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Getting 3 flies will either give Isaac a Pretty Fly orbital or an Attack Fly being spawned from the machine.
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The symbols include Pills, bombs, hearts, keys, coins, flies, and dollar signs. To get a pickup/fly, the slot's three symbols must match (e.g., three hearts).
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It is possible to find Bombs (regular, troll, or 1+1 free), Hearts (half heart, full heart, soul heart or. Walking up to the machine and bumping it will cost you one Penny, and roll the slots. Using the Tarot Card 'X Wheel of Fortune' will spawn a Slot Machine in the current room. Coins, hearts and bombs can all appear two at a time. The Slot Machine is similar to the Beggar in that the results are random. It is possible to find Bombs (regular, troll, or 1+1 free), Hearts (half heart, full heart, soul heart or eternal heart, ), Keys (normal or golden), Coins (penny, nickel, or dime), Pills (any color), Flies (Pretty Fly or black enemy fly), and A Dollar. Using the Tarot Card "X Wheel of Fortune" will spawn a Slot Machine in the current room. The Slot Machine is similar to the Beggar in that the results are random.