A strong tremor shook quake-hit areas of central Italy on Tuesday and sent rescuers and residents fleeing from damaged buildings in the ravaged medieval city of L'Aquila.
Chunks of concrete dropped from already crumbling buildings and the shock was felt as far away as Rome, 70 miles (110 kilometers) to the southwest. The ANSA news agency said at least one person was killed near L'Aquila.
Rescuers were still searching through the rubble for survivors and bodies when the earth shook again Tuesday.
The official toll from the quake stood at 207 dead, 15 missing and some 1,000 injured. However, ANSA reported it had tallied 228 dead at a hangar being used as a morgue.
ANSA said the aftershock caused further damage to the Chiesa delle Anime Sante, one of the many historic buildings in this city that partially collapsed in the quake.
While the US Geological Survey said Tuesday's aftershock measured 5.6, Italian seismologists using the Richter scale put it at 5.3. The epicenter was near L'Aquila.