The Fire and Disaster Management Agency said 214 people were treated for injuries in hospital, majority in Osaka - Japan's second city.
At 7:58 a.m. Monday, June 18 a magnitude 6.1 natural disaster hit Osaka, Japan at a depth of 10km (6.2mi).
Japan's Fire and Disaster Management Agency said 41 others had been injured.
A 9-year-old girl died at Juei Elementary School in Takatasuki, Osaka Prefecture, after the wall of a swimming pool complex collapsed, according to the Osaka prefectural police and other sources.
Japanese authorities don't confirm death until after an examination at a hospital. The agency originally put the quake's magnitude at 5.9 but later raised it to 6.1.
A number of train services were suspended, including the "shinkansen" bullet train, as multiple smaller aftershocks followed the quake.
Steve Huen Kwok-chuen, executive director of EGL Tours, said its travel agency had more than 10 tours in Osaka, and all had reported in as being safe.
The quake caused partial building collapses, building fires and toppled walls A 9-year-old girl and two men in their 80s were the reported dead.
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Senior government officials are gathering for an emergency meeting at the Prime Minister's office, broadcaster NHK reported . Japan's Fire and Disaster Management Agency said two people were found with no vital signs and 41 others had been injured.
Several buildings in Osaka and Takatsuki collapsed and were on fire.
Some subway service resumed in the afternoon, but train stations remained crowded with passengers waiting for trains to restart, many of them sitting on the floor.
The prime minister, Shinzo Abe, said the government was assessing the damage and that its priority was to rescue anyone trapped inside buildings.
A strong quake shook the city of Osaka in western Japan, causing scattered damage including broken glass and partial building collapses. Mitsubishi Motors briefly shut down production at two plants in Kyoto and Shiga prefectures, while Daihatsu Motor Co, a subsidiary of Toyota Motor Corp, suspended operations at two plants in Osaka and Kyoto prefectures. Most of the injured were in Osaka - Japan's No. 2 city bustling with businesses.
Live TV coverage of the immediate aftermath showed ruptured underground pipes spewing water on to the street, while firefighters were seen tackling a blaze at a home on the city's northern outskirts.
Osaka, Japan's third most populated city, is a major business hub and tourist hotspot in western Japan.
Kilpatrick, visiting Japan for the first time, said alarms went off nearly immediately in the hotel and a loudspeaker told guests to stay away from windows. "The whole world was aggressively shaking", she said. "I thought it was a nightmare because I was so confused", she said. The city is close to Kobe, which was hit by a deadly magnitude 6.9 quake in 1995.