After taking 12-20 / 6-12 hits a removed tonsil familiar starts following Isaac, blocking enemy shots.
The effect can happen twice, after which the trinket will be destroyed.
The familiar does not deal damage to enemies.
Notes
When the familiar is generated, Isaac will gain the familiar permanently as a passive item. This allows Isaac to drop the trinket while keeping the familiar.
The passive Tonsil item does not exist in any item pool; thus, this is the only way to find it and make it appear in the Collection Page aside from starting with it as Eden.
If Eden starts with the passive tonsil item and picks up the trinket, the trinket will spawn only one familiar before being consumed.
Damage that is blocked by Holy Mantle or the Holy Card does not count to the number of hits that are needed for the tonsil familiar to spawn.
Familiars that follow behind Isaac have a certain priority in how close their position is to him over other familiars, with Tonsil having the lowest priority at 6th and thus being farther from Isaac than familiars of different priorities.
Interactions
D4: If a passive Tonsil item is given, this item can't be rerolled by the D4 or other items that reroll passive items.
Tonsils are soft tissue located near the back of the throat which, in the event of inflammation to the point of obstructing the throat, can be removed without much noticeable difference.
The passive item form of Tonsil is technically the only item to be removed from the game.
Broken Glass Cannon has the same ID that the passive item form of Tonsil used to have.
12-20 / 
6-12 hits a removed tonsil familiar starts following Isaac, blocking enemy shots.
The passive Tonsil item does not exist in any item pool; thus, this is the only way to find it and make it appear in the Collection Page aside from starting with it as 
Eden.
IV Bag or 
Blood Donation Machines, can spawn a familiar.
Holy Mantle or the 
Holy Card does not count to the number of hits that are needed for the tonsil familiar to spawn.
Familiars that follow behind Isaac have a certain priority in how close their position is to him over other familiars, with Tonsil having the lowest priority at 6th and thus being farther from Isaac than familiars of different priorities.
D4: If a passive Tonsil item is given, this item can't be rerolled by the D4 or other items that reroll passive items.
Broken Glass Cannon has the same ID that the passive item form of Tonsil used to have.
The Binding of Isaac: Rebirth
