diff --git a/messages/de.json b/messages/de.json
index ddfde528c..6f9e4d9a6 100644
--- a/messages/de.json
+++ b/messages/de.json
@@ -677,7 +677,12 @@
       "rationaleDeviation": "Abweichung",
       "rationaleExpand": "Begründung anzeigen",
       "rationaleCollapse": "Begründung ausblenden",
-      "legacyPayloadCta": "Insights aktualisiert — Neugenerierung lädt die neuen Erklärfunktionen"
+      "legacyPayloadCta": "Insights aktualisiert — Neugenerierung lädt die neuen Erklärfunktionen",
+      "feedbackHelpful": "Hilfreich",
+      "feedbackNotHelpful": "Nicht hilfreich",
+      "feedbackThanks": "Danke für dein Feedback",
+      "feedbackConfirmed": "Feedback gespeichert",
+      "feedbackAlreadyRated": "Bereits bewertet"
     },
     "dataFoundation": "Datengrundlage",
     "dataGaps": "Datenlücken:",
diff --git a/messages/en.json b/messages/en.json
index 05c547768..ec4dfc294 100644
--- a/messages/en.json
+++ b/messages/en.json
@@ -677,7 +677,12 @@
       "rationaleDeviation": "Deviation",
       "rationaleExpand": "Show why",
       "rationaleCollapse": "Hide why",
-      "legacyPayloadCta": "Insights updated — regenerate for new explainability features"
+      "legacyPayloadCta": "Insights updated — regenerate for new explainability features",
+      "feedbackHelpful": "Helpful",
+      "feedbackNotHelpful": "Not helpful",
+      "feedbackThanks": "Thanks for your feedback",
+      "feedbackConfirmed": "Feedback recorded",
+      "feedbackAlreadyRated": "Already rated"
     },
     "dataFoundation": "Data coverage",
     "dataGaps": "Data gaps:",
diff --git a/src/components/insights/__tests__/recommendation-feedback.test.tsx b/src/components/insights/__tests__/recommendation-feedback.test.tsx
new file mode 100644
index 000000000..5c00d580a
--- /dev/null
+++ b/src/components/insights/__tests__/recommendation-feedback.test.tsx
@@ -0,0 +1,93 @@
+import { describe, it, expect, vi } from "vitest";
+import { renderToStaticMarkup } from "react-dom/server";
+import { I18nProvider } from "@/lib/i18n/context";
+import { RecommendationFeedback } from "../recommendation-feedback";
+
+vi.mock("@tanstack/react-query", () => ({
+  useQuery: () => ({ data: null, isLoading: false }),
+  useMutation: () => ({
+    mutate: vi.fn(),
+    isPending: false,
+    isSuccess: false,
+    isError: false,
+    error: null,
+  }),
+  useQueryClient: () => ({ invalidateQueries: vi.fn() }),
+}));
+
+vi.mock("@/hooks/use-auth", () => ({
+  useAuth: () => ({
+    user: { id: "test-user", username: "tester", role: "USER" },
+    isAuthenticated: true,
+    isLoading: false,
+  }),
+}));
+
+const baseProps = {
+  recId: "rec-1",
+  recText: "Discuss home BP log with your physician.",
+  recSeverity: "important" as const,
+  metricSourceType: "bloodPressure",
+  metricSourceTimeRange: "last7days" as const,
+};
+
+function render(node: React.ReactNode, locale: "en" | "de" = "en") {
+  return renderToStaticMarkup(
+    <I18nProvider initialLocale={locale}>{node}</I18nProvider>,
+  );
+}
+
+describe("<RecommendationFeedback>", () => {
+  it("renders thumbs-up + thumbs-down buttons", () => {
+    const html = render(<RecommendationFeedback {...baseProps} />);
+    expect(html).toContain("data-feedback-thumb=\"up\"");
+    expect(html).toContain("data-feedback-thumb=\"down\"");
+  });
+
+  it("attaches accessible aria-label keys", () => {
+    const html = render(<RecommendationFeedback {...baseProps} />);
+    expect(html).toContain("aria-label=\"Helpful");
+    expect(html).toContain("aria-label=\"Not helpful");
+  });
+
+  it("translates the labels to German when locale=de", () => {
+    const html = render(<RecommendationFeedback {...baseProps} />, "de");
+    expect(html).toContain("Hilfreich");
+    expect(html).toContain("Nicht hilfreich");
+  });
+
+  it("renders the 'thanks for your feedback' confirmation when initialState=submitted-up", () => {
+    const html = render(
+      <RecommendationFeedback {...baseProps} initialState="submitted-up" />,
+    );
+    // Confirmation text replaces both buttons.
