Dozens of people are missing following a deadly earthquake in Taiwan, with more than 40 feared trapped in a multistory building tilting perilously in the northeastern city of Hualien.

The magnitude 6.4 quake struck 22 kilometers (13 miles) north of the city late Tuesday, killing at least seven people and injuring 262 others. It also damaged bridges and buckled roads in the east of the island.

Video from the site of the quake showed smoke rising from collapsed buildings on Wednesday morning as firefighters patrolled streets full of rubble.

Emergency workers used enormous beams, raised with a crane, to prop up the Yun Men Tsui Ti building, a large residential and commercial complex, which leaned ominously over the street below.

Of 63 people still missing in the city, 11 are believed to be inside a bed-and-breakfast called the Beauty Inn in the Yun Men Tsui Ti building, according to the Tourism Bureau. An additional 37 residents registered in the building have not been reached, although it's unclear if they were there when the quake struck.

It's one of four buildings in the city that were either tilting or had collapsed, authorities said.

At the flattened Marshal Hotel in downtown Hualien, rescuers reached two workers who had been trapped near the main counter in the lobby, Taiwan's official news agency, CNA, reported Wednesday.

One appeared dazed as rescue workers escorted him out. The other didn't survive.

Numerous aftershocks followed Tuesday and Wednesday. At least 15 aftershocks, measuring as much as 4.8 magnitude, shook the area on Wednesday afternoon and evening alone, according to Taiwan's Central Weather Bureau.

Meanwhile, 600 military personnel and more than 750 firefighters combed through rubble and helped with rescue efforts, according to Taiwan's Central Emergency Operation Center.

One of the dead was a Chinese tourist who was visiting with her son, according to CNA. She passed away Wednesday evening after suffering a head injury during the quake, the news agency reported.

Nine Japanese were injured and taken to the hospital, authorities said, but they have all been released. In total, 31 foreigners were affected, including 14 South Koreans, two Czechs, two Singaporeans and one Filipino, CNA reported.

Hualien is close to Taiwan's famous Taroko Gorge, a popular tourist destination.

Photos on state media showed the narrow highway in and out of the gorge on Wednesday morning covered in rocks, rubble and other debris from the earthquake.

Hundreds of Hualien residents whose homes were destroyed took shelter at a local stadium, with relief organizations providing emergency supplies.

Some 1,900 households lost power in the wake of Tuesday's quake, but most had it restored by Wednesday morning, according to the Central Emergency Operation Center.

However, an estimated 35,000 residents were still without water, the center said.

Pacific Ring of Fire

The quake struck late Tuesday in the East China Sea, north of Hualien, an eastern county that's home to more than 350,000 people.

The temblor was felt as far away as the capital, Taipei, about 120 kilometers (74 miles) to the north, according to reports sent to the US Geological Survey.

Taiwanese President Tsai Ing-wen visited the site of the earthquake Wednesday. Tsai thanked the island's first responders in a message on her official Twitter account.

Taiwan is situated on the Pacific Ring of Fire, which runs around the edge of the Pacific Ocean and is known for causing massive seismic and volcanic activity from Indonesia to Chile.

The island is regularly rocked by earthquakes. A magnitude 6.4 quake hit in 2016, killing 40 people. The biggest earthquake in recent memory was a 7.3 temblor that killed 2,400 people in 1999.

'We're going to sleep in the tent'

Jason Grenier, a Canadian living with his Taiwanese wife and daughter just south of Hualien, said Wednesday that their home is intact and they have power and water. But the family was poised to spend a second straight night sleeping outside, wary of possible aftershocks.

Tuesday night's quake was the most violent he's felt in his 17 years on the island, he said. It jolted his family awake and sent him scrambling for his 7-year-old daughter and running outside.

"Sometimes (earthquakes) kind of slam you up and down -- it's like the whole house jumps. Sometimes it's like a rocking. This was like a combination of everything all at once ... you could hear the earth groaning," Grenier, an instructor at National Dong Hwa University, said Wednesday.

The Greniers spent the rest of the night in a vehicle. On Wednesday, they pitched a tent on their property.

"Even tonight, we're going to sleep in the tent, I think," Grenier said. "Because every time there is a temblor, you have to get up and decide if you're going to bolt. It doesn't make for a restful sleep."

'Nerves are jangled'

Laura Lo, a worker at a 7-Eleven convenience store across the street from the Marshal Hotel, said the first and second floors of the hotel appeared to be severely damaged.

Her store also suffered broken glass, she said, and roads in the area were closed.

An employee at the Park City Hotel down the street told CNN he felt the quake but there was no damage at his location.

Margaret K. Lewis, a law professor living in Taipei, said she felt prolonged swaying at her high-rise apartment building in the Beitou District in the northern part of the city.

"Nothing broken, and two children slept peacefully through the event. We have since felt a few mild aftershocks," Lewis said in an email. "Nerves are jangled, but otherwise all appears well. I have not been outside to look for damage, but my expectation is that my area is generally fine."