Thirty-seven of the deaths were in Turkey, authorities there said, and two were in Greece. At least 885 people were injured in Turkey.
A total of 20 buildings were seriously damaged in Izmir by the tremor Friday afternoon, according to Izmir Mayor Tunc Soyer, the majority of them in the middle-class Bayrakli district.
Search-and-rescue operations remained underway in nine buildings as of Saturday afternoon, while operations have been completed in eight other buildings, Turkey's disaster agency said.
Turkish President Recep Tayyip Erdogan said Saturday that 103 people have been rescued from the quake's rubble.
Overnight, tens of people gathered anxiously around each collapsed building, huddling under blankets in the bitter cold as search-and-rescue teams worked to locate those trapped. The rumble of heavy construction machinery filled the air, punctuated by bursts of crying and shouting.
Much of the activity was focused on the large Riza building, which housed businesses and apartments on its eight floors.
One survivor, 28-year-old Buse Hasyilmaz, was pulled alive from the rubble there at about midnight, several hours after the building collapsed.
Hasyilmaz, who was at a dental practice in the building with her parents when the earthquake hit, was able to talk to rescue teams and a Turkish minister on the phone while they were trying to reach her.
In a video from the scene, she told them "unleash the dogs. I will make a cat sound," in an effort to attract the rescue dogs' attention.
The minister responded that this was a good idea, adding: "I want you to remain calm like this. Keep your spirits up and be patient."
Hasyilmaz's father was also rescued safely. It wasn't immediately clear whether her mother had been located.
Hours later, workers reached and rescued 16-year-old Inci in the same building.
"I'll come and listen to you play the violin," a female rescue worker promises the teenager, seen in another video. Her legs are trapped, she can't feel them. She's pinned down by a block of cement.
"I hurt a lot," Inci says, pleading with the rescue worker to hold her hand. For nearly a full day she's been alone, in pain and terrified.
"You look like your mother. She's fine, she's waiting for you," the rescue worker tells her.
As the search teams work to clear buckets of rubble, hauling away concrete beams, they call out for quiet. An eerie silence descends on the crowds.
This is just one of many videos showing the incredible efforts of the teams searching through the aftermath of the quake.
In another collapsed building a mother and her four children were all pulled out alive, 23 hours after the tremors. One of them later died, the Turkish health minister said.
A young woman whose husband was trapped under the rubble at his mother's house, where he had been working while his mother was away, hoped for good news on Saturday morning.
Rescue teams had told her that thermal cameras showed a man moving, she told CNN. She was praying that her husband would be safely reunited with their two children, aged seven and 10.
A nurse, who asked not to be named, said her colleague was under the rubble in Bayrakli with her two nephews. She told CNN that she was confident her colleague's professional skills would help all three to survive.
Hundreds of aftershocks
The United States Geological Survey (USGS) measured the tremor's magnitude at 7.0, while Turkish authorities said it was 6.6. The quake struck 14 kilometers (8.7 miles) northeast of the town of Néon Karlovásion on Samos, the USGS reported, at 1:51 pm Greek time (7:51 a.m. ET).
It hit at a relatively shallow depth of 21 kilometers (13 miles), the USGS reported, making its impact powerfully felt at ground level around the epicenter.
There have been 615 aftershocks so far, of which more than 40 were over 4.0 magnitude, the Turkish disaster agency said Saturday.
Greek authorities said two teenagers, a boy and a girl, died on the Greek island of Samos after a wall collapsed on them.
The earthquake triggered what authorities have called a "mini tsunami."
TV footage showed water flooding through the streets of Cesme and Seferihisar in parts of Turkey's wider Izmir province, as well as on Samos. No tsunami warnings were issued.
Greece-Turkey tensions
Idil Gungor, who works as a journalist and runs a guesthouse in the Turkish town of Siğacik in Izmir province, said Friday that the area was damaged more by the force of the water than the quake itself.
Her guesthouse, in a 100-year-old building, had been inundated and fish were swimming inside it, she said. Shops in town had also been flooded and their goods damaged.
Greek Prime Minister Kyriakos Mitsotakis said Friday on Twitter that he had spoken to his Turkish counterpart and offered his condolences. Tensions between the two nations have flared recently over energy claims in the eastern Mediterranean.
"Whatever our differences, these are times when our people need to stand together," Mitsotakis wrote.
In a tweet, the Turkish president offered his condolences to Greece and said "that two neighbors show solidarity in difficult times is more valuable than many things in life."
According to Erdogan, both Turkey and Greece were ready to send aid to the other.
French Interior Minister Gérald Darmanin said on Twitter his country had also offered to send assistance to Turkey and Greece.
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Rescuers have pulled more than 100 earthquake survivors from the rubble of Izmir - CNN
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