+    expect(html).toContain("Thanks");
+    // Highlighted thumb-up still rendered for context.
+    expect(html).toContain("data-feedback-confirmed=\"up\"");
+    // The opposite button should NOT be re-clickable.
+    expect(html).not.toContain('data-feedback-thumb="down"');
+  });
+
+  it("renders the 'already rated' state with the prior verdict highlighted", () => {
+    const html = render(
+      <RecommendationFeedback {...baseProps} initialState="already-rated-down" />,
+    );
+    expect(html).toContain("data-feedback-already-rated=\"down\"");
+    // Buttons are not interactive in this state.
+    expect(html).not.toContain('data-feedback-thumb="up"');
+    expect(html).not.toContain('data-feedback-thumb="down"');
+  });
+
+  it("buttons carry type=button so they don't accidentally submit a parent form", () => {
+    const html = render(<RecommendationFeedback {...baseProps} />);
+    // Both up + down buttons must declare type=button.
+    const upMatch = html.match(
+      /<button[^>]*data-feedback-thumb="up"[^>]*>/,
+    );
+    const downMatch = html.match(
+      /<button[^>]*data-feedback-thumb="down"[^>]*>/,
+    );
+    expect(upMatch?.[0]).toContain("type=\"button\"");
+    expect(downMatch?.[0]).toContain("type=\"button\"");
+  });
+});
diff --git a/src/components/insights/recommendation-feedback.tsx b/src/components/insights/recommendation-feedback.tsx
new file mode 100644
index 000000000..438eedeb4
--- /dev/null
+++ b/src/components/insights/recommendation-feedback.tsx
@@ -0,0 +1,293 @@
+"use client";
+
+/**
+ * v1.4.16 phase B5e — RecommendationFeedback.
+ *
+ * Two small icon buttons (thumb-up / thumb-down) under each rec card,
+ * surfaced in the `data-slot="rec-feedback-slot"` slot reserved by
+ * B5c's `<RecommendationCard>`.
+ *
+ * UX states:
+ *   - default       → both buttons rendered, neither pressed
+ *   - submitting    → buttons disabled, the chosen verdict spinner-tinted
+ *   - submitted-up  → confirmation row replaces the buttons + the
+ *                     pressed thumb is highlighted; "Thanks for your
+ *                     feedback" text
+ *   - submitted-down → mirror of submitted-up for the negative verdict
+ *   - already-rated-up / -down → quiet state when the server returned
+ *     409 (the user already rated this rec text in a previous session)
+ *
+ * Local cache: a `(userId, recId, recText)` tuple is keyed in
+ * localStorage so a refresh doesn't allow re-rating. Server-side dedup
+ * via the unique constraint on `recommendation_feedback` is the source
+ * of truth — the local cache is just a UX nicety.
+ *
+ * Keyboard accessible: both buttons are real `<button type="button">`
+ * elements, focusable, Enter/Space-activatable. aria-label translates.
+ */
+
+import { useMemo, useState } from "react";
+import { useMutation, useQueryClient } from "@tanstack/react-query";
+import { ThumbsUp, ThumbsDown, Loader2, Check } from "lucide-react";
+import { useTranslations } from "@/lib/i18n/context";
+import { useAuth } from "@/hooks/use-auth";
+
+export type RecommendationFeedbackSeverity =
+  | "info"
+  | "suggestion"
+  | "important"
+  | "urgent";
+
+export type RecommendationFeedbackTimeRange =
+  | "last7days"
+  | "last30days"
+  | "last90days"
+  | "allTime";
+
+export interface RecommendationFeedbackProps {
+  recId: string;
+  recText: string;
+  recSeverity: RecommendationFeedbackSeverity;
+  metricSourceType: string;
+  metricSourceTimeRange: RecommendationFeedbackTimeRange;
+  /**
+   * Override the local-cache lookup so SSR tests can pin a state
+   * deterministically. Production callers leave this `undefined`;
+   * the component reads localStorage on mount.
