Ham N' Berries (collectible, boss pool.)
When the item is gained, the player gains an empty red heart container, then depletes their heart containers until they only have one filled red heart container. When a boss that's in a boss room dies, they drop a Berry pickup.
Berry (pickup/card/pill item.)
When used, it grants the player a full soul heart in normal mode or a half soul heart in hard mode. If the Berry is held when you transition to a new stage, it becomes a Rotten Berry.
Rotten Berry (pickup/card/pill item)
When used, it grants the player blue attack flies and a full black heart in normal mode or a half black heart in hard mode.

Pearl of Wisdom (collectible, treasure, shop, angel pools.)
When the item is gained, a Lil' Pearl pickup is spawned.
Lil' Pearl pickups have a chance of replacing Hearts, Batteries, Keys and Bomb pickups that'd drop as a reward for clearing a room.
Lil' Pearl (pickup/card/pill item)
When used, the item is held above the player's head similar to Bob's Rotten Head. There's 5 different ways to use the Lil' Pearl after holding it up:
- Press Q or whatever button you use to hold it up to put it back in your pocket.
- Press a firing direction to launch the Pearl as a projectile explosive, the longer it is held the more range and explosion radius it has.
- Press space or whatever button you use to activate an item to recharge any deactivated active item you may have.
- Walk into a locked chest or door to unlock it.
- Hold the Pearl for a couple second to absorb it as a heart, it'll heal any empty red heart containers. If you're already at full red HP, it'll provide a soul heart instead.

Void Die (collectible, treasure, devil, angel pools.) [6 charge active item]
Upon activating in a room with pedestal items or collectibles, you absorb them and add counters equal to the amount of pedestal items or collectibles absorbed by the item.
For every counter on the item, you have a random stat up.
Upon activating in a room without pedestal items or collectibles, you remove half of all the counters on the item rounded up and spawn pedestal items or collectibles of the current rooms pool equal to the number of counters removed.

Who Lost China (pickup/card/pill item, low chance to replace another card.)
Deals your damage stat to all enemies in the room and applies the silence status effect for 10 seconds. The Silence status effect prevents monsters/bosses from firing projectiles, spawning other entities and creating creep.