A piece of paper with text on it, and blood dripping off the lower right edge.
Turns Isaac's body black, giving him small horns, and making him seem more aggressive.
- Picking this item up and going down to 0 heart containers will kill Isaac, even though he will have 2 Soul Hearts.
- The Pact seems to be signed in blood. In satanic rituals, a contract with a demon is usually signed with its conjurer's blood. See also: Pacts with the Devil.
- When playing as ???, if you have three Soul Hearts and take The Pact, you will still have two soul hearts remaining, but you will lose the game. If you have Scapular and 3 soul hearts, it will not kill you.