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The monster resembles a human with dark-colored bandages wrapped around its head. The eyes are not visible through the wrappings but the creature's gaping mouth can be seen filled with long sharp teeth. Aside from the bandages, it only wears a tattered hospital robe. The monster also has skeletal hands with sharp claws and is barefoot.
It is encountered in the Secret Basement after the player obtains the key to the Isolation Zone. It is first seen hanging from a noose in a corner of the room, flickering in and out of visibility like an apparition. After the player takes the key, it disappears from the noose and the ambient music playing in the room suddenly stops. Leaving the room, it lets out a roar and the true chase begins.
It deals 16 damage to the player with a one second cooldown.
This particular monster acts much like Specimen 6, only moving when the player is not making direct eye contact. Much like Specimen 6, it also randomly teleports away and continues its attack if the player stares directly at it for too long. It can also move while being looked at, but only at a very minuscule speed.
It always spawns from the door directly behind the player while entering a new room during its chase.
When Monster 4 kills the player, a text shows up along with his death screen:
"Dark worms scream inside my brain.
Begging me to eat again.
Hearts, and blood, and bile, and soil.
I must consume to end turmoil."
Monster 4 appears in the main game's Endless Mode, being one of many creatures who can randomly engage the player in a chase. It acts like it does in Karamari Hospital and has the same chase theme. It also has new hallucinations and a death screen.
Before chasing the player, the apparition of it hanging from the ceiling can be seen for a few seconds. When being chased, a foggy overlay clouds the player's vision.
"T-Rex Can't Wear Mittens", Monster 4's chase theme.
"M6_AMB2", Monster 4's death screen theme.
- Notably, while it is chasing the player, Monster 6's hallway can still be accessed.
- While Monster 4 is chasing the player, Monster 3 will not appear in the hallways.
- The monster's death screen shows many screens, one of a human family, and another of a suicide note.
- This gives evidence that the monster hanged itself.
- Another interesting thing found in Monster 4's death screen is a QR code. Scanning the code reveals a link to a lifehack quote site.
- It is possible that Monster 4 represents Autophagia.
- The roaring heard at the beginning of the chase theme is in fact, part of the chase theme, which also happens in Specimen 4's chase themes.
No changes whatsoever.
It now spawns in front of the player when they leave its room. When attacking, it now makes a clanking sound instead of the regular damage sound, and deals 20 damage instead of 16.
In Endless Mode, it behaves the same as it did in the original game, but can now be damaged by the Sword. Hitting it will make it disappear for the entire room and will deduct one room from the chase duration. The fog overlay has been removed. It also has its own starting room, which mimics the one found in Karamari Hospital.
The overall mechanics of the Specimen has been overhauled, causing it to sporadically teleport less and to stop teleporting in walls. It no longer slowly floats towards the player, instead, it will rotate to face the player and teleport short distances when observed.
- Its fog has been given to Monster 6 to replace her black overlay from the original, because it sometimes caused the player to be blinded.
- As of The Halloween Update, it cannot fly over gaps and acid pits. This makes it slower in those rooms.