Initially, the Medal is broken up into 7 pieces. When all 7 pieces are assembled however, the following changes and events occur: * Tedhaun will appear for the first time to replace the following mid-bosses. * Stage 3 of Prism Plains: Mr. Frosty will be replaced. * Stage 2 of Cushy Clouds: Boxy will be replaced. * Stage 4 of Jam Jungle: Buboo will be replaced. * Stage 4 of Ice Island: Boxy will be replaced. * Stage 8 of Gamble Galaxy: Mr. Frosty will be replaced. * Sleep + Sleep will now equal Ghost when mixed together (through both traditional mixing and bubble mixing). Without the Medal, Ninja would be produced instead. * A Ghost Bubble will appear inside the Secret Area.