diff --git a/fhir/com.b2international.snowowl.fhir.core/src/com/b2international/snowowl/fhir/core/request/valueset/FhirValueSetExpandRequest.java b/fhir/com.b2international.snowowl.fhir.core/src/com/b2international/snowowl/fhir/core/request/valueset/FhirValueSetExpandRequest.java
index 298d63687d7..bb3966b7105 100644
--- a/fhir/com.b2international.snowowl.fhir.core/src/com/b2international/snowowl/fhir/core/request/valueset/FhirValueSetExpandRequest.java
+++ b/fhir/com.b2international.snowowl.fhir.core/src/com/b2international/snowowl/fhir/core/request/valueset/FhirValueSetExpandRequest.java
@@ -36,6 +36,7 @@
 import com.b2international.snowowl.fhir.core.codesystems.FilterOperator;
 import com.b2international.snowowl.fhir.core.codesystems.PublicationStatus;
 import com.b2international.snowowl.fhir.core.exceptions.BadRequestException;
+import com.b2international.snowowl.fhir.core.model.Designation;
 import com.b2international.snowowl.fhir.core.model.ResourceResponseEntry;
 import com.b2international.snowowl.fhir.core.model.codesystem.CodeSystem;
 import com.b2international.snowowl.fhir.core.model.dt.Uri;
@@ -247,11 +248,16 @@ private ValueSet computeFhirValueSetUsingUrl(ServiceProvider context, String url
 			.after(concepts.getSearchAfter());
 		
 		for (Concept concept : concepts) {
-			expansion.addContains(Contains.builder()
-					.code(concept.getId())
-					.system(baseUrl)
-					.display(concept.getTerm())
-					.build());
+			var contains = Contains.builder()
+				.system(baseUrl)
+				.code(concept.getId())
+				.display(concept.getTerm());
+			
+			if (Boolean.TRUE.equals(request.getIncludeDesignations())) {
+				contains.designations(Designation.fromDescriptions(concept.getDescriptions()));
+			}
+			
+			expansion.addContains(contains.build());
 		}
 		
 		return valueSet
diff --git a/fhir/com.b2international.snowowl.fhir.rest.tests/src/com/b2international/snowowl/fhir/rest/tests/valueset/FhirValueSetSnomedExpandTest.java b/fhir/com.b2international.snowowl.fhir.rest.tests/src/com/b2international/snowowl/fhir/rest/tests/valueset/FhirValueSetSnomedExpandTest.java
index 1ec7c1ce63a..0d69aa7bc2b 100644
--- a/fhir/com.b2international.snowowl.fhir.rest.tests/src/com/b2international/snowowl/fhir/rest/tests/valueset/FhirValueSetSnomedExpandTest.java
+++ b/fhir/com.b2international.snowowl.fhir.rest.tests/src/com/b2international/snowowl/fhir/rest/tests/valueset/FhirValueSetSnomedExpandTest.java
@@ -109,6 +109,34 @@ public void expandSnomedCodeSystemURL_FhirVsEclChildOfRoot() throws Exception {
 			.body("expansion.contains[0].display", equalTo("Substance (substance)"));
 	}
 	
