When the Lamb broke the fourth seal, I heard the voice of the fourth living creature saying, “Come.” I looked, and behold, an ashen horse; and he who sat on it had the name Death; and Hades was following with him. Authority was given to them over a fourth of the earth, to kill with sword and with famine and with pestilence and by the wild beasts of the earth. -Revelation 6:7-8
| Ball of Bandages|
|Defeat Mom for the first time|
- Death spawns Four scythes that stay stationary for a few seconds, then home in on the player.
- Uses The Hourglass to slow the player down.
- After enough damage is dealt, Death will dismount his horse for it to constantly charge throughout the room.
- It is at this point where the horse becomes an enemy... It will keep charging until you have gotten its HP to zero; even if Death was already vanquished.
- Death will occasionally spawn Knights.
- Black: In his first form, he summons Kamikaze Leeches instead of using the Hourglass. He spawns red maws rather than Knights when he dismounts his horse.
- Death is one of the Four Horsemen of the Apocalypse.
- Death's scythe attack is a homage to Castlevania's recurring boss, Death. Both summon four scythes that stay put for a few seconds, then home in on the player.
- Death is the only enemy to use a status effect on Isaac.