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In Afterbirth this item can cause enemies to drop black hearts if it was poisoned. After a few seconds a huge missile hits the target and deals 70 damage to anything nearby. In Afterbirth this item also appears in the Gold Chest item pool. Blue Baby, The Lost. After picking up a coin he has a random chance to drop pickups, including hearts, keys, bombs, coins, pills, cards or trinkets. In Afterbirth this is one of the 3 items required to create the Super Bum familiar transformation.