Large buildings including hospitals and hotels caved in, homes fell down and fires raged in the coastal city of Padang, home to nearly a million people, as communications and power remained cut hours after the 7.6-magnitude quake.
"Houses and buildings have collapsed, causing thousands of people to be trapped inside in the rubble," Health Ministry crisis centre head Rustam Pakaya told this agency, adding that a major city hospital was among the destroyed buildings.
Rescue teams and doctors had been sent overland and were expected to arrive in the city in about 10 hours, Pakaya said.
Confirming the death toll, Vice President Jusuf Kalla said there were grave concerns for thousands trapped under buckled buildings.
"The initial level is 75 but it's certain to be higher than that," Kalla told reporters.
Local media reported that panicked residents rushed from their homes during the quake, which struck off Sumatra's west coast at 5.16pm (6.16 pm in Brunei), 47km northwest of Padang.
"A number of hotels in Padang have been destroyed," Indonesian tsunami warning head Rahmat Triyono said, adding the agency did not release a tsunami alert.
The Pacific Tsunami Warning Center in Hawaii however issued a tsunami watch for Indonesia, Malaysia, India and Thailand, but later cancelled it.
"Up to now we haven't been able to reach Padang, communications have been cut," Triyono said.
The quake was felt in the capital Jakarta, 940km away, and sent frightened office workers streaming out of buildings in nearby Singapore and the Malaysian capital Kuala Lumpur.
"The shaking was the worst I had ever felt," Yuliarni, a resident of Pariaman district outside Padang, told TVOne news channel.
"Houses have collapsed, the lights and electricity were cut off... People were fleeing to higher ground and some were hurt," she said.
The quake caused a landslide that destroyed houses at Lake Maninjau inland from Padang, local resident Hafiz told the channel, and the airport was also closed for damage.
"Part of the roof of the arrival hall at the Padang airport collapsed but nobody was injured. The runway is okay. The airport has been closed but will reopen at 7am tomorrow," Hariyanto, an official of airport operator company Angkasa Pura II, said.
Geologists said Padang, which lies near the colliding Indo-Australian and Eurasian tectonic plates, was vulnerable to more quakes and tsunamis.
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