat Ultra Greedier as Lazarus	305
Pointy Rib		Unlocked a new item.	Defeat Satan as The Forgotten	394
Pokey Mans		Unlocked a new challenge.	Defeat Mom's Heart 11 times	279
PONG		Unlocked a new challenge.	Defeat Isaac 5 times	281
Pop!		Unlocked a new item.	Beat Chapter 4 without taking damage	374
RERUN		Unlocked the power of RERUN.	Complete 3 Victory Laps and start a 4th	337
Rotten Penny		Unlocked a new item.	Have 20 blue flies at the same time	388
Sack of Sacks		Unlocked a new item.	Defeat Ultra Greedier as Cain	298
Sacrificial Altar		Unlocked a new item.	Take 50 devil deals	383
Samson Feels Healthy!		Unlocked a new starting item.	Complete challenge #34	334
Scarred Womb		Alt stage to the womb.	Defeat It Lives 30 times	345
Schoolbag		Unlocked a new item.	Enter every shop from Chapter 1 through Chapter 3 in one run	379
Shade		Unlocked a new item.	Defeat Delirium as Judas	285
Silver Dollar		Unlocked a new item.	Defeat Delirium as Cain	284
Sin collector		Unlocked a new item.	Collect every entry in the Bestiary (Bugged v190 - Mobs that don't exist in the bestiary are being counted. This allows Sin Collector to be unlocked without a complete bestiary)	324
Slipped Rib		Unlocked a new item.	Defeat Isaac as The Forgotten	393
Smelter		Unlocked a new item.	Defeat Mom's Heart or It Lives! on hard mode as Apollyon	318
Something wicked this way comes!		Unlocked new bosses!	Defeat ??? as 3 different characters	346
Something wicked this way comes+!		Unlocked even more bosses!	Defeat ??? as 6 different characters	347
Sprinkler		Unlocked a new item.	Beat chapter 1 without taking damage	351
Stem Cell		Unlocked a new item.	Defeat Ultra Greedier as Samson	301
Technology Zero		Unlocked a new item.	Pick up two technology items in one run	369
Telekinesis		Unlocked a new item.	Beat Chapter 2 without taking damage	365
The Forgotten		Unlocked a new character.	It's complicated	390
The gate is open!		Unlocked new enemies!	Defeat The Lamb for the 1st time	348
The Marathon		Unlocked a new item.	Get a 5-win streak in the Daily Challenges	336
Trisagion		Unlocked a new item.	Take 25 items from Angel rooms	380
U Broke It!		Unlocked a new item.	Obtain 50 items on a run (e.g., via two Steam Sales and Restock - Duplicate passives/familiars count towards the total, e.g., multiple Breakfasts)	330
Ultra Hard		Unlocked a new challenge.	Defeat ??? or The Lamb for the first time	280
Void		Unlocked a new item.	Defeat Delirium as Apollyon	295
Wooden Cross		Unlocked a new item.	Sleep in a bed	359
ZIP!		Unlocked a new item.	Defeat The Lamb in under 20 minutes	326