Background: The injury incidence rates and factors associated with injury in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied. Purpose: To determine injury incidence rates, characteristics of injury, and associated factors in the sport of athletics at the London 2012 Paralympic Games. Study Design: Prospective, cohort study. Methods: Nine hundred seventy-seven athletes competing in the sport of athletics were followed over a total 10-day competition period of the Games. Daily injury data was obtained via two databases: 1) a custom built, web-based injury and illness surveillance system (WEB-IISS), populated by team medical personnel, and 2) the organizing committee database, populated by medical providers in the medical stations operated by the Organizing Committee. Athlete impairment category and event discipline were obtained via the International Paralympic Committee athlete database. Injury incidence rates (injuries per 1000 athlete-days) by impairment type, event discipline, sex, and age were examined. Results: The overall injury incidence rate was 22.1 injuries per 1000 athlete-days (95% CI;19.5 - 24.7). In track disciplines, ambulant athletes with cerebral palsy experienced a lower incidence of injury (IR=10.2, 95% CI; 4.2 - 16.2) when compared to ambulant athletes from other impairment categories. Athletes in seated throws experienced a higher incidence of injury (IR=23.7, 95% CI; 17.5 – 30.0), when compared to athletes in wheelchair racing (IR=10.6, 95% CI; 5.5 - 15.6). In both track and field disciplines, the majority of injuries did not result in time-loss from competition or training. Ambulant athletes experienced the greatest incidence of injuries to the thigh (16.4% of all injuries, IR=4.0), observed predominantly in track athletes. Wheelchair or seated athletes experienced the greatest incidence of injuries to the shoulder/clavicle (19.3% of all injuries, IR=3.4), observed predominantly in field athletes. Conclusion: This is the first prospective cohort study examining injury incidence rate and associated factors in the sport of athletics at the Paralympic Games. Injury patterns are specific to the event discipline and athlete impairment type. The majority of injuries occur to the thigh (ambulant athletes) or shoulder/clavicle (wheelchair or seated athletes), and are not time-loss.