+	@Test
+	public void expandSnomedCodeSystemURL_IncludeDesignations() throws Exception {
+		givenAuthenticatedRequest(FHIR_ROOT_CONTEXT)
+			.queryParam("url", RestExtensions.encodeQueryParameter(SnomedTerminologyComponentConstants.SNOMED_URI_SCT + "/900000000000207008?fhir_vs=ecl/<!138875005"))
+			.queryParam("includeDesignations", true)
+			.when().get("/ValueSet/$expand")
+			.then()
+			.statusCode(200)
+			.body("resourceType", equalTo("ValueSet"))
+			.body("id", notNullValue())
+			.body("expansion.total", equalTo(16)) // minified dataset only has 16 top level nodes
+			.body("expansion.contains[0].code", equalTo("105590001"))
+			.body("expansion.contains[0].system", equalTo(SNOMEDCT_URL))
+			.body("expansion.contains[0].display", equalTo("Substance (substance)"))
+			.body("expansion.contains[0].designation[0].value", equalTo("Substance"))
+			.body("expansion.contains[0].designation[0].language", equalTo("en"))
+			.body("expansion.contains[0].designation[1].value", equalTo("Substance"))
+			.body("expansion.contains[0].designation[1].language", equalTo("en-x-900000000000508004"))
+			.body("expansion.contains[0].designation[2].value", equalTo("Substance"))
+			.body("expansion.contains[0].designation[2].language", equalTo("en-x-900000000000509007"))
+			.body("expansion.contains[0].designation[3].value", equalTo("Substance (substance)"))
+			.body("expansion.contains[0].designation[3].language", equalTo("en"))
+			.body("expansion.contains[0].designation[4].value", equalTo("Substance (substance)"))
+			.body("expansion.contains[0].designation[4].language", equalTo("en-x-900000000000508004"))
+			.body("expansion.contains[0].designation[5].value", equalTo("Substance (substance)"))
+			.body("expansion.contains[0].designation[5].language", equalTo("en-x-900000000000509007"));
+	}
+	
 	@Test
 	public void expandSnomedCodeSystemURL_FhirVsRefSetRoot() throws Exception {
 		givenAuthenticatedRequest(FHIR_ROOT_CONTEXT)
@@ -122,7 +150,7 @@ public void expandSnomedCodeSystemURL_FhirVsRefSetRoot() throws Exception {
 			.body("expansion.total", equalTo(0))
 			.body("expansion.contains.code", nullValue());
 	}
-
+	
 	@Test
 	public void expandSnomedCodeSystemURL_AfterAndNext() throws Exception {
 		givenAuthenticatedRequest(FHIR_ROOT_CONTEXT)
diff --git a/fhir/com.b2international.snowowl.fhir.rest/src/com/b2international/snowowl/fhir/rest/FhirValueSetExpandOperationController.java b/fhir/com.b2international.snowowl.fhir.rest/src/com/b2international/snowowl/fhir/rest/FhirValueSetExpandOperationController.java
index 1a25020449f..88dd89702fc 100644
--- a/fhir/com.b2international.snowowl.fhir.rest/src/com/b2international/snowowl/fhir/rest/FhirValueSetExpandOperationController.java
+++ b/fhir/com.b2international.snowowl.fhir.rest/src/com/b2international/snowowl/fhir/rest/FhirValueSetExpandOperationController.java
@@ -159,6 +159,7 @@ public Promise<ResponseEntity<byte[]>> expandType(
 			.count(count)
 			.displayLanguage(displayLanguage == null ? null : new Code(displayLanguage))
 			.withHistorySupplements(withHistorySupplements)
+			.includeDesignations(includeDesignations)
 			.build();
 		
 		return expand(expandRequest, nextUriBuilder, accept, _format, _pretty);
@@ -378,6 +379,7 @@ public Promise<ResponseEntity<byte[]>> expandInstance(
 			.count(count)
 			.displayLanguage(displayLanguage == null ? null : new Code(displayLanguage))
 			.withHistorySupplements(withHistorySupplements)
+			.includeDesignations(includeDesignations)
 			.build();
 		
 		return expand(expandRequest, nextUriBuilder, accept, _format, _pretty);
diff --git a/snomed/com.b2international.snowowl.snomed.datastore/src/com/b2international/snowowl/snomed/core/request/SnomedConceptSearchRequestEvaluator.java b/snomed/com.b2international.snowowl.snomed.datastore/src/com/b2international/snowowl/snomed/core/request/SnomedConceptSearchRequestEvaluator.java
index c2ba5ac6056..9f921b57b6b 100644
--- a/snomed/com.b2international.snowowl.snomed.datastore/src/com/b2international/snowowl/snomed/core/request/SnomedConceptSearchRequestEvaluator.java
+++ b/snomed/com.b2international.snowowl.snomed.datastore/src/com/b2international/snowowl/snomed/core/request/SnomedConceptSearchRequestEvaluator.java
@@ -17,6 +17,7 @@
 
 import java.util.Comparator;
 import java.util.List;
+import java.util.Optional;
 import java.util.SortedSet;
 import java.util.stream.Collectors;
 import java.util.stream.Stream;
@@ -145,7 +146,9 @@ private Concept toConcept(ResourceURI codeSystem, SnomedConcept snomedConcept, S
 	public static SortedSet<Description> generateGenericDescriptions(SnomedDescriptions descriptions) {
 		return descriptions.stream()
 				.flatMap(description -> {
-					final String languageCode = description.getLanguageCode();
+					// FIXME falling back to en when the languageCode is not available on concept descriptions
+					// descriptions expand is needed but only when the requestor truly needs them, but that requires a bit larger set of changes
+					final String languageCode = Optional.ofNullable(description.getLanguageCode()).orElse("en");
 					var acceptabilityDesignations = description.getAcceptabilityMap().keySet().stream()
 							.map(refsetId -> new ExtendedLocale(languageCode, null, refsetId))
 							.map(language -> new Description(description.getTerm(), language.toString()).withInternalDescription(description));