The 51-year-old woman was struck by the bus and became trapped in its axles at the intersection of Clarence Street and Erskine Street just before 4pm (AEDT).
She spent two hours pinned under the vehicle before a rescue team could free her. She was rushed to the Royal North Shore Hospital, but died a few hours later.
Emergency services described the extraction of the woman from underneath a city bus on Wednesday as one of the most delicate rescues in almost 40 years.
Ambulance Inspector Norm Spalding said on Wednesday the rescue was "slow, arduous and very difficult for all those involved".
Insp Spalding said the woman had extensive injuries to her lower limbs.
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