Soul Hearts - When you have less than 6 total heart containers of any kind Trinkets - If you have no trinkets and there are no trinkets on the ground in the room Red Hearts (Full hearts) - When you have at least half a red heart container empty Red Hearts (Full hearts) - While at 0.5 red hearts Soul Hearts - When you have no red heart containers and less than 2 soul hearts The priority list of what will drop from champion enemies in order is as follows: This item will modify drops from room clearing and champion enemies based on your current player state. Fetus, this item will also cycle through random Bomb Modifiers (e.g. Tear effects include: Anti-Gravity, Ball of Bandages (Lvl 4), Bumbo (Lvl 3), Continuum, Cupid's Arrow, Compound Fracture, Euthanasia, Explosivo, Eye of Greed, Fire Mind, Flat Stone, Flat Worm, God's Flesh, Godhead, Head of the Keeper, Holy Light, Hook Worm, Ipecac, Iron Bar, Jacob's Ladder, Knockout Drops, Lachryphagy, Little Horn, Lodestone, Mom's Contacts, Mom's Eyeshadow, Mom's Perfume, Mucormycosis, My Reflection, Mysterious Liquid, Ocular Rift, Ouija Board, Ouroboros Worm, The Parasite, Parasitoid, Polyphemus, Pop!, Proptosis, Pulse Worm, Ring Worm, Rotten Tomato, Rubber Cement, Serpent's Kiss, Sinus Infection, Spider Bite, Strange Attractor, Sulfuric Acid, Technology Zero, Tiny Planet, Trisagion and Wiggle Worm Gives you a different tear effect with every tear that you fire