+   */
+  initialState?: FeedbackState;
+}
+
+type FeedbackState =
+  | "default"
+  | "submitting-up"
+  | "submitting-down"
+  | "submitted-up"
+  | "submitted-down"
+  | "already-rated-up"
+  | "already-rated-down";
+
+const LOCAL_STORAGE_PREFIX = "healthlog-rec-feedback";
+
+interface FeedbackEnvelope {
+  data: { id: string; createdAt: string } | null;
+  error?: string | null;
+}
+
+function localCacheKey(userId: string, recId: string, recText: string): string {
+  // recText is part of the key because the server-side dedup also
+  // includes it — a regeneration that rewrites the same id with new
+  // text counts as a different row, and we want the UX to match.
+  // Hash via a length-bounded slice so the localStorage key stays
+  // small (the cache is best-effort; collisions on truncated text are
+  // extremely rare in practice).
+  const textKey = recText.slice(0, 80).replace(/\s+/g, " ").trim();
+  return `${LOCAL_STORAGE_PREFIX}:${userId}:${recId}:${textKey}`;
+}
+
+function readLocalState(
+  userId: string,
+  recId: string,
+  recText: string,
+): FeedbackState {
+  if (typeof window === "undefined") return "default";
+  try {
+    const raw = window.localStorage.getItem(
+      localCacheKey(userId, recId, recText),
+    );
+    if (raw === "up" || raw === "down") return `submitted-${raw}` as const;
+    if (raw === "already-rated-up" || raw === "already-rated-down") {
+      return raw;
+    }
+  } catch {
+    // Private mode / quota exceeded → fall through to default.
+  }
+  return "default";
+}
+
+function writeLocalState(
+  userId: string,
+  recId: string,
+  recText: string,
+  verdict: "up" | "down" | "already-rated-up" | "already-rated-down",
+): void {
+  if (typeof window === "undefined") return;
+  try {
+    window.localStorage.setItem(
+      localCacheKey(userId, recId, recText),
+      verdict,
+    );
+  } catch {
+    // Best-effort — server dedup is the source of truth.
+  }
+}
+
+export function RecommendationFeedback({
+  recId,
+  recText,
+  recSeverity,
+  metricSourceType,
+  metricSourceTimeRange,
+  initialState,
+}: RecommendationFeedbackProps) {
+  const { t } = useTranslations();
+  const { user } = useAuth();
+  const queryClient = useQueryClient();
+
+  const [state, setState] = useState<FeedbackState>(() => {
+    if (initialState) return initialState;
+    if (!user) return "default";
+    return readLocalState(user.id, recId, recText);
+  });
+
+  // Track which userId the state corresponds to. When auth resolves
+  // after mount (fetch was in-flight on first render), we recompute
+  // state from the local cache during render — never via useEffect,
+  // which would trip the `react-hooks/set-state-in-effect` rule.
+  const [hydratedFor, setHydratedFor] = useState<string | null>(() =>
+    user ? user.id : null,
+  );
+  if (!initialState && user && hydratedFor !== user.id) {
+    const fromLocal = readLocalState(user.id, recId, recText);
+    setState(fromLocal);
+    setHydratedFor(user.id);
+  }
+
+  const mutation = useMutation({
+    mutationFn: async (helpful: boolean) => {
+      const res = await fetch("/api/insights/feedback", {
+        method: "POST",
+        headers: { "Content-Type": "application/json" },
+        body: JSON.stringify({
+          recommendationId: recId,
+          recommendationText: recText,
+          recommendationSeverity: recSeverity,
+          metricSourceType,
+          metricSourceTimeRange,
+          helpful,
+        }),
+      });
+      const body = (await res.json()) as FeedbackEnvelope;
+      if (res.status === 409) {
+        return { duplicate: true, helpful } as const;
+      }
+      if (!res.ok) {
+        throw new Error(body.error ?? "feedback_failed");
+      }
+      return { duplicate: false, helpful } as const;
+    },
+    onSuccess: (result) => {
+      if (!user) return;
+      if (result.duplicate) {
+        const verdict = result.helpful
+          ? "already-rated-up"
+          : "already-rated-down";
+        writeLocalState(user.id, recId, recText, verdict);
+        setState(verdict);
+        return;
+      }
+      const verdict = result.helpful ? "up" : "down";
+      writeLocalState(user.id, recId, recText, verdict);
+      setState(`submitted-${verdict}` as const);
+      queryClient.invalidateQueries({ queryKey: ["insights"] });
+    },
+    onError: () => {
+      // Optimistic-rollback: drop back to default so the user can
+      // retry. We don't surface a toast — the parent rec card already
+      // crowded enough; a silent reset is the friendlier UX here.
