First place medal is a passive item in Elitium, a mod for The Binding of Isaac.

Gives Isaac one of the following stat boosts based on which of his stats is the highest:
• +0.2 speed.
• +0.5 fire rate.
• +1 flat damage.
• +2.5 range.

Also drops either 3 coins, 1 bomb, or 1 key, depending on what Isaac has the most of. For the purposes of this calculation, each key or bomb is equivalent to 3 coins.

If Isaac has the same amount of 2 highest stats, one of them is selected randomly.

Having temporary stat boosts, such as those given by cards, will affect the payout given by the item.

A Soul Heart may be dropped as Bethany, or 2 Hearts as Tainted Bethany.

Poop Nuggets may be dropped as Tainted ??? if he does not have Keys and Coins. The game will check for his regular bomb count when doing this which is always 0.

First place medal can be found in the following item pools:

The following tags are applied to this item:

• Download Elitium from the Steam Workshop.