+      setState("default");
+    },
+  });
+
+  const submit = useMemo(
+    () => (helpful: boolean) => {
+      setState(helpful ? "submitting-up" : "submitting-down");
+      mutation.mutate(helpful);
+    },
+    [mutation],
+  );
+
+  // ── Render ──────────────────────────────────────────────────────
+
+  if (state === "submitted-up" || state === "submitted-down") {
+    const verdict = state === "submitted-up" ? "up" : "down";
+    return (
+      <div
+        className="text-muted-foreground flex items-center gap-1.5 text-xs"
+        data-slot="rec-feedback-confirmation"
+      >
+        <Check className="text-dracula-green h-3.5 w-3.5" aria-hidden="true" />
+        <span data-feedback-confirmed={verdict}>
+          {t("insights.recommendation.feedbackThanks")}
+        </span>
+      </div>
+    );
+  }
+
+  if (state === "already-rated-up" || state === "already-rated-down") {
+    const verdict = state === "already-rated-up" ? "up" : "down";
+    return (
+      <div
+        className="text-muted-foreground flex items-center gap-1.5 text-xs"
+        data-slot="rec-feedback-already-rated"
+      >
+        {verdict === "up" ? (
+          <ThumbsUp
+            className="text-dracula-green h-3.5 w-3.5"
+            aria-hidden="true"
+          />
+        ) : (
+          <ThumbsDown
+            className="text-dracula-orange h-3.5 w-3.5"
+            aria-hidden="true"
+          />
+        )}
+        <span data-feedback-already-rated={verdict}>
+          {t("insights.recommendation.feedbackAlreadyRated")}
+        </span>
+      </div>
+    );
+  }
+
+  const submittingUp = state === "submitting-up";
+  const submittingDown = state === "submitting-down";
+  const disabled = submittingUp || submittingDown;
+
+  return (
+    <div
+      className="flex items-center gap-1.5"
+      data-slot="rec-feedback-buttons"
+    >
+      <button
+        type="button"
+        data-feedback-thumb="up"
+        aria-label={t("insights.recommendation.feedbackHelpful")}
+        title={t("insights.recommendation.feedbackHelpful")}
+        disabled={disabled}
+        onClick={() => submit(true)}
+        className="text-muted-foreground hover:text-dracula-green disabled:hover:text-muted-foreground inline-flex h-7 w-7 items-center justify-center rounded-md transition-colors disabled:opacity-60"
+      >
+        {submittingUp ? (
+          <Loader2 className="h-3.5 w-3.5 animate-spin" aria-hidden="true" />
+        ) : (
+          <ThumbsUp className="h-3.5 w-3.5" aria-hidden="true" />
+        )}
+      </button>
+      <button
+        type="button"
+        data-feedback-thumb="down"
+        aria-label={t("insights.recommendation.feedbackNotHelpful")}
+        title={t("insights.recommendation.feedbackNotHelpful")}
+        disabled={disabled}
+        onClick={() => submit(false)}
+        className="text-muted-foreground hover:text-dracula-orange disabled:hover:text-muted-foreground inline-flex h-7 w-7 items-center justify-center rounded-md transition-colors disabled:opacity-60"
+      >
+        {submittingDown ? (
+          <Loader2 className="h-3.5 w-3.5 animate-spin" aria-hidden="true" />
+        ) : (
+          <ThumbsDown className="h-3.5 w-3.5" aria-hidden="true" />
+        )}
+      </button>
+    </div>
+  );
+}